http://weight-loss.fitness.com/printthread.php?t=24035&pp=40

http://weight-loss.fitness.com/printthread.php?t=17546&pp=40

http://weight-loss.fitness.com/printthread.php?t=13065&pp=40

http://www.womens-health.com/boards/weight-loss/8193-removyl-advanced-formula-print.html?pp=40

http://www.womens-health.com/boards/weight-loss/6966-soy-whey-protein-diet-plan-print.html?pp=40

http://www.womens-health.com/boards/weight-loss/9372-apidexin-print.html?pp=40

http://bazzy245.irepcni.com/home/index.asp

Interesting article

http://www.healthyweightforum.org/eng/articles/low-gi-diet/

http://www.atkinsdietbulletinboard.com/forums/main-forum/main-atkins-diet-forum/print-76906-dont-want-lose-weight.html?pp=40

Good Diabetes related discussion thread, but not current, a few moths old

http://www.apinchofhealth.com/forum/vbb/printthread.php?t=5926&pp=40

Some articles you may like

http://www.weightlossblackbook.com/Articles/

Makes interesting reading BUT OLD dated 2006

http://www.sugarbustersforum.com/forum/index.php?showtopic=3295

http://www.weightlossfriends.com/q/20lbs

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Total: 23.6 million children and adults — 8.0% of the population — have diabetes.

Diagnosed: 17.9 million people

Undiagnosed: 5.7 million people

Pre-diabetes: 57 million people

1.6 million new cases of diabetes were diagnosed in people aged 20 years or older in 2007.

Total prevalence of diabetes

Under 20 years of age: 186,300, or 0.22% of all people in this age group have diabetes. About one in every 400 to 600 children and adolescents has type 1 diabetes.

Two (2) million adolescents (or 1 in 6 overweight adolescents) aged 12-19 have pre-diabetes .

Although type 2 diabetes can occur in youth, the nationally representative data that would be needed to monitor diabetes trends in youth by type are not available. Clinically-based reports and regional studies suggest that type 2 diabetes, although still rare, is being diagnosed more frequently in children and adolescents, particularly in American Indians, African Americans, and Hispanic/Latino Americans.

Age 20 years or older: 23.5 million, or 10.7% of all people in this age group have diabetes.

Age 60 years or older: 12.2 million, or 23.1% of all people in this age group have diabetes.

Men: 12.0 million, or 11.2% of all men aged 20 years or older have diabetes although nearly one third of them do not know it.

Women: 11.5 million, or 10.2% of all women aged 20 years or older have diabetes although nearly one quarter of them do not know it. The prevalence of diabetes is at least 2 to 4 times higher among non-Hispanic Black, Hispanic/Latino American, American Indian, and Asian/Pacific Islander women than among non-Hispanic white women.

Non-Hispanic Whites: 14.9 million, or 9.8% of all non-Hispanic whites aged 20 years or older have diabetes.

Non-Hispanic Blacks: 3.7 million, or 14.7% of all non-Hispanic blacks aged 20 years or older have diabetes.

Race and ethnic differences in prevalence of diagnosed diabetes

Sufficient data are not available to derive prevalence estimates of both diagnosed and undiagnosed diabetes for all minority populations. For example, national survey data can not provide reliable estimates for the Native Hawaiian and other Pacific Islander population. However, national estimates of diagnosed diabetes for certain minority groups are available from national survey data and from the Indian Health Service (IHS) user population database, which includes data for approximately 1.4 million American Indians and Alaska Natives in the United States who receive healthcare from the IHS. Because most minority populations are younger and tend to develop diabetes at earlier ages than the non-Hispanic white population, it is important to control for population age differences when making race and ethnic comparisons.

• Data from the 2005 IHS user population database indicate that 14.2% of the American Indians and Alaska Natives aged 20 years or older who received care from IHS had diagnosed diabetes. After adjusting for population age differences, 16.5% of the total adult population served by IHS had diagnosed diabetes, with rates varying by region from 6.0% among Alaska Native adults to 29.3% among American Indian adults in southern Arizona.
• After adjusting for population age differences, 2004-2006 national survey data for people diagnosed with diabetes, aged 20 years or older include the following prevalence by race/ethnicity:
  • 6.6% of non-Hispanic whites
  • 7.5% of Asian Americans
  • 10.4% of Hispanics
  • 11.8% of non-Hispanic blacks
• Among Hispanics rates were:
  • 8.2% for Cubans
  • 11.9% for Mexican Americans
  • 12.6% for Puerto Ricans.

For more information in English or Spanish, contact the American Diabetes Association at 1-800-DIABETES (1-800-342-2383).

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You’ve probably wondered how you got diabetes. You may worry that your children will get it too.

Unlike some traits, diabetes does not seem to be inherited in a simple pattern. Yet clearly, some people are born more likely to get diabetes than others.

What leads to diabetes?

Type 1 and type 2 diabetes have different causes.  Yet two factors are important in both.  First, you must inherit a predisposition to the disease. Second, something in your environment must trigger diabetes.

Genes alone are not enough.  One proof of this is identical twins.  Identical twins have identical genes.  Yet when one twin has type 1 diabetes, the other gets the disease at most only half the time.  When one twin has type 2 diabetes, the other’s risk is at most 3 in 4.

Type 1 diabetes

In most cases of type 1 diabetes, people need to inherit risk factors from both parents.  We think these factors must be more common in whites because whites have the highest rate of type 1 diabetes.  Because most people who are at risk do not get diabetes, researchers want to find out what the environmental triggers are.

One trigger might be related to cold weather.  Type 1 diabetes develops more often in winter than summer and is more common in places with cold climates.  Another trigger might be viruses.  Perhaps a virus that has only mild effects on most people triggers type 1 diabetes in others.

Early diet may also play a role.  Type 1 diabetes is less common in people who were breastfed and in those who first ate solid foods at later ages.

In many people, the development of type 1 diabetes seems to take many years.  In experiments that followed relatives of people with type 1 diabetes, researchers found that most of those who later got diabetes had certain autoantibodies in their blood for years before.

(Antibodies are proteins that destroy bacteria or viruses.  Autoantibodies are antibodies ‘gone bad,’ which attack the body’s own tissues.)

Type 2 diabetes

Type 2 diabetes has a stronger genetic basis than type 1, yet it also depends more on environmental factors.  Sound confusing?  What happens is that a family history of type 2 diabetes is one of the strongest risk factors for getting the disease but it only seems to matter in people living a Western lifestyle.

Americans and Europeans eat too much fat and too little carbohydrate and fiber, and they get too little exercise.  Type 2 diabetes is common in people with these habits.  The ethnic groups in the United States with the highest risk are African Americans, Mexican Americans, and Pima Indians.

In contrast, people who live in areas that have not become Westernized tend not to get type 2 diabetes, no matter how high their genetic risk.

Obesity is a strong risk factor for type 2 diabetes.  Obesity is most risky for young people and for people who have been obese for a long time.

Gestational diabetes is more of a puzzle.  Women who get diabetes while they are pregnant are more likely to have a family history of diabetes, especially on their mothers’ side.  But as in other forms of diabetes, nongenetic factors play a role.  Older mothers and overweight women are more likely to get gestational diabetes.

Type 1 diabetes: your child’s risk

In general, if you are a man with type 1 diabetes, the odds of your child getting diabetes are 1 in 17.  If you are a woman with type 1 diabetes and your child was born before you were 25, your child’s risk is 1 in 25; if your child was born after you turned 25, your child’s risk is 1 in 100.

Your child’s risk is doubled if you developed diabetes before age 11.  If both you and your partner have type 1 diabetes, the risk is between 1 in 10 and 1 in 4.

There is an exception to these numbers.  About 1 in every 7 people with type 1 diabetes has a condition called type 2 polyglandular autoimmune syndrome.

In addition to having diabetes, these people also have thyroid disease and a poorly working adrenal gland.  Some also have other immune system disorders. If you have this syndrome, your child’s risk of getting the syndrome including type 1 diabetes is 1 in 2.

Researchers are learning how to predict a person’s odds of getting diabetes.  For example, most whites with type 1 diabetes have genes called HLA-DR3 or HLA-DR4.

If you and your child are white and share these genes, your child’s risk is higher.  (Suspect genes in other ethnic groups are less well studied. The HLA-DR7 gene may put African Americans at risk, and the HLA-DR9 gene may put Japanese at risk.)

Other tests can also make your child’s risk clearer.  A special test that tells how the body responds to glucose can tell which school-aged children are most at risk.

Another more expensive test can be done for children who have siblings with type 1 diabetes.  This test measures antibodies to insulin, to islet cells in the pancreas, or to an enzyme called glutamic acid decarboxylase.  High levels can indicate that a child has a higher risk of developing type 1 diabetes.

Type 2 diabetes: your child’s risk

Type 2 diabetes runs in families.  In part, this tendency is due to children learning bad habits eating a poor diet, not exercising–from their parents.  But there is also a genetic basis.

In general, if you have type 2 diabetes, the risk of your child getting diabetes is 1 in 7 if you were diagnosed before age 50 and 1 in 13 if you were diagnosed after age 50.

Some scientists believe that a child’s risk is greater when the parent with type 2 diabetes is the mother.  If both you and your partner have type 2 diabetes, your child’s risk is about 1 in 2.

People with certain rare types of type 2 diabetes have different risks.  If you have the rare form called maturity-onset diabetes of the young (MODY), your child has almost a 1-in-2 chance of getting it, too.

More Information on Genetics

If you would like to learn more about the genetics of all forms of diabetes, the National Institutes of Health has recently published The Genetic Landscape of Diabetes.  This free online book provides an overview of the current knowledge about the genetics of type 1 and type 2 diabetes, as well other less common forms of diabetes.  The book is written for health professionals and for people with diabetes interested in learning more about the disease.

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Over 18 million Americans have diabetes; of these, about 5 million do not know they have the disease (1).

Type 1 diabetes accounts for 5-10% of cases, affecting 1 of 400 children and adolescents.

Type 2 diabetes is extremely common, accounting for 90-95% of all cases of diabetes. This form of diabetes can go undiagnosed for many years, but the number of cases that are being diagnosed is rising rapidly, leading to reports of a diabetes epidemic.

The Type 2 Diabetes Epidemic

When people think of epidemics, they often think of infectious diseases such as SARS, HIV, or the flu. However, the prevalence of type 2 diabetes is now at epidemic proportions. In the United States, diabetes accounts for over 130 billion dollars of health care costs and is the fifth leading cause of death ( 2). The number of new cases being diagnosed continues to rise. It has been estimated that of the children born in the year 2000, 1 of 3 will suffer from diabetes at some point in their lifetime ( 3). Diabetes is predicted to become one of the most common diseases in the world within a couple of decades, affecting at least half a billion people ( 4).

In the past, type 2 was rarely seen in the young, hence its original name of “adult-onset diabetes”. But now type 2 diabetes is increasingly being diagnosed in young adults and even in children. In Japan, more children suffer from type 2 than type 1 (“juvenile onset”) diabetes. This young generation of diabetics will have many decades in which to develop the complications of diabetes.

In 1990, 4.9% of the American population were diagnosed with diabetes (see Flash Animation 1). This increased to 7.9% by the year 2001 ( 5).

Obesity

The driving force behind the high prevalence of diabetes is the rise of obesity in the population. In today’s society, it can be difficult to maintain a healthy weight. We have the combination of ample food and a sedentary lifestyle. This is in stark contrast to only a couple of hundred years ago, when people were more active and food supplies were not as abundant. As a result, many of us are heavier than we should be.

Being overweight or obese is defined by a calculation called the Body Mass Index (BMI). It is a calculation that takes your height and weight into consideration and gives you a score. A score of 18–24.9 is a healthy weight. If you are overweight, your score lies within the range to 25–29.9; a score of 30 and above indicates obesity.

In 1991, it was estimated that 12% of the population were obese ( 5). By the year 2001, this had increased to an estimated 20.9% of the population; this represents over 44 million obese adult Americans. A more recent study estimated that a record 30% of the American population are now obese ( 6) (see Flash Animation 2).

Obesity is a major problem for the United states. Every year, an estimated 300,000 US adults die of causes related to obesity ( 7). Obesity is also a huge economic burden, accounting for up to 4% of healthcare costs in the United States ( 8).

Thrifty Genes

Epidemics of infectious diseases increase when there is increased spread of the infectious agent and decrease when the number of victims who are susceptible falls (they either become immune or they die). An epidemic of a genetic disease such as type 2 diabetes is similar. The number of cases rises when there is a rise in environmental risk (abundant food supplies, lack of activity) and decreases when the number of susceptible individuals falls (by deaths from the complications of diabetes).

The classic example of an epidemic of diabetes is found on an remote island in the Pacific Ocean, the island of Nauru. Before the turn of the 20th century, the lifestyle of Nauruans was harsh. The soil was poor, agriculture was difficult, and frequent episodes of starvation were common. Despite these adverse conditions, the islanders were noted to be “heavy”. In 1922, it was discovered that Nauru contained phosphate rock, which was then mined for use in fertilizer, and for which the islanders received royalties. Over several decades, the Nauruans became extremely wealthy, and with their new-found riches came major lifestyle changes. Food was now abundant and could be bought from stores. Instead of fishing and farming, Nauruans now led sedentary lives. By the 1950s, type 2 diabetes exploded from being non-existent in this population to affecting 2 of 3 adults over the age of 55 and becoming a common cause of death.

The case of the Nauruans is an extreme case of how type 2 diabetes can rapidly reach epidemic proportions, and “thrifty genes” may be involved. It has been postulated by Neel ( 9) that genes that are metabolically thrifty give a survival advantage in times when there is a constant threat of famine and starvation. When food is abundant, these genes aid the efficient metabolism of the food, enabling rapid build up of fat stores. This enabled people like the Nauruans to survive food shortages later on. But when food is always abundant, a thrifty genetic makeup turns into a survival disadvantage. Thrifty genes cause obesity, which in turn predisposes to diabetes. The epidemic that took hold of the island of Nauru is now emerging in developing countries and already has a firm hold on the developed world.

References
1. National Diabetes Statistics . National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

2. Hogan P, Dall T, Nikolov P. Economic costs of diabetes in the US in 2002. Diabetes Care 2003; 26(3):917-932. (PubMed)

3. Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk for diabetes mellitus in the United States. JAMA 2003; 290(14):1884-1890. (PubMed)

4. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care 1998; 21(9):1414-1431. (PubMed)

5. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2001; 289(1):76-79. (PubMed)

6. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002; 288(14):1723-1727. (PubMed)

7. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA 1999; 282(16):1530-1538. (PubMed)

8. Allison DB, Zannolli R, Narayan KM. The direct health care costs of obesity in the United States. Am J Public Health 1999; 89(8):1194-1199. (PubMed)

9. Neel JV. Diabetes mellitus: a "thrifty" genotype rendered detrimental by "progress"? JAMA 1962; 14:353-362. (PubMed)

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Preface

1. Introduction to Diabetes
Created: July 7, 2004

Classification

History of Diabetes

Epidemiology

Physiology and Biochemistry of Sugar Regulation

The Story of Insulin

2. Genetic Factors in Type 1 Diabetes
Created: July 7, 2004

IDDM1 Contains the HLA Genes

IDDM2 Contains the Insulin Gene (INS)

Other Type 1 Diabetes Susceptibility Loci: IDDM3–IDDM18

An Inhibitor of the Immune Response (CTLA4)

3. Genetic Factors in Type 2 Diabetes
Created: July 7, 2004

The Sulfonylurea Receptor (ABCC8)

The Calpain 10 Enzyme (CAPN10)

The Glucagon Receptor (GCGR)

The Enzyme Glucokinase (GCK)

The Glucose Transporter GLUT2

The Transcription Factor HNF4A

The Insulin Hormone (INS)

The Insulin Receptor (INSR)

The Potassium Channel KCNJ11

The Enzyme Lipoprotein Lipase (LPL)

The Transcription Factor PPARG

The Regulatory Subunit of a Phosphorylating Enzyme (PIK3R1)

4. Other Types of Diabetes
Created: July 7, 2004

Genetic Defects of Beta Cell Function (MODY and Others)

MODY1: Caused by a Mutation in Transcription Factor HNF4A

MODY2: Caused by a Mutation in the Enzyme Glucokinase (GCK)

MODY3: Caused by a Mutation in Transcription Factor TCF1

MODY4: Caused by a Mutation in Transcription Factor IPF1

MODY5: Caused by a Mutation in Transcription Factor TCF2

MODY6: Caused by a Mutation in Transcription Factor NEUROD1

Genetic Defects in Insulin Action

Diseases in the Exocrine Pancreas

Diseases of the Endocrine System

Drug- or Chemical-induced Diabetes

Infections

Uncommon Forms of Immune-mediated Diabetes

Other Genetic Syndromes Sometimes Associated with Diabetes

5. Gestational Diabetes
Created: July 7, 2004

NIH Lectures

The Genetic Landscape of Diabetes

Preface

"The Genetic Landscape of Diabetes" is a guide to the variations in our DNA that may influence our risk of developing diabetes.

It is well known that a lifestyle of inactivity and excessive food intake plays an important part in diabetes risk. But diabetes is a genetic disease as well as a disease of lifestyle. Rare forms of diabetes are caused by a single gene mutation, but in most cases of diabetes, many genes are thought to be involved, together forming a "genetic risk".

Who should read this book?

Readers with an interest in science, patients with diabetes, physicians, high school students, and research scientists.

For patients and students, summaries provide outlines of the roles of genes, and background information introduces scientific information in a gradual way.

Research scientists and geneticists may be interested to read the "Molecular Information" for each gene. Here the book showcases the power and utility of NCBI tools for biomedical research. These tools include a gene "catalog" (Entrez Gene), the gene location (Map Viewer), searching for similar genes in other species (BLAST), and the latest research findings (PubMed and OMIM).

Why should you read this book?

"The Genetic Landscape of Diabetes" introduces the reader to what diabetes is—from its discovery thousands of years ago to our modern-day understanding of how this disease, characterized by high blood sugar, develops.

The first chapter provides calculators that help you calculate your ideal body weight and BMI. Animated maps of the United States show the rise in obesity and diabetes.

Other chapters guide the reader through the genetic variations that may play roles in type 1 diabetes, type 2 diabetes, and other types. The genes discussed encode proteins that have diverse functions in cells—from transcription factors that influence the expression of other genes, to ion channels that control the release of insulin, from transporters that pump glucose into cells, to enzymes that speed up the break down of glucose.

The book closes with "NIH lectures"—videos of some of the most recent lectures given by researchers who have been invited to the NIH to discuss obesity and diabetes.

What makes this book unique?

The genetics of diabetes is complicated—but this book is not and is written for a wide audience. Because what we know about the genetics of diabetes is continually changing, links to live searches of the latest published literature and data will keep this book up to date. All of the content (the online book and the PDFs) is free.

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Nowadays, we hear about carbohydrate all the time. Did you know there are three main types of carbohydrate? There are starches, sugars, and fiber. You’ll also hear terms like naturally occurring sugar, added sugar, low-calorie sweeteners, sugar alcohols, reduced-calorie sweeteners, processed grains, enriched grains, complex carbohydrate, sweets, refined grains, and whole grains. No wonder knowing what kind and how much carbohydrate to eat can be confusing!

The three main types of carbohydrate are:

• Starch (also known as complex carbohydrates)
• Sugar
• Fiber

On the nutrition label, the term "total carbohydrate" includes all three types of carbohydrates. This is the number you should pay attention to if you are carbohydrate counting.

Starch

Foods high in starch include:

• Starchy vegetables like peas, corn, lima beans, and potatoes
• Dried beans, lentils, and peas such as pinto beans, kidney beans, black eyed peas, and split peas
• Grains like oats, barley, and rice. (The majority of grain products in the US are made from wheat flour. These include pasta, bread, and crackers but the variety is expanding to include other grains as well.)

The grain group can be broken down even further into whole grain or refined grain.

A grain, let’s take wheat for example, contains three parts. The parts are the bran, germ, and the endosperm. The bran is the outer hard shell of the grain. It is the part of the grain that provides the most fiber and most of the B vitamins and minerals. The germ is the next layer and is packed with nutrients including essential fatty acids and vitamin E. The endosperm is the soft part in the center of the grain. It contains the starch. Whole grain means that the entire grain kernel is in the food.

If you eat a whole grain food, it contains the bran, germ, and endosperm so you get all of the nutrients that whole grains have to offer. If you eat a refined grain food, it contains only the endosperm or the starchy part so you miss out on a lot of vitamins and minerals. Because whole grains contain the entire grain, they are much more nutritious than refined grains.

Sugar

Sugar is another type of carbohydrate. You may also hear sugar referred to as simple or fast-acting carbohydrate. There are two main types of sugar:

naturally occurring sugars such as those in milk or fruit

added sugars such as those added during processing such as fruit canned in heavy syrup or sugar added to make a cookie
On the nutrition facts label, the number of sugar grams includes both added and natural sugars.

There are many different names for sugar. Examples of common names are table sugar, brown sugar, molasses, honey, beet sugar, cane sugar, confectioner’s sugar, powdered sugar, raw sugar, turbinado, maple syrup, high-fructose corn syrup, agave nectar, and sugar cane syrup.

You may also see table sugar listed by its chemical name, sucrose. Fruit sugar is also known as fructose and the sugar in milk is called lactose. You can recognize other sugars on labels because their chemical names also end in "-ose." For example glucose (also called dextrose), fructose (also called levulose), lactose, and maltose.

Fiber

Fiber comes from plant foods so there is no fiber in animal products such as milk, eggs, meat, poultry, and fish. Fiber is the indigestible part of plant foods, including fruits, vegetables, whole grains, nuts, and legumes. When you consume dietary fiber, most of it passes through the intestines and is not digested.

For good health, adults need to try to eat 25 to 30 grams of fiber each day. Most Americans do not consume nearly enough fiber in their diet, so while it is wise to aim for this goal, any increase in fiber in your diet can be beneficial. Most of us only get about ½ what is recommended. Fiber contributes to digestive health, helps to keep you regular and helps to make you feel full and satisfied after eating. Additional health benefits, of a diet high in fiber — such as a reduction in cholesterol levels — have been suggested by some so may be an additional benefit.

Good sources of dietary fiber include:

• Beans and legumes. Think black beans, kidney beans, pintos, chick peas (garbanzos), white beans, and lentils.
• Fruits and vegetables, especially those with edible skin (for example, apples, corn and beans) and those with edible seeds (for example, berries).
• Whole grains such as:
• Whole wheat pasta
• Whole grain cereals (Look for those with three grams of dietary fiber or more per serving, including those made from whole wheat, wheat bran, and oats.)
• Whole grain breads (To be a good source of fiber, one slice of bread should have at least three grams of fiber. Another good indication: look for breads where the first ingredient is a whole grain. For example, whole whe+at or oats.) Many grain products now have "double fiber" with extra fiber added.
• Nuts — try different kinds. Peanuts, walnuts and almonds are a good source of fiber and healthy fat, but watch portion sizes, because they also contain a lot of calories in a small amount.

In general, an excellent source of fiber contains five grams or more per serving, while a good source of fiber contains 2.5 - 4.9 grams per serving.

It is best to get your fiber from food rather than taking a supplement. In addition to the fiber, these foods have a wealth of nutrition, containing many important vitamins and minerals. In fact, they may contain nutrients that haven’t even been discovered yet!

It is also important that you increase your fiber intake gradually, to prevent stomach irritation, and that you increase your intake of water and other liquids, to prevent constipation.

Because fiber is not digested like other carbohydrates, for carbohydrate counting purposes, if a serving of a food contains more than or equal to 5 grams of dietary fiber, you can subtract half the grams of dietary fiber from the total carbohydrate serving of that food.

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Understanding the effect of carbohydrate on blood glucose levels is key to managing diabetes. The carbohydrate in food makes blood glucose levels go up.

The key to keeping blood glucose levels at your goal is to balance the food you eat with your physical activity and any pills or insulin you take. If you eat more carbohydrate than usual, you can expect your blood glucose levels to be higher than usual. Likewise, if you eat less, you can expect your blood glucose levels to be lower. Finding the balance for yourself is important so you can feel your best, do the things you enjoy, and lower your risk of diabetes complications.

There are three main types of carbohydrate in food. They are starch, sugar and dietary fiber. Starch and sugar both raise blood glucose levels so including both types in your meal plan is essential. Foods that contain carbohydrate are:

• Beans and legumes
• Grains and starchy vegetables
• Fruit
• Dairy products like milk and yogurt
• Sweets and snack foods like chips

Meal planning for diabetes is more than just cutting back on starch or sugar. There are many options that people with diabetes use to help them plan their meals. Having diabetes doesn’t have to mean eating the same foods day after day. By choosing the right meal planning tool for you, you’ll be able to try new foods and enjoy your favorites. You may want to try them all or use a combination to find out which you like the most.

Plate Method

It’s simple! Include more non-starchy vegetables and smaller portions of everything else. No special tools and nothing to count or read.

Carbohydrate Counting

Carbohydrate-containing foods raise blood glucose levels. By keeping track of how many carbohydrates you eat and setting a limit for your maximum amount to eat, you can help to keep your blood glucose levels on track.

Glycemic Index

The amount and type of carbohydrate affects blood glucose levels. Choose most of your foods with a lower glycemic response as a way to fine tune your carb counting.

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Carbohydrate counting, or "carb counting," is a meal planning technique for managing your blood glucose levels. Foods that contain carbohydrate raise blood glucose. By keeping track of how many carbohydrates you eat and setting a limit for your maximum amount to eat, you can help to keep your blood glucose levels in your target range. Finding the right amount of carbohydrate depends on many things including how active you are and what, if any, medicines you take.

How much carb?
A place to start is at about 45-60 grams of carbohydrate at a meal. You may need more or less carbohydrate at meals depending on how you manage your diabetes. You and your health care team can figure out the right amount for you. Once you know how much carb to eat at a meal, choose your food and the portion size to match.

What foods have carbohydrate?
Foods that contain carbohydrate are:

• starchy foods like bread, cereal, rice, and crackers
• fruit and juice
• milk and yogurt
• dried beans like pinto beans and soy products like veggie burgers
• starchy vegetables like potatoes and corn
• sweets and snack foods like sodas, juice drinks, cake, cookies, candy, and chips

Non-starchy vegetables have a little bit of carbohydrate but in general are very low.

How much carbohydrate is in these foods?
Reading food labels is a great way to know how much carbohydrate is in a food. For foods that do not have a label, you have to estimate how much carbohydrate is in it. Keeping general serving sizes in mind will help you estimate how much carbohydrate you are eating.

For example there is about 15 grams of carbohydrate in:

• 1 small piece of fresh fruit (4 oz)
• 1/2 cup of canned or frozen fruit
• 1 slice of bread (1 oz) or 1 (6 inch) tortilla
• 1/2 cup of oatmeal
• 1/3 cup of pasta or rice
• 4-6 crackers
• 1/2 English muffin or hamburger bun
• 1/2 cup of black beans or starchy vegetable
• 1/4 of a large baked potato (3 oz)
• 2/3 cup of plain fat-free yogurt or sweetened with sugar substitutes
• 2 small cookies
• 2 inch square brownie or cake without frosting
• 1/2 cup ice cream or sherbet
• 1 Tbsp syrup, jam, jelly, sugar or honey
• 2 Tbsp light syrup
• 6 chicken nuggets
• 1/2 cup of casserole
• 1 cup of soup
• 1/4 serving of a medium french fry

Protein and Fat
With carbohydrate counting, it is easy to forget about the protein and fat in meals. Always include a source of protein and fat to balance out your meal.

Using Food Labels
Carbohydrate counting is easier when food labels are available. You can look at how much carbohydrate is in the foods you want to eat and decide how much of the food you can eat. The two most important lines with carbohydrate counting are the serving size and the total carbohydrate amount.

1. Look at the serving size. All the information on the label is about this serving of food. If you will be eating a larger serving, then you will need to double or triple the information on the label.

2. Look at the grams of total carbohydrate.
Total carbohydrate on the label includes sugar, starch, and fiber.
Know the amount of carb you can eat, figure out the portion size to match.

Other important label information:
3. If you are trying to lose weight, look at the calories. Comparing products can be helpful to find those lower in calories per serving.

4.To cut risk of heart disease and stroke, look at saturated and trans fats. Look for products with the lowest amount of saturated and trans fats per serving.

5. For people with high blood pressure, look at the sodium. Look for foods with less sodium.

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Often, when people are diagnosed with diabetes, they don’t know where to begin. One way is to change the amount of food you are already eating. Focus on filling your plate with non-starchy vegetables and having smaller portions of starchy foods and meats. Creating your plate is an easy way to get started with managing blood glucose levels.

You don’t need any special tools or have to do any counting. It’s simple and effective — draw an imaginary line on your plate, select your foods, and enjoy your meal! You may have heard of this as the “Plate Method.” Once you’ve changed your portion sizes, you can work on making healthier food choices from each food group.

The easiest way to get started with managing your diabetes is to create your plate.
It’s simple and effective for both managing diabetes and losing weight. Creating your plate let’s you still choose the foods you want, but changes the portion sizes so you are getting larger portions of non-starchy vegetables and a smaller portion of starchy foods. When you are ready, you can try new foods within each food category.

Try these 6 simple steps to get started:

1. Using your dinner plate, put a line down the middle of the plate.

2. Then on one side, cut it again so you will have 3 sections on your plate.

3. Fill the largest section with non-starchy vegetables such as:

• spinach, carrots, lettuce, greens, cabbage, bok choy
• green beans, broccoli, cauliflower, tomatoes,
• vegetable juice, salsa, onion, cucumber, beets, okra,
• mushrooms, peppers, turnip

4. Now in one of the small sections, put starchy foods such as:

• whole grain breads, such as whole wheat or rye
• whole grain, high-fiber cereal
• cooked cereal such as oatmeal, grits, hominy, or cream of wheat
• rice, pasta, dal, tortillas
• cooked beans and peas, such as pinto beans or black-eyed peas
• potatoes, green peas, corn, lima beans, sweet potatoes, winter squash
• low-fat crackers and snack chips, pretzels, and fat-free popcorn

5. And then on the other small section, put your meat or meat substitutes such as:

• chicken or turkey without the skin
• fish such as tuna, salmon, cod, or catfish
• other seafood such as shrimp, clams, oysters, crab, or mussels
• lean cuts of beef and pork such as sirloin or pork loin
• tofu, eggs, low-fat cheese

6. Add an 8 oz glass of non-fat or low-fat milk. If you don’t drink milk, you can add another small serving of carb such as a 6 oz. container of light yogurt or a small roll.

7. And a piece of fruit or a 1/2 cup fruit salad and you have your meal planned. Examples are fresh, frozen, or canned in juice or frozen in light syrup or fresh fruit.

Breakfast
Your plate will look different at breakfast but the idea is the same. If you use a plate or bowl for breakfast, keep your portions small. Use half your plate for starchy foods. You can ad fruit in the small part and a meat or meat substitute in the other.

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What is the glycemic index?
The glycemic index, or GI, measures how a carbohydrate-containing food raises blood glucose. Foods are ranked based on how they compare to a reference food– either glucose or white bread. A food with a high GI raises blood glucose more than a food with a medium or low GI.

Meal planning with the GI involves choosing foods that have a low or medium GI. If eating a food with a high GI, you can combine it with low GI foods to help balance the meal. Examples of carbohydrate-containing foods with a low GI include dried beans and legumes (like kidney beans and lentils), all non-starchy vegetables and some starchy vegetables, most fruit, and many whole grain breads and cereals (like barley, whole wheat bread, rye bread, and all-bran cereal). Meats and fats don’t have a GI because they do not contain carbohydrate.

What affects the GI of a food?
Fat and fiber tend to lower the GI of a food. As a general rule, the more cooked or processed a food, the higher the GI; however, this is not always true.

Below are a few specific examples of other factors that can affect the GI of a food:

• Ripeness and storage time – the more ripe a fruit or vegetable is, the higher the GI
• Processing – juice has a higher GI than whole fruit; mashed potato has a higher GI than a whole baked potato, stone ground whole wheat bread has a lower GI than whole wheat bread.
• Cooking method: how long a food is cooked (al dente pasta has a lower GI than soft-cooked pasta)
• Variety: converted long-grain white rice has a lower GI than brown rice but short-grain white rice has a higher GI than brown rice.

Other things to consider if using the GI:

• The GI value represents the type of carbohydrate in a food but says nothing about the amount of carbohydrate typically eaten. Portion sizes are still relevant for managing blood glucose and for losing or maintaining weight.
• The GI of a food is different when eaten alone than it is when combined with other foods. When eating a high GI food, you can combine it with other low GI foods to balance out the effect on blood glucose levels.
• Many nutritious foods have a higher GI than foods with little nutritional value. For example, oatmeal has a higher GI than chocolate. Use of the GI needs to be balanced with basic nutrition principles of variety for healthful foods and moderation of foods with few nutrients.

Is the GI a better tool than carbohydrate counting?
There is no one diet or meal plan that works for everyone with diabetes. The important thing is to follow a meal plan that is tailored to personal preferences and lifestyle and helps achieve goals for blood glucose, cholesterol and triglycerides levels, blood pressure, and weight management.

Research shows that both the amount and the type of carbohydrate in food affect blood glucose levels. Studies also show that the total amount of carbohydrate in food, in general, is a stronger predictor of blood glucose response than the GI.

Based on the research, for most people with diabetes, the first tool for managing blood glucose is some type of carbohydrate counting. Balancing total carbohydrate intake with physical activity and diabetes pills or insulin (if needed) is key to managing blood glucose levels.

Because the type of carbohydrate does have an affect on blood glucose, using the GI may be helpful in “fine-tuning” blood glucose management. In other words, combined with carbohydrate counting, it may provide an additional benefit for achieving blood glucose goals for individuals who can and want to put extra effort into monitoring their food choices.

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