Eating healthy foods is critical to your disease management, and meeting with your dietitian or diabetes educator will help you develop a meal plan specific to your needs. Although meal planning is probably one of the most confusing aspects of diabetes, it is one of the most important concepts for you to understand. In fact, it is the one element that will impact your blood sugar level fastest.

Eating the right foods at the right times and in the appropriate amounts will help keep your blood sugar at safe levels. Start by following these simple but basic rules:

• Eat a variety of foods, trying to select foods that are closest to their natural state. Try fresh fruits instead of canned or juice, fresh vegetables instead of canned, and breads and cereals made with whole grains instead of white flour.
• Choose a diet low in fat, especially low in saturated fats. Select chicken and turkey with no skin, lean cuts of beef or pork, or soft margarine instead of butter. Grill or broil meats rather than frying; use skim or 1% milk, low fat cheeses and no-stick cooking spray.
• Learn to identify and measure carbohydrate foods, which are foods the body turns into blood sugar or blood glucose. These include starches (rice, potatoes, pasta, bread, cereal, flour, corn, peas, beans), fruit and juices, milk and yogurt, and sweets. Some of these food groups are high in calcium, vitamins, minerals and fiber, so they can be important to your diet. However, too much of these groups at one time can increase blood sugars dramatically. Remember 15 grams of carbohydrates can raise blood glucose levels as much as 30 points.
• Maintain a healthy weight. For some people with diabetes, this will mean losing weight by increasing exercise and limiting portion sizes. By losing only 5-10 percent of your body weight, you can improve your average blood sugars and your quality of life overall.

Meal planning and preparation are the secret to success in sticking to a healthy diet. Eating regular meals and snacks is particularly important if you are taking medication for your diabetes. Note: Always check with your health care provider before drastically changing your eating habits.

Some foods are unhealthy and should be limited, if not avoided, by everyone – regardless of whether or not they have diabetes. These include foods with large amounts of concentrated sweets and those that are high in salt and saturated fats. Learning to count carbohydrate grams will help you identify groups of foods that cause a rapid rise in blood sugar levels. American Diabetes Association meal planning recommendations for people with diabetes allow some foods with sugar, allowing you to incorporate an occasional sweet treat into your day, as long as you watch other carbohydrate foods. We like to think that no food is off limits for someone with diabetes as long as it is used in moderation.

Foods that are part of any healthy diet are also appropriate for people with diabetes. Lots of fresh vegetables and three fresh fruits per day add essential vitamins and fiber. Whole grain breads and cereals, brown rice and unprocessed foods add important fiber, vitamins and minerals. Fish, lean meats and skinless poultry add protein without saturated fats. Drinking water is beneficial as well, particularly for flushing toxins from the body.

If it’s important to your meal plan, it’s all right to include desserts. Our caution is that you should avoid high fat, high sugar desserts. Substitute fresh fruits, no-fat sugarless yogurt or sugar-free gelatin. Avoid large amounts of foods made with "alcohol sugars" (sweeteners that are synthesized and not extracted from natural sources). These sweeteners are listed on food labels as sorbitol, mannitol, xylitol, erythritol, lactitol, isomalt and maltitol. These contain carbohydrates and in excessive amounts will raise blood sugars and may cause gas and diarrhea. If choosing a concentrated sweet, limit yourself to a very small portion.

Normal blood sugar levels for people without diabetes are less than 100 mg/dl if fasting and less than 140 mg/dl two hours after a meal, with the body automatically adjusting levels to stay within this range no matter what has been eaten. However, if you live with diabetes, your body is unable to perform this job appropriately. Several studies have shown that if people diagnosed with diabetes kept their blood sugar levels as close to normal as possible, the damaging effects of diabetes could be greatly reduced. Follow your physician's advice. National guidelines suggest blood sugar readings between 70-100 mg/dl fasting, between 90-130 mg/dl before meals and less than 180 mg/dl two hours after a meal. Your doctor may have different levels that are safe for you if you have other health concerns or if you are pregnant, but this gives a general guideline to follow. Remember that these goals will not be reached every time you test your blood sugars. However, the more often they are in that range, the less likely it is that you will develop complications of diabetes.

Ask your physician, but many sources suggest that your blood sugar level should not go below 70. If blood sugar falls below 70, often the brain cannot function properly, causing a series of unpleasant symptoms. You may feel a rapid, pounding heartbeat (palpitations), feel suddenly weak or fatigued, break out in a cold sweat or develop a sudden headache. People often feel nervous or anxious, and may become irritable and confused. Some people become dizzy, hungry or nauseated, and develop shaking hands (tremors). Vision may become dim, memory poor and judgment impaired. You may experience one or many of these symptoms, although people often do not develop the same symptoms each time they have a low blood sugar (hypoglycemic) episode. If you develop these symptoms, but are not sure if your blood sugar is low, it is best to do a blood sugar test if possible.

Sometimes people do not experience any symptoms at all. This can be dangerous because you could pass out before realizing something is wrong. Any time you begin to feel "different," it’s advisable to check your blood sugar level. If you take insulin or use a medication that can cause a blood sugar level to go too low, you should carry something that says you have diabetes – whether in the form of a bracelet, necklace or ID card in your wallet.

When your blood sugar gets below 70 or the level set by your doctor, you should take immediate steps to bring it up to a normal level. One-half cup of juice or regular soda, one cup of skim milk, one tablespoon sugar, honey or syrup, one small box of raisins, or 3-4 hard candies will start to work immediately. You can also purchase chewable glucose tablets or packets of glucose gel. These are easy to carry with you. Retest your blood sugar after 15 minutes, and if you see no improvement, repeat treatment. If it will be more than one hour before a meal, you may need 1/2 sandwich and 1/2 glass of skim milk. However, do not subtract this from your next meal. If you begin feeling symptoms and cannot take your blood sugar level, begin treatment anyway. It would be better to treat a blood sugar level that wasn't low, rather than not treating a “low" when you needed it.

High blood sugar levels can develop slowly, gradually climbing a little each month, especially if you are gaining weight. They may also develop quickly by eating a meal or snack high in carbohydrates, not exercising, forgetting your medicine or becoming ill. There are often observable symptoms when blood sugar is too high. Thirst and hunger often increase, you may become sleepy or tired and urinate more frequently. Infections are more common, wounds don't heal and your vision may become blurred. These symptoms may be gradual and may come and go. If your blood sugars are high, you can often make great strides in lowering them yourself. Drink plenty of water, follow your exercise plan daily and follow your meal plan carefully. Check blood sugar levels more often than usual and be sure to take the right amount of diabetes medicine at the prescribed time. However, if blood sugars do not fall within your normal range in 2-3 days, call your doctor. If blood sugars are above 240 mg/dl, or if you are sick, test for ketones. If the test is positive for ketones, call your doctor. Illness or an infection can rapidly increase your blood sugar, so you should have your doctor treat your illness. Your blood sugar should begin to fall to normal as you recover.

When you have low blood sugar (usually below 70), hormones are released that tend to increase the blood sugar level for 12-24 hours. This is a normal body response to the low level. Do not increase your diabetes medication to cover the high level – this should balance out after 24 hours. If it does not, consult your doctor. Also, if you overtreat a low blood sugar response with too much juice, soda or other forms of carbohydrate, your blood sugar may rebound into an abnormally high range.

This is an important long-term blood sugar test that helps determine your average blood sugar level for the past 60-90 days. It does not replace daily monitoring at home, but gives a larger picture of what your blood sugar level has been for several months. It may also be called a glycohemoglobin, hemoglobin A1C or glycosylated hemoglobin. As background, hemoglobin is the solid part of the blood, or red blood cells. These attract sugar as they float through the blood. The more sugar you have in your blood, the more sugar is attracted to the red blood cells. Although lab results may differ, usually an HbA1C under 7 percent is considered good control. A result that is higher suggests treatment should be adjusted to correct blood sugar levels that have been too high. Be sure to ask your doctor about having this test performed.

If you suspect you may have diabetes, ask your doctor to order a fasting blood test. This is usually done in the morning before you have had anything to eat or drink. According to the American Diabetes Association, if your blood glucose level is 126 or higher, it may mean you have diabetes. Another way to diagnosis diabetes is by having your physician order a glucose tolerance test. A random blood reading – a blood test done regardless of when you last ate – that yields a reading of 200 or greater may also indicate diabetes. Finally, although many individuals do not experience symptoms of diabetes, these may include increased thirst and urination, fatigue, blurred vision, frequent infections, poor wound healing or unexplained weight loss.

Type 1 diabetes, previously called juvenile diabetes, affects only 5-10 percent of the diabetic population. It can be a result of an autoimmune destruction of the beta cells in the pancreas that make insulin. People can develop Type 1 diabetes as either a child or adult and it must be treated with insulin. Type 2 diabetes, previously called adult onset diabetes, affects 90-95 percent of the diabetic population. Contributing factors may include a family history of diabetes, obesity, lack of regular physical activity, being a member of a high risk ethnic population (African American, Latino, Native American, Asian American or Pacific Islander), having delivered a baby that weighed more than 9 lbs. or having elevated triglycerides. Type 2 diabetes can be treated with diet and exercise, oral medications and/or insulin.

One excellent opportunity is to contact Certified Diabetic Services at 1.888.966.6909 to check on the availability of diabetes education classes in your area. These classes are covered by Medicare and most private insurance. If we are not offering classes where you live, we can provide you with additional educational materials. We also have trained certified diabetes educators on staff to help you with your questions. CDS members also receive a free informative quarterly newsletter with their supplies.