Archive for April, 2011

I am a Nutrition Editor at, a website designed to help people with diabetes.  Here is a question I recently received:


I was recently diagnosed with Pre-Diabetes and was wondering how strict my diet really needs to be?  Does every meal and snack need to be completely sugar and carb free?”


When newly diagnosed with pre-diabetes, one may require changes in eating patterns and lifestyle such as improving health through healthy food choices and increasing physical activity.  The goal would not be to completely cut out all carbohydrates, rather improve the quality of the carbohydrate. 

Typically, a Registered Dietitian or a Certified Diabetes Educator would sit down with a client newly diagnosed with pre-diabetes and would calculate how many grams of carbohydrates that person would need in a day (because carbohydrates are needed for energy). 

How Does It Work?

The next step would be to distribute the carbohydrates evenly throughout the day to help keep blood sugars stabilized. 

  • For example, let’s say a dietitian calculated that the client needs 225g of carbohydrates per day (calculation is based on a percentage of total calorie needs; your carbohydrate needs may be higher or lower). 
  • To distribute:  First decide how many meals and snacks are consumed throughout the day.  Let’s use 3 meals and 2 snacks for this example.  This is helpful for better blood sugar control because typically it allows a person to eat smaller, more frequent meals with a consistent amount of carbohydrates throughout the day.  The more consistent you can be with your carbohydrate intake, the happier you will make your pancreas (this is the organ that is supposed to produce insulin when you ingest carbohydrates).  Now to calculate:  one option would be to give a larger amount of carbohydrates to the 3 meals (60g each), then a smaller amount for the two snacks (one snack at 25g and the other snack at 20g).   You could also distribute the 225g evenly for each of the 5 small meals, which would give you 45g at each sitting.  A dietitian can help you figure out the best option and meal plan for you.
  • Type of carbohydrate:  The quality of the carbohydrate may make a difference.  Meaning, there are some sources of carbohydrates that contain vitamins/nutrients and fiber (such as brown rice, sweet potatoes) and there are some sources of carbohydrates that may be empty calories (such as candy, pastries).  Yes both of these sources are digested and turn into glucose and wait for the insulin to move it out of the blood and into the cells. However, good health depends on what you put into your body, so why not strive for maximum health benefits and go for the sources with the vitamins/nutrients and fiber.  In other words, get some bang for your buck.

Now that you have been diagnosed with pre-diabetes, you have an opportunity to learn how to control you blood sugar levels by keeping it within a certain range (work with your doctor to figure out what your range is).  The closer you get to this range, the lower your risk may be for developing diabetes and/or long-term health problems associated with diabetes. 

I wish you much health and happiness.  Remember, this carbohydrate counting and distributing thing may seem overwhelming at first, but stick with it and it will make sense over time.


I am a Nutrition Editor at, a website designed to help people with diabetes.  Here is a question I recently received:


On my lunch breaks I go to a sandwich shop.  I usually get a large deluxe sandwich with a side of potato salad or coleslaw.  Now that I have diabetes, I’m trying to modify my lunch order.  Can you make some suggestions of what to order?”


Kudos to you for taking an interest in modifying your lunch to help manage diabetes.  Eating out at a sandwich shop can be inexpensive and convenient however it may not always be healthy.  There may be many options that pack on the sodium and fat, which as you know is not an optimal situation for people with diabetes.  As an informed consumer, you can make healthier choices and still enjoy the price and the convenience of the sandwich shop.

Here are some tips for making healthy choices at a sandwich shop:

  • Convert from less healthy choices to healthier options:
    • Instead of high-fat meat such as ham, tuna (with a lot of mayo), bacon, meatballs or steak, try ordering lean meat such as chicken breast, turkey breast, tuna (without may), or a veggie sandwich.
    • Substitute low-fat cheese for regular cheese.
    • Choose whole grain bread instead of white or take one slice off and eat it as open-faced (depending on how many carbohydrates you need at each meal).
    • Substitute fresh fruit or a garden salad for the side of potato salad or coleslaw.
  • Prepare ahead: Many restaurants may have nutritional content on their website or in a pamphlet that you can pick up at the location.  Take a look at the nutrition facts to find optimal choices such as low fat, low calorie, and/or low sodium.  Sometimes a seemingly innocent little sandwich may appear healthy from a picture or a description, but may be a landmine of fat with some mayo-based dressing.  Let’s look at the some of the breads offered at Subway Restaurants (as an example) and figure out how to analyze the nutrient information.
    • 6” Italian white bread (calories-200, total fat-2g, sodium-390 mg, carbohydrate-38g, fiber-1g)
    • 6” 9-Grain wheat bread (calories-210, total fat-2g, sodium-410mg, carbohydrate-41g, fiber-4g)
    • 6” Roasted Garlic (calories-230, total fat-2.5g, sodium-1360mg, carbohydrate-45g, fiber-2g)
    • 6” Hearty Italian bread (calories-220, total fat-2g, sodium-390 mg, carbohydrate-41g, fiber-2g)
    • 6” Honey Oat (calories-260, total fat-3g, sodium-430mg, carbohydrate-49g, fiber-5g)


The first thing that jumps out at me here is that the 6” Roasted Garlic has 1360mg of sodium.  Raise the red flag here as the current recommendations from the American Heart Association are to limit your daily                              sodium intake to 1500mg (Source: so this would be almost a day’s worth of sodium at one meal (and that is  just from the bread).  Next let’s look at fiber.  The two options for the highest fiber are the 6”         Honey Oat (5g ) and the 6” 9-Grain wheat (4g).  Since the Honey Oat has more calories, carbohydrates and fat, the optimal solution here may be to go with 9-Grain wheat bread.

  • Portion control: Portion control is important with sandwiches and subs as many places will serve enough food to feed all of your coworkers.  A suggestion would be to eat half of the sandwich and save the other half for the afternoon (about 3 hours later).  By cutting your portion in half PLUS eating three hours later, you may find you have better control over your blood sugars.  Sometimes if we eat a huge meal at noon and then nothing until 7pm, the blood sugars may spike and drop to extremes.
  • Drink water at your meal: This will help keep you full and is a much better option than soda.  Soda is a huge source of hidden calories and sugar.  (Note:  some populations may be required to drink in between meals and not during meals, such as those who have undergone bariatric surgery).
  • Special order: If nothing on the menu seems healthy, ask for something special.  Many restaurants will be accommodating for these types of requests.  Order a sandwich with whole grain bread, a small amount of turkey, load up the vegetables and top it off with a tiny bit of olive oil.
  • Eat mindfully: The last tip I will leave you with is to always be present while you are eating.  Try not to watch TV or work on your computer when eating.  Eat slowly and aim to chew your food about 20 times per bite.  This will help you learn the body’s cues for telling you when you are full.  Mindful eating also relaxes you, which may be better for digestion and may make you feel more satisfied.

Thank you for the question and I’m so happy to hear that you are making changes for a healthier you!

I am a Nutrition Editor at, a website designed to help people with diabetes.  Here is a question I recently received:


I have heard I should avoid fruit juice since I have diabetes.  What about vegetable juices?  Can I have tomato juice and other vegetable juices?”


We all know that vegetables are an important part of a healthy diet.  Many Americans report not getting the recommended amount of vegetable servings per day which is about 5-8.  Vegetable juice may make it easier to reach that goal.  The question is; are there any repercussions?  Well…many vegetable juices may be high added sugar, sodium or “other” flavors which may elevate blood sugars and sodium levels (increased blood sodium levels may lead to hypertension, plus “other” flavors may not be defined and we could be taking a chance of ingesting more sugar or some other substance and not know it).  On the other hand, you may be able to find a juice that is 100% vegetable juice which may provide fiber, vitamin C, and other nutrients (depending on the type of vegetable).

A suggestion would be to aim to get most of your vegetables in their “whole”, natural state and drink the vegetable juice as a back-up plan.  A “whole” food takes longer for the body to digest, which is great for people with diabetes because the sugar content is released slowly into the bloodstream.  A vegetable juice is no longer “whole” (it’s processed) and may spike your blood sugar faster than a “whole” food item.  Also, the slower the food item digests; the more vitamins and nutrients that will enter the bloodstream; another plus for whole vegetables.

Making your own vegetable juice with a juicer might be a good option for you.  This will allow you to choose vegetables that are lower in sugar content.  A quick rule of thumb; vegetables that are grown above ground are low in sugar while those that grow below ground are high in sugar (i.e.; beets, carrots, yams to name a few).

If you do choose to buy vegetable juice, try to be aware of your serving size compared to the serving size on the nutrition facts panel.  If the serving size is 4oz (which might be about 15-20g carbohydrates), then make sure you are not chugging down tall glasses full of the juice all day long.  Monitoring your blood sugar levels after consuming vegetable juices will also help you determine if they are right for you.

Thank you for the question.