Diabetes and the seriousness of the diagnosis cannot be understated, particularly by Latinas who are at greater risk for developing the disease. On the positive side, however, it’s one of the few diseases that can be controlled with proper medication, diet, and exercise. “My simple advice to patients is to watch your p’s and q’s, or portions and quality,� says Lorena Drago, nutritionist and director of diabetes education at Lincoln Hospital in New York. “Diabetes patients need to watch how much they eat and replace quantity with quality foods.� Along with a good diet, the second element of a healthy lifestyle includes exercise, and when it comes to diabetes, the effect can be powerful. “Exercise helps insulin in the body work more effectively,� explains Drago. “I ask my patients, ‘If you had a pill that was free and that lowered cholesterol, helped manage blood sugar and had zero side effects, would you take it?’ They usually respond with a yes, so I tell them: ‘Go in your closet and get your sneakers because that’s what exercise will do.’� There are several types of diabetes, the most common is Type 2, which accounts for 90–95 percent of all diagnosed cases. It develops gradually, starting with insulin resistance. Associated with older age, obesity, and family history of diabetes, among other things, Type 2 diabetes can eventually cause the pancreas to lose its ability to produce insulin, the essential protein for metabolizing glucose or blood sugar, the fuel on which the human body runs. Certain foods can help or hinder this conversion process, so diabetics need to approach dieting aggressively in order to offset the graver effects of the disease, like blindness, loss of limbs, or heart disease. Foods that are low on the glycemic index appear to have less of an impact on blood sugar levels after meals. According to WebMD: “For people with diabetes, the total amounts of carbohydrates consumed each day must be monitored carefully. Of the different components of nutrition—carbohydrates, fats, and proteins—carbohydrates have the greatest influence on blood sugar levels.� . In her work counseling diabetes patients, Drago admits that many foods on the Latino menu fall under the carbohydrate category, particularly staples like rice, potatoes, and plantains, and Latinas are particularly reluctant to give them up. Using her portions and quality rule, she advises Latinas to consider replacing certain foods with healthier foods or rather than deleting them, eating less of them. The recommended amount of carbohydrates consumed per day for a diabetic is 150 grams, or 50 for breakfast, lunch, and dinner, Drago asserts. “One cup of cooked rice has 45 grams of carbohydrates. So in one meal, you’ve already matched your whole carb quota with rice. If you eat half that amount, or add more vegetables to the rice, or cook with olive oil rather than corn oil, you can reduce the carbs,� she offers. A native of Colombia, Drago says she pursued nutrition as a career because she loves to eat. “I believe access to good food should be a right,� she stresses. Drago began working with Latino diabetes patients in New York when she noticed a dearth of resources for Latinos from different cultural backgrounds. She’s also the published author of, Beyond Rice and Beans published in 2006 by the American Diabetes Association and co-authored Cultural Food Practices, published last year by the American Dietetic Association. The goal of nutrition for people with diabetes is to attain the ABCs of diabetes, or “the trio� as Drago calls them, blood sugar, blood pressure, and cholesterol. The A stands for the A1c or hemoglobin A1c test, which measures average blood sugar over the previous three months. Normal blood sugar levels are between 70–120 mg/dl according to the American Diabetes Association. B is for blood pressure, and C is for cholesterol. “Patients need to ask themselves, ‘Can I still eat what I like and fit in my favorite foods, and manage the trio,’� Drago states. Grissel Lopez was diagnosed with diabetes more than five years ago. She admits that she was overweight at the time and did little exercise. Her father and grand mother both suffered from the disease. A clerk with the WIC program at the Lincoln Hospital and mother of two, Lopez has lost 20 pounds since then but she still struggles with diet. “I’m Puerto Rican and lots of my favorite foods are carbohydrates. I try to eat salads for lunch and avoid fast food,� she says. “I haven’t lost more weight but I do remain steady at the same weight.� Lopez manages the disease with medication and she has added walking as a form of exercise. “I tell clients to just get out of the house and walk for 10 minutes and then walk back, that’s 20 minutes of exercise,� asserts Drago. “Or for those who live in less safe neighborhoods, take advantage of our music and just dance.�

Making Healthy Food Choices

When you have diabetes, eating well takes practice and planning. A good balance of the right foods, along with regular exercise and your prescribed medications, can help you feel better and stay healthier. Work with your doctor and dietitian to create a meal plan that:. • works with your schedule • keeps your weight on track • improves your blood glucose, blood pressure, and cholesterol numbers

What Can I Eat?

The Diabetes Guide to Healthy Food Choices (Source: American Diabetes Association) How is diabetes managed? Taking care of diabetes is up to you. Your part in taking care of your diabetes includes: • Choosing what, how much, and when to eat • Including physical activity in your daily routine • Taking medicine (if needed) • Learning all you can about diabetes: read, ask lots of questions, and attend diabetes education programs. Nutrition Basics In the past, diets for people with diabetes were very restrictive. Things are different now. People with diabetes watch what they eat and try to make choices that include their favorite foods into their meals. There isn’t a one-size fits all “diabetic diet.� Everything is individualized so you have more flexibility in planning your meals. What does “healthful eating� really mean? Before starting to plan meals, let’s back up and go over some of the basics. Healthful eating means: • Eating a variety of foods. Include vegetables, fruit, whole grain, non-fat dairy foods, fats, and lean meats or meat substitutes. • Trying not to eat too much food or too much of one type of food. • Spacing your meals evenly throughout Making Choices Managing diabetes from day to day is up to you. A large part of it is making choices about the foods you will eat. Everyone knows that vegetables are better for us than cookies. From there, it can get confusing, especially when you add diabetes management to the mix. The seven different food groups are: • Non-starchy vegetables • Fruit • Milk • Grains and starchy vegetables • Meats and meat substitutes • Fats • Sweets and sugar substitutes Eating foods from the first six food groups is important just to keep healthy. The seventh group adds some treats into your meal plan. Within each food group, there are foods that are the absolute best choices because of the nutrients they contain. Meal Planning For people with diabetes, managing blood glucose levels requires finding the right balance among food, physical activity, and medicine—insulin and/or diabetes pills—if needed. Of the foods you eat, those with carbohydrate raise blood glucose so they are the key to managing blood glucose levels. This does not mean you have to eliminate carbohydrate from your diet, it means you need to think about how much you’re eating, make the best choices you can, know your limits, and keep your portions under control. The other things to keep in mind are cutting back on saturated fat, cholesterol and trans fats. All three of these are linked to high blood cholesterol levels and increase your risk of heart disease. So the two main things to consider are carbohydrate and the “bad fats.� To help you put it all together it is sometimes easier to follow a guide of what to eat or a meal plan.

Here are a few tips on making healthful food choices for you and your entire family.

• Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety. • Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans with meals. • Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce. • Include dried beans (like kidney or pinto beans) and lentils into your meals. • Include fish in your meals 2-3 times a week. • Choose lean meats like cuts of beef and pork that end in “loin� such as pork loin and sirloin. • Remove the skin from chicken and turkey. • Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese. • Choose water and calorie-free “diet� drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks. • Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats are high in calories. If you’re trying to lose weight, watch your portion sizes of added fats. • Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream. • Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes. For More Information The book, What Do I Eat Now? A Step-by-Step Guide to Eating Right With Type 2 Diabetes, is a resource to keep in your kitchen as a handy reference guide when it comes time to preparing meals.

Meal Planning

For people with diabetes, managing blood glucose levels requires finding the right balance among food, physical activity, and medicine-insulin and/or diabetes pills-if needed. Of the foods you eat, those with carbohydrate raise blood glucose so they are the key to managing blood glucose levels. This does not mean you have to eliminate carbohydrate from your diet, it means you need to think about how much you’re eating, make the best choices you can, know your limits, and keep your portions under control. The other things to keep in mind are cutting back on saturated fat, cholesterol and trans fats. All three of these are linked to high blood cholesterol levels and increase your risk of hearth disease. So the two main things to consider are carbohydrate and the “bad fats.� To help you put it all together it is sometimes easier to follow a guide of what to eat or a meal plan.

Basic Tips for Healthy Food Choices

Knowing what to eat can be confusing. Everywhere you turn, there is news about what is or isn’t good for you. There are some basic principles, however, that have stood the test of time. Here are a few tips for you and your entire family. • Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety. • Choose whole grain foods over processed grain products. • Include dried beans (like kidney or pinto beans) and lentils in your meals. • Include fish in your meals 2-3 times a week. • Choose lean meats and remove the skin from chicken and turkey. • Choose non-fat dairy such as non-fat milk, yogurt and cheese. • Choose water and calorie-free “diet� drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks. • Choose liquid oils for cooking instead of solid fats. • Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream. • Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes.