Earlier I mentioned that my mom has diabetes. A few years ago, after Thanksgiving, she was diagnosed with type 2 diabetes. Mama was having severe back problems and wasn’t able to be very active. But she and my dad were still enjoying the holidays with more food, which meant more calories. As a result, her weight went up to its highest point ever. As part of a routine checkup, her doctor checked her blood glucose level. Her blood glucose indicated she might have diabetes, so her doctor checked again a week later. Her blood glucose was still too high. Mama was scared when she was diagnosed with diabetes. She was scared because her sister had died from diabetes problems. But she was also surprised. She said she never thought she would have to worry about diabetes—even though diabetes ran in her family.
Her doctor signed her up for diabetes education classes at one of the local hospitals. While she was waiting to attend the classes and see a dietitian, she wanted me to be her dietitian! She wanted to get started right away. I told her it would be hard to be her daughter and her dietitian at the same time. She needed her own dietitian. But while she was waiting to see the dietitian, we got started. She and I talked about Rate Your Plate. After rating her own dinner plate, she decided she was eating way too many carbs. Mama loves carbs like I do—like mother like daughter, they always say. She also knew she and her doctor had agreed that she’d work on losing 15 pounds. We then talked about carb counting and trying for 3 carb choices at each meal and 1 carb choice for an evening snack.
Mama wanted her carb counting to be as simple as possible. She didn’t want to be looking things up in a book all the time. Here’s what we worked out for her to count as 1 carb choice:
1/2 cup of any starchy food, such as potatoes, cooked beans, peas, or corn
1/3 cup of cooked pasta or rice
1 small piece of fruit or 1/2 cup of fruit
1 cup of milk or yogurt
1/2 cup of low-fat ice cream or frozen yogurt
2 small cookies
1 handful (about 3/4 ounce) of pretzels, baked chips, or snack crackers
1 small dinner roll, tortilla, or muffin
1 piece of bread, 1 biscuit, 1/2 English muffin, 1/2 hamburger or hot dog bun, or 1/4 of a bakery bagel
1 cup of soup, such as chicken noodle, tomato, or split pea
1/2 cup of cooked cereal, such as oatmeal or grits
3/4 cup of dry ready-to-eat cereal, such as Cheerios
Any food that contains about 15 grams of total carbohydrate on the Nutrition Facts Label (see Steps in Using a Food Label to learn more about reading food labels).
Mama thought the serving sizes seemed awfully small, especially that 1/4 bagel. Then we talked about having 3 carb choices at breakfast. Three carbs could be a 1/2 bagel (2 carb choices) and a 1/2 cup orange juice (1 carb choice) to drink with her medicine. That seemed more like something she could do. Today Mama skips the orange juice and drinks low-sodium vegetable juice to take her medicines. She likes saving that carb for fresh fruit or jam.
Next we did some meal planning for lunch and dinner. She decided on a sandwich on whole wheat bread (2 carb choices) and some baked chips (1 carb choice) for lunch. For dinner she wanted all 3 of her carb choices as spaghetti (about 1 cup, cooked).
For her bedtime snack, Mama said she would have a piece of fruit (1 carb choice), like a peach, apple, or orange. Or she might choose a glass of 1% milk for 1 carb. Or she might have a cup of light yogurt, like lemon or blackberry, for 1 carb. Or a couple of small cookies would be 1 carb.
“This isn’t so hard,” Mama said. “It’s like I have a bank account of carbs for my meals and my evening snack. Then I spend the carbs in my bank account for the foods I love.”
Then she thought about the rest of her meals. “But what about the rest of my meal?” Mama asked. “What about the meat and my salad with dressing?” I suggested she try for about 3 ounces of lean meat, poultry, or fish.
“I don’t love meat the way I love carbs, but I’m not sure how much 3 ounces would be,” Mama said. “And I need this to be simple. I don’t have all day to be weighing and measuring my food. Besides, I thought you said carbs were what would raise my blood glucose.”
“That’s right, carbs are what raise blood glucose, but because you want to lose weight, you’ll want to watch your portions of meats, too,” I said.
“So portion power is coming into play with meats, too,” Mama said. “How can I keep this simple?” We decided to look at a serving of 3 ounces of fish, poultry, or meat this way:
• a meat patty or serving the size of a mayonnaise jar lid
• a serving the size of the palm of your hand
• a serving the size of a deck of cards
• a serving the size of a checkbook
• a serving of three meatballs the size of ping pong balls or golf balls
“Those would all fill about one-fourth of my plate, just like when I rate my plate,” Mama said. “That makes sense to me. But what about tuna fish or cottage cheese—how do you count them?” she asked. We decided to count half of a 5- or 6-ounce can of water-packed tuna or 3/4 cup of low-fat cottage cheese the same as 3 ounces of meat.
“But what about regular cheese—how do I count it?” Mama asked.
“Mama,” I said, “1 slice of cheese would be equal to
1 ounce of meat. Or a 1-inch cube of cheese, say, the size of 4 dice, would be equal to 1 ounce of meat. You know that a lot of cheeses are high in fat and cholesterol. Think about choosing fat-free or low-fat cheeses when you can. This will be good for your heart and blood cholesterol level.”
“That reminds me that we haven’t talked about fats yet, like margarine and oils,” Mama said. “I know they say to eat less fat to lose weight.”
“That’s right, Mama,” I said. “Fats have twice as many calories as carbs or protein. So choosing one or two fats at a meal or snack would be about the right amount.”
“So how much is a fat?” Mama asked. “And keep it simple.”
“A fat serving is about 5 grams of fat and about 45 calories, but that’s not simple, is it?” I said. Mama and I decided about 4 fats a day would be right for her and that she’d count these as 1 fat:
• 1 teaspoon margarine, butter, mayonnaise, or oil. That’s about the size of the tip of your thumb.
• 1 tablespoon reduced-fat margarine, reduced-fat mayonnaise, cream cheese, or half-and-half cream, the size of the pad of your thumb.
• 2 tablespoons reduced-fat salad dressing, reduced-fat cream cheese, or reduced-fat sour cream. Two tablespoons would be about half a ladle of dressing at a salad bar.
“How would you like some good news, Mama?” I asked.
“What’s good about having diabetes?” she asked.
“The good news is that sometimes finding out you have diabetes is a wake-up call,” I said. “People eat better, lose weight, get more active, start feeling better, and just enjoy life more. But the best news about diabetes is that you can prevent or delay diabetes problems like the problems Aunt Carla had.”
“That is the best news I’ve had in a long time!” Mama said. “Is that all there is to eating with diabetes?”
“That’s a good start, Mama,” I said. “Plus just keep on making healthy food choices.”
Then the time arrived for Mama’s diabetes