Issue: November 2015
Section: Diabetes views

Healthy eating challenges for diabetes self-management

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 IDF’s World Diabetes Day campaign for 2015, 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, CELEBRITY CHEF, FILM MAKER AND WORLD DIABETES ADVOCATE, DIAGNOSED WITH TYPE 2 DIABETES IN 2011, USA

Just this week I was at the doctor for a follow up to my visit the previous week. 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 am 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!

My first step is to lose the extra 15 pounds that I don't need. I should be at my ideal weight and that's that. So I need to start with a plan that allows me to lose 15 pounds and then maybe I can shed more. What works for me is a low carbohydrate, low sugar, and low starch meal plan. A few months back I recently lost 12 pounds and it was primarily from lots of walking! In order to achieve that, I was walking about three times a day for about forty minutes per walk. I drank nothing but water and was eating lean meat and vegetables. As a celebrity chef, it can be hard staying away from the food–heck it can be hard for anyone to stay away from the table. Food is truly a drug that can be used for good and for bad. When society accepts that healthy eating and an active lifestyle can make a positive change then we will be in a much better place.

I always go back to what a healthy food choice is for me and my type 2 diabetes. I start with what God gave us and go from there. We can’t go wrong with loads of vegetables and water. We can’t go wrong with small portions of lean meat and limit our total intake. Let’s face it, when I am back in my home country of Jamaica, I go crazy at times. I love curried goat and ackee and salt-fish, the national Jamaican dish! I know some Jamaican foods are the cause for many people suffering in the Caribbean islands with high cases of type 2 diabetes. But in reality, when I get there I actually slim down a bit because I go on a fresh food diet. If I need to eat on the go, I will make a small meal, like some egg whites or some curried chicken. Now that's mostly protein and vegetables, low in calories, but these choices still have that great taste.

When I am out with friends or family, that can also be an issue that haunts us. I always suggest sticking to quality vegetables and protein. I suggest that people with diabetes grab a steak or some lean chicken, because these options can be tasty but still healthy. Also, grab some steamed veggies instead of the rice, and always make sure your portions are small. Don't forget if you live with diabetes, you need to make sure what you do today, won’t hurt you tomorrow.

Fortunately, I got back to my healthy ways again with a smile on my face and I'm down a few pounds in only a few days and counting. I also got my medical tests back and it’s all clear. I must admit I was very nervous and I know those test results were a wake-up call for me. I don’t miss some of the bad choices I make from time to time and with the holidays coming up, I want to make sure I am heading in the right direction.

DICKY POON, STUDENT, DIAGNOSED WITH TYPE 1 DIABETES AT 6 YEARS, HONG KONG

Last year 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 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, 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.”

Kate Cornell, writer, diagnosed with type 2 diabetes at 50 years, USA

“My diagnosis of type 2 diabetes changed a lot of things for me, but the biggest change related to food. Everything revolves around food in our society, which makes eating with type 2 diabetes more challenging. Challenging, but not impossible.

The way I eat now is dramatically different than the way I ate ten years ago but those changes didn’t happen overnight. Type 2 diabetes is a progressive condition and, therefore, I have made progressive changes to the way I eat. One change at a time.

As luck would have it, most of my favourite foods became difficult for me. I couldn’t keep my blood glucose levels where they needed to be if I ate bread, pasta, cereals and potatoes. Some fruits also became off-limits. It was necessary for me to remove those things from my food plan because I do not use insulin to manage my diabetes. Finding alternatives made living with these food changes much more bearable. Alternative flours, such as almond and coconut, allowed me to make breads, cookies and cakes that didn’t spike my blood glucose. Replacing pasta with spaghetti squash or zucchini made a huge difference! Some might say that I am now following a low carb diet, but I prefer to call it a “no processed carb” diet. I’m choosing to eat whole foods that I (mostly) cook myself as opposed to processed meals or foods that contain too much of what isn’t good for me.

I’m fairly successful at home, but eating out, travelling or attending social functions add a layer of difficulty to my food choices. I choose to eat a sandwich with a fork and knife, avoiding the bread. I order cottage cheese or sliced tomatoes instead of potatoes. I travel with my own snacks so that I can avoid fast and convenient foods. Attending a celebration means loading up on salad and having only a taste of that birthday cake.

These may seem like sacrifices but I no longer feel deprived. I’m happy to be eating in a way that has made me healthier and will hopefully help prevent complications down the road. I’m lucky to live where I have choices.

Kate’s blog on living with diabetes can be found here: http://kates-sweet-success.blogspot.com/

SCOTT JOHNSON, DIABETES ADVOCATE, DIAGNOSED WITH TYPE 1 DIABETES AT 5 YEARS, USA

I believe that learning more about healthy eating would be good for me. It would give me an additional set of tools to manage my blood sugar, and my overall health. Essentially, I've allowed myself to look the other way when I eat something unhealthy, especially if I can manage my blood sugar by doing fancy tricks with my insulin.

I tell myself it's OK because diabetes is all about blood sugar management, right?

No. I'm justifying unhealthy eating behaviour and using blood sugar as an excuse. Honestly, I'm intimidated by the idea of learning about food. The endeavour seems overwhelming, with conflicting opinions and misinformation throughout the journey. Where do I start? Who do I trust?

People living with type 2 diabetes successfully are my heroes here. Their most influential tools are often food and activity. They may not know how much I admire them or look to them for inspiration and leadership. Why?

Because I imagine, at diagnosis, they also had little interest in learning about food. It may have even been an emotional trigger evoking the diagnosis experience all over again.

And now, here they are, the challenge overcome, using the power of healthy eating to manage their health. They are setting examples that can often serve us all well, regardless of what type of diabetes we have. I have much to learn from my friends in the community living with type 2 diabetes. Thank you for being brave, inspirational type 2 diabetes leaders. I am ever grateful to you.

Scott Johnson’s blog can be found here: https://scottsdiabetes.com

HÉLÈNE COLON-RAPHAEL, GRANDMOTHER, DIAGNOSED WITH TYPE 1 DIABETES AT 23 YEARS, USA

There are many challenges in having diabetes, but I faced one big hurdle when it comes to healthy eating and being social. I declined invitations to friends’ homes because I was afraid of what I was going to be challenged to eat and how it was going to affect my blood glucose. Now, I accept social invitations, with the caveat that I am allowed to bring a dish or a beverage. Bringing something for myself to eat is reassuring knowing that there is something I will feel comfortable eating or drinking. It is important 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 properly dose my insulin. Sometimes I will bring an appetizer, side dish or a beverage, and I make sure I know how many carbohydrates are in each. Otherwise, it is very difficult. I will have to guess, or ask the host what exactly is in each dish which can lead me to take either too much insulin or too little insulin. When deciding on an item to bring to a host’s party, I typically bring homemade hummus, shrimp cocktail, white bean stew or low calorie/no sugar added margaritas. With my strategy, going out socially means I have lower stress, and I can enjoy visiting friends and family at their home.

JOÃO VALENTE NABAIS, PRESIDENT OF IDF EUROPE, DIAGNOSED WITH TYPE 1 DIABETES AT 12 YEARS, PORTUGAL

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 used only for hypoglycaemia episodes (low blood glucose events).

With the evolution of diabetes treatment options, including new insulin and monitoring devices, a new world opened up to me. This evolution was extremely positive in all aspects and the freedom to choose a variety of foods is only one of them. But new challenges came along! How can I choose healthy food with all opportunities available? Carbohydrate counting is like a game, in particular when I am travelling abroad and the food is unfamiliar. Adjusting the insulin dose correctly to exercise and food can sometimes feel like a horror movie.

There are apps for smart phones, devices to evaluate the food content and a panoply of tools 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.