ADA guidelines for type 2

[jimmys devoted]

ADA guideline sor exchanges seem to ahve taken a back seat to herbals and fad diets.
What we do know after years of research and clinical studies is it is by and far the most important tool to know and have. It can help you to compensat if your medication is not available for a short period of time. It teaches you how to read your body in reaction and relation to foods.
tis probably the most important aspect of self managment classes.

[Dusty]

I looked at the ADA website when I was first diagnosed and didn't really like what I saw. I don't do the exchange program and their recommended diet would have my numbers through the roof.

I eat good healthy foods and my numbers are good so I must be doing something right.
I honestly don't see how any type II not on insulin can get good numbers eating by the ADA recommendations. Just my personel view, your milage may vary. :)

[jimmys devoted]

being a Diabetes Educator, it is often my place to explain what is being taught.
for basics theer are a few things ot know.. just for edification.
no more than 45 grams of carbohydrate or the equivilent of 3 slices of bread per meal, no mor ethan 30 grams or teh equelent of 2 sliesof bread per meal/.
Nomore than 56 grams maximum of protein permeal to prevent protein secretions in urine and cause kidney damage.

when you are set up by your diabetes educator your allocation is based on what your blood and urine tests are.

For me.. when i was on orals i was on teh standard 45/30 carb and 20 protein per meal.

everyone eventually finds their own balance.

[Serra]

no more than 45 grams of carbohydrate or the equivilent of 3 slices of bread per meal, no mor ethan 30 grams or teh equelent of 2 sliesof bread per meal/.
Nomore than 56 grams maximum of protein permeal to prevent protein secretions in urine and cause kidney damage.

when you are set up by your diabetes educator your allocation is based on what your blood and urine tests are.

For me.. when i was on orals i was on teh standard 45/30 carb and 20 protein per meal.


What do you mean no more than 45 grams per meal or no more than 30 grams per meal? Which is it?

[jimmys devoted]

The basic rules are as follows:
45 grams of carbohydrate per MEAL
30 grams of carbohydrate per snack
15 grams per hypoglycemic episode.

It is also base don your current blood sugar readings prior to the meal.
If you are above target range premeal, then its a good idea to drop down to 30 grams of carbohydrate for the meal.
If you do this, then your post prandial glucose level will eb more manageable and youll be able to go back to eating your normal amount.

So.. for the basic for meal planning to start with begin with 45 grams.

[Serra]

The basic rules are as follows:
45 grams of carbohydrate per MEAL
30 grams of carbohydrate per snack
15 grams per hypoglycemic episode.



I've been looking around and I can't find these numbers anywhere online. There is lots of discussion about carbs, but no one seems to have the actual number of grams.

How do I judge the effectiveness of those amounts? Obviously, those will have different effectivenesses depending on who is eating them, right? What would be a good gauge of how good those numbers fit me?

[Dusty]

The basic rules are as follows:
45 grams of carbohydrate per MEAL
30 grams of carbohydrate per snack
15 grams per hypoglycemic episode.

It is also base don your current blood sugar readings prior to the meal.
If you are above target range premeal, then its a good idea to drop down to 30 grams of carbohydrate for the meal.
If you do this, then your post prandial glucose level will eb more manageable and youll be able to go back to eating your normal amount.

So.. for the basic for meal planning to start with begin with 45 grams.


That actually helps explain my reason for running the other way when I went to the ADA website.
That list you posted adds up to near 200 carbs a day which in my opinion is way too much if you're trying to gain control with oral meds, exercise, and diet.

Insulin dependant types may be fine with that amount because they can adjust their insulin to cover the added carbs. As a TII IR I can't do that so I limit my carbs to between 30-60 carbs a day total. My fasting numbers are usually in the low to mid 80s and one hour post meal I'm usually in the upper 90s to low 100s. Rarely do I go over 125 anytime.
There's no way I could have that control eating the recommended amount of carbs a day. I eat a lot of food a day but its mostly veggies, meat, etc.

I only take 750mg of extended release metformin in the morning which helps supress my liver from dumping more glucose in my system. I want to preserve my remaining beta cells as long as I can.

Serra
What are your numbers now?
Really the only way to find what works for you is start keeping a close count on your carbs and test before, after 1 hour, and after 2 hours and adjust your intake to get the numbers you are looking for.

[jimmys devoted]

As a diabeets educator, and I am one. plus the NDEP i ahve some news for you.

To low of carbohydrates acuses your liver to compensate for the low levels of carbohydrates glucose metabolism. So if you eat less carbohyadrtes your liver is actually compensating.
Also you ahve to take into consideration the carb/protein ratio.

Proteins and carbs need teh same amount of Kcal to burn each other out. for every 4 grams of carbohyadrtes it uses 4 grams of protein to burn it out. So when you see numbers as I ahve potsed that not all that you are eating during the day. theer uis about 51-65 grams of protein, 25-56 grams of fiber as well. PLus high calcium and minerals.

You can find all of this information not nessacerily on the net. But in ADA books, Daibetes magaazine like diabetes monitor and of course you must talk with a diabetes educator who is certified or a diabetologist nutritionist.

Just go to lulu.co and look for Factoring Diabetes,, it was written by me, Dr. Julai Sherman and it has all of the information you need to get ahold. PLus you can go to to your local ada meeting or contact the office online and theyw ll send you the exchange guides for a small fee.
Endocrine and diabetologist text books also contain the information.

[airvalves]

I was diagnosed as Diabetic II 4 years ago as a result of exposure to Agent Orange in Vietnam. I went to the ADA website and felt that the only interest there was getting people to join the ADA. So we, surfed the internet and found what turned out to be, for me, the best information coming out of Australia and New Zealand - mainly with Low Carb eating and the Glycemic Index. We were neophytes in dealing with this as we knew absolutely nothing at that time about diabetes or it's relationship with carbohydrates.
To make a long story short - the day I was diagnosed the following were my stats;
6"2" 254 lbs, blood glucose level over 400, cholesterol over 400, tryglycerides over 1300 and blood pressure normal.
Went on a 50 carb or less per day life style change (diets doom you to failure, life style changes guide you to success) and started walking 2 miles per day.
6 months later - blood glucose level running between 85 and 95 (my comfort zone), cholesterol down to normal, tryglycerides down to normal, blood pressure still at normal, still 6'2" but down to 190lbs.
I have gained 10 lbs back since that time but am comfortable at 200 and still maintaining my blood glucose levels between 85 and 95 as a norm. Once in a while we will go out and celebrate with a good Italian meal with lots of carbs and I will jump it up to 125 or 130 but it comes back down the next day. I only do this if I maintain my levels for 30 days consequetive - it is my reward and this reward helps me to maintain my lifestyle change nad not fail as all diets eventually do.
I hope this helps some of you new to diabetes out there. Be encouraged - you can live with this disease and have an almost happy co-existense if you manage it and don't let it manage you.
Yes, I eat a lot of salads, meat and cheeses, stay away fro bacon and sausage (high fat content), don't eat anything fried unless it is fried in olive oil, switched from pretzels to celery and a few carrots with salsa dip for the bears games and cocktail shrimp with salsa instead of cocktail sauce. There are a lot of delicious ways to avoid carbs and you do not really have to cut back on the amount you eat if you eat right and exercise regularly.
We learned to eat poorly and we can learn to eat right!

[Serra]

I'm not ready for a 50 carb day yet. I'm moving in that direction, but I'm more thinking of no more than 2 40 carb meals a day!

Looking at the numbers, I am heading in that direction though.

Given your current diet, what is your fat intake?

[jimmys devoted]

Being a diabetic all of my life I have been through all teh levels; MODY, type 2, diet controlled, oral meds and now insulin.
Its a natural progression.

One pitfall about low carb diets though is ketosis. Too much protein and not enogh carb to balance will casue microalbinuria. If oyu are on such alow carb diet you ned to do daily dipsticks for protein spillover.

I am on southbeach version for diabetics,, we have 45 grams per meal of carbohydrates,, i stick at 30 though. Too much carb and I get nauseated.

The ada thorugh their website is very uninofrmative,. a shame becasue we as diabetic educators get more information to pass on than they provide at their website.


You also ahve to takeinto ocnsideration on your curent healtha spect what your insuin level is........ while my need formedication was based on an A1c of 8 and a BG of 407, i ahve since gone into pancreatic exhaustion from oral medication.

I also trie dthe Glycemic INdex, whichhas been disproven as effective for some diabetics.. I for one cant go by it at all.. the foods that they say are low, spike me up too high for too long,,a nd teh ones thattheys ay have high impact and spike,, are non impact n me..... and its been found in others as well.

But ifit worlks for you more power to you.

Diabetes managment classes and some of the diabetes self managment books rea very enlightening. theer is one thats an inexpensive ebook.. its called Factoring Diabetes and it has a lot of information that is not normaly taught and has a great way to learn to count carbs and exchanges.
j

[airvalves]

I think what I was trying to say is that when you are diagnosed with diabetes it is a slap in the face and a wake up call at the same time. How you treat it and manage it is totally dependant upon how it has effected you as an individual. We are all effected differently because of our physiology. The main thing is to manage your situation according to how you are personally effected. You must maintain a positive attitude and a determination to manage yo9ur diabetes and not let it manage you. You will need to experiment with carb and protein intake to find your own levels that work. 50 carbs a day or less worked for me. More important than the amount of carbs was the type of carbs. For me it was dumping the majority of starch carbs. A baked potatoe has. say 50 carbs, but you can cut the carbs in half by not eating the skin. I basically did away with pastas and breads. My largest carb intake meal is breakfast with oatmeal - 28 grams of carbs but good for the heart and I seem to manage those carbs quite well.
I would recommend for everyone with diabetes to look at what their carb intake is currently per day. Goal one would be to weed out the unnecessary carbs - such as bread - still want a cheeseburger - go ahead and have one - just not on a bun. You don't say to yourself at lunch - I would really like to have a hamburger bun - you say boy I would really like to have a cheeseburger. If you cut your daily intake of carbs by 25% or 50% you would be doing better than what you are currently doing.
AND GET YOUR EXERCISE!!!! I can not stress that enough - walking 2 miles a day at a 4 mile per hour clip is great cardial vascular exercise and drops your bs drastically. I took my bs one day and it was high - 115 so I took my walk and re-tested when I got back - 97 - so exercise is a great control tool.
Running bores me and is not good on the shins or knees - too high of an impact - upper midwest weather is not always conducive to rowing, bicycling, etc. SO when the weather is nice I walk - meet neighbors I had never met before - see things i have driven past before and never seen. When the weather is bad - I go to the mall and walk my 2 miles.
Everyone needs to find their own levels of management and manageability - just do not give up and keeep a positive attitude - you can do this. One other thing - READ FOOD LABELS CAREFULLY - there is a lot of information on the food labels and this will help you in you management skills.
Bill

[Dusty]

Welcome to the forum airvalves!
I totally agree with most of what you said. This disease is totally different with every person so it is up to US to determine what works for us.
Your story sounds very similar to mine about getting serious after being diagnosed.

I went to my GP yesterday and got a look at my numbers when I was first diagnosed in June-06.
Total chol...687
HDL....29
LDL...258
Tryglicerides.....over 1500!
BG.....414
Weight 281 lbs.

After 60 days the results were.
Total Chol. 159
HDL....31
LDL...69
Tryglicerides...188
BG...94
Weight....206

I have lost another 10lbs since then and will do another lipid profile in Dec.

We walk about 3-4 miles a day, sometimes twice a day if time permits and also cycle and weight train as often as possible.

I gave up potatoes, breads, pasta, most grains, chips, candy, cookies, etc. and after a few weeks I really didn't miss it.
My goal is to keep my BG at a normal (non diabetic) level and will do whatever I have to do to accomplish that.

Congratulations on your numbers and for taking the inititive to try and understand and find what works for you.

I can't believe how many people don't take this disease seriously. In my shop a few weeks ago, a lady came in and asked if she could sit down while her family looked around. After a few minutes she told me that she was diabetic and had eaten a lot of pastry for breakfast because it looked so good and her BG was so high that she was getting dizzy.

Why would you do that if you know what the end result is going to be?

[jimmys devoted]

While your diet may work for you, you do have some learning to do. First a potatoe does not have 50 carbs on it. A potatoe the size of you fist has 15 grams of carbohydrate. You do not cut your carbs in half by omitting the skin. the skin contains fiber and minerals you need. yuo would havet to eat a tater the size of your head to get that much carbohydrate.
What is afact is food racts differently to each person. Fo rme, a potato has no impact on my BGs, neither does rice. But two tablespoons of kidney beans, plain will send me above 400 easily.

being diabetic was not a slap in teh face, it was not a wakeup call. For some yes it probably is. But for thsoe of us who have long family history of it and are screened every three to six months for our lives, its something that is inevitable.


While you clearly expouse the benefits of walking for miles at a time, it ios clear you ave not hit the neuropathy stage. It makes it impossible to do anything when you get it. And believe me you will. Its the nature of the disease. when it affects your hands, your feet and your face, it is impossible to concentrate on anything. And neuropathyw ill and does come on when you least expect it, regardles sof how diligent you are.

In general, while what works for you may not work for a majority of those who are full blown type 2s or type 1s, or type 1.5 X.
You also have to realize that what works now wil nto work in teh future, or in progression of your disease. Your disease changes, affects you body in ways that you wil ahve to rollw ith it and change along with it.
I applaud you for the great work you are doing now, but be warned, diabetes is fickle playmate and can change as suddenly as the wind.

[Dusty]

Calorie King lists a potato the size of my fist at 64.5 grams of carbs.

http://www.calorieking.com/foods/calories-in-vegetables-fresh-potatoes-raw-flesh-and-skin_f-Y2lkPTE0Nzc1JmJpZD0xJmZpZD03MDk2OSZwYXI9.html

Please don't take this the wrong way but if a diabetes educator told me what you just posted I would certainly look for another DE. I am a firm believer that complications can be prevented and even reversed in some cases by the proper control of BG levels. This is not possible for some people because they are not dedicated to a lifestyle that it would take or because they may have had diabetes for quite some time before being diagnosed.

I know people that have been living with D for 40 years and have no serious complications.
People need to understand how serious this disease is but they also need to hear that it may be possible to prevent or at least minimize complications with good control. Without that then they really have no reason to even try.

[Serra]

Calorie King lists a potato the size of my fist at 64.5 grams of carbs.
http://www.calorieking.com/foods/calories-in-vegetables-fresh-potatoes-raw-flesh-and-skin_f-Y2lkPTE0Nzc1JmJpZD0xJmZpZD03MDk2OSZwYXI9.html


I have Calorie King on my PDA, very helpful.


I am a firm believer that complications can be prevented and even reversed in some cases by the proper control of BG levels.

From what I've read, this is true. Of course, I've read a lot that later turned out to be false, but I'd like to believe that it is possible to live without complications.

[jimmys devoted]

It is a shame that you are not into continuing education. Calorie King might be fine for those who are interested in calorie counting. Howeverthe discrepencies are too vast fo rthseof us who ahve studied nurition and metabolic diseases for years.

Again,, while your diet works for you,, as a diabetic who has gone through all teh stages,, and am in very very strict control, on insulin orla meds and exercise metabolic diet i can honslty say that it will come a time when you will atke a look back at your first complication or lack of control regardless of how well you think you control it.
That day I will stand up and say I told you so...............

[Dusty]

Again,, while your diet works for you,, as a diabetic who has gone through all teh stages,, and am in very very strict control, on insulin orla meds and exercise metabolic diet i can honslty say that it will come a time when you will atke a look back at your first complication or lack of control regardless of how well you think you control it.



I'm under no illusions that I may have complications down the road, and I'm well aware that diabetes is a progressive disease. My point is that the longer I can control it, the less time I give it to control me. My first HbA1c was 7.0 I am hopefull my next one in December will be well down in the 5.? range based on what my testing numbers have been. We're all fighting the same foe, some of us are just using different tactics that work for us.

That day I will stand up and say I told you so...............
I sincerely hope that if that time does come it will be years from now and you are still able to stand up and say it.
My response will be yep, you were right, but I did everything I could to slow it down! Cheers. :)

[bra]

The basic rules are as follows:
45 grams of carbohydrate per MEAL
30 grams of carbohydrate per snack
15 grams per hypoglycemic episode.

It is also base don your current blood sugar readings prior to the meal.
If you are above target range premeal, then its a good idea to drop down to 30 grams of carbohydrate for the meal.
If you do this, then your post prandial glucose level will eb more manageable and youll be able to go back to eating your normal amount.

So.. for the basic for meal planning to start with begin with 45 grams.

Hi, thank you for listing that, it has helped me rethink. Do you happen to have a website/link that gives this listing with more information, I would like to bookmark and read more. Thank you in advance.

[jimmys devoted]

theer is Factopring Diabetes Ebook. Its helpful and is copied from teh exchange guides from teh ADA and NDEP and NIDDK and NIH.

you can go to the ADA website and order teh exchange guides. They are relatively inexpensive.

You can call your local Hospital and see what handbook they ae Giving out to diabetics. These calsses are often free or paid for by insurance. But they ususally have an outreach center thathas self managment handbooks.

[bra]

Okay, thank you. I am going to schedule appointment this week for testing. I'm not sure when they will get me in but the doctor is only in on Tuesdays. I will get more information from them about our classes.

[ramesh68]

Hi there

ADA guidelines works as a reference and we can follow them at regular intervals. When we go for checkups we get some results and compare them with ADA guidelines and we can see the difference. So depending on the difference we have to adjust our lifestyles and try to keep sugar levels under control. I hope this helps.


Thanks

[Marci Sloane]

The meal planning for everyone with diabetes needs to be individualized. However, a good guide to consider is the calories you need to take in for the day for proper nutrition for your height and weight. Then, between 40 and 50% of those daily calories coming from carbs, 20-30% coming from protein (lean types) and 20-30% of those calories coming from healthy unsaturated (especially monounsaturated and omega 3) fats.

To figure out the math, remember that there are 4 calories for each gram of protein and carbs and 9 calories for each gram of fat. For ex: If you're on a 1600 calorie meal plan and trying to get 40-50% of those calories from carbs: 1600 x .40 = 640 (calories) divided by 4 (calories per gram) = 160 grams of carbs a day. Each carb serving (a piece of bread or 1/3 cup of cooked pasta or rice) is 15 grams of carbs. So, you would be able to consume about 10 servings. If you're looking for 50% of your calories from carbs: 1600 x 50% ( .50) = 800 divided by 4 = 200. Divide 200 by 15 grams per serving and it gives you 13 servings of carbs to evenly distribute throughout the day.