Diabetes: Finding the Balance

By Kristi Willis

Laurie Gonzales, a department manager at the University of Texas in her early 40s, was not surprised when she found out she had type 2 diabetes. She was overweight, had a history of diabetes in her family and was diagnosed with gestational diabetes 18 years before when she was pregnant with her son Matt.

“I knew it was coming,” she says. “It was a confirmation of what I’ve known all along: I eat poorly and I don’t exercise. I didn’t make any modification to my diet until I got the diagnosis.”

Gonzales is not alone in ignoring the warning signs of diabetes. According to the Centers for Disease Control and Prevention (CDC), one in twelve Americans now lives with diabetes and, of those 25.8 million children and adults, seven million of them are undiagnosed—increasing their risks for heart disease, stroke, blindness, kidney disease and nervous system damage.

People inherit a genetic predisposition to diabetes that is then triggered by something in their environment, such as poor diet, an unrelated illness that weakens the pancreas, or lifestyle factors, such as not exercising. With type 1 diabetes—previously called juvenile diabetes—the body no longer produces insulin, and therefore insulin therapy is required. Type 2 and gestational diabetes, on the other hand, occur when the body doesn’t produce insulin properly and can sometimes be kept in check without medication by using diet and exercise to control blood glucose (also referred to as “blood sugar”) levels. 

John Sonnenberg, an Austin pharmacist, contracted a virus, and the antibodies his body produced to fight the illness also attacked his pancreas, causing it to no longer produce insulin. At 45, he was diagnosed with type 1 diabetes and had to quickly learn to manage the disease. “I ride my bike almost every day for about 40 minutes, because a well-tuned body processes sugars more efficiently,” says Sonnenberg. “I check my blood sugar four times a day and try to keep it in a normal or slightly normal range, and I watch what I eat.” And because carbohydrates convert into glucose in the blood stream, causing glucose levels to spike, Sonnenberg counts carbs at every single meal

While type 1 diabetes is not preventable, type 2 is. An estimated 79 million Americans have—most often unknowingly—prediabetes, or an elevated blood glucose level that is not yet within the range of diabetes but signals danger ahead. Overweight, inactive adults, forty-five-years old or older with a diabetic parent or sibling are at greatest risk for prediabetes, as are women who had diabetes while pregnant or people with an African-American, Hispanic, American-Indian, Asian-American or Pacific-Islander family background. 

Having prediabetes does not necessarily mean a future type 2 diabetes diagnosis, though. Lifestyle changes, such as losing 5 to 10 percent of body weight and exercising moderately 30 minutes per day, five days each week, can keep blood glucose levels in a normal range. 

Stephanie Dunbar, director of nutrition and medical affairs at the American Diabetes Association, encourages those concerned about prediabetes to make gradual changes to achieve a healthy body weight. “While it would be preferable for everyone to get down to his or her ideal weight, it’s somewhat unrealistic to be able to do that if you’ve been heavy for a long time,” she explains. “Reducing just a little bit of your weight can make a significant difference to prevent diabetes.”

Once diagnosed with diabetes, diet and exercise become key factors to having a healthy, active life. Eating consistent, balanced meals helps keep blood sugar on an even keel. Lisa Jepson of the Austin office of the American Diabetes Association explains that portion sizes and timing of meals are critical. “You don’t want to be on a roller coaster, going up and down with meals,” she says. “You want to be on a nice, slow, lazy river, with equally spaced meals and snacks throughout the day, not high and low drops.”

Julie Paff, a registered dietitian at Seton’s Diabetes Education Center, encourages newly diagnosed diabetics to meet with a diabetes educator to get an individualized plan to minimize the risk of future complications. “I wish I could hand you a sheetThis Is What You Can Do to Improve Your Future Life with Dietbut it’s just not that easy,” explains Paff. “It’s best to individualize—look at where that person is and identify the one or two changes they could make to really reduce risk in the long haul.”

The elements of a healthy diet for a diabetic are similar to general healthy eating guidelines, such as eating a primarily plant-heavy diet with a rainbow of vegetables; limiting starchy vegetables, such as potatoes and corn; choosing whole-grain foods over processed-grain products; and adding fish and lean meats for protein. Steering away from sodas and sugary sports drinks is another important step: Those who are diabetic or prediabetic should opt for water or unsweetened tea and coffee drinks instead.

In addition to counting carbohydrates to control glucose levels, some find it helpful to also pay attention to a food’s glycemic index (GI), or the measure of how quickly levels of glucose in the blood rise after consuming that food. For example, picking a grapefruit with a GI value of 25 over watermelon, which has a hefty GI of 72, is a better choice for balancing glucose. Tallying and tracking the GI of a variety of foods can feel overwhelming, though; experts typically recommend concentrating on balancing the plate instead. “When people are first diagnosed with diabetes, they’re terrified to eat,” says Dunbar. “We steer people, initially, toward a create-your-plate model—recommending half a plate of non-starchy vegetables, a quarter of the plate either whole grains or starchy vegetables and then a quarter of your plate with your protein source.” 

Local writer and performer Owen Egerton was fortunate to have his diabetic brother to turn to for advice when he was diagnosed with type 1 diabetes 10 years ago. “My brother flew in and took me through a kind of ‘basic training’ for diabetics,” says Egerton. “He was aware that a lot of people who are diagnosed with diabetes develop this frustration with eating because it’s such a complicated process, and he was very good about encouraging me to live and eat freely and wisely. For example, when I asked him if I could have pancakes, he said, Sure! But just to make sure that I didn’t have too many, and that I ate a good amount of fat and protein at the same time because those things slow digestion and, consequently, will slow down glucose conversion. Having butter and bacon with pancakes didn’t feel like such a horrible sacrifice,” he says with a laugh. 

For Gonzales, cutting out sugar, flour and processed carbohydrates and starting an exercise regimen were enough to lower her blood sugar without medication or insulin. “I predominantly eat fruits, vegetables and meat, and my numbers are absolutely normal.” She carefully watches portion sizes when eating carbohydrates and keeps them well within the 45-grams-per-meal recommendation from her doctor. That can be a challenge when eating Asian food, for example, which would normally come with a big mound of rice. “An appropriate serving of rice would fit in my cupped hand,” says Gonzales. “I don’t eat rice very often just because it’s hard not to eat a lot of rice.” Instead, she substitutes things such as bean sprouts to get the crunchy texture she craves, but without the extra carbohydrates. 

For Sonnenberg, his love of Mexican food is a big challenge. With type 1 diabetes, he has to take a unit of insulin for every 15 grams of carbs he eats. “That’s like five [tortilla] chips,” he explains. “I don’t eat it very often anymore, but when I eat Mexican, I count everything—the beans, the rice, the tortillas, the chips—and have to measure my insulin to match.”

Egerton was surprised to discover that his emotional state—being nervous, excited or stressed—also affected his blood sugar. “If I’m particularly nervous about a show, then my blood sugar starts to spike. One thing that diabetes has given me is the opportunity to get in touch with how my body works,” he says. 

Planning ahead becomes a key factor, whether creating a menu for a family dinner, researching restaurant menus or packing the right food and snacks for an outing or road trip. The American Diabetes Association’s MyFoodAdvisor website offers diabetes-friendly recipes and meal plans with complete nutritional information, as well as shopping and cooking tips. 

Gonzales recommends becoming involved in the community and engaging with the American Diabetes Association and other organizations for support and advice. Seton offers a number of resources, including a 10-hour class for people with type 2 diabetes, as well as individualized counseling and Ask the Expert seminars. The Central Texas Diabetes Coalition also offers diabetes education and self-management classes and support groups.

Dunbar encourages people to be patient as they adjust to their new lifestyle. “First, work on changing the proportions and increasing those non-starchy vegetables. Then, cut back on the starchy foods and the sweets. Allow yourself some time to adjust and gradually make changes.”

After the initial shock of the diagnosis wore off, Gonzales began to see it as a blessing in disguise. “That diagnosis is what I needed to get my act together. For me, it was a start of a new chapter of my life where I am focused on being more healthfuland it’s working.”

A FEAST OF GOOD MEASURE

By Elif Selvili

When attempting to monitor and control blood glucose levels in the body, there is much debate about whether it’s better to keep an eye on general carbohydrate intake (even healthy complex carbohydrates such as legumes) or to pay attention to a food’s glycemic index—a measure of how quickly levels of glucose in the blood rise after eating a particular type of food. Health experts agree that the best nutritional path for anyone, whether living with diabetes or not, is to achieve a balanced plate with whole grains, greens and fewer simple carbohydrates. This doesn’t mean you need two separate menus when entertaining friends, some of whom may also be watching their blood glucose levels. Here’s a menu that provides taste, nutritional value and a sense of adventure with a Middle Eastern flare.



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