You can teach an old dog new tricks
to improve diabetes care!
In 1976 the American Diabetes Association and the American Dietetic Association joined hands to create the Holy Grail aka, the "Exchange List For Meal Planning" It would pave the way to good diabetes meal planning and result in better diabetes management for those who adhered to its guidelines. It even promised that, by following its instructions and calculations, you could "eat at the family table" how nice.
The list is divided into categories composed of milk, bread, fruit, vegetables, meat and fat exchanges, from which to pick and construct a meal plan. I carried the booklet (along with a set of measuring cups and spoons) around for years. It traveled from schoolbag to backpack to attaché case to eventual retirement in my diabetes archives (a huge cardboard carton in the basement storeroom). Although I used the exchange list to calculate grams, exchanges and calories, I never really felt comfortable nor enthusiastic with it. In fact, I never liked it. It was a constant reminder of the daily grind of living with diabetes, plus it had a certain clinical resonance that made food taste like medicine. This of course, is my own personal taste and opinion, as a chef and dedicated "foodie". Not a physician or dietitian. However, the one residual benefit from having used the exchange list was learning about food groups and balanced meals.
When I eventually abandoned the list I discovered a greater sense of liberty and enjoyment to navigate a fresher, tastier, more seasonal diet without strings to that very stringent reminder of diabetes. Food became delicious. Exercise became an integral part of daily life. Months and years rolled on with not much new happening. Then, one day, new stars glimmered on the horizon for all diabetics to reach for, and soon everybody was pumping insulin and carb counting. Could this old dog learn a new trick or two? Or, would counting carbohydrates be another boring exchange list deal? I am happy to report that counting carbs it is easy to learn and offers precision and flexibility in meal planning.
There are several good pamphlets to keep on hand whether you are new to carb counting or an old pro, who needs a little refresher. Some resources you might tap into for simple, accurate explanations, written in plain language, are listed below. You can also take a stroll to the bookstore here at www.diabetesnet.com. Look under the category of Carbs Counting, to discover several excellent books on the subject.
The ADA publishes a purse sized book titled, Diabetes Carb and Fat Gram Guide which provides information on a slew of foods, including those fast ones some people eat. Many of the meter companies offer carb counting information. Calorie King Calorie, Fat & Carbohydrate Counter, is another useful implement. It now comes in a palm database, if you use a palm pilot gizmo. These are only a smidgen of the many resources available to begin or brush up on carb counting skills. It's a good idea to keep such information handy, whether you are new at the game or have mastered the skill. It's good background music to play.
There are several choices to pick from, for carb counting.The simplest is to consider 1 slice bread/starch, 1 small fruit or 1 glass milk(dairy) as 1 carb, and 1 portion meat or vegetables as 1/3 carb. With a little basic addition and a carb list on board, you can approximate insulin needs. Another elementary method is the "15 rule", which assigns 15 carb grams to 1 bread/starch or 1 fruit, and 12 carb grams to 1 cup milk. Easy enough. Add up the total carbs in a meal, divide it by your carb/insulin ratio number and arrive at a bolus. You can build on this raw material as you familiarize yourself with all the foods you enjoy. You'll learn how to adjust boluses according to portion size and grams. If you weigh 110 -130 lbs. your ratio is 1:15, that is 1 unit insulin for each 15 carb grams you nourish yourself with. If you're eating 2 cups (cooked) pasta = 60 carb grams, you'll need a 4 unit bolus to cover the carbs. The best way to see how you are doing and to experiment with a variety of foods is to test, test, test. Test an hour before a meal and 2 hours after. Make adjustments according to results.
Carb counting is not an exact science, but it is a good barometer for balancing insulin and carbohydrates to achieve smooth diabetes care. One catch can be the temptation to overindulge in empty carbs like cakes and candy. Sure, you can bolus for the amount of carbs in a brownie once in awhile, but a steady diet of such indulgence will eventually take its toll on all systems. Be smart and go for the nutrient dense foods like fresh veggies, whole grains, seasonal fruits, lean protein and unsaturated fat. These are the big winners that payoff by making you look great and feel vibrant. You can't hide a good thing. How about droping down to Recipe Central for a taste of a few good carbs you can "count" on.
We all have our favorite foods. I sometimes smile with the image of sitting propped up on a huge comfortable pillow around a tasting table laden with 20 different types of pasta which I eat as I please without restriction or thought of fat, calories or carbs. When I awaken from the reverie, I go to the stove and create a healthy pasta dish to satisfy the dream while keeping my blood sugars smiling.