and vegetable soup do not. It’s also important to note that the type of carbohydrate (e.g., starch or sugar) does not consistently predict the GI. For example, some fruits have a low GI and others have a higher GI. The GI doesn’t consider typical food portions; however, GL does. The GL takes the glycemic index of a food and then factors in its common serving sizes to give a more practical indicator of the effect that food will have on blood glucose.
Raising Your Blood Glucose
Other factors that contribute to how foods raise your blood glucose are
• your blood glucose at the time you eat
• how much blood glucose-lowering medicine you take, when you take it, and when you eat
• your level of insulin resistance in general and at the time you eat the food(s)
• individual responses to foods and different responses on different days
• the amount of fiber and whole grains in a meal (these can slow the rise of blood glucose)
• how ripe a fruit or vegetable is when you eat it (the riper the food, the more quickly it can raise blood glucose)
• the form of the food (for example, fettuccine can affect blood glucose differently than macaroni)
• the variety of the food (for example, long-grain or short-grain rice, Yukon gold or red potatoes, and when and where a product was grown)
• whether you eat the food raw or cooked (the more a food is cooked, the more likely it is to raise blood glucose quickly)
• the other foods you eat along with the carbohydrate (a meal that is mainly carbohydrate with a small amount of fat will raise your blood glucose more quickly than a meal with more fat)
Many of the foods that have a low GI are healthy foods. Consider eating more whole-grain breads and cereals, legumes (beans), and fruits and vegetables. Include these foods in your eating plan, but don’t completely omit foods with a higher GI if they are healthy foods and you enjoy them.
You may find it helpful to create your own personal GI by recording the results of your after-meal blood glucose checks. Make notes about your experiences with certain foods and meals, and note what changes you might make when you eat that food or meal again, such as eating a smaller portion, avoiding them, or adjusting medicine (if you can).
Consider using the concepts of GI and GL in conjunction with other healthy eating strategies and priorities. First, look at your total carbohydrate count at meals, limit your intake of sweets and sugars, increase the amount of whole grains, fruits, and vegetables you eat, and then factor in the GI or GL of a food.
Protein
The ADA suggests that eating 15-20% of your calories as protein is fine as long as you don’t have diabetes-related kidney disease. This is not a lot of protein, as you can see in the model meals on pages 53-58. Eating 15-20% of your calories as protein certainly doesn’t allow for an 8-ounce piece of steak, fish, or chicken each night at dinner. Eating smaller (about 2-4 ounces), as well as leaner, portions of animal protein will also help reduce your intake of saturated and trans fat and will help you to reach your blood lipid targets. Read the information on fat, below, to learn more.
Protein can influence blood glucose, but to a much lesser degree than carbohydrate does. In people with type 2 who still make some insulin on their own, protein intake can cause an increase in the release of insulin from the pancreas; however, this doesn’t raise blood glucose. Because people with type 1 diabetes no longer make insulin, moderate amounts of protein have little effect on blood glucose. Keep in mind that a high-protein meal, which is often also high in fat, can cause a delayed rise in blood glucose.
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Most Americans eat more protein than their bodies need to be healthy— about 15-20% of your total calories. Portions need to be closer to 2-4 ounces cooked to achieve this goal.
Fat
As a person with diabetes or prediabetes, you may have abnormal blood lipid levels (unhealthy LDL, low HDL, and/or high triglycerides) and high blood pressure. Because these conditions put you at risk for heart and blood vessel problems, the most important advice for you is to limit the amount of saturated fat you eat to less than 7% of calories and to keep trans fat as low as possible. In years past, there was more emphasis on eating less total fat. Today, experts believe that anywhere from about 20-40% of your calories can come from fat. The key is to minimize the unhealthy fats and oils and to get the remainder of your calories from fat from the healthier monounsaturated and polyunsaturated fats. With our food choices today this is easier said than done. Try to keep your trans fat intake as close to zero as possible.
Fat affects blood glucose by slowing down the rise of blood glucose after you eat. In other words, a high-fat meal may cause a slower rise in blood glucose than a high-carbohydrate meal. This doesn’t mean you should eat a lot of fat, especially saturated fat, as a way to manage your blood glucose. Keep your total fat intake moderate and choose the healthiest fats. You’ll learn how to reach these goals in the pages ahead.
Sodium
Research showing the benefits of a lower sodium count on blood pressure is mounting. Control of blood pressure is an important topic because nearly three-quarters of people with diabetes have high blood pressure. A lower sodium intake can impact blood pressure even more in people with diabetes or high blood pressure, along with African Americans and adults who are middle-aged and older. Keep in mind that we now eat around 4,000-6,000 milligrams of sodium a day. More than half of this is from processed foods. Research shows you can further lower your blood pressure by eating sufficient fruits, vegetables, whole grains, and low-fat dairy foods that provide much needed potassium (among other essential nutrients). Learn more about how to reduce your sodium intake and raise your potassium count in chapter 8.
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Research shows that getting your sodium intake down to below 2,500 milligrams per day can help lower and control blood pressure.
Alcohol
The recommendation for alcohol is consistent with general dietary guidelines. Women should have no more than 1 drink a day, and men should have no more than 2 drinks a day. Research shows there are some benefits of various types of alcohol on the heart.
Vitamins and Minerals
If you eat at least 1,200 calories a day from a wide variety of healthy foods and your blood glucose levels are within the target ranges at this point, the ADA does not believe you need to take vitamin, mineral, or dietary supplements. People with diabetes have not been shown to have any greater need for various vitamins and minerals than anyone else.
You may be at risk for or have difficulty getting sufficient amounts of some critical vitamins and minerals. Studies show that many people are deficient in vitamins A, C, D, and E along with essential minerals like choline, folic acid, magnesium, and potassium. Your first step to ensure that you do get enough of these important nutrients is to eat a wide variety of foods. Choose nutrient-rich as well as minimally processed foods. Next, talk to your health care provider about a multivitamin and mineral supplement that offers you optimal amounts of missing vitamins and minerals as extra “insurance.” This is especially true if your daily calorie intake is at or below 1,200, or you know you don’t get enough of certain vitamins or minerals. (See chapter 7 for more information
