One consolation: You’ve got company. According to the 2014 National Diabetes Statistics Report, more than 29 million Americans now live with diabetes, defined as the body’s lack of or inability to use insulin, which leads to high blood glucose levels. Even more worrisome: 86 million more have prediabetes (9 out of 10 don’t know it), and at least 1 out of 3 people will develop diabetes in their lifetime.
Right now, diabetes causes more U.S. deaths annually than breast cancer and AIDS combined; complications range from blindness and amputation to neuropathy (nerve damage) and stroke. “When people are diagnosed with diabetes, it’s like a deer in headlights,” says Betsy Ramirez, RD. “There’s a long list of things you have to modify, and it’s very difficult to take it all in.”
One solution: hope-based education. Ramirez is one of a growing number of dietitians who specialize in retail settings, enlightening people through tours and workshops. “Especially with diabetes, a dietitian is a key resource in the grocery store,” she says. Here are Ramirez’s tips for managing diabetes through nutrition.
What’s happening inside
When you eat carbohydrates, those foods break down into glucose, which your body uses as fuel; subsequently, your pancreas, an organ behind your stomach, releases the hormone insulin. Insulin then “unlocks” cells throughout the body by activating proteins in outer cell membranes, thereby allowing glucose into cells—think of insulin like a switch that lowers a drawbridge to let cars across a river.
But if you have diabetes, explains Ramirez, the insulin switch isn’t working, so glucose builds up in your system. “And when your blood is overwhelmed with glucose over long periods of time, that can cause long-term consequences,” she says.
Know food basics
When managing diabetes, portion size is critical, so on food labels look first at serving size. “That’s really the most important number,” says Ramirez. “A lot of people look at a 20-ounce Coke or a bag of chips and say ‘oh, this is my serving,’ when, in fact, it’s really calculated as two or three servings—so you have to multiply everything on the food label.”
Foods offer a combination of fat, carbohydrates, and protein. “To manage blood sugar, you have to have these three main components on your plate,” says Ramirez. “You need carbohydrates but carbohydrates are sugar—on a food label, they’re the same thing. Always have a team mentality: Nothing should ever be on your plate by itself. Protein with fat and carbs—that’s what I always preach.”
Understand (good) carbs
One serving of carbohydrates is 15 grams; as a general guideline, a man with diabetes can have 45–60 grams per meal and a woman usually 45 grams, says Ramirez. The key is to make carbs count by choosing high-quality options like whole grains and, especially, vegetables. “[Veggies] don’t have a lot of carbohydrate, so a lot of them count as ‘free food,’” she says. Also look for high fiber, which helps regulate blood sugar.
The tricky parts: items like peanut butter and salad dressings. “When I ask [store customers] which dressing is the healthiest, they often go and pick up a light or fat-free version,” she says. “But then we’ll flip the bottle over and look at the sodium and carbohydrate or sugar counts, which are always higher than in the [full-fat] version. Fat is not a four-letter word! It’s better not to put that sodium and carbohydrates into your body and to have a smaller amount of full-fat dressing or peanut butter instead.”
Monitor and record
When you have diabetes, it’s a must to measure your blood sugar two hours after eating 45 grams of carbohydrates (sugars). Many stores sell blood glucose monitoring kits. “Ask if the store gives free demonstrations on how to use them,” says Ramirez.
Next, book a one-on-one appoint-ment with a dietitian to determine your specific needs. “Many people don’t realize they have access to this through their insurance,” Ramirez says. Keep a journal of the foods you eat and your glucose levels two hours post-meal. Then, working with a dietitian, “you can adjust the carbs and calories you need based on your data.”
And take heart. “Diabetes doesn’t have to define you,” says Ramirez. “You just need to adapt around it.”