I'm Dr. David Hite, a member of the American Association of Diabetes Educators.
I provide Diabetes Education classes for a large non-profit healthcare organization in Sacramento, California. I know that most of you can't attend my diabetes class in person at the clinic, so I've created an educational DVD and this e-book "Type-2: Straight Talk About Diabetes Self-Care" to help you understand Type-2 Diabetes, and learn how you can Take Control of Your Diabetes or offer needed help to a friend or loved one who may be struggling to avoid the medical complications that often come with this disease. This information is also perfect for those of you who have pre-diabetes and want to reverse those symptoms and avoid progression to diabetes. If you have not already done so, I encourage you to get my complete Diabetes Basics-Take Control DVD presentation and learn even more about your condition. Good health. Live well.

Type-2: Straight Talk About Diabetes Self-Care

Diabetes is a chronic condition. It’s not yet curable. But we do know some secrets to help you stay healthy and avoid diabetic complications. Your doctor is a very important part of staying healthy, so visit and have blood tests 2-3 times each year so you can spot potential problems early and to make sure you're still on track. But also remember what you do for yourself when you leave the doctor is just as important as anything your doctor can do. The secret involves Taking Control of your diabetes by following my 5 M’s of diabetic care. Sounds simple, but you all know that diabetes is a complex and frustrating medical condition. There’s a lot to learn, but the more you know, the easier it will be to stay healthy. I hope this section specifically on the topic of eating healthy meals will help to answer some of your questions and set you on the road to good health.

MEALS

If I have so much sugar in my blood why do I feel so tired and hungry all the time?

When you have diabetes, sugars are trapped in the blood in high amounts. Your cells aren't absorbing sugar properly, and that’s why you may feel hungry and lack energy much of the time. Your body cells are crying out for nourishment despite having sugar all around them. It’s easy for a person with diabetes to overeat in response to these “hunger feelings” and gain weight. This weight gain, especially when the weight is held in the belly area, actually predisposes a person to diabetes and makes it harder to control once you have it because it increases insulin resistance. This inability to use insulin properly causes the pancreas to work harder and tire sooner. Lowering insulin resistance is one key to successful diabetes management.

So how do I regulate my blood sugars?

You can control your blood sugars, but you must do it manually. For most of your life your body was on “cruise control”, and the amount of sugar in your blood was controlled in a very narrow range. But now this sugar cruise control is broken. Your pancreas is no longer automatically controlling your blood sugars. Now you need to take control, and to do that you need to understand the factors that affect blood sugar and how you can make healthy changes that will make it easier for you to self-regulate your sugars and keep them in a healthier range. The first step is twice a day Monitoring of your blood sugars (like driving a car with broken cruise control you need to check your gauges to monitor your speed and then make manual adjustments to avoid problems).

*** Remember low blood sugar is more immediately dangerous than a mildly elevated reading. If your blood sugar is less than 80 when you check, it's time to eat something. If your sugar reading is less than 70 or you're experiencing symptoms and feeling shaky, sweaty or weakness, eat something with fast acting sugar (about 15 grams), such as 1/3 can of regular soda, or half a glass of orange juice or 4 glucose tabs, available at any drug store, then check again in about 15 minutes. If it's still low take 15 more grams. The general rule is that 15 grams of sugar should raise your blood sugar about 50 points, so don't over do it (a full can of soda has 40 grams of sugar!). After your blood sugar reading is over 80 or symptoms subside, eat a small snack with some protein in it to keep your sugar stable.

I really don't want to take pills until I have to. Can I control my diabetes without them?

Yes, often you can, especially in the early stages of diabetes when blood sugars are only mildly elevated. It's even possible to get off Medications after you've started by working hard on the other aspects of blood sugar control. Understand that you're not ignoring your diabetes, but rather you're keeping Medication in reserve, as a safety net, and controlling sugars by employing your other tools: Monitor, Meals, Motion, and Motivation. Ultimately, with or without medications, success is measured by maintaining a healthy blood sugar levels.

Which of your 5M's is the most important?

I think nothing is more important for effective blood sugar control than eating a nutritious well balanced diet. I'm not suggesting that you "go on a diet." The healthy diet I’m talking about could best be described as the total of all nourishment you supply to your body. It includes materials for activity, growth, repair, and enough energy to complete that work. Of course it’s also undeniable that we eat for reasons other than nourishment and fuel, and these important issues will be discussed below. But from the perspective of basic biology, what you eat, when you eat, and how much you eat are the factors that must be confronted if you are going to get control of your blood sugars.

My problem is that everything I eat seems to turn to fat

You might be right! Researchers have discovered that the kind of bacteria in your intestines (your gut), has a strong influence on whether you burn off your calories or store them as fat. Two main types of bacteria live in your gut, Bacteriodetes (good guys), and Firmicutes (bad guys). These gut bugs aid in digestion and the breakdown of waste products, but they may also affect metabolism, fat storage, and inflammation. Evidence is mounting that the balance of these gut microbes determines whether a person will be lean or obese.

The exciting part of this news is that the balance of these organisms is largely determined by factors in the environment, the misuse of antibiotics, and diet. We have some control over these factors! I think that prebiotics that encourage the growth of good bacteria, and probiotics, like active culture yoghurt which contains live "good guy" bacteria, might help influence this balance of power and help swing us back to a healthy state. So we really "are what we eat". Feed the good guys, eat healthy! To learn more about this new research click on these links: Bacteria and Obesity, and this one: gut flora (scroll down to read the section on obesity), and finally this new article from July 2010 Newsweek magazine: How bacteria could make you fat

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I've heard that eating a low carb diet can help control diabetes.

I'd qualify that and say that eating a lower carbohydrate diet can help control blood sugars. Carbohydrates, classified as either simple (sugars) or complex (starches), are the simplest food type and so require the least amount of processing in the digestive tract. They are usually released into the blood quickly (15 minutes) where they stimulate the release of insulin from the pancreas, which allows them to be absorbed into the cells for energy. A healthy pancreas has little problem doing this, but for someone with diabetes, or at risk for diabetes, this puts tremendous stress on an already weakened pancreas.

Well then, why not avoid carbohydrates altogether.

Carbohydrates are fuel foods, and we all need energy. Carbohydrates should be eaten in quantities that match your circumstances (i.e. - activity level and metabolism). Lance Armstrong, the famous bicycle racer, got 70% of his calories from carbohydrates. But clearly he had enormous energy demands he had to meet. Most adults, with slower metabolic rates, and a less active lifestyle usually shoot for about 50% of their intake of food in the form of carbohydrates. I think someone with diabetes could eat less, maybe as low as 40% carbohydrate, but it's not really that simple. Besides controlling the amount of carbohydrate in your diet, you need to pay attention to the quality of your "carbs" as well. High quality carbohydrates are natural and unprocessed, and contain plenty of vitamins, minerals and most importantly fiber.

If you are interested in trying this, check out the South Beach Diet. It's a lower carbohydrate diet that encourages eating lean protein, healthy fats, and high fiber natural "good carbs". I think on balance it offers a sensible lower carbohydrate plan.

A similar reduced carbohydrate plan comes from the Mayo Clinic. It's based on their "Healthy Weight Pyramid" that emphasizes not only a healthy diet, but also exercise, weight loss and health promotion. The diet itself recommends filling up on vegetables, whole fruit, high fiber carbohydrates and healthy fats. This diet is not specifically designed for diabetics however, so I think you should be prudent and limit your intake of fruit. A word of caution here; there has been "fake" mayo clinic diets around for some time. These diets are not associated with the actual Mayo Clinic and are what I would call "fad" diets not based on healthy eating principles. You can read more about their approach at the official website at: Mayo Clinic Diet.

What's so important about fiber?

Fiber plays many roles in a healthy diet. First, fiber slows digestion, and this slows the amount of sugar that’s released into the blood at any one time. Remember the old saying; “The whiter your bread, the sooner you’re dead?” Well that’s just a way of saying we need more fiber in our diet. Americans average only about 17 grams of fiber a day, but we need twice that much. Grains have three parts: the germ, full of healthy oil and protein; the bran, or fiber, which slows digestion and helps you feel full, and starch a complex carbohydrate made of sugars that are linked together in long chains. White bread is made with only the starchy part. Whole grains provide the natural balance that nature intended. When you eat starchy foods like white potatoes, or refined starches with the fiber taken out, it raises blood sugars nearly as fast as pure sugar, putting a real strain on your pancreas. Sugars, from the broken down starches, flood into the blood like freeway traffic at rush hour.

One way to combat this blood sugar "traffic jam" is to increase the fiber in your diet by eating fresh vegetables; beans, legumes, peas and lentils; whole grains and cereals; and maybe a piece of fruit each day. To help increase your daily fiber intake try a whole grain, high fiber pasta like those from Dreamfields. Eat brown rice instead of white sticky rice. Switch from white potatoes to a red skin potato, new potatoes, or try a yam or sweet potato. If you like cereal for breakfast be sure to stay away from sugary brands. Try a healthy high fiber cereal like those from Kashi. These carbohydrates take longer to digest and enter the blood, reducing that after meal blood sugar spike.

Another trick is to eat your starches al dente, or slightly chewy. Undercooking starches helps keep the starch from turning gooey and breaking down right in the pan. Aim for 30-35 grams of fiber per day, but add it slowly, maybe 5 grams at a time, and note your body's response. Fiber helps to keep you regular and avoid constipation, but too much fiber too quickly may cause bloating or diarrhea. Natural sources of fiber are of course best, but if you want to add additional fiber in supplement form, I recommend Benefiber brand. It’s made from soluble fiber so it doesn’t taste gritty and will also help lower your cholesterol.

If I reduce my "carbs" don't I have to increase my fat and protein intake?

Yes, it all has to add up to 100%, but it's not as bad as it sounds. Increasing your lean protein and healthy fat intake can provide real benefits if done correctly. The sugar traffic jam I described above touches on an important concept, so let's get into detail by reviewing some basic principles of nutrition first. All edible foods fall into three categories; proteins, fats and carbohydrates. That means that everything we eat is made up of one of these types or a combination of the three. Each is different in its complexity requiring different amounts of time to disassemble it (digest it), and each has its own special purpose in the body, so finding a proper balance is very important.

This idea is better known as Glycemic Index and I think it offers a good strategy to follow if you’re struggling with your meal planning. The idea is based on a simple observation: Foods don’t digest and supply usable energy at the same rates. Some digest slowly and some digest quickly and when we mix them we can alter the effect (like making sure you have food in your stomach when you drink alcohol - it slows the effect on the body). The concept might be more obvious to you if you think about starting a fire in your fireplace. You know to be careful of lighter fluid because it burns so quickly. Kindling burns slower and helps to stoke the fire and get it going, and a log burns most slowly and provides slow continuous energy. In the same way we need to find a healthy balance in the types of foods we eat. Choose to eat the right balance of foods so your body is supplied with the type and the amount of energy we need; Lean protein and healthy fat will provide you with steady energy so you feel full and satisfied, complex carbs will stoke your internal fire and give you energy when you need it, and fast burning sugars? Well, unless you're training for the Tour de France, those are troublesome and you’re going to have to go easy.

Let's discuss protein in more detail. Protein is what we’re made of; muscle, skin, hair, blood, our internal organs; all protein. So when we eat protein we do so primarily to bring in building supplies for growth and repair. Protein supplies us with four calories of energy per gram, the same as carbohydrates, but protein is very complex and therefore burns slowly providing that satisfying full feeling longer. This is the food that sticks to the ribs and will help stabilize blood sugars. Every meal should include some high quality lean protein. Good sources of protein are beans, peas, lentils; low fat dairy, and yoghurt; lean meats like chicken, turkey and fish; and nuts and seeds. Even lean cuts of beef and pork can be included in modest amounts. Eggs are also a great source of protein. Although the yolk is high in cholesterol, I think their bad reputation is undeserved. One egg per day shouldn’t cause problems for your cholesterol levels. I believe a healthy diabetic diet should include about 20-25% protein. A word of caution here however, if you’re suffering from kidney disease your protein intake will need to be lowered somewhat to accommodate any decreased function. Ask your doctor to be sure exactly how much you should include in your diet.

Healthy fats? I thought fat was bad for you.

Fats aren't bad for you; bad fats are bad for you! Healthy fats are, well, healthy. Fat is the richest form of food in our diet, supplying nine calories of energy per gram. Bite for bite that’s more than twice the calories of any other food. It’s complex and slow burning so it mostly provides us with a slow steady background fuel for our body’s daily metabolic needs. It’s also our savings account for times when food is scarce, so we come by our craving of fatty foods naturally. The ability of our ancestors to store fat during times of plenty is certainly one of the most important biological adaptations ever made, but our intake needs to reflect the changes our culture has made and today’s new realities. The television psychologist Dr. Phil says it this way: “We don’t eat any more calories than our grandparents; the problem is we don’t do what our grandparents did.” In other words listening to this ancestral urge to store extra fat for lean times needs to be balanced with the reality that those lean times don’t happen much any more, so nowadays we’re storing too much fat and it’s killing us. The average American brings in about 40% of their calories from fat, and most of that is from unhealthy sources. I think 30-35% is a better number and remember these should come from healthy sources. Natural fats from plants in the form of oils should be the main source of fat in our diet. Olive oil, canola oil, the oils from nuts and seeds, omega-3 oils, and yes, even avocados are cholesterol free and full of healthy fat. They’re easy to digest and use for fuel rather than storing around the waistline. Peanut butter is a great snack, but be sure to get the natural kind. Make room in your diet for these healthy fats by getting bad fats out!

Okay, so which ones are the unhealthy fats I should avoid?

Bad fats come from two sources, one natural, the other man-made. They are - animal fats and trans-fat. These types of fat are easily recognizable because they’re solid at room temperature; white and greasy. They’re like this because of their chemical structure. The carbon chain that makes up the backbone of these fat molecules is surrounded, or saturated with hydrogen. This hydrogenated fat is structurally stable and therefore difficult to break down. Good for frying, bad for digesting. Remember too that cholesterol only comes from animals, so animal fat is loaded with it. Trans-fats are artificially saturated with hydrogen. These hydrogenated (or partially-hydrogenated) fats are made by forcing hydrogen onto a plant fat where nature didn’t have one before. Crisco first made “shortening” in 1911. This new form of man-made fat, solidified plant fat, was more resistant to breakdown and didn’t turn rancid as fast. This allowed the commercial food industry to box foods and put them on the shelves without fear of spoilage. The problem? We now understand that the bond that’s created in this process, the trans-bond, is difficult to digest (in Latin the word ‘trans’ means across). The carbon chain twists, leaving the added hydrogen across from each other - a trans-fat). Trans-fats, being resistant to breakdown, tend to stick around and cause health problems. If you don't burn it, you wear it.

While trans-fats have no cholesterol themselves they do cause your bad cholesterol to go up, your good cholesterol to go down, and also increase insulin resistance and blood vessel inflammation that leads to an acceleration of the diabetic complications we discussed earlier. In January of 2006 the U.S. government began requiring that food labels show the amount of trans-fat in all packaged goods. Fast food restaurants however aren’t getting the message and are probably the greatest source of these artery-clogging fats. Bad idea. Avoid them! If you’re unconvinced about this or need reminding, play the clip from the documentary "Fast Food Nation", or watch the movie "Super Size Me". It’s a real eye opener. It’s about a young man who ate three meals a day from McDonalds for a full month. Not a happy ending. Trans-fats really need to be avoided in all foods. Read food labels and choose wisely.

What about butter and margarine? Which is better for you?

Butter is an animal fat and has loads of cholesterol so use it sparingly. You need some cholesterol, but your liver makes all that your body needs. Cholesterol isn’t bad, it’s actually necessary to help strengthen cell walls and also to make bile and certain hormones your body needs. Too much cholesterol however will build up and clog arteries increasing your risk of heart attack and stroke. Remember when you have diabetes you have extra sugars in the blood which damage the smooth inner lining of your arteries. In the same way that rough, damaged spots on a Teflon cooking pan cause food to stick, rough spots in your blood vessels give cholesterol a chance to stick and begin to clog. One million heart attacks and half a million strokes occur in this country every year because of clogged blood vessels. Watch your cholesterol levels! Margarines on the other hand are made from liquid vegetable oils, which have no cholesterol. The problem here is that the oils must first be hardened into a spreadable form. It’s this process of artificial hardening called hydrogenation that turns them into unhealthy trans-fats, the worst kind of fat (remember Oleo?). Manufacturers of margarines however are trying to make healthy changes. New spreads that don’t use trans-fats are appearing on the market and these are considered healthy to eat. Look on the label before you buy and choose brands that use healthy fats. Benecol or Smart Balance are two that I would recommend.

I usually skip breakfast to help keep my sugars down. Is this a good idea?

No, it's actually a very bad idea to skip breakfast. It seems to defy logic, but studies have shown that people who skip breakfast actually weigh more than people who eat breakfast. People who skip breakfast because they’re not “hungry” or because they think they can save a few hundred calories and help their weight loss plan; actually do more harm than good. Skipping breakfast means you will likely go 16 hours without food. This sets off a reaction in your body similar to a starvation reaction. Your metabolism slows and your body begins to crave food. During times of starvation your body actually starts to burn lean muscle tissue and tries hold on to its supply of fat. When you do finally eat your body is so “starved” that you tend to eat too much and often eat the wrong foods. Large meals alternating with periods of starvation set up a "roller coaster effect" with blood sugars ranging high then low then high again. Stay off the roller coaster! Eating smaller meals, more often will help to stabilize blood sugar swings and provide just enough fuel that you don’t feel hungry or deprived. In fact getting into the habit of eating a little something every 3 or 4 hours during the day makes a lot of sense. Hunger is a survival mechanism. By the time you feel “hungry” your body is already making unhealthy metabolic changes that are working against you.

I know it would help if I bought better foods. Any help with grocery shopping?

Be especially careful when you’re going grocery shopping or heading out to a restaurant to eat. Grocery shopping when you’re hungry often leads to poor choices and the purchase of foods you know will sabotage your diet plan. Make a list before you go and be careful of adding “impulse items” while you’re shopping. Heeding the old saying "shop around the outside of the market" is pretty good advice. Nowadays restaurant meals are much too large to be eaten all at one sitting. Don’t eat large meals! Besides affecting your blood sugars, heartburn and related conditions are made worse when you eat too much because abdominal fat doesn’t make room for your stomach to expand very much. The pressure created on the stomach causes food to be forced back up into your throat where sensitive tissue is burned by stomach acid. You can protect against “portion distortion” by asking for a carry-out box when your meal is brought to the table. Divide the portion before you start eating and you won’t struggle with the issue of when to stop eating. Of course if you are with someone, simply sharing one meal is a great solution to portion distortion.

I've heard about portion distortion. So how do I know how much to eat?

That’s tricky. When patients ask me “how many calories do I need to eat each day?” I respond by saying “It depends.” Not a satisfactory answer I know, but they would get the same answer if they asked me “how much gas do I need in my car each day?” You know that depends on how much your car burns and how far you drive each day. How much you eat should be based primarily on need. Your body needs fuel based on two things, your basal metabolism, and your activity level. Basal metabolism is how much you burn at rest. In general you can figure it this way: Your body is burning about 1 calorie of energy every minute just to carry on basic life processes. Since there’s 1,440 minutes in each day, you would need to provide that much fuel in balanced amounts to maintain your present weight. Any more fuel than that will be stored as fat for future needs and you gain weight, less fuel than that and you will have to withdraw some energy from your fat cells to make up the difference and you’ll lose weight.

Of course you don’t sit or sleep every minute of the day, so each minute that you’re more active you’re burning more than one calorie per minute. Walking burns about 5 calories per minute and more vigorous activities burn even more, perhaps 10 calories per minute. Remember Lance Armstrong? He ate 7,000 calories a day to meet his needs during his bike racing days. Now that he’s retired he has to cut back and eat only what his less active body needs. You need to find the range that meets your caloric needs. I’m guessing that for most of you it will be between 1,500 and 1,800 calories per day. This amount is enough to supply good balanced nourishment, and also enough food that you don’t feel deprived. Never eat less than 1,200 calories each day unless you are under direct care from a medical doctor or registered dietician. Don’t try to starve yourself! Diets that are too strict are destined to fail because they are so restrictive it’s virtually impossible to stay on them very long.

Here's a trick you can use to see if your meals are balanced as to carb-protein-fat content and are the proper portion size. Check your blood sugar before you eat and then again 2 hours after your meal. Your blood sugar at that time should be less than 180. Check like this often to satisfy any doubts you have and learn which meals are balanced, and which need to be re-worked.

What about sugar substitutes? Can I use them without raising my blood sugar?

Artificial sweeteners aren't digestible, so they don't raise blood sugars; however some people believe that using sweeteners triggers the urge for more sweets. I think that sugar substitutes like Sweet-n-low, Equal (NutraSweet), or Splenda, as a way of cutting back on sugar, can play a useful role in your diet if used in moderation. Some concerns have been raised about their long-term safety. Aspartame, the sweetener found in Equal (NutraSweet), is said to be unstable when it gets hot, causing it to break down into harmful byproducts. I personally don’t think the evidence they cause harm is strong enough that they need to be totally avoided, but if you believe you’re having side-effects like headaches or body aches, stop using them altogether. Of the three products available on the market, I think sucralose, sold under the brand name Splenda, is the best choice. The main advantage is that it’s chemically stable and won’t break down even when you cook with it. This can really help those of you who are trying to prepare satisfying meals for a family. I also think it has a more natural taste, so no one is likely to notice the substitution. The fact that Splenda is so chemically stable is also an advantage because since it isn’t broken down into other chemicals, isn’t absorbed into the body tissues and is quickly eliminated from the body unchanged; I see no potential for harm. Daily coffee or a diet soda once in a while is not likely to cause any problems, but half a dozen diet sodas a day is way too much and not a good idea.

Another group of sweeteners, sugar alcohols like sorbitol or maltitol, are digestible and will raise blood sugars some, though usually not as much as sugar itself. The thing to be careful of is how much you’re getting. Sugar alcohols have a laxative effect and some people are very sensitive to them. If you have diarrhea after eating sugarless ice cream, or dietetic chocolates, this is likely the cause. Go easy on these until you know how you’re body is going to react.

A new product on the market that might be useful is Stevia. Stevia comes from the leaves of a South American plant. It can be purchased by that name or as "Truvia". I've gotten mixed reviews from my patients, but give it a try and see if you like the taste.

What about cinnamon? I heard it lowers blood sugar.

Research has shown that as little as 1 gram (1/2 teaspoon) of cinnamon may in fact help lower blood sugars. The type of cinnamon used in most of these studies is cassia cinnamon, sometimes call Chinese cinnamon (This type is different from Ceylon or true cinnamon). Cassia cinnamon is the most common type found in this country, but check the label to be sure. The active ingredient in cinnamon is Proanthrocyanidin, the water soluble part of cinnamon. It is thought to function by activating the insulin receptor on the surface of the cell allowing the cell to absorb sugar from the blood. Cinnamon oil did not show this blood sugar lowering effect. I think, given these research findings, that cinnamon supplements may be helpful if nothing more than offering a tasty addition to food besides sugar. Talk to your doctor about this and then proceed carefully so that you don't put yourself at risk of a hypoglycemic event. Just in case it actually works.

What do you think about supplements in general?

I think supplements can be useful safeguards. Be clear with yourself however; supplements are not substitutes. There are no shortcuts that can take the place of a healthy lifestyle. I see it as 95% healthy choices and maybe 5% help from supplements, not the other way around. Over my years as a diabetes educator I've heard about many "miracle cures" for diabetes. I'm open, but also a bit skeptical. If you want to try fish oil, or a good multiple vitamin or ginkgo biloba, chromium, or selenium, talk to your doctor first (some supplements can have significant effects on things like blood thinning). Then find a reputable company. This industry (food supplements) has very little oversight and I have heard horror stories about purity issues, and "fake ingredients". Here is a website link that may help direct your search: Nutrition Data. Another site, run by the U.S. Department of Agriculture is: Food and Nutrition Information Center.

Can I drink alcohol?

While it's not absolutely forbidden for a healthy diabetic to drink, alcohol use may complicate your treatment plan for a number of reasons. Drinking alcohol will in the short term raise blood sugars because of the carbohydrates in the drink, but in the hours following you may put yourself a risk for a hypoglycemic episode (low sugar) because of the effect alcohol has on the liver. Never drink on an empty stomach. Remember that many of your medicines advise against using alcohol because it can increase the risk of side effects or magnify them. This is an important discussion that you need to have with your doctor. Together you can come to an understanding of what your risks are and whether a glass of beer or wine with a meal is okay for you.

Sometimes I find myself eating when I'm not really hungry. What can I do about overeating?

My final thought on eating has to do with the constant battle of wants versus needs. Many of my patients struggle with overeating not so much because of hunger, but because of a lack of satiety. Satiety is the feeling of being satisfied with a meal and is just as powerful an urge as hunger itself. Here are some ideas on that. First, take smaller bites and eat more slowly. The feeling of fullness after a meal is not just in the stomach, it’s also in the brain. The body produces chemicals, which control the urge to eat. One of these hormones, leptin, is responsible for letting the brain know when you’re full and should stop eating. The problem is that it takes about 30 minutes for this chemical to be released and go to work. If you eat too fast you can “over-consume” and eat far more than your body really needs or wants. If you’re eating small meals more often, as I suggest, this will be much easier to do because you won’t feel so starved that you lose control. Emotional eating, and by this I mean compulsive eating, is sometimes a sign of clinical depression. Talk with your doctor or counselor about your feelings about food and eating.

Take joy in eating. It's a good thing when it’s done in a healthy way. Don't make food the enemy or you'll be doomed to fight your whole life. Guilt is just "stinkin thinkin”.

In his book Healthy Pleasures Dr. David Sobel suggests that if we learn to enjoy all of the pleasurable aspects of eating we benefit by feeling greater overall satisfaction. Learn to eat more slowly and savor your food. Use this time to talk to your companions. Eat a wide variety of foods and take time to appreciate all the different flavors and smells and textures. Even the process of cooking itself is an important part of the joy of eating. Enjoy the whole experience. All of these things will leave you feeling more satisfied after meals and help you guard against mindless over-consumption.

Here are some other helpful books and websites that will help you stay motivated and on track.

Diabetes Burnout by William H. Polonsky, is a supportive guide to keeping you on track during tough times.

For healthy eating tips I think the Mayo Clinic Healthy Weight Pyramid is a good guide to follow, but remember you will have to limit your intake of fruit.

Michael Pollan's book In Defense of Food: An Eaters Manifesto is a fantastic book and will make you reconsider everything you thought you knew about food. His advice is simple: "Eat food. Not too much. Mostly plants." Follow his motto: "If it came from a plant, eat it; if it was made in a plant, don't."

The South Beach Diet is a lower carbohydrate diet that encourages eating lean protein, healthy fats, and high fiber natural "good carbs".

Check out Toma Grubb's website and new book Toma's Diabetic Diet - A Layman's Guide to Controlling Blood Glucose with Diet.

He includes a trial version of CyberSoft's Nutribase-7 Personal Plus Nutrition and Fitness Software that helps you make healthy eating choices and track the results.

One of the early pioneers of diabetes information online is David Mendosa. His website is an excellent source of information on all things related to diabetes. Toma and David are both living well with diabetes and are an inspiration to others wanting to control their blood sugars and avoid health problems by adopting a healthy lifestyle.

A good book and resource for understanding glycemic index and healthy eating is The New Glucose Revolution. by Jennie Brand-Miller.

I also think you should get a calorie-counting guide and begin to learn about the foods you eat. I recommend Allan Borushek’s The CalorieKing Calorie, Fat & Carb Counter. This book is full of great ideas and explanations about how to make healthy food choices.

For those of you who like to chat online, I will recommend a wonderful website where you can network with other people with diabetes, ask questions and get ideas and support at Diabetic Connect.

Finally, if you would like to get involved with community-based programs that increase awareness about diabetes, the American Diabetes Association website can help get you connected and active locally.

I hope my explanations in this e-book have been helpful. If you have not already, I encourage you to get my complete Diabetes Basics-Take Control DVD presentation and learn even more about your condition. Be your own advocate, your own best friend, and most importantly, don’t beat yourself up over small setbacks. Believe in yourself and in your ability to take control of your life and control your diabetes; then take the first step toward living a healthy life. Remember, knowledge is powerful only if it leads to positive change. If this e-book was helpful or if you have suggestions to improve it please email your comments to: Doc@healthdoc.org. Good health. Live well.

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