food and diet

Questions about food and diet that have been answered by a Diabetes Educator. Browse our site to see many more diabetes questions and answers.

Q: I switched to a low carb diet and my glucose level rises too high 2-3 hours after eating. I need to gain weight but how do I do that without increasing my levels?

A: Perhaps you need to find a balance between adding back some of the healthy carbs you may have eliminated and whatever fat/proteins you are now eating. Having 5-6 small well balanced meals a day might work well for you as eating too much at a time can spike levels. Fats and proteins turn into sugar 2-4 hours after eating. Coconut oil works well for many and may help with weight gain without a huge spike. Track what you do for 3 months to see how things may be changing for you.

Q: When my blood sugar goes up, is it measuring what I ate the previous day or the current day? What does my morning blood sugar number tell me? What does my evening blood sugar tell me?

A: Your evening blood sugar is going to reflect your daytime meals and activities including changes in routines and stress levels. Your morning numbers are a reflection of your nighttime eating plus nocturnal hormonal activity. Your morning blood sugar levels will be less impacted when you eat smaller, earlier evening meals.

Q: Does drinking alcohol raise or lower sugar levels?

A: Alcohol can do both, depending on amounts and types. Moderate amounts of alcohol may increase levels, especially if they are higher carbohydrate drinks such as beer or sweeter mixed drinks. Too much alcohol can cause low blood sugar by suppressing the liver’s ability to release glucose into the bloodstream; the liver preferentially breaks down alcohol (treated like a fat) before other nutrients. It can take more than one hour to break down one drink.

Q: I wanted to try intermittent fasting to lose some weight but if I skip breakfast my sugar goes higher and higher to about 180 by lunch and as soon as I eat it drops way down to normal. Is this normal and should I continue to try to fast to lose weight?

A: Your liver will send glucose into the bloodstream if it perceives that you are in a hunger state. With any “diet”, there are pros and cons and no one program is the answer for everyone. If you are not taking any medication, you may consider giving this a trial period to see if fat loss does happen for you, with better fasting levels surfacing after some time. If you are taking medication for diabetes, it may need to be evaluated for adjustment to better target the fasting levels. This would be a conversation with your physician.

Q: Is it true that drinking too much diet cola can affect my blood sugar?

A: Yes, in that diet and regular colas/sodas are irritating to the gut area. When our GI tract is challenged by poorer food choices and stressful lifestyles, it can throw off our metabolism, contributing to poorer blood sugar control. An occasional diet soda is not the culprit. I find it even better to take 2-3 oz. of pure juice and dilute it with 5-6oz. of naturally flavored seltzer water if you crave the fizz. You can also add the seltzer water to a partial glass of soda if you are drinking them daily and find it difficult to quit. The goal would be to keep cutting back.

Q: Should I use artificial sweeteners or real sugar in cooking, baking, etc? 

A: Being healthy is much more than just sugar vs. sugar substitute; it involves taking a close look at your total lifestyle. In general, your food intake should consist of unrefined, whole foods, with an emphasis on vegetables. Starches should be kept to smaller portions. An active lifestyle is most important. As for sweeteners, stevia, in my opinion, would be a better choice. It is plant derived, not chemically altered.

Q: What is difference between white rice and brown rice? Can a diabetic take brown rice? Is there any difference in carb content? 

A: Brown rice has not been refined, so it contains a bit more fiber and nutrients. This means that brown rice may not be converted to sugar quite as quickly as white rice. Both brown and white rice have the same carbohydrate content at 15gm for 1/3cup. Testing your blood sugar one hour after your meal will let you know how you are responding. Mixing 2/3 cup of rice with a vegetable and protein source may be well tolerated.

Q: How many carbohydrates per meal or a day would be good for a diabetic?

A: There is no one answer to your question; your meal program needs to be individualized to meet your needs. The best rule is to eat lots of veggies, fish like salmon or lean meats or poultry, 1-2 servings per meal of whole, unrefined carbs, while avoiding any refined, processed foods. This would be the equivalent of 15-30 grams of carbohydrate per meal.

Q: I check my blood sugar when I wake up in the morning and it is around 180. For breakfast I ate one fried egg in olive oil, tomatoes and one slice of wheat toast with water. Two hours after breakfast, I checked my glucose levels and it goes up around 260. Why is it going up so high because after lunch it is back down?

A: Food will raise glucose levels after you eat, as digestion will convert 100% of carbohydrates to sugar within the hour (and approximately 60% of protein, and 12% of fat). Since your fasting levels were higher, what you experience is normal. As you burn up fuel during the day, your levels will decrease.  

Q: I ate a normal sized meal followed by some candy. I took my blood sugar 20min later and it was at 76. I felt weak and “off” shortly after so I ate more sugar and tested in another 30 min my levels only rose slightly. It continued to stay under 90 Which I know is an okay level but I still feel sick and even more food or sugars won’t make it rise. 6hrs later it’s still in the low 70s.

A: If you are taking medications for diabetes, it may be time to discuss with your physician about lowering your doses. Carbohydrates, especially simple carbs like candy will normally elevate you within 5-20 mins: 1 gm carb raises you 2-4 mg/dl. Complex carbs in a mixed meal will rise at a slower rate. For comparison, a slice of bread is generally 15 gm carbs. A non-diabetic will will generally not rise above 140 after meals. With diabetes, ceilings are often set higher, but a good goal is to be as close to a normal range as you can to avoid complications over the long haul. If you are not on medications, learning to eat for hypoglycemia would be important. You may also want to request a 2 hour Glucose Tolerance Test to see how your glucose responds at 30 minute intervals with a high dose of sugar syrup. 5-6 small meals with protein and healthy fats can often get this under control.  

Q: Is there a certain amount of carbohydrates/sugar per day that I should adhere to? I have type 2 diabetes and I am overweight.

A: This is not a question that can be neatly answered, as there are many variables: your body size, activity level, overall lifestyle to name a few. A general rule of thumb for overweight, moderately active females is an overall calorie level between 1400-1600 calories/day. Of course, this would be individualized. And of course, success would be achieved by making healthy food choices from whole, unrefined foods as much as possible. Nutritional supplementation may very well be needed. Exercise is a MUST. It would be most helpful for you to seek individual nutritional/diabetes counseling to help you get started.

Q: I have been told that oatmeal is good for people with diabetes. However, when I eat a breakfast of 1/4 cup of uncooked oatmeal with or without berries and/or sliced almonds, my glucose spikes to about 230. How is this possible?

A: If your levels are elevated before breakfast, a rise within the first 30-60 minutes after eating carbs is expected. If your levels fall into a more normal range during the day and are only elevated fasting, you may want to consider eating a healthy protein/fat at breakfast instead since they have slower digestion times. If taking medication, it may help to adjust the timing to better target your fasting levels.   

Q: My blood sugar was 370 when I woke up. After a breakfast of oatmeal and a piece of whole grain toast, I just tested again it says 404! Shouldn't it have gone down?

A: Food elevates blood sugar after eating, then generally begins to lower during the day’s activities. Your meal of mostly carbs turns into glucose within the first hour post meal, showing an increase from pre-meal levels. If eating healthfully and just enough to meet your daily fuel needs, your activity during the day will help to burn up any excess fuel.

Q: I purchased a sugar cane, about six feet in length, to cut open and suck out the juice. I am a diabetic. Will this cause a spike in my blood sugar?

A: Testing your blood sugars is one way to know if adding sugar cane juice affects your levels or not. Moderation is always a good plan with most foods. Your proof will be how your levels are and overall health.

Q: What can I do to gain weight without increasing my blood sugar levels?

A: It is important for you to choose the right fats such as coconut oil, grape seed, and avocado. Each tablespoon of fat has 120-130 calories and can be increased to help raise your calories. This would mean also decreasing your overall carbs and eating those with higher fiber content. Eating smaller but more frequent meals may help with digestion. Often nutrition supplements are helpful to increase nutrient intake and absorption.  

Q: I am not diabetic but worry about it and the holidays are here. Is there a better time of day to binge eat on sugary foods, chocolates etc? Is binge eating bad things better than eating it all day long? 

A: Hopefully you made it through the holidays without too much “sugar trauma”! Binge eating is relative to how a person normally eats. For someone who eats mostly unrefined foods, eating some cookies, candies, etc. in even moderate amounts may make them feel ‘hungover”. Try to never go to a party hungry where all you will be offered is sweets, etc. Bingeing before bedtime would be the worst, making for a fitful sleep. Best advice is to always spread the goodies out, giving your body a chance to process the sugars at a reasonable rate.  

Q:  What coffee creamer is safe for type 2 diabetes? I used sugar free vanilla. Then took my blood sugar, it was 160. 

A: You would first want to know your glucose level before taking the creamer for comparison. Coffee, especially caffeinated, may momentarily raise levels. Also, know that “sugar free” does not necessarily mean carbohydrate free. As always, the amount of anything you are ingesting needs to be considered so look to see the number of carbs in a serving of creamer and how many servings you are consuming. If you are tracking these numbers before any food eaten, follow the same pattern for few days and see if your numbers change.

Q: My husband with type 2 diabetes is trying to get his blood sugar down by eating a low carbohydrate diet and skipping lunch. He is having problems with an increased evening reading. Should he eat regular meals? 

A: Skipping meals can send glucose levels on a bit of a roller coaster ride. The liver can actually release too much glucose into the bloodstream when no food has been eaten, perceiving a “hunger” situation. He may be better off eating smaller meals with lower carb/healthy foods that will convert to glucose at a more reasonable rate, generally resulting in better levels. 

Q: Can a person respond differently to complex carbs vs. simple sugars? My husband has type 2 diabetes and I notice that when he eats foods with sugars, his blood sugars will escalate. However if he eats foods such as potatoes it may go up a little but nothing to be concerned about. 

A: Starchy foods such as potatoes have some plant protein and some fiber that can help slow down how quickly they are converted into sugar. Sugary foods, especially juices, can affect blood sugar levels within 5 minutes. The best advice is to consume fewer carbs and primarily those from whole foods.

Q: I've been juicing to help increase my intake of fruits and vegetables but I wonder if I am drinking too much sugar this way.

A: You may be raising your levels with too much juice, especially if you are using lots of fruit. For example, a small glass of orange juice may take 2-4 oranges depending on their size. One fruit serving is one small to medium orange or 15 grams of simple sugar so a glass of fruit juice can easily contain over 60 grams of sugar. Even though fruit juice is high in vitamins, it is still sugar to the body and challenges insulin output. Perhaps you should get a meter and check your blood sugar levels for a time to see how your current juices are affecting your levels.

Q: I currently enjoy wine with my dinner and wonder if I will have to give this up with the no sugar diet my doctor has placed me on. 

A: The most definitive way is to observe the effect on your own body; no two people will respond exactly the same. Do you test your blood sugars? If not, get a meter. You can test 1 hour or so after your meal with wine to see if you are over 140. Try the same meal test without the wine and see if there is a difference. If you are exercising and eating smaller meals with whole, unprocessed foods, your glass of wine may fit in just fine.

Q: My A1C the last three years was 5.4, 5.5, and now 5.6. I practice 16:8 intermittent fasting daily, exercise 4 days/week (weight lifting), do not drink alcohol, less than 40% if daily calories from carbs. I feel like Im doing everything I can to control my sugar intake, but it seems to come up short. I have a glucose meter, and every morning my glucose level is between 100 and 117. My dad had T2D. Any suggestions? Keto diet perhaps? longer fasts? 

A: With time, all our organs tend to operate less efficiently, particularly the liver. Its job of storing/breaking down glucose may not be as efficient, resulting in slightly higher levels. If you are taking medications, that can also have an impact. Since animal protein, especially red meat, can be tough on the liver, a 4:1 ratio of greens to meat may help to reduce potential inflammation. It will take experimentation because we are all so different in how we may respond. If you are otherwise quite healthy, continue what you are doing.

Q: Even whole grain foods like oatmeal cause my blood sugar levels to skyrocket. Should I still be eating them?

A: There is no requirement that says you need to get your carbs from grains - no matter how wholesome. Focusing on high plant/veggie intake is the first best choice, adding legumes, then smaller amounts of fish and other "flesh" foods. If you enjoy eating grains, try working small amounts in around your exercise to see if you don't handle them a bit better. Whole grains, especially gluten-free grains, are nutrient dense and a good source of those much needed B vitamins.

Q: Which is a better way to eat for diabetes: moderate carbohydrate or very low amounts of carbohydrate? 

A: There is a balance with all of this somewhere in the middle of the plans you are mentioning. Certainly non-starchy veggies and fish as a "flesh" of choice are foods that will impact your glucose levels the least. Legumes and starchy veggies are positive foods for nutrient density and fiber, with whole grains in greater moderation following close behind. Refined carbs and even fruits impact levels the most. Testing your glucose at different times during the day will let you know how your foods are affecting your levels. The more nutrient dense your foods are, the better your overall health profile.

Q: I’ve had gastroparesis for years and I can’t find anything to eat that doesn’t cause my blood sugar to go crazy. What can I eat that I can digest without causing me pain?

A: In general, foods need to put in a blender and be lower fiber as you probably know. I assume you are eating small, more frequent meals, giving your system opportunity to better digest. Blending vegetables into soups may be one way to increase nutrients. Aloe vera juice, starting with 2 oz. in water may alleviate some pain. Perhaps a nutritional shake will work mixed with water or non-dairy milks. Herbal digestive tea blends may help. If yogurt works for you, that may help with some probiotics.  

Q: My doctor put me on a 1200 calorie weight-loss diet, but it allows very little protein, and I find it hard to manage my appetite. For instance, I ate cold cereal for breakfast one morning, and after a very few hours I was shaky, sweaty etc. Is it OK to have more protein?

A: My first suggestion is to have protein in the morning such as eggs, as they seem to stabilize morning blood sugars very well. There are some medical researchers who feel that 20-30 grams of protein in the morning lends better stability to the thyroid, which in turn helps with more stable metabolism. 1200 calories may be too low for you and you may want to consult with a nutritionist who can calculate your needs based on all your conditions. Cravings do also often diminish. Eat high fiber foods, drink lots of water, and focus on eating veggies, legumes, and fish. Be patient, and in time, you'll learn what works for you.

Q: A nutritionist informed me if you balance carbs with protein, the food doesn't turn to sugar as fast. My doctor never heard of this - is this something new? 

A: Carbs and proteins are digested and metabolized and turned into blood sugar at different rates. Carbs, especially simple carbs, become sugar anywhere from 5 minutes to 30-60 minutes after eating. The higher the fiber, the slower the carbs turn to sugar. Protein begins breaking down into sugar about 2 hours after eating. When your starches and fruits are mixed with protein, they will take even longer to turn into sugar. Juice is almost always immediately turned to sugar, which is why we don't advise juice be in your food plan at all - or rarely. Getting the bulk of your carbs from veggies/whole grains/legumes is the best approach for including them in your meal plan without raising your glucose levels as quickly.

Q: If my blood sugar is high in the morning (say 150) can I have breakfast right away or should I wait until it goes down?

A: Eat breakfast, but don’t have many carbs. An example may be an egg/cheese/lean breakfast meat on a slice of high fiber toast. Hold the fruit until later. The amount of food will depend on your size and intake fuel requirements. If you like plain yogurt or cottage cheese, this also can work. 30-45 grams of carbohydrates from higher fiber sources should be the maximum if you are a “medium” size person. And of course, be as active as you can. Watch your nighttime eating, and don’t eat a few hours before bed.

Q: Why does Chinese food cause my blood sugar to spike? 

A: The white rice alone is enough to spike glucose. 1/3 cup of white rice is equivalent to eating one slice of white bread, and it is very easy to eat 1 or more cups. Most sauces have significant amounts of oil, salt and/or sugar which can also increase blood sugar levels. Depending on what you order and how much you eat, it is not unheard of to reach a 1000 calorie meal. When ordering out, don’t be shy to ask what ingredients are in each dish. Your safest bet is to eat grilled, unrefined, fresh as possible foods. Be sure you are exercising, maybe more on those days you want to indulge a bit more.

Q: Why do I constantly crave sweets? 

A: Craving sweets is often because we are not eating in a good balance, usually consuming too many carbohydrates. Carbs don't stick around long after we eat them, so, if we do not eat a meal that has protein, some fat, and higher fiber carbs, our body will tell us it still needs fuel, and sweets are the quickest form of fuel we have, turning into sugar in our bloodstreams the fastest. And of course, staying active and exercising will help as well!

Q: I am curious about cottage cheese. Most books and websites say it is a good choice for people with type 2 diabetes but there are a few websites that warn about it. One says that people with diabetes should never eat it! 

A: Reactions with dairy are different for different people. Cottage cheese is a good source of protein and for many, does help with stabilizing glucose levels as opposed to a meal more carb focused, such as many cereals. Dairy, if eaten, is ideally "organic" and free of hormones. Fat free dairy will raise levels more quickly, as fat slows down the digestive rate. Cow dairy can cause gastrointestinal distress, mucous production, and even eczema for lactose deficient folks. Unpasteurized milk would be the healthiest, eaten in moderation, but is not generally available for many obvious reasons. Monitoring your overall health, glucose levels, and GI reactions to foods will assist in knowing if you can handle a certain class of foods.

Q: How much fruit am I allowed to eat? 

A: Meal planning with diabetes takes some patience and time. All refined carbohydrates, including fruit and fruit juices, can raise blood sugar very quickly. The best starting advice is that no one meal should be larger than the next, and to eat unrefined foods, especially lots of veggies. Two or three servings of fruits a day can usually work for many people, but not at the same time. A serving size is one small to medium piece of fruit. Your body size and activity levels have a lot to do with the amount of carbohydrates you can handle. Checking your blood sugars will let you know if you are on the right track.

Q: How long does it take after you eat for your food to break down and turn to sugar? 

A: Generally, carbs turn into sugar anywhere from 5 minutes to 2 hours, depending on the amount of fiber, liquids vs. solid, etc. in the food item. 60% of protein begins to turn into sugar 2-3 hours post meal, and 12% of the fat intake at 3-4 hours. Your own body's rate may be different.

Q: Is it safe for a pre diabetic to take coconut oil which contains medium chain triglycerides?

A: Most definitely! Coconut oil/milk/water have many therapeutic properties which are now being more widely researched and accepted. Lauric acid, a medium chain triglyceride, is an important essential fatty acid found in coconut oil. These fatty acids may aid in increased metabolism and fat loss. As with any foods, one must check glucose levels to ascertain their effects. All fats have 135 calories per tablespoon, so quantity must still be a consideration.

Q: Is it safe to say that a diabetic can have any sugar-free food item?

A: With any food, with or without sugar, it is the amount that is important. Be careful of the term "sugar free". Even foods that make this claim may still have calories or carbs. A light yogurt, for instance, has fewer carbs than a full flavored yogurt, but still has enough carbs to add up to a serving. It is important to read labels and pay attention to the amount of carbs in a food. Also, artificial sweeteners are not necessarily the benign substitutes we may think. They can send false signals to the brain that carbs are on the way down, so the body thinks that insulin needs to be released. Since no food comes, the insulin removes existing sugar left in the blood stream, which may lead to headaches and low blood sugar. This can also contribute to fatiguing the insulin producing cells of the pancreas. The best route is to eat unrefined foods as much as possible, monitor your blood sugars, and eat any artificial foods sparingly. Of course, staying very active is a key to successfully keeping the lid on rising sugars.

Q: What else can I eat for a high protein breakfast besides eggs? I am sick of them! I am on a no-grain diet and don't want to eat oats etc. 

A: Familiarize yourself with some sources of non-grain protein such as meats, poultry, fish, cheese, tofu, yogurt, legumes, and nut butters. Then determine what is palatable to you in the morning, and experiment with different combinations. Some folks eat chili or other bean/soup combos for breakfast. Eggs really do support the thyroid well in the morning. If this is a short run venture for you, I suggest you try to hang in with the eggs. If you are doing this longer term, you may consider some grain. Steel cut oats with nut butter can provide a good base. A very hearty whole grain bread with melted cheese or some form of a breakfast sandwich can be sustaining. There are meal replacement shakes, but one has to choose carefully for a balance, then also chew something to help stimulate the digestive track.

Q: What is sugar alcohol? I noticed on a "sugar free" dark chocolate candy that alcohol sugar is present. 

A: Sugar alcohols are by-products of sugars and starches that have been chemically derived in a lab and added to foods for added sweetness without the same effect on blood sugar levels. Some sugar alcohols are derived directly from plants. Sorbitol, mannitol and xilotol are three names that you'll often see in "dietetic" foods. They don't act like beer or wine on the brain, but can ferment in the gut and cause bloating, diarrhea or other GI related side effects. Because only part of the sugar is absorbed into the blood stream, they have a lower effect on blood sugar levels. They are also not as sweet as sucrose, our common table sugar. Consumed in small amounts these products may not have an effect. Just be aware of what effects can be if you start to experience any of them. That would be a sign to cut back or cut out that product. Also, remember that "sugar free" does not mean "carbohydrate free"!

Q: I have been experimenting with the Atkins diet. I haven't been eating more than 20g Carbohydrates per day for a week. I have been trying to avoid high fat foods, by eating lean meats, mostly chicken and pork, no beef. I'm eating some cheese, but not that much per day to be considered high fat. I'm eating about two cups a day of lettuce, with some cucumber and celery. If I have really been working at avoiding all sugar and my intake of carbs is very low, why am I still having blood sugar issues? 

A: I would advise you to downsize the high protein and dramatically increase the veggie side of life. Veggies are carbs, but the kind that can reduce some of the high acid load generated by the proteins. Large intakes of protein can show up as high glucose levels up to 48 hours later, depending on the type and amount of protein. Protein takes longer to digest, and high protein intakes are low in fiber, meaning that a sluggish colon can result. The carbs to limit are the starches, especially the refined ones. Avoid those for a time, eat lots of high water veggies and some legumes, and see if your numbers improve. You will feel better and ultimately have better energy.

Q: My husband is taking a whey protein supplement in the mornings because he doesn't eat enough protein at breakfast time. His glucose levels have been pretty high about 2-3 hours later. Does whey protein interfere with Humulin N?

A: Look at the carb content of the whey protein, as I'm assuming it is flavored. Include the carb content of milk, if that is what he is mixing it in. The whey protein doesn't interfere with insulin per se, but the entire drink may not have enough coverage of insulin. Protein is converted into glucose at about 60% 2-3 hours after eating. He is better off with a drink that is balanced with carbs, protein, fat if he is not eating food and using this drink as a meal replacement. Eating a piece of high fiber toast along with the drink may slow down the rate of absorption. Of course, eating a morning meal that includes such foods as eggs, for those who eat them, should have less of an impact on sugar levels.

Q: Does using coconut oil help diabetes?

A: Coconut oil is a "good" fat, not the "bad" fat it is often depicted as. It appears saturated because it is solid at room temperature, but it does melt fairly easily. It has a supportive effect on the liver, and metabolizes a bit differently than butter. However, all fat, regardless of whether saturated, unsaturated, or monounsaturated is 135 calories per tablespoon so should be used sparingly when watching one's weight and/or blood sugar numbers.

Q: On a TV commercial I saw an advertisement that stated there was benefit to a person with type 2 diabetes if she drank a glass of red wine daily. Is this true? 

A: Red wine has substances that fall into the antioxidant category that have shown in one study to reduce the oxidative stress on type 2 subjects two hours after a meal. This means less stress on the vascular system, the goal in order to reduce the climate for complications. There are many ways to achieve this same goal, so if you are not a wine drinker, no need to become one! Alcohol has its negatives. If you do enjoy wine, then by all means go for the red, as it is many times more potent in the antioxidant category than white. This is all assuming that your glucose is in good control to begin with - a caution when drinking any alcohol, especially if you are taking oral medications.

Q: How much protein do I need to eat every day?

A: A general rule of thumb is .8 gm of protein for each kg of body weight; 1.0 gm of protein per kg for vegetarians for healthy maintenance. Body builders and elite athletes may require more. Your main dietary focus should be unrefined foods, lots of veggies, and fish as a "flesh" of choice for accelerated body composition changes. Fish is also easier on the digestive system. Whole grains and plant foods contribute a vegetable protein source. 3 ounces of meat/poultry is considered a serving.

Q: If I am on a low carb (Atkins) diet, and in ketosis, do I need to worry about my blood sugar?

A: Ketosis is not a good long term fuel source. Ketones if built up too rapidly are toxic. What I suggest is lots of veggies and include legumes for your carb sources and do not eat large protein portions at any one time. A well portioned salad would be something like 4 oz. or so of salmon on 4 cups lettuce and very light dressing. This helps to maintain an acid/alkaline balance. I am in favor of eggs for breakfast as they seem to stabilize well. Red meat is best kept to 3 oz. servings, depending on your size. Stir-fry is a good way to prepare red meat, of course adding lots of veggies as well. High protein is tougher on the kidneys, and with diabetes, it may invite other conditions, like gout. Your heart and brain prefer running on carb fuel sources since they are a more immediate source of glucose. I suggest you get a meter and start checking your blood sugars to know how food affects yours.

Q: No matter how little I eat or how much I exercise, I cannot seem to lose enough weight. I follow a 1200 calorie/day balanced food plan provided by the nutritionist, and maintain a written food diary. I joined a gym with a personal trainer and for 6 weeks I am exercising 1 hour in the morning before work and an additional 1-2 hours after work on most days. I am insulted and frustrated when the dietician says she doesn't know what to do because "the weight should be falling off me". The doctor and endocrinologist look at me suspiciously when I voice my frustration and simply tell me to continue to "watch my diet and keep exercising". My blood sugars have come down significantly, but are still not where they need to be and still fluctuate wildly at times. This is horrible….I have given up all foods that I "love" and exercise has taken up most of my free time. I don't know how long I can continue the sacrifice without seeing results and don't know where else to turn. 

A: The first main thing is that your glucose is coming down significantly. Is your stamina now better? Do you sleep better? Is your energy fairly even? If you answer "yes" to these questions, you are most definitely leaner, meaning your body composition has changed. Lean tissue weighs more than fat. I do bioelectric impedance measurements on all my patients. In someone with a profile similar to yours, I may see 10% or more drop in body fat %, drop in fat mass pounds, with no change in weight! In time, weight will decrease overall, but is much slower to show up in certain body types. As for foods, be sure all your carbs are unrefined, that veggies and legumes are your focus, along with fish, eating as preservative-free and organic as possible. You liver has been working hard for some time, and needs to have as light a load to process as possible. Eggs in the morning balance the thyroid for the day and may very well help to stabilize your glucose. Overall, 50 grams of fiber/day and 20-30 grams of protein (plants and grains have protein) are indicated. Since you have lowered your caloric intake, up your free food veggies. If you are tired in the daytime, you may not have enough fuel, especially with the 2-3 hours exercise. Bread products and wheat/gluten may not be appropriately metabolizing. I'm finding this to be especially true with hormonal changes. If you are at all gaseous, you need to thoroughly review your types of foods. Nutritional supplementation, to include essential fatty acids and a B-complex are important in calorie restricted intakes. As for medication, is insulin part of your mix? If not, you may do well to discuss this with your team, even if for a short time to give your beta cells a rest. You may find, as time goes along, that you won't need as much of the other medications, which have more side effects. It is a balancing act. Don't get discouraged; you are on the right path, just ask a few more questions. Not every practitioner is abreast of some of the points I pose here, particularly where weight is involved.

Q: I am vegetarian and have diabetes. I do not like the taste of eggs or fish. How can I get enough protein in my diet? 

A: If you are vegetarian for ethical and other personal reason, then you want to be sure to include plenty of high protein plant based foods. I do not encourage regular consumption of soy "designer" foods such as energy bars. Tofu and tempeh would be better choices. Over consumption of gluten - the protein portion of grains such as wheat and oats - is also not the best choice, especially if you experience any GI disturbances. Nut butters, such as almond, are good. I was vegetarian for a long time, but realize how much better a "machine" I am now that I eat eggs and fish. 2 eggs in the morning can carry me successfully for many hours. This is giving my adrenal glands the support they need. Fish provides those heart healthy fats we all need; salmon is the number one choice. You'll just need to figure out your approach, and get a food chart to see how much protein is in the foods you choose. All grains and beans have protein, it just takes more. Your diet is now more carb focused, so it does require more fine tuning to stabilize your blood sugars. You can include flax seed oil which might work for you, but folks with long standing diabetes often need fish oil. A multivitamin, B-complex can be purchased anywhere. Just make sure your vitamins are hypoallergenic, preservative free, etc.

Q: Can I fast (from sun up to sun down) if I have a type 2 diabetes? I take 1000mg of Metformin twice a day. So I would take the meds in the morning before sun up and then take another at night at sun down and no food in between. 

A: I do not have a set answer for you, but do know it is possible depending on the overall health of the person. If you eat an early meal that includes eggs or some other good protein source, and stay well hydrated during the day, you may be fine. Testing your blood sugars will let you know. Your activity levels will also be factors to consider on a daily basis. If you get too low, you may need to cut back on dosage. Work this out with your physician. I would also advise against a large meal at night, as this may cause a blood glucose spike. Give it a try with close attention, and be willing to do what is best for you to stay safe.

Q: My husband has type 2 diabetes and has been eating an English Muffin for breakfast. I feel that he should be eating whole grain bread. We've argued about this and he says a "carb is a carb". His sugar spikes to 160 after breakfast. Is this normal? 

A: In general, the higher the fiber, the slower the carb will turn into sugar, which will result in lower numbers. He should include some protein at breakfast, and try a higher fiber English muffins that may result in better numbers. Just so he knows, he should do random checks 2 hours post meals so that he gets a view for the impact of each meal on his blood sugars. It is the higher 2 hour post meal sugars that, over the long term, may open the door for complications more quickly than elevated fasting glucoses alone. People without diabetes won’t exceed 140 after meals; an otherwise healthy person is encouraged to strive for as close to normal blood sugars as possible.

Q: Why did my blood sugar spike to 262 two hours after having a Glucerna weight loss drink? I thought this product was to prevent spikes.

A: Drinks and shakes can be tricky. The total carbohydrates of the product are definitely a consideration, and when they are in liquid form, absorption is much quicker.

Q: Can diabetic people eat honey?

A: Yes, in moderation since it is more about how MUCH you are eating and what other foods you eat at the same time. If you aren't consuming a large amount of other simple carbohydrates, then 1-2 tsp. of honey may be just fine. Monitoring your blood sugars will give you a better idea on how all your meals are impacting your blood sugars. If you are high in general, then you would be wise to get some guidance on what good meal balancing is all about for better blood sugar control.

Q: I have started to drink iced coffee 4 times a week, with 6 packs of splenda and cream. Is this harmful to my glucose level? 

A: Are you checking your blood sugars? That would certainly give you immediate feedback. I would suggest you switch to Stevia for a sweetener. Glucose control never centers around one food or habit; it is reflective of your total lifestyle. If you are making healthy food choices and staying active, your coffees might not be an issue for you. Moderation and balance are still good focuses to follow.

Q: I love fruit smoothies at the gym, should I stay away from them?

A: This is not just about a smoothie, but your overall diet. If your workouts are full, and your lifestyle is active, a smoothie made of all fresh fruits and no added sugars should fit in, depending on the rest of your food intake.

Q: I love fish and like to eat as much of it as possible, but I’m afraid to eat sushi because I’m afraid the rice will spike my blood glucose levels.

A: A few sushi pieces may be fine but too much may spike your blood sugar. Your reaction will depend on many factors, mainly the amount you eat and what else you are eating together with the sushi. The best way to know the effect of any food on your blood sugar levels is to test 2 hours after eating. If you are under 140, you are doing very well. (Your physician may have a higher range for you depending on your medical history.)

Q: Is unrefined "natural" sugar better than the granulated cane sugar I normally buy?

A: In terms of the effect on your blood sugar: not really. Unrefined sugar contains some minerals, and it has been reported that chewing raw sugar cane does not produce dental cavities. In general, as with most foods, use sugar in moderation and check your blood sugars.

Q: Is a low-carbohydrate type of diet going to provide me with the necessary energy to complete fairly rigorous cardiovascular and weight training exercises?

A: It all depends on the type of low carbohydrate diet you pursue. Eliminating refined carbs (sugar, white flour) is the first best move. Including lots of veggies and legumes as your major carbohydrate source is a better move. Legumes are high in plant protein, so they provide a great nutrient base. Carefully monitoring your intake with your blood sugars will let you know if you are on the right track.

Q: Is frequent urination a side effect of a low carbohydrate diet?

A: I don't necessarily see frequent urination as a result of low carb diet. Often, it is the opposite (decreased urination) if a person increases their intake of meat. This will also depend on the amount of water intake. Uric acid levels may become high in a person eating higher meat levels. It is always healthy for the body to be regularly eliminating. Be certain your frequent urination is not triggered by higher blood sugars, or beginnings of kidney problems. The latter can certainly be triggered by a protein overload.

Q: Is a vegan diet helpful for someone with diabetes?

A: For some people, a vegan diet can be effective in controlling blood sugars, as was shown in a study funded in part by Diabetes Action. When the RIGHT amounts of carbs are consumed - legumes (beans), veggies, and moderate amounts of whole grains - a balance is achievable with the inclusion of the plant protein and fiber. The richest source of micronutrients is found in legumes. The caution side of a vegan diet is to ensure one stays in nutrient balance. Appropriate supplementation is often indicated. As with any individual intervention, it is just that: individual. One's overall health history needs to be taken into consideration. There are many individuals who seem to respond better with inclusion of fish and/or eggs. Anemia can sometimes be an issue. Monitoring your health on all levels will show you the best path to follow in your case.

Q: What is the sugar content in 1% milk? Does soy milk have less sugar?

A: Since blood sugars are raised more quickly by carbohydrates than by protein or fats, that is what we focus on when managing blood sugars. Most of the carbohydrate in milk is sugar (lactose). If you look on the milk label, you will see the grams of carbohydrates listed. Generally, you will find 12 grams of carbs/sugar in 8 oz. of any type of plain milk. Do the same for the label of your soy milk, looking for grams of carbs. Flavored soy milk will probably have even more sugar.

Q: When reading labels on bread, what are the most important things to look for: carbs, fat, calories, or what?

A: One standard slice of bread is about 15 grams of carbohydrate. Since it is wise to limit the amount of carbohydrate you consume at each meal, make each slice as nutritious as possible. Look for higher fiber breads made with whole grains and seeds. Ideally the bread should be truly fresh, meaning you can pronounce everything on the label - no preservatives - and it must be either frozen or eaten fairly soon after buying. Bread that can sit out for weeks has lots of preservatives that make your liver work harder.

Q: Is it alright for me to drink a high protein whey shake 2-3 times a day to help me add muscle?

A: There is not one good answer here. The first consideration is testing your blood sugars, and assuming your diet is well balanced and keeping you stable, see if adding one shake makes a difference in your blood sugars. Consuming more than that as a way to add muscle may not be the way to go if your meals are also high in protein. Maintaining a low acidic system and healthy kidney functioning should always be considered when embarking on the higher protein intake. Balance is the key, and may take some monitoring to achieve.

Q: Why am I constantly hungry and unable to lose weight even though I work out 7 days a week? My blood sugar appears to be under control, but I am hungry most of the time. I am about 20 lbs overweight which is mostly in the abdomen. Is there some appetite suppressant that can help with this constant hunger?! 

A: We are not designed to be hungry most of the time. While it is great that you have your glucose in good control, you may also be inviting a nutrient deficiency if you are very calorie restricted. If you feel deprived of food, you may not effectively lose weight, but re-gain more. The types of food you are choosing may make a difference. Are you primarily eating high fiber, unrefined whole foods? Foods such as legumes (beans) can help to satisfy your hunger without providing too many calories. Appropriate nutritional supplements can be helpful if you have a medical practitioner in your area who is knowledgeable. 

The midriff is the "toughie" to lose. Abdominal fat cells are called "alpha fat cells" and they do invite cardiovascular-related diseases when out of balance. I suggest for starters you make sure you have a protein source at each meal/snack: beans and nuts can count here, and plenty of veggies. Raw veggies will rarely raise blood sugar. It may mean another period of trial and error to get blood sugars balancing well with your food intake, but it can be achieved without you resorting to methods that may have side effects or just unpleasant effects.

Q: Are there any studies done on diabetics and Noni juice? I have several friends who sell the product and they feel that it is wonderful for diabetic but I read a small article that seemed to contradict all the good I had heard about the juice.

A: There are a few studies. As with many studies involving nutrients, it is the source of the nutrient in question that can positively or negatively impact outcomes. In the case of Noni, a negative study was counteracted by a positive outcome study that showed the quality of the Noni juice was quite different in each study. When pure Noni from healthy fruits was used, the high potassium content had no negative kidney impact, for one comparison. I have not seen data on blood sugar comparisons. There are many berries indigenous to other areas of the globe that are now being offered in juice form, usually with a high antioxidant claim. Personally, I have experienced different people reporting positively improving with different juices in small amounts. As with most of nature's bounty, all people do not respond to all nutrients the same way. After one has put into place a solid healthy eating plan and is getting as active as one's lifestyle permits, then incorporating some of these other foods may be of benefit. Do not look for them to be the magic bullet, in and of themselves.

Q: What are the normal daily needs for carbs and proteins if you are on a 2000 calorie diet?

A: Your first priority is for the majority of your food intake to be from whole, unrefined foods. Protein needs at 2000 calorie level can reflect between 10-25% or 50-125g depending on your overall health and objectives. Carbs, most importantly being unrefined, may reflect 45-65% of your daily food intake, or 225-325g.

Q: This morning I had coffee and a blueberry muffin for breakfast and when I returned I took my blood count it was 298. What steps should I take now to bring my sugar down?

A: Most muffins are not much more than a dose of quick sugar. Try starting your day with protein sources such as egg, cheese, nut butters, meat, tofu, fish, etc with whole grain toast or oatmeal, fresh fruit and yogurt adding up to 20-30 grams of carbohydrate. Any carb that has fiber in it will be more slowly metabolized. Be sure you are eating higher fiber foods at all meals to avoid going over 140 at any time after eating.

Q: I was diagnosed with borderline Gestational Diabetes and am supposed to be eating a bedtime snack. Can it have any carbs? Just protein? 

A: The reason for the snack would be to keep you from spilling ketones. Are you checking for them every morning? That is part of gestational diabetes management. If not, then you don't need a snack. The idea is for the baby to appropriately gain weight, and mom not to "starve". If your fasting blood sugars continue to rise, you may need short term insulin. Have you carefully evaluated each meal to include good protein balance and the right kind of carbs (complex, high fiber)? Often a good bedtime snack is yogurt: plain with bit of fruit, or 1/2 whole grain bread sandwich, such as cheese. Exercising such as walking, is also key.

Q: What are the pros and cons of carbohydrate counting?

A: Carbohydrate counting is helpful for fine tuning your blood sugars. Carbs turn into sugar in our bodies anywhere from 5 to 120 minutes after eating. The primary carbs to limit are refined and simple such as white flour and pasta. If, after following the general guidelines for a healthier lifestyle for management you are still not in control, then counting carbohydrates may be for you. The cons with counting any food is that it can feel like dieting to many of us. You be your own judge here.

Q: I am frustrated because after an initial 17 pound weight loss on a 1200 calorie diet, I cannot lose any more weight. I do have more energy due to the change in my eating habits. Would it be best for me to obtain a 1000 calorie diabetic food plan? I love cheezits; and am addicted to them, and find myself snacking them each and every night. 

A: Take heart, you sound like you are on the right path. Quite frankly, 1200 calories may have been too restricted for you and reducing your intake even more is probably not the answer. It all depends on your body composition and the types of foods you are eating. In general, eat as many veggies you like. Baked/broiled fish is the flesh of choice if you like it; starches keep to a moderate minimum, keeping them unrefined and high in fiber. Factor in your crackers if you crave them, chewing very slowly. The key here is to be exercising daily. Just walking will work! Stay very active. It's normal to reach plateaus; fluid retention at low levels can cause "weight gain". If you are feeling better and your glucose is in good control, then you certainly are improving! STAY WITH IT!

Q: How can I safely gain weight when I am already so near the fasting blood glucose cutoff of 100? When I was first diagnosed with diabetes, my doctor recommended that I get more exercise, cut down on heavy pasta dinners, and avoid sugary snacks. I started running at least 20 miles per week, lost 12 pounds (to 144), and bought myself a glucose meter. Since then, I have been much more serious about my diet. I'm eating salmon at least twice a week and eating beans as my primary carbohydrates. As long as my dinners are small (and no dessert), and I run at least 3 miles per day, I can get my fasting blood glucose down to the 90 - 100 range. However, these new changes have made me lose more weight and my wife tells me I look gaunt at 136 (I am 5’11”).

A: During the day, try adding some coconut and olive oil to your diet in tablespoon increments. Avocados and nut butters are also good choices. If the bulk of your food intake is finished 4 hours or so before sleep, you may be just fine. 136 is a bit lean for you; I would think around 150 of lean mass would be good, but numbers are not always hard and fast determiners of what is good health. Have you tried any supplements? Cinnamon in therapeutic quantities is helpful, as are many other nutritionals.

Q: Is the sugar substitute, Stevia, OK for those with diabetes?

A: Stevia is derived from the leaves of the plant, stevia rebaudiana. It is 200 times sweeter than sucrose and can be used in cooking. In addition to its sweetening property, Stevia has been shown to lower both blood pressure and blood sugar levels in animal studies. It is the sweetener of choice for many. It is packaged under more than one name, and is available in both liquid and powder forms.

Q: I will be traveling to Belize for two weeks and it will be difficult for me to eat well when the usual meal consists of rice, beans, tortillas, and very few vegetables. Last time I was there itwas a disaster for me. Are there any pre-packaged snack foods that I could take with me in case I can't get something healthy to eat?

A: First of all, stay away from the rice! Beans are a much better choice. This is a time when a protein type bar would be helpful since it packs well. Avoid granola type bars, as they are higher in carbs. If you have a health food store near you, ask for a bar with at least 40% protein. If there are any veggies at all, even if not exciting, try to eat them whenever you can. Factor in some fruit servings to get fiber and real food. I’d say your best ally will be lots of activity and exercise.

Q: Can glucosamine have an affect on blood sugar levels?

A: Glucosamine is a carbohydrate, but it does not get converted to glucose. Some reports are that insulin levels may be affected. A study done with type 2 diabetes showed glucosamine to have a minimal effect on glucose, concluding that the benefits of using glucosamine for arthritis outweigh a risk for a slight fluctuation in blood sugars. As is always true with diabetes, each person is an individual who may respond differently. Best suggestion is always to monitor your glucose for any changes.

Q: If a food is labeled as having 15 grams of carbohydrate and 4 grams sugar what is the total number of carbs?

A: 15 grams carbs should be the total, with 4 grams of that considered as sugar which is usually added. Look at the ingredients to see if sugar by its many names has been added. Just remember: 15 grams of carbohydrate from a drink will raise your glucose more quickly than 15 grams from a fresh fruit serving, like a small apple.

Q: I am 13 years old and have a weight problem. I know I am at high risk of getting diabetes but when I diet, it doesn't make a difference and I can't lose weight. I play lots of sports and am not lazy. Do I have some type of diabetes that prevents me from losing weight?

A: Diabetes in and of itself does not generally cause you to retain weight. Sometimes the medications a person is taking will often interfere, contributing to levels of fluid retention. Be as active as you can, striving to become a "lean machine", even if the numbers on the scale don't immediately change. Be very honest with yourself about your food intake/portions vs. activity levels. If you can locate a nutritionist in your area who also will suggest appropriate vitamin/mineral compounds and carbohydrate vs. protein amounts, that may be the boost you need.