Maudene Nelson, RD, CDE has been a nutrition educator at the Columbia University Institute of Human Nutrition for the past thirty years. She is also a diabetes [healthopedia] educator at the Naomi Berrie Diabetes Center where she teaches people with diabetes how to make their diets better in order to improve their health. Here she tells us how people with diabetes can start changing the things they eat to manage their diabetes.

Q: When you're talking to people with diabetes about their diet, do you have different recommendations for people who have Type I diabetes and those who have Type II diabetes?

A: The most important thing in diabetes care is that you personalize it.  There isn't a cookie-cutter treatment for someone who has Type I diabetes or Type II diabetes.  Instead, the goal is to adapt the dietary goals to each person.

Our goal as certified diabetes educators is to get the person's blood sugar level [healthopedia] to stay as close to normal range [link to anchored question below] as possible throughout the day.  For most people, they can do this by keeping track of the amount of carbohydrates [link to anchored question below] in their diet.  The good news is that there's almost no food that you have to say, "I can't eat that because I have diabetes."  It's about learning to count how many grams of carbohydrates you're eating.  It's easy once you practice.

You also want to keep an eye on the kinds of and amount of fat you're eating because that will have an impact on your cholesterol level.  Having diabetes increases the risk of health complications that involve your blood vessels. Examples are stroke and heart attacks.  High cholesterol is related to damaged blood vessels, so the lower you can get your LDL cholesterol, the better.

Q: What is a carbohydrate?

A: Carbohydrates are sugars and starches.  We get them from all plants (such as vegetables, fruits, potatoes, rice, corn, oatmeal, and bread) and milk.  A sugar and a starch are basically the same thing. Carbohydrates that you eat will become glucose in your blood in about ten minutes.  This is normal.  If you have diabetes it's possible to manage your blood sugar level by watching how much carbohydrates are in your meals and snacks.

Q: What is a "Normal range" of blood sugar?

A: For someone who doesn't have diabetes, their blood sugar level should be between 65 and 100.  For someone who has diabetes, their blood sugar level should be under 110 for as much of the day as possible.

Q: How do you know what your blood sugar level is?

A: Generally, somebody who has diabetes will use a small meter.  It's very simple. You use a tiny device to stick your finger and get a very little drop of blood.  People may feel squeamish about this at first, but very soon it becomes routine.  Anyone who can put in contact lenses or change their pierced earrings, can stick their finger to check the blood sugar.  The little drop of blood is placed in the meter, and it tells you what your blood sugar level is in less than thirty seconds.

Q: How do you know the amount of fat and carbohydrates you're eating?

A: Information on fat and carbohydrate is on food labels.  When checking the label be sure to find the "serving size" - the information on grams of carbohydrate [link to anchored question above] or grams of fat is based on this amount.  Other than food labels, one can find information on the fat and carbohydrate content of foods on the government website www.nutrition.gov and many other online sites.  There are many books available that list nutrient information.

To make sense of the amount of carbohydrate [link to anchored question above] and fat that in on your plate, you can start by measuring your food.  Use standard measuring cups to know the amount that you eat.  To know the amount of meat that you're eating it's ideal to use a scale.  Another way to estimate ounces of meat is to use another reference point.  For example, a deck of cards is approximately 3 ounces of cooked meat (one serving).   

If you want to track your total carbohydrate [link to anchored question above] or fat from day to day, keep a log or diary.  Write down everything, being thorough about measuring the quantity or portion size.  Most likely you'll know your average fat and carbohydrate per meal or per day after a few days because we're all creatures of habit. 

By looking at the foods you've eaten in a week you can figure out the amount of carbohydrates in your favorite foods. A nutritionist or dietitian can help you learn how to do this.  Once you know how much you're eating, you can work with your nutritionist to set a goal about the number carbohydrates you can have in a meal in order to keep your blood sugar in a good target  range [link to anchored question above] .

If you are interested in working with Maudene Nelson and bringing nutrition into your community, please e-mail her at mln2@columbia.edu.

Harlem Word is a series of interviews with community health experts written by HHPC and reviewed by our Health Advisory Board.