and drinks low-sodium vegetable juice to take her medicines. She likes saving that carb for fresh fruit or jam.
Next we did some meal planning for lunch and dinner. She decided on a sandwich on whole wheat bread (2 carb choices) and some baked chips (1 carb choice) for lunch. For dinner she wanted all 3 of her carb choices as spaghetti (about 1 cup, cooked).
For her bedtime snack, Mama said she would have a piece of fruit (1 carb choice), like a peach, apple, or orange. Or she might choose a glass of 1% milk for 1 carb. Or she might have a cup of light yogurt, like lemon or blackberry, for 1 carb. Or a couple of small cookies would be 1 carb.
“This isn’t so hard,” Mama said. “It’s like I have a bank account of carbs for my meals and my evening snack. Then I spend the carbs in my bank account for the foods I love.”
Then she thought about the rest of her meals. “But what about the rest of my meal?” Mama asked. “What about the meat and my salad with dressing?” I suggested she try for about 3 ounces of lean meat, poultry, or fish.
“I don’t love meat the way I love carbs, but I’m not sure how much 3 ounces would be,” Mama said. “And I need this to be simple. I don’t have all day to be weighing and measuring my food. Besides, I thought you said carbs were what would raise my blood glucose.”
“That’s right, carbs are what raise blood glucose, but because you want to lose weight, you’ll want to watch your portions of meats, too,” I said.
“So portion power is coming into play with meats, too,” Mama said. “How can I keep this simple?” We decided to look at a serving of 3 ounces of fish, poultry, or meat this way:
• a meat patty or serving the size of a mayonnaise jar lid
• a serving the size of the palm of your hand
• a serving the size of a deck of cards
• a serving the size of a checkbook
• a serving of three meatballs the size of ping pong balls or golf balls
“Those would all fill about one-fourth of my plate, just like when I rate my plate,” Mama said. “That makes sense to me. But what about tuna fish or cottage cheese—how do you count them?” she asked. We decided to count half of a 5- or 6-ounce can of water-packed tuna or 3/4 cup of low-fat cottage cheese the same as 3 ounces of meat.
“But what about regular cheese—how do I count it?” Mama asked.
“Mama,” I said, “1 slice of cheese would be equal to
1 ounce of meat. Or a 1-inch cube of cheese, say, the size of 4 dice, would be equal to 1 ounce of meat. You know that a lot of cheeses are high in fat and cholesterol. Think about choosing fat-free or low-fat cheeses when you can. This will be good for your heart and blood cholesterol level.”
“That reminds me that we haven’t talked about fats yet, like margarine and oils,” Mama said. “I know they say to eat less fat to lose weight.”
“That’s right, Mama,” I said. “Fats have twice as many calories as carbs or protein. So choosing one or two fats at a meal or snack would be about the right amount.”
“So how much is a fat?” Mama asked. “And keep it simple.”
“A fat serving is about 5 grams of fat and about 45 calories, but that’s not simple, is it?” I said. Mama and I decided about 4 fats a day would be right for her and that she’d count these as 1 fat:
• 1 teaspoon margarine, butter, mayonnaise, or oil. That’s about the size of the tip of your thumb.
• 1 tablespoon reduced-fat margarine, reduced-fat mayonnaise, cream cheese, or half-and-half cream, the size of the pad of your thumb.
• 2 tablespoons reduced-fat salad dressing, reduced-fat cream cheese, or reduced-fat sour cream. Two tablespoons would be about half a ladle of dressing at a salad bar.
“How would you like some good news, Mama?” I asked.
“What’s good about having diabetes?” she asked.
“The good news is that sometimes finding out you have diabetes is a wake-up call,” I said. “People eat better, lose weight, get more active, start feeling better, and just enjoy life more. But the best news about diabetes is that you can prevent or delay diabetes problems like the problems Aunt Carla had.”
“That is the best news I’ve had in a long time!” Mama said. “Is that all there is to eating with diabetes?”
“That’s a good start, Mama,” I said. “Plus just keep on making healthy food choices.”
Then the time arrived for Mama’s diabetes education classes. I told Mama that she needed to tell her dietitian the way she likes to eat and then work together to design her own meal plan.
Your meal plan needs to fit your schedule, your likes and dislikes in foods, how active you are, when you like to eat, and where you go when you eat out. You and your dietitian will then design a meal plan that will fit the way you live and will include the foods you and your family like.
Luckily, a diabetes meal plan is good for the whole family. Making one dinner is hard, but making two—one for you and one for your family—just won’t work. The foods you choose for taking care of your diabetes are the same foods that we all need to eat to stay healthy, whether we have prediabetes or diabetes or not. It’s been great that Dad has been part of Mama’s diabetes team. He’s helping her count carbs. In fact, he’s lost about 10 pounds by rating his plate and counting his carbs, too. And he’s starting to walk some. Mama has been a good role model for him.
The first day of Mama’s classes, a nurse educator talked to the group about diabetes in general, about checking blood glucose, and about things that affect blood glucose. Many family members, like me, were there to learn about diabetes care. They asked lots of questions and learned from each other.
Mama then worked with Marion, a dietitian and CDE. Marion started by talking about Carb Counting with Mama. Marion was pleased to learn that Mama had already started counting her carbs. Marion agreed that 3 carb choices at meals and 1 carb choice for a bedtime snack was a good starting point for her. Marion told Mama the next step was to start checking her blood glucose to see how this plan was working for her. For more on checking your blood glucose, see Chapter 7.
Next, Marion had Mama look at a food label. The Nutrition Facts label can help with meal planning. It can also help you make better food choices when you’re shopping.
In the food label shown below, let’s go through the steps together to see how it can help you.
Steps in Using a Food Label
Step 1—Serving size.
Look first at the serving size. All of the numbers in the Nutrition Facts box are based on this serving size. Is this the serving size you will be eating? How many servings are in the
