• There are some foods and some factors about the qualities of food that may cause them to raise blood glucose faster or slower than others.
• To help keep blood glucose in control while following a healthy meal plan, it’s important to consume healthy sources of carbohydrate in consistent amounts through the day.
• When foods that provide mainly protein (meat, fish, etc.) and fat are eaten in amounts consistent with a healthy eating plan, they raise blood glucose levels minimally.
Identify foods (food groups) that contain carbohydrate
Ensure that the person knows the list of foods (food groups) that contain carbohydrate. Do not assume that people know this. It is quite common for people to equate starches with carbohydrate and have no knowledge that foods such as fruits, milk, and ice cream also contain carbohydrate.
Food groups that contain carbohydrate:
• Starches, including breads, grains, and cereals
• Starchy vegetables, including beans (legumes)
• Fruit and fruit juices
• Vegetables (nonstarchy)
• Milk, yogurt, ice cream, and some other dairy foods
• Sugary foods
• Sweets and desserts
• Fat-free foods (often in the form of carbohydrate-based fat replacers)
• Sugar-free foods (which contain polyols)
Identify foods (food groups) that do not contain carbohydrate
Assure that the person also knows the list of foods (food groups) that do not contain carbohydrate.
Food groups that do not contain carbohydrate:
• Meats, seafood, poultry
• Eggs
• Cheese (hard and soft cheeses contain minimal carbohydrate)
• Fats, such as margarine, butter, and mayonnaise (Note: Do point out that some fats, such as commercially prepared salad dressings, do contain some carbohydrate. Also point out that many fat-free foods contain some carbohydrate.)
• Oils
• Nuts (other than chestnuts, which contain minimal carbohydrate)
Understand that many foods that contain
carbohydrate are healthy and offer energy and
an array of vitamins and minerals
A common reaction, once a person realizes that carbohydrate raises blood glucose levels, is to eat less carbohydrate than is recommended for health and healthy eating. This belief is also cultivated by promises of low-carbohydrate, high-protein diets to improve metabolic control and produce weight loss. People often don’t know that sources of carbohydrate are not the same and carbohydrate-containing foods essentially fall into two groups—healthier and less healthy sources of carbohydrate. People also often think that the current American diet is high in total carbohydrate, which is untrue. Americans eat about 50 percent of their calories as carbohydrate. The concern is that a large percent of carbohydrate intake is from added sugars, as opposed to more desirable sources (U.S. Department of Health and Human Services et al. 2005).
Consider teaching the following points:
• Many carbohydrate-containing foods are among the healthiest foods to eat: whole grains, fruits, vegetables, and low- or fat-free milk and yogurt (Institute of Medicine 2002). Carbohydrate-containing foods are the body’s primary and preferred sources of energy and provide many essential vitamins and minerals. Also, whole grains and many fruits, vegetables, and starchy vegetables are the body’s main source of various types of dietary fiber.
• Delineate between healthier food sources of carbohydrate and less healthy sources. Today, Americans in general eat insufficient amounts of healthy carbohydrates and overconsume less healthy carbohydrates (U.S. Department of Health and Human Services et al. 2005).
Less than healthy sources to mention:
• Reinforce that careful attention to the portion size of carbohydrate-containing foods is critical to achieving blood glucose control—even when eating healthier sources of carbohydrate.
• Many people ask when they need to start counting carbohydrate from nonstarchy vegetables. This question is often beside the point, since most people do not consume enough nonstarchy vegetables. For most, the amount of carbohydrate from nonstarchy vegetables at meals is likely <10 grams of carbohydrate. However, people who eat several servings (about 1 cup raw, 1/2 cup cooked) of vegetables at meals should count the carbohydrate once it equals 10 grams or more. Educators should certainly encourage people to eat more nonstarchy vegetables, but also note that large quantities of some vegetables, such as carrots and tomatoes, can affect blood glucose.
Understand that healthy foods that contain
carbohydrate should not be significantly limited
or avoided as a means to achieve glycemic control
Reinforce the message that blood glucose control should not be achieved by avoiding healthy foods. Limiting foods that contain healthy sources of carbohydrate can compromise nutritional status.
Some people with type 2 diabetes facing the need to start an oral or injectable blood glucose—lowering medication may attempt to limit carbohydrate intake as a means to lower blood glucose. They believe that this will further delay the need to add or transition to new medication regimens. For this reason, it is important to discuss with them the common progression of type 2 diabetes. People need to understand that, as time goes on, they will produce less insulin and continue to have insulin resistance. They will need to introduce and/or modify their blood glucose—lowering medication to continue to achieve target blood glucose goals.
Know how much carbohydrate to eat per day
A person’s need for carbohydrate relates to his or her calorie needs. Calorie and carbohydrate needs depend on numerous factors:
• Height
• Weight and weight history
• Usual food habits and daily schedule
• Level of physical activity
• Blood glucose control
• Blood lipid levels
The current American Diabetes Association (ADA) nutrition recommendations note that no optimal nutrient mix for carbohydrate, protein, and fat has been determined for people with diabetes (ADA 2008b) and that the Dietary Reference Intake (DRI) of 45–65% of total calories from carbohydrate is reasonable to follow (Institute of Medicine 2002). On average, Americans eat about 50% of their calories as carbohydrate, although a greater than desirable percent of these calories comes from less healthy carbohydrate sources (Institute of Medicine 2002; U.S. Department of Health and Human Services et al. 2005). It is optimal