HOW TO BE AN EFFECTIVE FOOD SHOPPER
WHEN YOU HAVE DIABETES

by Andrea Ciccone Troutner, RD, LD

Imagine eating a milk chocolate-coated, caramel nougat candy bar that has only 3 grams of fat, 21 grams of total carbohydrate and 90 calories per bar—and you're still following your diabetic meal plan. Now, the dream can become a reality. How? By understanding the 1995 "Exchange List" diabetes guidelines and these practical suggestions, you can easily convert recipe and food label information into exchanges, and enjoy your favorite foods, while adhering to your meal plan.

Healthy meals include foods that contain carbohydrate, protein, and fat. For people with diabetes, carbohydrate is the most important nutrient to consider in making food choices. If you know how many grams of carbohydrate you are eating, then you'll know where your blood glucose level is headed. This is why planning meals and snacks is so important. Whether you have type 1 or type 2 diabetes, you will work on eating the same amount of carbohydrate, at the same meal, each day. You focus on the types of food (carbohydrate, protein, and fat), the size of portions, and how often you eat during the day.

Carbohydrate is found in starches and sugars. Keep in mind that sugars may be added to food or naturally present. The following foods are sources of carbohydrate:

*Grains/beans/starchy vegetables

*Vegetables

*Fruits

*Milk

*Refined sugar

The Nutrition Facts panel, found on the food label, is the best way to get information on a food's carbohydrate content, but not all foods have labels. You may need to look for other sources of carbohydrate information. But even when you have this information, you still need to weigh or measure the amount of the food you're going to eat, to determine the total grams of carbohydrate in your portion.

The "Exchange Lists for Meal Planning," available from the American Diabetes Association, can help you learn how to count carbohydrates. (EDITOR'S NOTE: The "1995 Exchange Lists for Meal Planning" is available in Braille ($10) or audiocassette ($2), from the National Federation of the Blind Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314. The Materials Center is open weekdays, 12:30 to 5 p.m. EST).

In the revised 1995 "Exchange Lists," a group called "Other Carbohydrates" has been added. This list includes foods which are often high in carbohydrate and fat, such as cake, pie, cookies, candy, ice cream, jelly, chocolate, chips and some crackers. You can substitute foods from this list for foods found on the starch, fruit, or milk lists, and still be following your plan. Some choices will also count as one or more fat choices. Although you can include foods from the "Other Carbohydrate" list in your meal plan, to eat a balanced diet, be sure to include foods from all the lists. As stated earlier, foods from the "Other Carbohydrate" list contain added sugars or fat but also do not contain as many important vitamins and minerals as choices on the starch, fruit or milk lists. Also, because many of these foods are concentrated sources of carbohydrate and fat, the portion sizes can be very small. So, be careful!

If you regularly substitute fruits or starchy foods for milk, calcium intake may be decreased and portion status, in children, may be compromised. On the other hand, regularly choosing milk, instead of fruits or starches, may result in inadequate fiber intake. That is why it is important to choose a variety of foods from all of the food lists. This will ensure an adequate intake of protein, fat, carbohydrate, vitamins, minerals and fiber.

Now, with the new diabetes guidelines, food choices can be expanded beyond what is listed on your exchange lists. All you have to do is look at the food label and follow these simple rules of thumb:

To determine which foods fit into the starch, fruit and milk groups, or to exchange foods between groups:

-- Count 1-5 grams of carbohydrate as a free food
-- Count 6-10 grams of carbohydrate as half a carbohydrate exchange
-- Count 11-20 grams of carbohydrate as 1 carbohydrate exchange

To determine which foods fit into the fat group and how to count them:

-- Do not count a fat exchange for foods containing 2 or less grams of fat
-- Count foods with 3 grams of fat as half a fat exchange
-- Count foods with 4-7 grams of fat as 1 fat exchange

To determine which foods fit into the meat group and how to count them:

-- Do not count a meat exchange for foods containing 3 grams or less of protein
-- Count foods with 4-10 grams of protein as 1 meat exchange

Many fat-free or reduced-fat products, made with fat substitutes, may contain large amounts of carbohydrate and may need to be counted. Talk with your registered dietitian to learn how to count these foods in your meal plan.

*KEY WORDS AND WHAT THEY MEAN*

FAT FREE: Less than 0.5 grams of fat per serving.

LOW FAT: 3 grams of fat or less, per serving.

LEAN: Less than 10 grams of fat, 4 grams of saturated fat and 95 milligrams of cholesterol per serving.

LIGHT (LITE): For calories--1/3 less calories than in the original version; For fat—no more than half the fat than in the original; For sodium—no more than half the sodium than in the original version. Note: "Lite" can also refer to the color or texture of the food.

CHOLESTEROL FREE: Less than 2 milligrams of cholesterol and 2 grams or less of saturated fat per serving.

For more information on "Carbohydrate Counting," I recommend the following resources:

"1995 ADA Carbohydrate Counting: Getting Started, Level 1"

"1995 ADA Exchange Lists For Meal Planning"

Wheeler, M., et al, "Helpful Hints: Using the 1995 Exchange Lists for Meal Planning," DIABETES SPECTRUM, Vol. 8, No. 6, Nov/Dec 1995, pp.325-326.

Rafkin-Mervis, L. "Carbohydrate Counting," DIABETES FORECAST, Feb. 1995, pp.30-37.