Three meals and three snacks a day used to be the standard advice given to people with diabetes, primarily because eating numerous times throughout the day was seen as a way to help control blood glucose levels. However, that was before the development of quick-acting and long-lasting insulins and the availability of diabetes medications and easy-to-use blood glucose monitors. With these tools available to manage diabetes, snacking has become a matter of desire rather than necessity.
That was not always the case, however. Snacking had been considered essential as recently as 1995, when the choices of diabetes medicines were slim. Regular insulin was short acting, and the only class of diabetes medications available was the sulfonylureas. A risk with these medicines was low blood glucose—hypoglycemia. In addition, prior to the mid-1980s people depended on urine testing to get—at best—a ballpark estimate of their blood glucose control.
Today, the risk of hypoglycemia is greatly reduced. There are oral medications that do not cause low blood glucose, such as metformin and glitazones. In addition, there are quick-acting insulins, such as Humalog and Novolog, which can minimize the risk of hypoglycemia. Blood glucose monitoring helps people check their blood glucose level, know what it is and manage it accordingly. For all of these reasons, the days of three meals and three snacks are gone.
What, when and how much you eat are still very important
In order to control your blood glucose levels, you need to tell your health care provider what, when and how much you eat to help design your food and medicine plan. Tell your health care provider whether you eat two meals a day or four small meals a day. They need to know if you eat full meals or prefer to nibble, as well as if your meals are at the same time every day or whenever you have a few minutes. The more your health care provider knows about you, the better he or she can match your eating style with available medicines.
It is common for many people with diabetes to find they eat more than they want or eat at times they do not want because of low blood glucose levels. This can result in blood glucose numbers that look like a roller coaster ride, more-frequent-than-necessary lows and undue hunger. It also can result in weight gain from too many calories and too much medicine. These are all signs that your medicines need adjustment. If you feel there’s a mismatch between your food plan and medicines, alert your health care provider.
What About Sugar-Free Foods?
The nutrition claim “sugar-free” or “made without sugar” may or may not mean calorie- or carbohydrate-free. For that reason, you need to know what these words mean and check the Nutrition Facts labels of products before you drop them in your shopping cart.
These foods fall into several groups:
- made with sugar alcohols and other regular sugars
- sweetened solely with a no-calorie sweetener, such as aspartame or sucralose
- sweetened with both sugar alcohols and no-calorie sweeteners
- sweetened with regular sweeteners and a no-calorie sweetener
The latter two are increasingly common.
Foods made with sugar alcohols (polyols) and other sugars: Polyols are found in some hard and soft candies, chocolate bars, cookies and ice cream. The names that you see on the ingredient list are sorbitol, mannitol and lactitol. Many polyols have an “ol “ ending. The benefits of polyols are that they have fewer calories than regular sweeteners, such as high-fructose corn syrup. They may also cause a lower rise in blood glucose than regular sweeteners.
However, according to the American Diabetes Association’s nutrition guidelines, there are no studies that show that the use of foods with polyols help people with diabetes reduce their intake of calories or carbohydrate. Remember, these foods are sugar free, but not carbohydrate or calorie free. And often, they do not lower the calorie or carbohydrate content that much.
One note: polyols, if you eat enough products that contain them, they can cause gas and diarrhea, especially in children. For this reason, the FDA requires manufacturers to put a statement about this on some products. Foods made with no calorie sweeteners: Familiar names of no-calorie sweeteners are acesulfame-k, aspartame, saccharin, sucralose and, the newest, neotame. These sweeteners contain next-to-no calories or carbohydrate. Foods sweetened with no-calorie sweeteners may or may not have calories and carbohydrates from ingredients other than the no-calorie sweetener. Foods, such as diet soda, diet gelatin and powdered drink mix, contain next-to-no calories. Other foods sweetened with no-calorie sweeteners, such as hot cocoa mix, fruit yogurt and maple syrup, contain ingredients other than the sweeteners that may contribute carbohydrates, other nutrients and calories.
