Get help eating right when you have diabetes

People with diabetes may be told by friends, family, and even some health-care providers that they have to give up sweets or other types of food. But "there's no food that's a can't-ever-have," says Deborah Fillman, R.D., a certified diabetes educator and registered dietitian in Owensboro, Ky. And you don't have to follow a one-size-fits-all "diabetes diet" that is overly restrictive or that looks radically different from what other people eat, she says.

Our survey of 5,012 people with type 2 diabetes confirms that. It suggests that the most important dietary strategy for managing diabetes isn't limiting sugar or counting carbs but simply eating less. The two habits that separated successful survey respondents from unsuccessful ones were cutting calories and watching portion sizes.

Of course, eating less isn't always easy. And you may indeed need to tinker with your diabetes diet in other ways. For example, you may need to focus more on healthful carbohydrates, notably fruits, vegetables, and whole grains, and establish regular eating times to help even out your blood sugar.

While you can make some of those changes on your own, enlisting the help of a registered dietitian can pay dividends. The people in our survey said those professionals were by far the most helpful health-care providers in giving detailed nutritional advice.

Prepare for your visit by tracking what you've been eating, along with your blood sugar levels, and share the information during your first visit. Describe your lifestyle so the dietitian can create a plan that works for you. A person who doesn't cook often, for example, may need help choosing the best frozen foods or the healthiest items on a restaurant menu. Someone who loves cooking may need guidance measuring just the right portion sizes. An overweight person may require a lower-calorie or lower-carbohydrate diet to help him or her lose weight.

A dietitian can also help you avoid a common pitfall: trying to overhaul your diabetes diet all at once. Instead, work with him or her to identify small and manageable changes so you don't become overwhelmed and give up. Then you can build from there. "Diabetes is a lifetime disease," says Angela Ginn-Meadow, a dietitian and diabetes educator in Baltimore. You don't have to change your diet all at once, she points out. But over time, the results can be dramatic.

The slow-and-steady approach worked for Jill Knapp, 42, of Nampa, Idaho, who has type 2 diabetes. She started by cutting back on refined carbohydrates, switching to six small meals a day to balance her blood sugar, and using small plates to keep her portions in check. She spent nine months developing the habit of stopping eating when she felt full. Three years later she's 100 pounds lighter, her health is good, and she's even competing in beauty pageants.

"It's something you have to put your mind to, and it doesn't have to happen overnight," Knapp says "That's what people have to know." (See What consumers say for more stories from people who are successfully managing their diabetes.)

People tend to eat what's put on their plate, says Brian Wansink, Ph.D., a food researcher at Cornell University in Ithaca, N.Y. And most people put much more food on their plate than they should, since they're unclear about appropriate serving sizes. See this quick guide to proper portion sizes, and then try to limit yourself to those amounts. Or adopt other simple strategies in your diabetes diet to limit portions: Use smaller plates. When dining out, take half your entrée home for lunch the next day. Or use the "pick two" strategy: Order a main course and only two of the following: bread, appetizer, dessert, and alcoholic drink.

The American Diabetes Association has a simple way to make sure you get the right balance of foods. It works like this:

• Divide your plate in half, and then divide one of the halves in half again, so you now have three sections.
• Fill the largest section with nonstarchy vegetables, such as bok choy, broccoli, cabbage, carrots, or spinach.
• Fill one of the smaller sections with starchy foods, such as whole-grain breads, high-fiber cereals, pasta, or tortillas; cooked beans and peas; or starchy vegetables such as corn, potatoes, sweet potatoes, or winter squash.
• Fill the remaining section with meat or meat substitutes, such as eggs, lean cuts of beef and pork, poultry with the skin off, reduced-fat cheese, seafood, or tofu.
• Add an 8-ounce glass of nonfat or low-fat milk (or another small serving of carbs, such as a 6-ounce container of light yogurt or small whole-grain dinner roll) plus a serving of fruit.

Of course, you don't have to actually divide the foods that way on your plate; what matters is striving for the proper portions.

For more information on a diabetes diet, go to these Web sites:

• The American Diabetes Association
• The National Diabetes Information Clearing House
• The Weight-Control Information Network

In addition, see our complete guide to preventing and treating diabetes.

More than three-quarters of the people in our survey said they had made dietary changes to help them manage their diabetes. We looked at their eating habits to identify the dietary steps that worked best.

For each of the pairs of strategies in our diabetes diet quiz below, click on the one you think was more successful.