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Everyday Health Diabetes Series

Everyday Health Diabetes Series

I recently had the privilege of working with on a video piece they produced to educate their visitors on diabetes management.  The team included myself as the diabetes educator, another dietitian, a fitness trainer, and a physician, as well as a couple of patients living with diabetes.   In the videos we impart practical information on how to live well with diabetes and prevent the progression and complications of the disease.  The video is now posted on and you can access it by clicking here:

Everyday Health Diabetes Videos


How Might Diabetes Affect You?

How Might Diabetes Affect You?

Last Saturday, I had the privilege of joining celebrity chef Charles Mattocks for the Phoenix leg of his “The Diabetic You” tour. I spent the day on the tour bus answering questions about Type 2 diabetes and spreading the word about its prevention.  Charles prepared samples of healthy foods, and talked with guests about his own experience with Type 2 diabetes.  Above is a photo of Charles and I in front of the tour bus.

The tour bus was parked at the downtown Phoenix farmer’s market, and I expected it to draw the attention of people with Type 2 diabetes.  What I did not expect was that many people without diabetes came onto the bus wanting to learn how to prevent diabetes.

Anytime I’m asked a question about nutrition or health, I figure there are probably others who have the same question, and that it may be a good topic to write about.  So for today’s newsletter, I’m answering the 3 main questions I heard on the tour.

1.  “Many of my family members have Type 2 diabetes.  So I’m doomed to get diabetes too, right?”

No.  Although there is an undeniable genetic component to Type 2 diabetes, having a family member who has diabetes is only one risk factor.  Other risk factors include being overweight, being inactive, race, age, and having had gestational diabetes or prediabetes.  Improving lifestyle factors, including what you eat and how active you are, can have a significant enough effect to delay or completely prevent Type 2 diabetes.

2.  “How can I prevent Type 2 diabetes?”

Aim for at least 150 minutes of physical activity weekly.  Check with your doctor before beginning an exercise program, and start with whatever activity and duration your current fitness level will allow, and then increase in gradual increments.

Improve your diet.  At meals, fill half your plate with nonstarchy vegetables (vegetables other than corn, peas, and potatoes.)  You can still eat corn, peas, and potatoes, but you will count them as a starch.  Fill ¼ of your plate with starch, preferably a whole grain, and the other ¼ of your plate with lean meat.  Eat with these proportions at least 80% of the time.  Cut restaurant portions in half by taking half home and eating it for another meal, or by sharing a restaurant meal with someone else.  Avoid sugared beverages:  instead drink water, diet soda, or unsweetened or artificially sweetened iced tea, hot tea, or water. Reserve sweets for special occasions or occasional treats.

Be screened for diabetes yearly.  The earlier Type 2 diabetes is caught, the more easily it can be controlled and complications can be minimized.

3.  “I have Type 2 diabetes.  Am I going to have all the complications that my relatives have had?”

Not necessarily.  When blood sugar is controlled over the years, risk of complications in people with Type 2 diabetes can be delayed or prevented to a significant degree.  Follow the guidelines above for eating and exercise, see a Registered Dietitian, and enroll in a diabetes education course.  Visit the doctor every 3 months when uncontrolled, and every 6 months even when your blood sugar is in good control.  Yearly you should have a diabetic foot exam, a dilated eye exam, a urine microalbumin test, and a cholesterol panel.

What questions do you have about diabetes?  You may discuss in the comments section below.

“The Diabetic Diet”


Many people with diabetes come to me asking what diet they need to follow. I am a dietitian after all, so I must have stacks of diets just ready to hand out to whoever walks in the door. “I would like the diabetic diet please.” “Here you go, that’ll be $20. Thank you, come again!”
Although a part of me wishes it were that easy, the truth is, each person’s dynamic health profile warrants a full nutrition assessment to be completed before an individualized nutrition plan can be built. Furthermore, most people find that a structured meal plan is nearly impossible to follow due to the unexpected twists and turns of daily life, and therefore the dietitian that hands out such a cookie-cutter plan should be prepared for mediocre results.

Because of this, people with diabetes actually need to understand, first and foremost, the carbohydrate content of their foods. This way they may plan their meals, in advance or on the fly, in a way that protects their blood vessels from the damage that high sugars can cause. Today’s savvy dietitian and diabetes educator is focused more on education than providing a diet, and more on empowering the patient to learn to build their own meal plans than having the patient rely on them for one.

Diabetes is a progressive disease in which the treatment is different at each stage. Effectively treating diabetes early on in a way that maintains blood sugars within a normal range most of the time will prevent damage to the blood vessels and delay the progression of the disease. No matter what stage you are at, it is never too late to learn to control your blood glucose so you can prevent any further damage from being caused. Below I have outlined the basic stages of diabetes and the appropriate dietary considerations that relate to them.
Newly diagnosed:

The average person with diabetes is not diagnosed until 5 years after they actually develop insulin resistance. Getting yearly doctor’s exams will help assure you catch diabetes as early as possible, well before this 5-year average. Early on, and for the long-term if your blood sugars are well-controlled, your pancreas still has enough available insulin to cover the carbohydrate eaten at your meals. You may or may not need to take oral medication.

In this case you budget your carbohydrates like you would your bank account. You establish a maximum amount of carbohydrate you can eat in a meal and still have a blood sugar at target (<140mg/dL) 2 hours after your meal. You may eat less than that amount if you wish, as long as you don’t exceed the maximum. (Disclaimer: The Dietary Guidelines For Americans recommend a bare minimum of 130 grams of carbohydrate daily)
After Diabetes has Progressed:

If blood sugars are left uncontrolled for an extended number of years, the pancreas is forced to make so much insulin over a period of time that it wears out. At this point, insulin needs to be injected, and/or oral medications may be used to stimulate insulin production or make your cells more sensitive to insulin. This will happen, on average, around the 8th year after the initial insulin resistance occurs. When you take insulin, you have a couple choices:

  1. Static insulin dose – when you take a consistent amount of insulin daily, you must keep the amount of carbohydrate eaten at meals constant. This is because those taking insulin are at a higher risk of hypoglycemia (low blood sugar) and must eat enough carbohydrate to match available injected insulin.
  2. Flexible mealtime bolus insulin dose – this is one of the best ways to control blood glucose and allows for patients with diabetes much more flexibility in what they eat, and how much. Your insulin:carbohydrate ratio is determined which tells you how much insulin you need to cover each unit of carbohydrates eaten (the insulin:carbohydrate ratio is individual to everyone). Once this ratio is determined, you can eat as much or as little carbohydrate as you like (within the Dietary Guidelines), as long as you take the appropriate amount of insulin to cover it. A diabetes educator can work with you and your doctor to establish this ratio and teach you how to count your carbohydrates to achieve this balance.


Many people with diabetes feel overwhelmed and frustrated with trying to control their diabetes. With the Western sick-care system, medications are prescribed but very little education is given on how to actually achieve healthcare. I feel strongly that this is wrong, and hate seeing people face complications from diabetes that could have been avoided. No matter what your stage of diabetes, make sure you get the education you need to keep yourself healthy. If you would like my help, please don’t hesitate to contact me via e-mail at In just a few weeks we can have you well on your way to achieving the health you deserve.