Managing Diabetes and Your Di... Health Article

• If you have to eat earlier than planned, save one Carbohydrate Serving for your regular mealtime.

• If you have to wait to eat a meal, have one Carbohydrate Serving at your usual mealtime, then eat the rest of the meal later. Or, if you usually have a snack later on, have the snack at your mealtime and eat the meal during your snack time.

Snacking—Green Light or Red?

It wasn't so long ago that people with diabetes were told they needed snacks to help them manage their diabetes—timing snacks to offset drops in their blood glucose caused by insulin and other diabetes medications. But today's diabetes medication choices are much more flexible, so snacks aren't strictly necessary; the decision to snack, or not, is up to you. If you manage your glucose better by eating more frequent, smaller meals, you'll want to include some planned-for snacks in your daily routine. If there's a time of day when your blood-glucose levels tend to drop regularly, a small snack can help tide you over.

That said, a go-ahead on snacking isn't a green light to nosh uncontrollably. The keys are to consider snacks as mini-meals, and to make room for them in the rest of your day's eating. Ideally, they can complement your other meals, supplying nutrients rather than just empty calories. Get in the habit of snacking on vegetables (especially nonstarchy ones like cucumbers and cut-up bell peppers), and you'll painlessly boost your vegetable intake.

You don't have to include protein, carbohydrate and fat at every snack, but it helps make them more balanced, substantial and satisfying. A good guide to aim for is 1 or 2 Carbohydrate Servings in your snack.

Eating on the Road

Having diabetes shouldn't keep you from traveling, but it does require you to plan ahead. Be sure your diabetes supplies and medications are up to date, and carry them with you rather than in checked luggage, so you don't risk losing them. It's a good idea to include a copy of your prescriptions plus a letter from your doctor identifying you as a person with diabetes. Pack some nonperishable snacks to keep you going if your meals are delayed, such as the suggestions on page 26. And, if you'll be crossing time zones, check with your diabetes specialist about adjusting your mealtimes and medications.

The biggest challenge, though, is finding something to eat in new territory. Again, planning ahead is the answer. Call a hotel before your visit and ask about area restaurants; pack a portable meal with you on the train or plane—or, if a meal will be served en route, ask if you can pre-order a "diabetes" or "heart-healthy" meal instead. If you're driving, use travel guides to plot a route where you'll have access to accommodating restaurants, farmers' markets, grocery stores and other easy venues for nutritious food. And even if your only choice is a fast-food rest stop, you still have plenty of options. You can ask for nutrition information if you're not sure about how an item adds up in your food plan; most fast-food restaurants have this information available.

Skip the Soft Drinks

Enticing, big-bucks ad campaigns make soft drinks look like a fabulous way to quench thirst—but the reality is anything but refreshing. The average 12-ounce can of regular soda supplies about 150 calories and 38 grams of carbohydrate—the equivalent of more than 9 teaspoons of sugar. And most of us drink all those calories and carbohydrate without noticing: studies show that when people have soft drinks with meals, they don't compensate for the extra, liquid calories by eating less solid food. So drinking soda regularly is a prescription for overconsumption.

Another reason to avoid soda: it may raise the risk of developing diabetes. A recent report from the Nurses' Health Study, which surveyed the health behaviors of over 51,000 women, found that those who drank one or more regular sodas a day were twice as likely to develop diabetes during the study period as women who drank less than one can a month. Even when the researchers took such factors as weight, diet and lifestyle differences into account, they still found that the soda drinkers were 1.3 times more likely to develop diabetes.

If you have a regular soft drink habit, switching to diet soda is a start. It makes sense to also focus on finding calorie-free ways to quench thirst or wash down your meals—like sparkling water or plain water, nature's best refresher.

Alcohol and Diabetes

In your diabetes treatment counseling, you were probably warned to limit your intake of alcohol, because when consumed without food, alcohol can cause low-blood-glucose episodes and, in large amounts, raise blood pressure. At the same time, you've no doubt seen reports that a daily drink can help reduce the risk of heart disease and stroke—two diseases that pose more problems for people with diabetes. Moderate drinking is even associated with lower risk of type 2 diabetes. What can you conclude from this conflicting advice?

According to the American Diabetes Association, recommendations for people who have their diabetes under control are no different from those aimed at the general population: If you choose to drink, limit it to two drinks a day for men and one daily drink for women. If you're pregnant, have high blood triglycerides (over 500 mg/deciliter) or a history of alcohol problems in your family, it makes sense to stay away from alcohol altogether.

The limits are there for a reason; for people with diabetes, there are real risks associated with going beyond them. The first is low blood glucose. When your liver is processing alcohol, it can't make new glucose. This can cause your blood-glucose levels to drop, sometimes sharply—if you're drinking on an empty stomach and are taking insulin or diabetes drugs. Worse, this effect can last for as long as 12 to 16 hours after you drink, depending on how long it takes your body to process the alcohol. And low blood glucose can make you feel and act tipsy, so you could be doubly impaired.