Introduction 1 About This Book 2 Foolish Assumptions 3 Icons Used in This Book 3 Beyond the Book 4 Where to Go from Here 4 Part 1: Getting Started with Carb Counting and Diabetes Management 5 Chapter 1: Delving into Diabetes and Carb Counting 7 Getting Up to Speed on Diabetes Basics 8 Checking out concerning trends in the diabetes epidemic 8 Improving outcomes and preventing complications 8 Building your diabetes team 9 Staying up to date with advances in diabetes care 10 Examining the Carb-Glucose Connection 11 Getting Acquainted with Carbs 12 Introducing the so-called simple carbs 13 Catching up on complex carbs 13 Noting the nutrition in carb food groups 13 Acknowledging that staying healthy isn't just about carbs 14 Making the Case for Carb Counting: To Count or Not to Count? 15 Counting carbs with type 1 diabetes: An essential tool 15 Gaining tighter control over blood-glucose levels with type 2 diabetes 15 Sticking with consistent carb counts when you're on set insulin doses 16 Managing weight with carb counting and portion precision 17 Regulating Carb Intakes 18 Figuring out how much carb you need 18 Timing your carb intake 18 Counting Carbs Successfully 19 Looking at the label lingo 19 Gathering carb-counting resources 19 Increasing carb-counting accuracy 20 Living Well with Diabetes: The Seven Pillars of Diabetes Management 20 Eating a healthy diet 20 Staying fit with exercise 21 Taking your medication 22 Monitoring your blood-glucose levels 22 Managing stress 23 Discovering how to problem-solve 23 Reducing risk with healthy behaviors and regular medical checkups 24 Chapter 2: Exploring the Diabetes-Carb Connection 25 Wrapping Your Brain around Diabetes and Related Conditions 26 Seeing how the body is supposed to process carbs 26 Discovering what causes diabetes 27 Noticing the symptoms of diabetes 28 Distinguishing the types of diabetes 29 Recognizing Diabetes Risk Factors and Getting Diagnosed 32 Type 1 diabetes risk factors 32 Type 2 diabetes risk factors 33 Diagnosing diabetes 34 Moving Forward with Managing Diabetes 35 Knowing that diet matters 36 Keeping in touch with your diabetes team 36 Embracing your central role in your own self-care 37 Chapter 3: Calling All Carbs: Recognizing Carbs in the Foods You Eat 39 Looking at the Chemical Structure of Carbohydrates 40 Introducing the So-Called Simple Carbohydrates 42 Going au naturel with glucose, fructose, and lactose 43 Finding other forms of sugar: Sucrose, maltose, honey, and syrups 44 Spotting simple carbs in the grocery aisles 45 Checking Out the Complex Carbohydrates 45 Identifying the starches 45 Focusing on fiber 46 Spotting complex carbs in the grocery aisles 48 Recognizing Carb-Free Counterparts 49 Pumping up with proteins: Meat, fish, and other sources 49 Finding the healthiest fats and oils 50 Exploring the role of noncarb foods in diabetes management 51 Chapter 4: Tracking Carbs through the Body 53 Filling Your Tank and Fueling Your Cells 54 Settling in your stomach 54 Extracting glucose via digestion 55 Pumping through your bloodstream 56 Fueling your cells 56 Saving Some for Later: Glycogen, the Storage Form of Glucose 57 Making a layover in the liver 57 Maintaining the muscles' glucose reserves 58 Noting What Happens When Glucose Levels Remain Elevated 58 Spilling glucose into the urine 58 Sticking glucose where it doesn't belong: Glycosylation 60 Recognizing the Risks of Undereating Carbs 62 Depleting glucose reserves and dealing with hypoglycemia 62 Making glucose but losing lean body mass 63 Producing ketones 64 Chapter 5: Finding Your Sweet Spot: The Right Amount of Carbs for You 67 Checking Out the Official Diet Guidelines 68 Advice from the American Diabetes Association 68 The 2015-2020 Dietary Guidelines for Americans 68 Intakes and allowances from the National Academy of Sciences 69 Figuring Out Calorie and Carbohydrate Intake Targets 69 Estimating your caloric needs 69 Adjusting calories for your weight target 71 Deciding on carb intake targets 72 Distributing carb intake 74 Leaving room on your plate for protein and fat 74 Tweaking Your Carb Intake Target When Conditions Change 75 Changing needs throughout the life cycle 75 Altering intake to account for activity 76 Adjusting portions when blood glucose is out of control 76 Managing sick days 76 Chapter 6: Timing Your Carb Consumption 79 Distributing Your Daily Carb Intake 80 Striving to eat three meals per day 80 Opting for smaller meals with controlled snacks 81 Stabilizing Blood-Glucose Levels at Breakfast and Dinner 82 Breaking your fast: The importance of breakfast 83 Considering the merits of an earlier dinner 83 Understanding Insulin Action 84 Comparing insulin options 85 Checking out concentrated insulins 85 Looking at blended insulin preparations 86 Pumping and inhaling insulin 87 Coordinating Insulin Action with Meals 88 Enjoying the flexibility of insulin-to-carb ratios 89 Keeping carbs consistent when using sliding-scale insulin dosing 90 Basing injection timing on pre-meal blood-glucose levels 91 Being regimented if you use 70/30 insulin 91 Managing Carbs on Oral Diabetes Meds 93 Keeping the carbs appropriate 93 Knowing your limits 94 Part 2: Carb Counting: From Basic to Advanced 95 Chapter 7: First Things First: Reading and Deciphering Food Labels 97 Finding Your Way around Food Labels 98 Paying particular attention to amounts 98 Viewing versions of traditional labels 100 Taking a sneak peek at newfangled food labels 101 Scrutinizing the Nutrition Facts 104 Sorting out serving sizes and servings per container 105 Calling out calories 105 Finding the fat 105 Noting the cholesterol content 106 Surveying the sodium 107 Focusing on total carbohydrate 107 Pinpointing the protein 110 Taking note of other valuable nutrients 111 Investigating the ingredients 111 Identifying allergens 111 Heading to the Grocery Store 112 Being skeptical about label claims 112 Preparing your carbohydrate cheat sheet 115 Developing supermarket savvy 115 Chapter 8: Mastering Carb Counting and Portioning Fundamentals 117 Estimating Carb Counts for Foods without Labels 118 Relying on food composition lists 118 Solving carb-counting conundrums in mixed dishes and ethnic foods 124 Calculating carbs in your favorite recipes 126 Preparing your carbohydrate cheat sheet 126 Sizing Up Servings with Measures and Weights 127 Measuring with standardized cups and spoons 127 Weighing in on whether to weigh foods 128 Dealing with Special Cases 132 Controlling carb intake when eating out 132 Keeping track of the carbs you drink 133 Guesstimating: When Carb Counts Aren't Critical 133 Balancing your plate with the plate model 134 Handling portions with the hand model 136 Chapter 9: Adding Tools for Carb-Counting Ease and Accuracy 137 Reviewing the Printed Resources 137 Reading the fine print for carb counts 138 Looking at labeling regulations for chain restaurants 138 Tapping into Online Resources 139 Digging up chain restaurant food facts 139 Foraging through Internet food databases 140 Using your search engine to count carbs 140 Enlisting the Assistance of Apps: One More Reason to Love Your Smartphone 140 Finding useful diabetes apps 141 Integrating apps and a food scale 142 Part 3: Going Beyond Counting Carbs 143 Chapter 10: Accounting for Variations in Digestion and Absorption Rates 145 Comparing Digestion Speeds for Fluids and Foods 146 Looking at liquid carbs 146 Singling out sugars 147 Figuring out fruit 147 Focusing on complex carbs and fiber 148 Recognizing the fat factor 149 Considering other variables 149 Gauging the Glycemic Index and Glycemic Load 150 Reducing Blood-Glucose Fluctuations: Tips and Tricks 152 Controlling portion sizes of foods that pack a blood-glucose punch 152 Adding activity for extra carbs 153 Combining foods to reduce glycemic effect 153 Altering the order in which you eat the components of your meal 154 Aligning Insulin and Digestion Rates 154 Optimizing mealtime insulin coverage 155 Using your insulin pump's fine features 156 Chapter 11: Rethink That Drink 159 Noting the Importance of Hydration and Low-Carb Drinks 159 Exploring the Pros and Cons of Different Drinks 161 Giving water a special place in your life 162 Sipping and swigging low-carb beverages 162 Mentioning the merits of milk and nondairy milk substitutes 163 Facing the facts about fruit juice 165 It's Not Just the Carbs - It's the Calories Too 167 Last Call for Alcohol: What's the Verdict? 169 Being informed about the risks 169 Going behind the scenes: How alcohol affects the body 170 Looking at liquor's carbs and calories 171 Drinking safely 173 Chapter 12: Let Me Call You Sweetie: Sugars and Substitutes 175 Comparing Sugars: The Sugar Showdown 176 Introducing the heavyweights: Sugar, honey, syrup, and other notables 178 Pointing out the qualities of natural fructose and agave nectar 180 Examining Sugar Alcohols 182 Opting for Alternatives: The Sugar Substitutes 184 Digging into the differences of the substitutes on the market 186 Exploring sugar-substitute safety records 186 Using substitutes in cooking and baking 188 Part 4: Embracing Whole Health and Happiness 189 Chapter 13: Eating for Health and Happiness 191 Eating a Rainbow of Fruits and Vegetables 191 Loading Up on Whole Grains 193 Identifying best-bet grains 193 Increasing your options and trying new grains 194 Leaning Toward Leaner Proteins 194 Choosing the healthiest options 195 Fishing for reasons to eat more seafood 196 Vegging out with meatless proteins 197 Daring to Do Dairy 197 Watching the fat content 198 Packing in more protein 198 Boning up on calcium 198 Checking out nondairy substitutes 199 Focusing on Healthy Fats 200 Having Diabetes and Dessert, Too 201 Making your own treats 201 Dressing up healthy fruits 202 Enjoying dessert while controlling the carbs 202 Trying Cooking and Serving Tips that Support Health and Weight Goals 203 Opting for lower-fat cooking methods 204 Controlling portion sizes 205 Chapter 14: Reaping the Rewards of Fitness 207 Exercising Safely 208 Getting the green light from your doctor 208 Being prepared: What to keep handy 210 Encouraging Exercise for Everyone 211 Developing an exercise plan 211 Enjoying the benefits 214 Being mindful of medical limitations 215 Clarifying What's Going On Behind the Scenes When You Exercise 217 Controlling blood glucose: How hormones are supposed to do it automatically 217 Identifying how diabetes alters fuel use 218 Sustaining exercise by tapping into fuels 219 Understanding hypoglycemia 219 Exercising with Type 1: Staying Safe While Having Fun 220 Monitoring matters 221 Fueling up or dialing down: Fine-tuning carbs and insulin 221 Knowing when to postpone activity: Too high or too low, don't go 223 Exercising with Type 2: Why It's Right for You 223 Improving glycemic control 224 Reducing cardiovascular risks 224 Supporting weight-control efforts 225 Chapter 15: Getting a Handle on Hypoglycemia 227 Understanding Hypoglycemia 228 Defining a low blood-glucose level 229 Identifying causes of hypoglycemia 229 Recognizing the symptoms of hypoglycemia 235 Losing symptoms of lows: Hypoglycemia unawareness 236 Treating Hypoglycemia 237 Choosing quick-acting carbs 237 Taking the right amount of carb 237 Rechecking your blood-glucose level 239 Watching out for rebounds 240 Requiring assistance: Severe lows and glucagon 240 Strategizing for Common Hypoglycemia Scenarios 242 Managing mealtime lows 242 Sleeping safely after a bedtime low 244 Considering insulin action when treating hypoglycemia 244 Preventing Hypoglycemia 246 Being prepared 246 Looking for patterns and problem-solving 246 Reflecting on prior exercise 247 Remembering your carb intake 247 Enlisting Your Doctor's Help 247 Keeping and reviewing blood-glucose logs 248 Sharing your data with your doctor 249 Chapter 16: Keeping the Beat with a Healthy Heart 251 Eating Smart for Your Heart 251 Getting the facts on cholesterol and fats 252 Acquainting yourself with types of fats 253 Choosing fats wisely 254 Adding soluble fiber to your healthy heart regimen 257 Creating a heart-healthy grocery list 258 Cooking your foods the heart-healthy way 259 Handling the (Blood) Pressure 260 Taking a look at the DASH diet 260 Shaking the salt habit and opting for alternate seasonings 261 Identifying hidden sodium suspects 262 Deciphering label claims related to sodium 263 Embracing Heart-Healthy Habits 263 Managing stress 264 Avoiding tobacco and secondhand smoke 264 Staying active 264 Controlling weight 265 Chapter 17: Living with Diabetes throughout the Life Cycle 267 Raising a Child with Diabetes 267 Beginning with basic pointers 268 Addressing type 2 diabetes in youth 271 Managing Diabetes in Pregnancy 273 Planning for pregnancy when you have type 1 or type 2 diabetes 273 Developing gestational diabetes 274 Understanding blood-glucose targets and fluctuations in pregnancy 275 Employing eating tips for diabetes during pregnancy 277 Keeping the Golden Years Golden When You Have Diabetes 279 Evaluating seniors' dietary concerns 279 Keeping physically fit 281 Chapter 18: Going Gluten-Free (Or Not): Does the Batter Matter? 283 Weighing In on the Gluten-Free Debate: Fad or Fact? 284 Avoiding gluten fastidiously when you have celiac disease 284 Forgoing gluten if you are allergic or have an intolerance 286 Choosing to go gluten-free for personal reasons 287 Against the Grain: Beginning a Gluten-Free Diet 288 Avoiding grains that contain gluten 288 Eliminating gluten-containing foods 290 Finding hidden gluten 291 Avoiding cross-contamination 292 Staying Gluten-Free Without Nutrient Deficiencies 293 Embracing foods naturally free of gluten 293 Incorporating gluten-free grains 294 Watching out for nutrient deficiencies 295 Part 5: Sampling Menus Complete with Carb Counts 297 Chapter 19: Beginning with Breakfast Menus 299 Starting Your Day Right with Breakfast 299 Personalizing Your Breakfast Meal Plan 303 Chapter 20: Looking for Lunch Menus 305 Loving Your Lunch Options 305 Personalizing Your Lunch Meal Plan 310 Chapter 21: Delving into Dinner Menus 313 Determining What's for Dinner 313 Personalizing Your Dinner Meal Plan 317 Chapter 22: Surveying Snack Ideas 319 Choosing Carb-Controlled Snacks 320 Picking Packaged Snacks 325 Part 6: The Part of Tens 327 Chapter 23: Ten Tips for Monitoring Your Blood Glucose 329 Picking a Meter for Your Needs 329 Safely Obtaining a Blood Sample 330 Acknowledging Error Issues 331 Assuring as Much Accuracy as Possible 331 Disposing of Lancets and Needles Properly 332 Varying Your Test Times 332 Knowing Your Blood-Glucose Targets 333 Keeping a Log and Reviewing Your Data 333 Getting Your A1C Done Regularly 334 Considering Continuous Glucose Monitoring 336 Chapter 24: Ten Tips for Controlling Carbs 337 Saving a Step with a Measuring Cup 337 Weighing Fruits in Advance 338 Having a Carb-Counting Contest 339 Making Better Breakfast Choices 339 Packing Your Own Lunch 340 Choosing Wisely at the Deli 340 Considering the Condiments 341 Fitting in a Favorite Dessert 341 Planning and Portioning Snacks 342 Curbing Late-Night Snacking 342 Chapter 25: Ten Worthwhile Websites to Help You Manage Diabetes 343 American Diabetes Association 343 American Association of Diabetes Educators 344 Academy of Nutrition and Dietetics 344 U.S Food and Drug Administration 345 American Heart Association 345 UCSF Diabetes Education Online 346 Mayo Clinic 346 Joslin Diabetes Center 346 U.S Department of Agriculture Food Composition Databases 347 WebMD 347 Part 7: Appendixes 349 Appendix A: Diabetes Exchange Lists 351 Starches 352 Fruits 354 Milk and Yogurt 356 Nonstarchy Vegetables 357 Meats and Meat Substitutes 358 Lean meats and meat substitutes 359 Medium-fat meats and meat substitutes 360 High-fat meats and meat substitutes 360 Fats 361 Free Foods 363 Appendix B: Conversion Guide 365 Index 367
Sherri Shafer, RD, CDE, is a senior registered dietitian and a certified diabetes educator at the University of California San Francisco Medical Center. She teaches diabetes self-management workshops and provides nutrition counseling for individuals with type 1 diabetes, type 2 diabetes, prediabetes, and gestational dia-betes. She is also the author of Diabetes Type 2: Complete Food Management Program.