fat (20 to 35 percent).
Not all carbohydrates have the same impact on blood glucose. Carbohydrates that are especially likely to raise blood glucose are said to have a high glycemic index and, as you might expect, those that that don’t raise blood glucose levels as much are said to have a low glycemic index. We discuss the glycemic index in detail in Chapter 4. Also, fibre, which is a form of carbohydrate, doesn’t raise blood glucose at all.
When discussing meal plans, we often refer to “Carbohydrate Choices.” One Carbohydrate Choice is equivalent to 15 grams of carbohydrate (excluding fibre). Knowing about Carbohydrate Choices will allow you to map out a meal plan that contains the appropriate amount of carbohydrates. Your dietitian is the best person to teach you about Carbohydrate Choices and how to incorporate them into your nutrition program. (Each recipe in Diabetes Cookbook For Canadians For Dummies – wow, that’s a mouthful of a title! – has the number of Carbohydrate Choices in a serving.)
Having diabetes, you should eat three square meals a day rather than engaging in that popular and ill-advised Canadian pastime of eating almost nothing all day, getting home ravenous after a long day’s work and chowing down on a big supper, and then grazing at the fridge and pantry the rest of the night.
The goal is to not go longer than six hours between meals during waking hours. If your next meal is going to be longer than six hours from your last one, have a snack to hold you over until meal-time comes around.
If you have diabetes, you need to obtain the expert advice of a registered dietitian. The designation “registered” means that the dietitian has completed a special program of training and has achieved official certification establishing his or her credentials. Many registered dietitians, like Cynthia, have also trained as certified diabetes educators, in which case they have the initials RD, CDE after their names.
A dietitian can assist you in many ways, including helping you
✔ Learn the ins and outs of healthy eating in general and healthy eating when you have diabetes in particular.
✔ Balance the amounts of carbohydrates, proteins, and fats in your diet.
✔ Master carbohydrate counting. (We discuss carbohydrate counting later in this section.)
✔ Figure out how to read food labels.
✔ Know what snacks to eat, when to eat them, and how often to eat them.
✔ Effectively use nutrition therapy to improve your blood glucose control, your blood pressure, and your lipids, including cholesterol and triglycerides. (See Chapter 4 for information about lipids.)
✔ Determine how to get the appropriate amounts of vitamins and minerals in your diet and, when necessary, what supplements of these nutrients you should take.
✔ Develop a meal plan that takes into account your particular food preferences as well as any food needs (or restrictions) related to religious, cultural, ethnic, or other factors.
✔ Calculate how many calories you need to consume to lose weight, maintain a steady weight, or, when necessary, gain weight; and how best to adjust your diet in order to achieve whatever weight change you require (if any).
✔ Adjust your diet to accommodate your exercise program, travel schedule, sleeping in, shift work, and other factors.
✔ Find great recipes; indeed some dietitians are so expert at cooking they even co-write entire books on this subject.. like this book!
These are a few ways you can find a registered dietitian to assist you:
✔ Call your local diabetes education centre (DEC). Most diabetes education centres allow self-referral, but if the one local to you doesn’t, then ask your doctor to refer you. The cost of the services provided by dietitians working out of a DEC are typically covered by the hospital or other health care facility where they are located, so you will not have to pay.
✔ Contact a private registered dietitian. You can find the name of a registered dietitian local to you in your phone book or online at http://dietitians.ca. Also your doctor can likely recommend one to you. Remember, it is a registered dietitian you want to see. Expect to pay a charge for the services provided by a private dietitian; however, if you have private insurance, your insurer may cover some or all of these costs.
✔ If your family physician works in a clinic setting, ask whether the clinic has a registered dietitian on staff. If so, you can book an appointment to see that clinic’s dietitian.
Exercise and Blood Glucose
Exercise has a powerful effect in controlling blood glucose. Indeed, if you’ve been sedentary and your blood glucose control hasn’t been very good, you’ll likely find yourself very impressed by how much your newfound exercise program helps bring your blood glucose down. This effect is made all the greater when coupled with nutrition therapy and weight loss. (Exercise also helps control blood pressure and cholesterol, lowers the risk of heart disease, and makes one feel generally better. Not too shabby, eh?) Cardiovascular (cardio) exercise causes your muscles to use oxygen and your heart to speed up and beat more forcefully. As the name suggests, cardiovascular exercise works – and benefits – the heart (hence the term cardio) and circulation (vascular). Examples of cardiovascular exercise are walking, running, and skating.
The Canadian Diabetes Association recommends you perform cardiovascular exercise for at least 150 minutes per week, spreading it out over a minimum of three days of the week. Also, you should avoid going more than two days in a row without performing cardiovascular exercise.
Resistance exercise uses muscular strength to move a weight or to work against a resistance. If you lift weights or exercise with weight machines, you’re performing resistance exercise. This type of exercise improves muscle strength and, as shown by pioneering Canadian research undertaken by Dr. Ron Sigal, also helps control blood glucose levels.
The Canadian Diabetes Association recommends that you perform resistance training at least two times per week (and preferably three times per week), starting with one set of 10 to 15 repetitions using a moderate weight, and gradually progressing toward a goal of three sets of eight repetitions three times per week using a heavier weight.
