New to Diabetes: What’s Next? (Part 3)

Last week[1] I focused on blood glucose monitoring and logging as essential tools to help people new to diabetes (well, actually ANYONE with diabetes) get a handle on how factors like food, alcohol, physical activity, and illness affect blood glucose.

If you don’t have a blood glucose meter, or if you have one but haven’t been using it, now’s the time to start. Remember that it’s your diabetes, and it’s up to you to learn how it affects you so that you can effectively manage it. Don’t be afraid of the numbers, learn from them. And if you’re not sure what they mean, take them to your doctor or to a diabetes educator[2] to help make sense of them.


Another monitoring tool
Blood glucose monitoring is great in that it gives you a snapshot of what your blood glucose level is at a particular time of day, whether it’s before you eat breakfast, after you go for a walk, or in the middle of the night. Wouldn’t it be even better if you could see what your blood glucose is doing every minute of the day? Well, now you can.

Continuous glucose monitoring (CGM, for short) can give you a glucose reading pretty much every few minutes, all day, every day. It does so with the help of a sensor that you insert under your skin (like inserting a pump infusion set). The sensor “reads” the glucose level in interstitial fluid, which is fluid that bathes your cells. There are only a few CGM devices on the market, and insurance coverage is a bit iffy for people with Type 2 diabetes[3], so check with your doctor about what your options are.

CGM also doesn’t replace fingersticks with your regular meter, so you can’t get out of checking your blood glucose quite that easily. But CGM helps you and your health-care team spot trends in your glucose that regular blood glucose checks don’t tell you. These devices also warn you with alarms if your glucose is going too low or too high. Talk to your doctor or diabetes educator if you’d like to learn more.

Learn about eating
There’s so much information available about eating with diabetes that it’s enough to make your head spin. Chances are, if you’re new to diabetes, you’ve had a few people tell you or suggest to you what you should eat, or what diet to try, or give you some other kind of dietary advice. Maybe you’ve gone online and thought about cutting carbs, or joining Weight Watchers, or going vegan. Here are a few tips to keep in mind when it comes to eating and meal planning:

Everyone’s diabetes is different. Folks become very passionate and even adamant about what to eat, and many are more than willing to tell you what they think you should be eating. Usually their advice is well meaning, but your diabetes is not their diabetes. Just because someone does well with a low-carb diet or with using meal replacements, for example, doesn’t necessarily mean that these approaches will work for you. You need to find out for yourself what works best and also what you can stay with long-term.

Meet with a dietitian. I say this more often than I can count, and yes, I’m a dietitian myself, but I really do think it’s worthwhile to sit down with someone who understands the physiology of diabetes and how food affects diabetes management. Medicare and most health-care plans cover visits with a dietitian (called medical nutrition therapy), but you’ll need a referral from your doctor.

You don’t have to stop eating certain foods. Your coworker or neighbor with diabetes is probably all too happy to tell you to stop eating bread and pasta, or to eat only organic foods, or to cut out all animal fats. The choice is yours, of course, but it’s generally not necessary to eliminate any one food or food group from your eating plan.

If it’s easy for you to do that, then you can certainly try it. But the real key is focusing on choosing healthy foods (you know what they are): fruits, vegetables, whole grains, lean meats, beans, vegetable oils, nuts, and seeds. Yes, grains and fruits have carbohydrate, but the body needs carbohydrate for fuel. Your job is to learn how much of these foods will work best for you to manage your blood glucose, manage your weight, and keep you healthy. A dietitian can give you guidance on this.

Start with your plate. A very simple and easy tool to get you going with meal planning is what’s called the Plate Method. Picture your dinner plate and divide it in half. Fill half of your plate with low-carbohydrate vegetables like spinach, broccoli, peppers, tomatoes, and carrots. Next, divide the other half of your plate into half. Fill one of these smaller halves with a healthy carbohydrate food like brown rice, quinoa, a sweet potato, or corn. Fill the other half with lean meat, skinless poultry, eggs, seafood, or tofu. Add a glass of low-fat milk or three quarters of a cup of low-fat or Greek-style yogurt and throw in a small piece of fruit for good measure.

Don’t forget that you can use some fat on your foods, such as olive oil, salad dressing, trans-fat-free tube margarine, a small amount of butter, or even some nuts. And there you have it. Eventually, you may want to learn how much carbohydrate you should aim for at your meals and snacks, and you’ll still need to watch portions, but you can be well on your way by using the Plate Method.

Treats aren’t off-limits. Once you’ve mastered some of the basics of eating with diabetes, you might decide to build in treats once in a while. It could be a slice of cake on your birthday, a piece of pie on Thanksgiving, or an ice cream cone with your grandchild. Again, it’s up to you to determine a) if you want to eat something sweet and fatty and b) how much you’ll eat. You might decide to forgo treats entirely, and that’s your choice. However, having diabetes doesn’t have to mean deprivation.

I’ll wrap up this series next week with a few more things to think about when you’re new to diabetes.

  1. Last week:
  2. diabetes educator:
  3. Type 2 diabetes:

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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

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