control both between-meal and after-meal blood glucose levels. Premixed insulins are typically given before breakfast and before dinner.
Used individually, insulin and nutrition therapies are very helpful in keeping blood glucose levels in control. Used together they provide a simply awesome one-two punch.
The key element to achieving success with insulin therapy is to give the right amount of insulin to match your body’s needs. Your body’s needs will depend on many factors including, importantly, the types and amounts of food you eat, and the types and amounts of exercise you do.
Of the various types of foods you eat (and liquids you drink), the carbohydrates influence your blood glucose levels and insulin requirements the most. In general, the more carbohydrates you ingest, the more your blood glucose level will potentially go up and thus the more insulin you need to take to prevent this from happening. (The main exception to this is if you’re eating carbohydrates in the form of fibre; fibre does not make blood glucose levels go up.)
If everything else in your life is stable (exercise, stress, general health, and so forth), and if you ingest a very similar amount of carbohydrate day-to-day, then you will likely find the amount of insulin you need to take to keep your blood glucose levels in check will be quite consistent. If, however, the amount of carbohydrate you eat (both in terms of types and quantities) varies quite a bit, then you will need to regularly adjust your insulin dose to match your intake. The best way to do this is to use a technique called carbohydrate counting. We look at this topic next.
Carbohydrate counting involves calculating how many grams of carbohydrate (“carbs”) – excluding fibre – you are about to eat and giving an amount of rapid-acting insulin proportionate to this. For most people, the formula works out to about one unit of insulin for every 10 grams of carbohydrate. For example, if you are about to eat a meal that contains 50 grams of carbohydrate (again, fibre isn’t included in the calculation), you would need to give yourself five units of insulin.
The other key factor in determining how much rapid-acting insulin you require before a meal is your blood glucose level before the meal. If your blood glucose level is high before your meal, you’ll need to take extra insulin to bring it down. This extra insulin is called a correction factor or sensitivity factor and is usually about one unit of insulin for every 3mmol/L your blood glucose level is above 7 or so.
In the accompanying sidebar (“Using carb counting and a correction factor”), we give an example of how to effectively use carbohydrate counting and a correction factor.
Using carb counting and a correction factor
Here’s an example of how to use carb counting and a correction factor.
Let’s say you’re about to eat a dinner that has 70 grams of carbohydrate (including 10 grams of fibre) and your before-meal blood glucose level is 13mmol/L. You are, say, using a carbohydrate counting ratio of 1 unit of insulin per 10 grams of carbohydrate and a correction factor of 1 unit of insulin per 3mmol/L your blood glucose level is above 7.
You will be eating 70 grams of carbohydrate but you exclude the 10 grams of fibre you’ll be eating from your calculations because the fibre doesn’t raise blood glucose. (The amount of fibre in a product is listed on the Nutrition Facts table.) Therefore, 70 grams of carbohydrate minus 10 grams of fibre leaves you with 60 grams of carbohydrate to use for your remaining calculations.
Because you’re now dealing with 60 grams of carbohydrate and you take one unit of insulin per 10 grams, that would mean you need six units of insulin to “cover” the food you’re about to eat.
Because your blood glucose is 13mmol/L and you need to take an extra one unit for each 3mmol/L above 7, you need to take an extra two units of insulin to “correct” the elevated blood glucose level.
You add the six units (from your carb counting) and the two units (from your correction factor), and thus you’d take a total of eight units of insulin.
Fibre is a carbohydrate that doesn’t influence blood glucose. In the recipes in this book, we note the available carbohydrate, which is the total carbohydrate minus the fibre. This is the carbohydrate amount you need to keep track of.
Chapter 2
You Are What You Eat
In This Chapter
▶ Discovering what makes up a healthy diet
▶ Exploring the core nutritional components
▶ Breaking down the vitamins and minerals you need
▶ Staying on top of nutrition with Canada’s Food Guide
Doctors seem to have an obsession with analogies to food. When describing certain diseases, doctors talk about nutmeg liver, strawberry tongue, and cauliflower ear; and when it comes to the risk of diabetes, whether you are pear-shaped (meaning your body is fuller around your buttocks, hips, and thighs) or apple-shaped (meaning being round around the middle). Being apple-shaped increases your risk of acquiring type 2 diabetes.
Eating healthfully is, pardon the pun, an essential ingredient to maintaining good health in general, and controlling diabetes in particular. Indeed, we can think of no better example of the phrase “You are what you eat.” How important is it to fuel your body with healthy nutrients if you have diabetes? Oh, no more important than having oxygen in the air that you breathe.
In this chapter, we look at how your food choices can help you manage your diabetes and keep you healthy. In particular we consider how your nutrition plan can help you
✔ Keep your blood glucose levels under control
✔ Lower your blood pressure
✔ Improve your cholesterol and triglyceride levels (that is, your lipids)
✔ Achieve and maintain a healthy weight
The recipes in this book were created with the preceding factors in mind; that is, the recipes provide healthy food choices that are geared toward assisting you in your quest to control not just your blood glucose levels but your blood pressure, your lipids, and your weight also.
What Is a “Diabetic Diet”?
This could be the shortest section in this entire book because, truth be told, we don’t believe a “diabetic diet” exists, and certainly not in a restrictive or limiting sense. Indeed, virtually any food can be accommodated if you have diabetes. A “diabetic diet” really means a well-balanced, nutritious, healthy eating program.
Because the word “diet” often conjures up so many negative connotations – crash diets, fad diets, failed diets, and so on – all replete with frustration and aggravation, we’re hesitant to even use the word. (Perhaps it’s no coincidence that diet is a four-letter word!) Our preferred term for a “diet” is “meal planning” or simply “healthy eating.” When we refer to a “diet” in this book it is this healthy eating strategy we’re referring to.
The Canadian Diabetes Association (CDA) recommends – as do we – that people with diabetes follow Eating Well with Canada’s Food Guide (which you can find online at www.healthcanada.gc.ca/foodguide, or in an