Written by: Jon Vredenburg, MBA, RD, CDE, CSSD, LD/N
Lifestyle management is the cornerstone of diabetes care. For some patients, just getting regular physical activity and following an individualized meal plan can yield sufficient outcomes. However, that is easier said than done. Diet and exercise are an intimidating pair to many people, and they can be especially daunting for patients with diabetes.
For many, figuring out what to eat is the most challenging aspect of their care. All individuals with diabetes should be referred to a registered dietitian who can provide a personalized approach to achieving glycemic targets. After all, nutrition therapy has been shown to reduce A1C up to 2% in persons with diabetes and is a covered benefit under health insurance plans. In addition to private health insurance plans, patients may also receive education benefits from Medicare. According to Medicare rules, a newly diagnosed patient is eligible to receive 10 hours of diabetes education—which includes nutrition education—in the first year, and 2 hours per year after that.
Historically, diabetes education was typically done in an outpatient setting, where patients could get access to registered dietitians and other professionals. Today, immediate access to a registered dietitian is not always possible, so front-line practitioners need practical tips and tools to help their patients navigate food choices in the interim. Not surprisingly, carbohydrate foods deserve the most attention in these mini-consults because of their impact on blood sugar. However, instead of hackneyed advice like, “avoid starches and sweets,” it is best to provide actionable steps focusing on what to eat, rather than what not to eat.
Although there is no such thing as a universal “diabetic diet,” there are three short-term goals that can help patients retain some semblance of control over eating while they await medical nutrition therapy.
- First, suggest switching to fiber-rich carbohydrate foods (e.g. wheat pasta, brown rice) and keeping these choices to no more than 25% of their plates at meal times. In addition, one small piece of fresh fruit per meal is a nutritious adjunct can still keep the meal time carb totals manageable. The fiber in these food choices helps blunt the glycemic response too.
- Second, using the nutrition facts panel for information about foods is indispensable. Many people with diabetes can achieve their glycemic targets in a range of 30-60 grams of carbohydrate per meal, depending on their level of activity.
- Finally, keeping a food log can help boost awareness of food choices and also provide the dietitian with information when it is time for the consultation. Monitoring total calorie intake is still important for weight management, and research shows that intake is reduced when individuals maintain daily food records.
Exercise has also been shown improve blood glucose control, in addition to reducing heart disease risk and helping maintain weight loss. The optimal “dose” is 30 minutes of aerobic activity most days of the week. The timing of exercise can play a factor as well. Post-prandial glucose spikes seem to decrease if an activity is started soon after a meal. Therefore, suggesting a brisk walk after meals is a practical way to boost activity in an impactful way. In terms of overall weight loss though, the best exercise for any patient is the table push-back.
 American Diabetes Association, “Standards of Medical Care in Diabetes—2019.” http://care.diabetesjournals.org/content/42/Supplement_1/S46.