Diabetes Voice Online - November 2015

DIABETES VOICES

Healthy eating challenges for diabetes

self-management
Elizabeth Snouffer

What is healthy eating? A healthy lifestyle involves many choices and for all people in our modern
world today choosing balanced nutrition is a priority to live a long healthy life. Generally, it is
recognized that a healthy eating strategy emphasizes vegetables, fruit, whole grains, lean meat and
foods low in salt and added sugar.

For people living with all types of diabetes, a healthy eating plan is extremely important to meet blood
glucose targets and avoid complications related to untreated or poorly managed diabetes. When a
person is first diagnosed with diabetes, this is one of the most significant self-care messages from
healthcare providers worldwide, and much of what is said in the healthcare setting about nutrition
and diabetes is delivered as common sense. However, it is also commonly appreciated that it can
be a challenge to put healthy eating, which sounds so simple - even easy, into practice. Add insulin
therapy into the mix, required for people living with type 1 diabetes, and matters become much more
complex. Careful coordination of carbohydrate intake with medication, physical activity, and other
variables including stress must be prioritized to manage blood glucose levels, and for many, survival.

In support of the International Diabetes Federation’s (IDF) World Diabetes Day 2015 campaign, which
recognizes healthy eating as an important part of the effective management of all types of diabetes,
we asked individuals living with diabetes to discuss their greatest challenges related to making the
right food choices and sticking to a strategy. In the following contributions, we hear from people who
are making a total effort to self-manage diabetes successfully, which for so many millions requires
24/7 vigilance and discipline.

CHARLES MATTOCKS (USA)

Celebrity chef, film maker and global diabetes advocate, diagnosed with type 2 diabetes in 2011

I was recently at the doctor for a follow up visit. don’t need.

We discovered that my HbA1c was higher than it
normally would be and that I had protein in my
urine which can be an early sign of kidney disease.
Needless to say, I was worried.

As much as I help and share other people’s

stories about living with diabetes, I am now
becoming a story of my own. Let’s be honest
here, I know what I should be doing for my type
2 diabetes and at times, like many other people
with diabetes, we just don’t do what’s right for
our condition. It’s time to get back on course!
© Charles Mattocks
My first step is to lose the extra 15 pounds that I

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don’t need. I should be at my ideal weight and islands with high cases of type 2 diabetes. But in
that’s that. So I need to start with a plan that allows reality, when I get there I actually slim down a
me to lose 15 pounds and then maybe I can shed bit because I go on a fresh food diet. If I need to
more. What works for me is a low carbohydrate, eat on the go, I will make a small meal, like some
low sugar, and low starch meal plan. A few months egg whites or some curried chicken. Now that’s
back I recently lost 12 pounds and it was primarily mostly protein and vegetables, low in calories,
from lots of walking! In order to achieve that, but these choices still have that great taste.
I was walking about three times a day for about
When I am out with friends or family, that can
forty minutes per walk. I drank nothing but water
also be an issue that haunts us. I always suggest
and was eating lean meat and vegetables. As a
sticking to quality vegetables and protein. I
celebrity chef, it can be hard staying away from
suggest that people with diabetes grab a steak
the food - heck it can be hard for anyone to stay
or some lean chicken, because these options
away from the table. Food is truly a drug that
can be tasty but still healthy. Also, grab some
can be used for good and for bad. When society
steamed veggies instead of the rice, and always
accepts that healthy eating and an active lifestyle
make sure your portions are small. Don’t forget
can make a positive change then we will be in a
if you live with diabetes, you need to make sure
much better place.
what you do today, won’t hurt you tomorrow.
I always go back to what a healthy food choice is
Fortunately, I got back to my healthy ways again
for me and my type 2 diabetes. I start with what
with a smile on my face and I’m down a few
God gave us and go from there. We can’t go wrong
pounds in only a few days and counting. I also
with loads of vegetables and water. We can’t go
got my medical tests back and it’s all clear. I
wrong with small portions of lean meat and limit
must admit I was very nervous and I know those
our total intake. Let’s face it, when I am back in my
test results were a wake-up call for me. I don’t
home country of Jamaica, I go crazy at times. I love
miss some of the bad choices I make from time
curried goat and ackee and salt-fish, the national
to time and with the holidays coming up, I want
Jamaican dish! I know some Jamaican foods are the
to make sure I am heading in the right direction.
cause for many people suffering in the Caribbean
HÉLÈNE COLON-RAPHAEL (USA)
Grandmother, diagnosed with type 1 diabetes at 23 years
There are many challenges in having diabetes, but properly dose my insulin. Sometimes I will bring
I faced one big hurdle when it comes to healthy an appetizer, side dish or a beverage, and I make
eating and being social. I declined invitations to sure I know how many carbohydrates are in each.
friends’ homes because I was afraid of what I was Otherwise, it is very difficult. I will have to guess,
going to be challenged to eat and how it was going or ask the host what exactly is in each dish which
to affect my blood glucose. Now, I accept social can lead me to take either too much insulin or too
invitations, with the caveat that I am allowed to little insulin. When deciding on an item to bring to
bring a dish or a beverage. a host’s party, I typically bring homemade hummus,
shrimp cocktail, white bean stew or low calorie/no
Bringing something for myself to eat is reassuring
sugar added margaritas. With my strategy, going
knowing that there is something I will feel
out socially means I have lower stress, and I can
comfortable eating or drinking. It is important
enjoy visiting friends and family at their home.
for me to know how certain food or drink will
impact my blood glucose and when I do know the
number of carbohydrates in my food, I am able to

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KATE CORNELL (USA)

Writer, diagnosed with type 2 diabetes at 50 years

My diagnosis of type 2 diabetes changed a lot zucchini made a huge difference! Some might say
of things for me, but the biggest change related that I am now following a low carb diet, but I prefer
to food. Everything revolves around food in our to call it a “no processed carb” diet. I’m choosing
society, which makes eating with type 2 diabetes to eat whole foods that I (mostly) cook myself as
more challenging. Challenging, but not impossible. opposed to processed meals or foods that contain
too much of what isn’t good for me.
The way I eat now is dramatically different than the
way I ate ten years ago but those changes didn’t I’m fairly successful at home, but eating out,
happen overnight. Type 2 diabetes is a progressive travelling or attending social functions add a layer
condition and, therefore, I have made progressive of difficulty to my food choices. I choose to eat a
changes to the way I eat. One change at a time. sandwich with a fork and knife, avoiding the bread.
I order cottage cheese or sliced tomatoes instead
As luck would have it, most of my favourite foods
of potatoes. I travel with my own snacks so that I
became difficult for me. I couldn’t keep my blood
can avoid fast and convenient foods. Attending a
glucose levels where they needed to be if I ate
celebration means loading up on salad and having
bread, pasta, cereals and potatoes. Some fruits
only a taste of that birthday cake.
also became off-limits. It was necessary for me to
remove those things from my food plan because I These may seem like sacrifices but I no longer feel
do not use insulin to manage my diabetes. Finding deprived. I’m happy to be eating in a way that has
alternatives made living with these food changes made me healthier and will hopefully help prevent
much more bearable. Alternative flours, such as complications down the road. I’m lucky to live
almond and coconut, allowed me to make breads, where I have choices.
cookies and cakes that didn’t spike my blood
Visit Kate’s blog on living with diabetes.
glucose. Replacing pasta with spaghetti squash or
JOÃO VALENTE NABAIS (PORTUGAL)
President of IDF Europe, diagnosed with type 1 diabetes at 12 years
I have been living with diabetes for 35 years. On
my journey, I have witnessed several changes in
the way food was taught to be managed for insulin
therapy. Back to the beginning of my diabetes,
treatment was based on one insulin shot of slow-
acting insulin, and the advice was to base the
“diet” (yes it was a “diet”!) on vegetables, meat
and fish with only a small portion of carbohydrates.
Sweets and similar food were the devil and to be © João Nabais
used only for hypoglycaemia episodes (low blood healthy food with all opportunities available?
glucose events). Carbohydrate counting is like a game, in particular
when I am travelling abroad and the food is
With the evolution of diabetes treatment options,
unfamiliar. Adjusting the insulin dose correctly to
including new insulin and monitoring devices, a
exercise and food can sometimes feel like a horror
new world opened up to me. This evolution was
movie.
extremely positive in all aspects and the freedom
to choose a variety of foods is only one of them. There are apps for smart phones, devices to
But new challenges came along! How can I choose evaluate the food content and a panoply of tools
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to help people with all types of diabetes. I use a
few of those to base my decisions, but most of the
time I use my experience and what I have learned
from other people with diabetes and healthcare
providers. Sometimes you make good choices,
sometimes not. But, this doesn’t make you a bad
person, only human!
I try to plan my meals as carefully as possible in
order to include healthy ingredients for both food
and drinks (water is the first choice along with red
wine or beer) but all have to be tasty and enjoyable.
When I travel I like to experience the local food,
which can be tricky because most of the time
you don’t know the fat or carbohydrate content.
For me, this is not a problem as I can always re-
adjust my insulin dose afterwards or eat a sugary
supplement (that we must carry all the time) to
ensure my blood glucose doesn’t go too low.

SCOTT JOHNSON (USA)

Diabetes advocate, diagnosed with type 1 diabetes at 5 years

I believe that learning more about healthy eating often food and activity. They may not know how
would be good for me. It would give me an much I admire them or look to them for inspiration
additional set of tools to manage my blood sugar, and leadership. Why?
and my overall health. Essentially, I’ve allowed
Because I imagine, at diagnosis, they also had little
myself to look the other way when I eat something
interest in learning about food. It may have even
unhealthy, especially if I can manage my blood
been an emotional trigger evoking the diagnosis
sugar by doing fancy tricks with my insulin. I tell
experience all over again.
myself it’s OK because diabetes is all about blood
sugar management, right? And now, here they are, the challenge overcome,
using the power of healthy eating to manage their
No. I’m justifying unhealthy eating behaviour
health. They are setting examples that can often
and using blood sugar as an excuse. Honestly, I’m
serve us all well, regardless of what type of diabetes
intimidated by the idea of learning about food. The
we have. I have much to learn from my friends in
endeavour seems overwhelming, with conflicting
the community living with type 2 diabetes. Thank
opinions and misinformation throughout the
you for being brave, inspirational type 2 diabetes
journey. Where do I start? Who do I trust?
leaders. I am ever grateful to you.
People living with type 2 diabetes successfully are
Visit Scott Johnson’s blog.
my heroes here. Their most influential tools are
DICKY POON (HONG KONG)
Student, diagnosed with type 1 diabetes at 6 years
In 2014 I joined a Youth Diabetes Action bike
tour for 8 hours a day over a period of nine days.
The greatest challenge was managing continuous
and vigorous exercise on insulin. During the
latter part of the journey, my daily insulin usage
actually decreased by 40%! The greatest threat
was hypoglycaemia, and even delayed effects of
low blood glucose at night. Even with all these
challenges, I believe that regular exercise, insulin
therapy and managing food all go hand-in-hand.

One of my challenges related to eating with © Dicky Poon

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diabetes is how to calculate the amount of
carbohydrates in food when eating out at a
restaurant or having take-away. In Hong Kong,
there are so many restaurants providing different
cuisines. One type of food, such as noodles, can
be cooked in so many ways with a huge variety
of sauces and seasonings, which usually contain
sugar. As a result, every time I visit a restaurant
where I have never been before, I can only guess
the amount of carbohydrates in those dishes, and
I often underestimate, which results in a higher
blood glucose value.
Overall, the food choices available and affordable
for students like me on a budget here in Hong Kong
are usually not healthy. What I can do is to eat “less
unhealthily” and choose dishes with enough meat,
Diabetes Voice Online - November 2015
vegetables with less salty or less sugary sauces
if possible, and avoid cold drinks which usually
contain a large amount of simple sugar.
Maybe this challenge can be overcome by bringing
packed lunch to school or workplace, which can
be prepared at home with the accurate number of
carbohydrate calculation for easy insulin dosing
at mealtime. Yet, having lunch with friends,
classmates or colleagues is a crucial part of my
social life, and everyone enjoys eating out. It’s
a hard decision to sacrifice my social life for a
healthier diet. It’s important to mention that most
people don’t care if I have diabetes or not, as it
is not the most important characteristic of myself.
Generally, I think most of the pressure comes from
ourselves.
© International Diabetes Federation