Maintaining a balanced diet can be difficult, but it is a necessity for those living with diabetes or prediabetes.Harriet Salzberg, Registered and Licensed Dietitian and Certified Diabetes Educator within the Department of Endocrinology and Diabetes, answers some questions about living with diabetes and how the diet can have such a large influence.

What are some good tips for portion control? Is it better for diabetics to eat smaller meals throughout the day, or the main three (breakfast, lunch, dinner)?

To help with portion control, it may be beneficial to use measuring cups to serve your portions when eating at home. For example pasta, rice, quinoa, barley or couscous use the appropriate cup for the portion you want – ⅔ cup of rice is 30 grams of carbohydrate, 1 cup is 45 grams of carbohydrate and ½ cup is 22 grams of carbohydrate. Use your hand size for meats as a 3-ounce serving of meat is about the size of a deck of cards. A small apple is the size of a tennis ball.  

Some people get very hungry before their meal and so adding a snack may decrease how much they will want to eat at their meal. For some, snacking is difficult either due to time constraints or because snack choices are sometimes difficult to plan and may include more calories and carbohydrates than needed.  Good snacks would include a fruit or vegetables with 2-3 tablespoons of a low-fat dip or hummus, or a yogurt.

With there being different types of carbohydrates, which ones are better for a healthy diabetic diet? Are there any types to be careful of?

It is important to get a variety of foods. It is okay to mix some white products with mostly whole grain products. For example, if you eat a meal with beans and brown rice it is ok to have some white bread or potato at another meal. For the best carbohydrate choices choose more of the following whole grain or complex carbohydrates:

• Bulgur (cracked wheat)
• Whole wheat flour
• Whole oats/oatmeal
• Whole grain corn/corn meal
• Popcorn
• Brown rice
• Whole rye
• Whole grain barley
• Whole faro
• Wild rice
• Buckwheat
• Buckwheat flour
• Triticale
• Millet
• Quinoa
• Sorghum
• All beans and peas
• All fruits
• All vegetables

The important thing to remember is the correct portion to fit into the diet that is recommended for you.

Since fruit has natural sugars, does that mean diabetics should limit their intake? Are certain fruits better than others for blood sugar?

Fruits are a good source of vitamins and fiber. Getting at least three servings of fruit per day can help get the needed vitamins for a healthy diet. Some fruits have more sugar (carbohydrates) than others so it is important to look at serving sizes and carbohydrate content of each fruit. It is best not to get all of your servings of fruit at the same time but to spread the servings of fruit throughout the day.

Is it important for diabetics to eat something before or after exercising? If so, what are some good options?

It is important to individualize the recommendations based on your blood sugar pattern during exercise, your medications and length and intensity of the exercise.  The general rule for exercise is to check your blood sugar before exercise and after exercise to be able to identify your blood sugar pattern with exercise. This will help you know how your blood sugars change with exercise.  If your blood sugar is below 100 get a snack with 15 grams of carbohydrate for every 45-60 minutes of exercise. Good snack options may include:

• One serving of fruit
• Light yogurt
• Granola bar
• 1 cup of skim milk

If you are going to do an activity for more than one hour or more of moderate intensity or high intensity eat a snack with some protein and carbohydrate such as:

• Apple and peanut butter or other nut butter
• 1 ounce of cheese and 5-6 crackers
• ½ sandwich or granola bar with more than 5 grams of protein
• 1 ounce of nuts and some fresh or dried fruit
• Granola bar with 15-20 grams of carbohydrate and 3-7 grams of protein

Is fasting safe/effective for people with diabetes? Can it provide a more accurate reading on blood sugar levels for those who are pre-diabetic?

We usually recommend three meals per day for the population as a whole. In order to maintain metabolism in energy burning mode, it is recommended to have a regular meal about every 4-6 hours. Eating at least three meals can avoid excess intake at another meal since skipped meals usually result in overeating at the next meal that is eaten – which may lead to weight gain and higher blood sugars. Some people even benefit from small frequent meals to avoid excess intake at their next meal. I don’t think that fasting would provide more accurate blood sugar levels for people with prediabetes as the blood sugars during a fast do not reflect the normal blood sugars patterns with meals.

Are there any good apps or programs for keeping track of meals for diabetics?

One app for logging food intake is MyFitnessPal which allows you to log food intake, enter recipes and it will calculate the carbohydrates and calories per serving. You can also enter a meal you usually eat name it and then enter the entire meal without having to add each item individually. It will calculate your calorie and carbohydrate goals based on your height, weight, activity and weight loss goals. You can print out the food logs each day. I also recommend using the notes section on the bottom of the daily log to enter blood sugars so all the information is in one place. There are other apps as well including Lose It, Calorie Counts or Fat Secret.

What is new in terms of diet/lifestyle recommendations with the 2017 ADA standards on diabetes care?

The major differences in the 2017 ADA standards of care for diet/lifestyle recommendations are the following:

Exercise recommendations.
The 2016 recommendation was to do at least 5-10 minutes of activity every 60-90 minutes.
The new recommendations for 2017 is that it is important to interrupt prolonged sitting every 30 minutes with short bouts of physical activity such as walking around the office. The other exercise recommendations is to add flexibility and balance training for older adults.

Weight loss.
In 2016 the modest, slow sustained weight loss of 5% of bodyweight will improve blood sugar control in people with Type 2 diabetes. For those people who are obese, a weight loss of greater than 7% may be needed to show improvement in blood sugar control. A modest weight loss of 5-7% of weight can also prevent progression from prediabetes to Type 2 diabetes.

Fat intake.
Fat intake in the guidelines continue to recommend mostly monounsaturated fats. The diet should also include foods high in omega-3 fatty acids such as fish, nuts and seeds to prevent and treat heart disease.