Diabetes Meal Planning Made Easy. Hope S. Warshaw

       Glycemic Index and Glycemic Load

      The use of the glycemic index (GI) and glycemic load (GL) in diabetes meal planning has been an area of debate for several decades. The ADA suggests that GI and GL may be valuable concepts for people with diabetes if these measures are used in addition to and after careful monitoring of total carbohydrate intake; however, using GI or GL to choose foods may or may not help you make healthier food choices. For example, you might decide to eat lentils or barley instead of white rice because lentils and barley have a lower glycemic index. Conversely, choosing a high-fat food like ice cream because it had a low GI instead of a serving of fruit with a higher GI, a banana or fresh pineapple, doesn’t make sense. Think of GI and GL as another factor, rather than the main factor, to consider when you choose which foods to eat.

      The GI measures the increase in blood glucose levels during the two hours after eating a particular kind of food. Some foods that contain carbohydrate create a quick and more dramatic rise in blood glucose, while others cause a slower and less dramatic rise. Glucose is the standard for the glycemic index and is assigned an arbitrary number of 100. Other foods are assigned GI numbers relative to the glucose standard of 100—either higher or lower. Today, there are several different glycemic indexes in use.

      Keep in mind that GI numbers are available only for several hundred commonly eaten, non-mixed foods. In other words, foods like carrots, watermelon, and potatoes have GI numbers, but casseroles and vegetable soup do not. It’s also important to note that the type of carbohydrate (e.g., starch or sugar) does not consistently predict the GI. For example, some fruits have a low GI and others have a higher GI. The GI doesn’t consider typical food portions; however, GL does. The GL takes the glycemic index of a food and then factors in its common serving sizes to give a more practical indicator of the effect that food will have on blood glucose.

      Raising Your Blood Glucose

      Other factors that contribute to how foods raise your blood glucose are

      • your blood glucose at the time you eat

      • how much blood glucose-lowering medicine you take, when you take it, and when you eat

      • your level of insulin resistance in general and at the time you eat the food(s)

      • individual responses to foods and different responses on different days

      • the amount of fiber and whole grains in a meal (these can slow the rise of blood glucose)

      • how ripe a fruit or vegetable is when you eat it (the riper the food, the more quickly it can raise blood glucose)

      • the form of the food (for example, fettuccine can affect blood glucose differently than macaroni)

      • the variety of the food (for example, long-grain or short-grain rice, Yukon gold or red potatoes, and when and where a product was grown)

      • whether you eat the food raw or cooked (the more a food is cooked, the more likely it is to raise blood glucose quickly)

      • the other foods you eat along with the carbohydrate (a meal that is mainly carbohydrate with a small amount of fat will raise your blood glucose more quickly than a meal with more fat)

      Many of the foods that have a low GI are healthy foods. Consider eating more whole-grain breads and cereals, legumes (beans), and fruits and vegetables. Include these foods in your eating plan, but don’t completely omit foods with a higher GI if they are healthy foods and you enjoy them.

      You may find it helpful to create your own personal GI by recording the results of your after-meal blood glucose checks. Make notes about your experiences with certain foods and meals, and note what changes you might make when you eat that food or meal again, such as eating a smaller portion, avoiding them, or adjusting medicine (if you can).

      Consider using the concepts of GI and GL in conjunction with other healthy eating strategies and priorities. First, look at your total carbohydrate count at meals, limit your intake of sweets and sugars, increase the amount of whole grains, fruits, and vegetables you eat, and then factor in the GI or GL of a food.

      Protein

      The ADA suggests that eating 15-20% of your calories as protein is fine as long as you don’t have diabetes-related kidney disease. This is not a lot of protein, as you can see in the model meals on pages 53-58. Eating 15-20% of your calories as protein certainly doesn’t allow for an 8-ounce piece of steak, fish, or chicken each night at dinner. Eating smaller (about 2-4 ounces), as well as leaner, portions of animal protein will also help reduce your intake of saturated and trans fat and will help you to reach your blood lipid targets. Read the information on fat, below, to learn more.

      Protein can influence blood glucose, but to a much lesser degree than carbohydrate does. In people with type 2 who still make some insulin on their own, protein intake can cause an increase in the release of insulin from the pancreas; however, this doesn’t raise blood glucose. Because people with type 1 diabetes no longer make insulin, moderate amounts of protein have little effect on blood glucose. Keep in mind that a high-protein meal, which is often also high in fat, can cause a delayed rise in blood glucose.

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      Most Americans eat more protein than their bodies need to be healthy— about 15-20% of your total calories. Portions need to be closer to 2-4 ounces cooked to achieve this goal.

      Fat

      As a person with diabetes or prediabetes, you may have abnormal blood lipid levels (unhealthy LDL, low HDL, and/or high triglycerides) and high blood pressure. Because these conditions put you at risk for heart and blood vessel problems, the most important advice for you is to limit the amount of saturated fat you eat to less than 7% of calories and to keep trans fat as low as possible. In years past, there was more emphasis on eating less total fat. Today, experts believe that anywhere from about 20-40% of your calories can come from fat. The key is to minimize the unhealthy fats and oils and to get the remainder of your calories from fat from the healthier monounsaturated and polyunsaturated fats. With our food choices today this is easier said than done. Try to keep your trans fat intake as close to zero as possible.

      Fat affects blood glucose by slowing down the