Meal planning for type 2 diabetes

Like a lot of people, I don’t have tons of time to spend on meal planning.  However, I know it’s not good for me (or my family) to eat on the run without any forethought and yes, planning.  I wonder if you struggle with this, too?

Does your idea of an eating plan mean simply that you plan to eat at some point when you get hungry? Are the “what” and “how much” left to be discovered when you open the refrigerator door or sit down at the table? While this approach cannot be endorsed as a design for healthy food consumption — for anyone, much less people with type 2 diabetes or those who are at risk for this disorder — it’s an accurate description of how many Americans approach meals. But the more we learn about the influence of diet on long-term health and well-being, the more important it becomes to make wise, conscientious food choices. When you have type 2 diabetes, this is even more crucial.

What is meal planning? As the name implies, it involves thinking ahead of time about what, how much, and even when and where you are going to eat. It may involve working out a “food budget” as well — although in this case you’ll be counting calories as well as dollars and cents.

When it comes to meal planning, no one strategy suits every person’s tastes or lifestyle. But two systems tend to be used most commonly: the exchange system and carbohydrate counting. You (and your dietitian, if you’re working with one) will decide which planning system works best for you. Another alternative — especially if you don’t have a dietitian — is to use your plate as a guide. Mentally divide the plate down the center and fill one half with vegetables. Split the other side of the circle into two parts, allowing equal amounts of space for your whole-grain carbohydrates and your lean proteins. This method is sometimes referred to as “building a balanced plate.”

The modern era of meal planning was ushered in with the advent of the Exchange Lists for Meal Planning in 1950. These now-familiar food lists were designed in a joint effort by the American Diabetes Association, the American Dietetic Association, and the U.S. Public Health Service to make meal planning more consistent among nutrition professionals and more accessible to patients. The exchange lists have been revised numerous times over the years to keep pace with popular tastes. Many people with diabetes still find the exchange system a useful tool, especially those who benefit from detailed information about serving sizes and food content.

Here’s how the system works: Based on your energy needs and blood sugar goals, your dietitian will designate the number of servings from each of several food groups that you should include in your meals to meet your daily caloric needs. Food groups include

·         carbohydrates, which encompass the starch, fruit, milk, vegetable, and “other” categories

·         meat and meat substitutes, which are further classified as very lean, lean, medium fat, and high fat

·         fats, categorized as monounsaturated, polyunsaturated, saturated, and trans fats.

When putting together a meal, you choose foods from the appropriate categories to account for the desired number of servings per day. Foods grouped within a category can be exchanged for another item in the same category (which is why this is called the exchange system).

The American Diabetes Association has published a guide to using the exchange system. To get the most out of this system, consult with your dietitian.

Since the late 1990s, the trend in diabetic meal planning has been toward the carbohydrate counting system. This meal-planning system tends to be less complicated and more accurate than other approaches because it focuses on only one major nutrient. It also allows more flexibility to include combination foods such as soups and casseroles in your diet because you don’t have to worry about finding a particular food item in the exchange lists.

The first step in tracking your carbohydrates is to assess the number of calories you need to take in each day. From this number, you and your dietitian will determine what portion of this energy total should come from carbohydrate foods. For example, if your meal plan calls for 1,800 calories a day, with 50% of these calories drawn from carbohydrates, you’ll need to take in 900 carbohydrate calories a day. One gram of carbohydrate delivers 4 calories, so using this scenario you would be allowed 225 grams of carbohydrates per day.

Many people with type 2 diabetes find that tallying carbohydrates in 15-gram servings, or choices, is more convenient than trying to add up carbohydrate totals. To help in this task, dietitians and diabetes organizations have developed carbohydrate choice lists (see Table). The number of carbohydrate choices to aim for each day depends on your total caloric goal.

Another thing to keep in mind is the portion of carbohydrate designated as dietary fiber. Since fiber is largely undigested, you can subtract these grams from the total carbohydrates if the fiber weighs in at 5 grams or more per serving.

What kind of meal plan do you use? Why do you like this method. We all need some advice on meal planning—let us know what works for you!

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

One of the biggest concerns for people with diabetes is their diet. Healthy Eating for Type 2 Diabetes takes the guesswork out of meal time, providing healthy eating strategies to prevent and treat the most common form of diabetes—Type 2 diabetes. The special report from Harvard Medical School includes meal plans, physical activity ideas, and 40 original recipes to get you on the path to healthy eating and living.

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