Diabetes and Your Lifestyle Toolkit

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Diabetes Toolkit

What is Diabetes?

Diabetes is a disease that causes blood glucose (sugar) levels to rise higher than

normal. As a result, your body does not use food properly for energy. Many of

the foods we eat turn into glucose (sugar), which is our bodies main source of

energy. Insulin, a hormone made by the pancreas, helps move glucose from the

blood into cells so that glucose can be used for fuel. With diabetes, your body

either produces too little insulin or does not use insulin.

What lab tests are used to manage diabetes?

• A1C is 6.5 or higher on two different lab tests

• Blood sugar is 126 mg/dl or higher on two fasting lab tests

• Blood sugar is 200 mg/dl or higher on one random lab test along with \

symptoms of high blood sugar

• A combination of two of these lab tests

Blood sugar targets:

Fasting/before meals 80-130 mg/dl

2 hours after meals <180 mg/dl

At bedtime 110-150 mg/dl

A1C goals

18-65 years old <7%

66-79 years old <8%

80 years and older <9%

This booklet will offer tips and

suggestions for managing your

diabetes, including the

following:

Nutrition

Healthy Eating

Meal Planning

Portion Control

Label Reading

Physical Activity

Types of Activity

Blood glucose with activity

Weight Management

Managing Stress

Coping Techniques and

Resources

Additional Resources

Programs, classes, and

websites

To schedule an appointment

with

a Registered Dietitian, please

call 303-614-1070 or schedule

online at KP.org

KPCO Nutrition Services


HEALTHY EATING

A healthy eating plan is an important part of diabetes management.

What to eat: What you eat affects your blood sugar. Yet you do not need special foods because you have

diabetes. In fact, the foods that are good for you are good for your entire family.

Eat More Eat Less Vegetables Processed Foods

Fruits Fried Foods

Whole Grains: multigrain bread, high fiber cereal, oats, brown rice, quinoa, high fiber pasta, barley, farro

Added Sugars

Lean proteins: poultry, lean beef and pork, eggs, tofu and soy, low fat cheese

Drinks high in sugar: soda and juices

Dairy: Greek yogurt, low fat milk, dairy alternatives, cottage cheese

Animal fats: butter, fatty meat, lard

Fats: olive oil, nuts, avocado and avocado oil, canola oil

Trans fats and hydrogenated oils

When to eat: Eating at regular times will help you regulate your blood sugars. Regular mealtimes may also

prevent low blood sugars (hypoglycemia).

• Start with breakfast. This meal should be 1-2 hours after waking.

• Eat three main meals every 4-5 hours. Snack only when needed.

• Do not skip or delay meals, especially if you are on diabetes medication.

• Be consistent with the number of carbohydrate servings at meals.

• Be aware of portion sizes, especially when eating out.

How much to eat: Your body processes most foods you eat into blood glucose. Eating too much food,

(especially carbohydrates) may make your blood glucose too high, while eating too little food may cause a low

blood sugar. Eating a similar amount of carbohydrates at each meal can help you manage your blood sugar.

There are two methods to help you plan your meals around carbohydrates:

1. Plate Method

2. Carbohydrate Counting

You can use one of these methods of meal planning, or a combination of all. The key is to be consistent with the

amount or portions of carbohydrates you eat.


1. Use a 9-inch plate

2. Fill ¼ Plate with Lean Proteins:

• Tofu, tempeh, veggie burgers, seitan

• Eggs, cottage cheese, low-fat cheese

• White meat chicken and turkey, no skin

• Fresh water fish and shellfish

• Lean beef and lean pork

3. Fill ½ Plate Vegetables:

• Spinach, salad, broccoli, cauliflower, cabbage, asparagus,

green beans, cucumbers, peppers

4. Fill ¼ Plate Starch or Whole Grain:

• Whole grain breads, high fiber cereal, oats, quinoa, grits/polenta, pasta, brown rice, tortillas

• Beans, peas, corn, potatoes, sweet potatoes, winter squash

5. Add a piece of fruit and/or a glass of milk at each meal to include all food groups

6. Have healthy fats in small amounts.

Olive oil, nuts, seeds, avocados, vinaigrettes

What if my meal isn’t served on a plate?

Some meals come in a bowl or cup which can confuse this way of eating. Think about your meal as percentages:

50% non-starchy vegetables, 25% starchy foods and 25% protein. An example of this could be chicken noodle

soup. Portion the non-starchy vegetables, noodles, and chicken like you would find on a plate. You may have to

increase the portion of vegetables. Or have a cup of soup and a side salad.

How does this work with mixed dishes such as tacos and pizza?

Some meals combine multiple ingredients into one item. For example, tacos are mostly beef or chicken and

tortillas. Simply fill half your plate with that combo food and fill the other half with vegetables such as fajita peppers

and onions.

Vegetables at breakfast? Ways to add vegetables to your first meal of the day: • Add greens to your smoothie.

• Include sautéed peppers, mushrooms, onions in your eggs or omelet.

• Have tomato slices and avocado on toast.

What about dessert? To include sweets, cut back on other carbohydrate foods at that meal. For example, if you

plan to have cake, skip the fruit and/or starchy food and have more vegetables. This “budgeting process” allows

you to keep the amount of carbohydrates like your normal portion.


METHOD TWO: CARBOHYDRATE COUNTING

How many Carbs per Meal? The amount of

carbohydrates you need depends on your diabetes goals, calorie needs, and activity.

General Guidelines:

• 30-45 grams per meal for women

• 45-60 grams per meal for men

• 15-20 grams per snack

What About Sugar? Sugar is a form of carbohydrate and

is included in the total carbohydrate

count. There are two types of sugar:

Naturally occurring sugars like

those in milk or fruit

Added sugars, which are added

during processing, like in regular

soda, sweets, and baked goods.

Sugar Alcohols: Sugar alcohols are

sweeteners that have about half the

calories of regular sugar.

Sugar Substitutes: Most of these

contain little or no calories or have

little effect on blood glucose.

Because these sweeteners are

sweeter than sugar, they can be

used in smaller amounts.

Foods listed “Sugar Free”,

“No Sugar Added” and

“Reduced Sugar” are not necessarily

carbohydrate-free or lower in calories

than the original version of the food.

Always check the Food Label.


UNDERSTANDING PORTIONS

Staying within recommended portion sizes will help you stay within your calorie and carbohydrate intake. Use

measuring cups and spoons to help you become familiar with recommended amounts of foods. Measuring

portions is important to do when you are evaluating your calorie and carb intake.

What is the difference between a portion and a serving? A portion is how much food you choose to eat at one time, whether in a restaurant, from a package, or at home.

A serving is the amount of food listed on a food label. It is listed as “Serving size” on the package label.

Some products have different serving sizes, which could be measured in cups, ounces, grams, pieces, or

quantity. A serving size on a food label may be more or less than the amount you should eat, depending on your

health goals. Keep in mind, your portion size may or may not match the serving size.

Comparing real life portions to everyday items is an easy way to help understand portion sizes — no measuring

cup or scale is needed.

Portion Size One Portion Looks Like

1 cup pasta A tennis ball

1 cup raw vegetables or fruit A baseball

1 medium potato A computer mouse

1 oz cheese 4 stacked dice

1 tortilla A DVD

2 tablespoon peanut butter A ping pong ball

3 oz fish A checkbook

3 oz protein A deck of cards

When you can’t measure, you can estimate


LABEL READING

Serving Size: The nutrition information on a food label is based on that serving size. You will need to adjust to adjust the other numbers if you eat more or less of a portion size.

Carbohydrate: Total Carbohydrate is the next thing you need to look for on the label. The grams of sugar listed are included in this number.

General guidelines for carbs at meals and snacks: • 30-45 grams for women per meal

• 45-60 grams for men per meal

• 15-20 grams per snack

Fiber: Aim for a total 25-38 grams of fiber per day

Choose foods with at least 3 grams fiber per serving.

Net Carbs: A term not legally defined by the FDA. This term is not used by the American Diabetes Association.

Fat: Choose foods that are lower in saturated and trans fats.

Protein: Adding a little protein to meals and snacks can help you feel full longer. If you have kidney damage, you

may be advised to eat less protein.


AIM FOR A HEALTHY WEIGHT

Making gradual changes that you can stick with is the key to long term weight management success. The first

change is to evaluate the what and the how much in your current lifestyle.

Track foods: Keep a record of the foods you eat and your activity. Consider online tools and apps to track such

as MyFitnessPal, Livestrong, Fit Bit, and Calorie King.

Count calories: This guide can help you figure out the number of calories you can eat to help with weight loss.

Your Starting Weight Calorie Goal

250 pounds or less 1200-1500

More than 250 pounds 1500-1800

Exercise: At least 30 minutes per day.

• Consider exercising for shorter times but several times a day if you are low on time.

• Choose and activity that you enjoy and think about want you CAN do instead of what you can’t do.

Portion Control: Keep your portions reasonable.

• Some restaurants may serve portions that are 2-3 times the amount of a recommended serving size.

• Try using a smaller plate or splitting meals.

• Avoid eating in front of the TV, computer, in the car, or at your work desk.

Plan meals and snacks: Prepare meals ahead of time and freeze to use throughout the week.

• Keep protein bars and shakes in your bag or car when you need a backup option.

• Eat 300-500 calories per meal.

• Have 100-200 calories per snack if you need a snack.

Counting calories along with carbohydrates:

Use this guide to help you figure out the amount of carbohydrates you should eat to help you stay within your

calorie target for weight loss.

Carbohydrate Totals 1200 calories 1500 calories 1800 calories

Per Day 120-160 grams 150-190 grams 180-225 grams

Per Meal 30-45 grams 30-45 grams 45-60 grams

Per Snack 0-5 grams 15-20 grams 15-30 rams


PHYSICAL ACTIVITY

Exercise can help lower blood sugar in the short term. When you are regularly active, it can also lower your A1C.

There are a few ways that activity lowers blood sugar:

• Insulin sensitivity improves which means your boy can use the insulin is has more efficiently.

• When your muscles contract during activity, your cells can take up glucose and use it for energy whether

insulin is available or not.

Types of Activity:

Aerobic: Improves heart health, builds endurance, improves blood circulation, and reduces stress.

Amount recommended: Aim for 30 minutes of Moderate Intensity activity at least five days per week for a total of

150 minutes per week; OR Aim for 75 minutes per week of Vigorous Activity.

If you haven’t been active for a while, start with 10 minutes per day. Increase the days per week that you’re active.

Eventually increase the time of each session. You’ll notice your endurance improving over time.

Strength Training: This activity makes your body more sensitive to insulin and builds strong bones and muscles.

The more muscle mass you have, the more calories you burn throughout the day.

Examples of strength training include:

• Working out with weight machines or free weights

• Using resistance bands

• Lifting objects at home such as water bottles, canned goods

• Using your body weight such as doing pushups, sit ups, wall squats, planks, lunges

Amount recommended: Aim for 20-30 minutes at least two days a week of strength training exercises. Work all

the major muscle groups. Wait 48 hours before you work the same muscle group again.

Physical Activity Resources

• Silver Sneakers Members can participate in fitness programs at designated recreational centers for free if

they are a Kaiser Permanente Senior Advantage Core, Silver, Gold or Medicare or PERA pre-65 member.

Call 1-800-476-2167 for more information or go to silversneakers.com

• Healthwaysfit.com is a website for SilverSneakers®. Contains exercise videos and motivational support.

• Class Pass: ClassPass partners with 30,000 gyms and studios around the world, offering a range of classes

including yoga, dance, cardio, boxing, Pilates, boot camp, and more. With this ClassPass offer, Kaiser

Permanente members can get:

•Unlimited on-demand video workouts at no cost

•Reduced rates on livestream and in-person fitness classes

https://healthy.kaiserpermanente.org/colorado/health-wellness/fitness-deals

http://www.silversneakers.com/

http://healthwaysfit.com/

https://healthy.kaiserpermanente.org/colorado/health-wellness/fitness-deals


PHYSICAL ACTIVITY AND BLOOD SUGAR

The effect physical activity has on your blood sugar will vary depending on how long you are active and many

other factors. Physical activity can lower your blood sugar up to 24 hours or more after your workout by making

your body more sensitive to insulin.

Checking your blood sugar level more often before and after activity can help you see the benefits of activity. You

also can use the results of your blood sugar checks to see how your body reacts to different activities.

Understanding these patterns can help you prevent your blood sugar from going too high or too low.

Hypoglycemia (low blood sugar)

Hypoglycemia is a blood sugar level that is below normal. Usually, it is a blood sugar that registers less than

80mg/dl on your glucometer. Some of the symptoms may be sweating, dizziness, weakness, irritability,

shakiness – however you may not experience any symptoms! People taking insulin or certain medications may

be at risk for hypoglycemia. It can also happen if you skip meals or are more active than usual. Check your

blood sugar if you are feeling symptoms OR prior to doing physical activity when you are on diabetes medications.

People taking insulin or certain medications may be at risk for hypoglycemia if insulin dose or carbohydrate intake

is not adjusted with exercise. Checking your blood sugar before doing any physical activity is important to prevent

hypoglycemia (low blood sugar).

If you experience hypoglycemia during or after physical activity, treat it immediately:

Follow the 15/15 rule to treat low blood sugar. After checking blood sugar:

Follow 15/15 rule to Treat Low Blood Sugar Eat 15 grams of carbohydrates (choose 1)

Wait 15 minutes

Recheck Blood Sugar

Eat 15 grams of carbohydrates

4 ounces juice

4 glucose tablets

1 tablespoon sugar or

honey

2 Tablespoons raisins

½ can of soda

4 ounces juice

4 glucose tablets

1 tablespoon sugar or

honey

2 Tablespoons raisins

½ can of soda


MANAGING STRESS

Stress can affect your diabetes and blood sugar control in two ways:

• It increases hormones that cause a blood sugar rise

• It can change the way you take care of yourself

Stress can be the result of physical or emotional causes. Learning to identify stressors and find ways to

cope can be helpful in controlling your stress response.

Coping with Stress:

• Regular exercise: Can boost your mood and reduce stress.

• Relaxation Methods: Use mindfulness, meditation, breathing exercises

• Positive Thinking: Practicing positive self-talk can help you develop more compassion for yourself and

put things in perspective.

Resources to Help You Relax Wellness Coaching by Phone: Call 1-866-862-4295 to make an appointment. In addition to stress management, Kaiser Permanente Wellness Coaches can help with:

• Weight Management

• Physical Activity

• Tobacco Cessation

• Healthy Eating

Center for Complementary Medicine: http://www.kpccm.org/

Mindfulness-Based Stress Reduction: Improve your ability to manage associated with chronic illness, chronic pain, anxiety, depression, and stress-related conditions using meditation and stress reduction techniques. To make an appointment, call 844-800-0788

Stress Management eLearning Modules on www.kphealthyme.com: this is a good starting point for developing resilience and taking control of stress.

No cost apps for Kaiser Permanente Members:

Calm is the #1 app for meditation and sleep — designed to help lower stress, reduce anxiety, and more. Kaiser Permanente members can access all the great features of Calm at no cost, including:

• The Daily Calm, exploring a fresh mindful theme each day

• More than 100 guided meditations • Sleep Stories to soothe you into deeper and better sleep • Video lessons on mindful movement and gentle stretching

myStrength is a personalized program that helps you improve your awareness and change behaviors. Kaiser Permanente members can explore interactive activities, in-the-moment coping tools, community support, and more at no cost.

• Mindfulness and meditation activities

• Tailored programs for managing depression, stress, anxiety, and more

http://www.kpccm.org/

http://www.kpccm.org/mbsr.html

http://www.kphealthyme.com/


RESOURCES

Kaiser Permanente Resources: Diabetes: Learn to Take Charge Class- A two-part class to learn about daily self-care, blood sugar and making food choices. Sessions are for two consecutive weeks and 1-2 hours in length. ▪ To register, call 303-338-4545. Members only ▪ Visit www.kphealthyme.com for current class schedules Online Resources: www.kphealthyme.com - this is the official website supported by KP dietitians. Contains materials including carbohydrate counting, sample menus and meal plans, and food records. • Recorded Webinar: Diabetes Management: Meals and More. Information on meal planning using

carbohydrate counting or the plate method • E-Learning Modules: Use this online course to learn how to manage your carbs with the Plate

Method, the basics of carb counting and reading nutrition labels. Weight Loss: Healthy Connections Class This group-based class gives participants the tools needed for long term weight management success. The class covers proven concepts on activity, nutrition, and behavior to help participants set up an individualized weight loss plan that fits their lifestyle. Cost for Members: Free Telephone Based Health Coaching: Take advantage of our healthier living telephone coaching program. The cost of the wellness coaching is free and is a service designed to support you in achieving your goals. 1-866-862-4295

Additional Resources: Metabolic Surgical Weight Management To learn more about other weight management options with Kaiser Permanente including weight loss medication and weight loss surgery, Call 303-861-3400. Pediatric Wellness: Our Pediatric Dietitians can help with your child or family’s eating and activity habits. Services are bilingual and include physical activity counseling and linkage to community resources. To access our services, call 303 614-1070 or visit kphealthyme.com Other Websites: American Diabetes Association (ADA): diabetes.org Current research and information for managing diabetes. Links to local state-affiliated sites. Calorie King: calorieking.com Products, computer software and services to help with carb counting, physical activity and weight loss. Diabetes Net: diabetesnet.com Home page hosts a “Diabetes Mall” filled with information on the care and management of diabetes. Smart Phone Apps and Websites for Meal Planning • Calorieking.com • Eatingwell.com • Livestrong.com • Loseit.com • Makemyplate.co (1200,1500,1800 calories meal plan templates) • Myfitnesspal.com More Websites for Recipes: • Doctoryum.org • Foodforhealth.kaiserpermanente.org • Preventionrd.com • Skinnytaste.com • Thelemonbowl.com

http://www.kphealthyme.com/


SAMPLE MEALS USING CARB COUNTING

Breakfast: Grams of Carbohydrate

Breakfast burrito with 6” tortilla, 1 egg, 1/2c. diced cooked potato and cheese and salsa 45-50 g

English muffin with 2 T peanut butter, and ½ cup Greek Yogurt 45 g

Toast 2 slices high fiber bread, add ¼ avocado and 1 scrambled egg 40 g

½ cup old fashioned oatmeal with sprinkled cinnamon, sliced ½ banana and 2T walnuts 48 g

Toast 2 slices of raisin bread, top with 1/2 cup low fat cottage cheese 37 g

1 cup cheerios, ¾ cup fat free or 1% milk and 1 small banana 43 g

Green Smoothie: 1 cup coconut milk, 1 cup spinach, 1 cup pineapple, ½ banana, 1 T flaxseed 40 g

2 poached eggs over 1 cup sautéed spinach and mushrooms + 1 cup polenta or grits 33 g

1 cup plain low-fat Greek yogurt topped with ¼ cup chopped pistachios + ¼ cup dried apricots 40 g

Tofu scramble: Sauté 1/5 block tofu crumbled, 1 cup peppers and onions + 1/2 cup black beans

+ spices (cumin, garlic powder) Serve with 2 corn tortillas and salsa. 40 g

Lunch:

Fill 6” pita bread with veggies and hummus and 1 ounce feta cheese 35g

2 slices of high fiber bread, with 1 ounce turkey, 1-ounce cheese and mustard.

Serve with side salad 40-45 g

1 cup minestrone soup, and 6 crackers, string cheese and a small apple 45g

Lentil Hummus Wrap: 1-6” whole wheat tortilla spread with 2 T. hummus, filled with

½ cup cooked lentils, red pepper flakes, and ½ cup salad greens. 45 g

Beet salad: ½ cup roasted beets + 1 cup arugula + 2 T. pumpkin seeds + 1 ounce goat cheese +

2 T. light vinaigrette dressing + 6 crackers. 47 g

Dinner:

Chicken breast grilled with spices, 1cup brown rice, with 1 cup broccoli 45 g

Bagged salad, add 3oz tuna or chicken, and add ½ cup beans, and a piece of fruit 45 g

3 oz. lean pork, medium sweet potato (6 oz), 1cup cauliflower, 3 graham cracker squares 45 g

½ baked spaghetti squash (cooled and insides separated with a fork). Mix with ¼ cup tomato sauce.

Place filling back in shell, top with parmesan cheese and bake until cheese melts. 30 g

Turkey burger with 1 whole grain bun. Top with lettuce/tomato/pickles/mustard.

Serve with ½ cup baked beans 50 g


SNACK IDEAS USING CARBOHYDRATE COUNTING

Little or no carbohydrates

2 slices of lean ham + 2 T light cream cheese + 2 pickle spears

3 oz shrimp + 1 T cocktail sauce

1 ounce goat cheese + ½ cup sliced cucumber

1 hardboiled egg + paprika and cumin

1 slice deli turkey + 1-ounce Swiss cheese

½ cup salsa + 1 cup jicama

¼ cup tuna + 2 T light mayo + fresh vegetables: cucumber/carrots/peppers/celery

1 slice deli turkey wrapped around 1/8 avocado

Pickled cucumber salad: ½ cup cucumber + white vinegar

1 ounce mozzarella cheese + 3 tomato slices + drizzle of balsamic vinegar and olive oil + fresh basil

Turkey and lettuce wrap

Low carbohydrates (≥15 grams)

½ cup Edamame

½ c cottage cheese + ¼ cup blueberries + sprinkle of cinnamon

1 cup watermelon + 1-ounce reduced fat feta + fresh mint

Tuna and bean salad: ¼ cup tuna + ¼ cup white beans + 2 T light vinaigrette dressing + salad greens

1-ounce smoked salmon + 2 T light cream cheese + 6 multigrain crackers

1 rice cake + cashew butter

1 cup cantaloupe + 1 ounce prosciutto

Ants on a log (1 celery stalk + 2 T peanut butter + 8 raisins

4 T hummus + ½ cup carrots

¼ avocado on whole wheat toast

15 Frozen grapes + 1 ounce string cheese

Cucumber and cantaloupe salad with mint

½ cup Low fat ricotta cheese + ¼ cup cherries + 1 T toasted almonds

¼ cup berries and ½ cup coconut milk with 2 T shredded coconut

Baba ghanoush (roasted eggplant dip) + ½ whole wheat pita

20-25 grams carbohydrates

Vanilla Almond Chia Seed Pudding: 2 T chia seeds + 1 cup almond milk + ½ teaspoon vanilla extract + ½

cup seasonal fruit

½ large banana + 1 T almond butter

15 Plantain chips and ½ cup salsa

2 T bean dip + 1 6” whole wheat tortilla + 1 ounce cheddar cheese

Whole wheat pretzels + mustard to dip + ¼ cup peanuts

4 dried figs stuffed with walnuts

¼ cup dried apricots and 1 ounce turkey jerky

¼ cup Roasted chickpeas


SAMPLE MEALS USING CARB COUNTING

All images compliments of https://thrive.kaiserpermanente

Diabetes and Your Lifestyle Toolkit

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