Medical Edge Newspaper Column

Diabetes: Eating Right Despite Obstacles

July 8, 2007
Dear Mayo Clinic:
I'm a 33-year-old man who was diagnosed with diabetes in 2001. I live and work in an institution where I'm limited to cafeteria food that is high in carbs. My A1C has been between 9.0 and 10.5 percent for the last year. How can I maintain a healthy lifestyle to get my blood-sugar levels under control?

Answer:
It's easy to understand your concern and frustration as you try to improve your glucose control. Maintaining healthy eating habits is challenging when we are not preparing meals for ourselves -- but it is not impossible. Although the food in most cafeterias is high in carbohydrates and fats, most establishments do offer healthier options such as lean meats, fish, vegetables, and fresh fruits. Never underestimate your power as a consumer in indicating to the server the foods and portion sizes you wish to be put on your plate.

Institutions are increasingly recognizing the value of including healthier alternatives in their menus when the people being served are employees. Given that the employer is likely responsible for paying all or part of constituents' health care premiums, the financial bottom line can be a great motivator. So we would encourage you to learn more about the nutritional values, if they are not already offered, of the foods available at your institution. Information such as calorie, carbohydrate, and fat content per serving can help guide you to making better choices. You should encourage your institution to post that information so that it is easily available to all consumers trying to improve their eating habits.

Of course, getting the information is not enough -- the options may turn out to be truly limited. In that event, you and other employees can work together to encourage change. Remember that you are not alone. One need not have a diagnosis of diabetes to be concerned about the adverse consequences of an unhealthy diet.

Assuming that options are sufficiently wide and you obtain the associated nutritional information, you will then need to apply the nutritional information when choosing your meals. In that spirit, it's useful to consult reliable authorities such as a dietitian and resources in libraries or on the Internet. Beware of self-serving spiels, however, from commercial sources; instead, rely on unbiased sources such as the National Institutes of Health.

The best advice is to reduce fat in your diet (limit fried foods, cheeses, bacon, and sauces); select lean meats, such as grilled chicken or beef; and choose high-fiber foods (vegetables, fruits, whole-grain breads, and salads). In particular, you should work to increase your intake of vegetables and fruits and curtail your intake of meats and carbohydrates. Whereas the typical American meal consists of a large plate that is half filled with a meat serving and the remainder filled by a carbohydrate serving, your modest-sized plate should be half filled with fruits and vegetables, one-quarter filled with a meat serving, and one-quarter filled with a carbohydrate serving.

A dietitian, especially one who is experienced working with patients with diabetes, can help you design a specific meal plan that is tailored to your own needs. And don't forget that another aspect of a healthy lifestyle is regular physical activity, which offers multiple health benefits. If these changes are not enough to achieve the glucose levels desired, your doctor will likely suggest adding a glucose-lowering medication or adjusting the dose of one you may already be taking.

Changes are indeed indicated for you, as your level of A1C (which measures your average blood-sugar level for the past two to three months) is significantly above the desired target. In contrast with your reported 9-10.5 percent, the level should be no greater than 7 percent, and as close to 6 percent as possible, to lower your risk of longer-term complications such as heart disease and damage to the nerves, kidneys, and eyes.

We understand that it takes great effort to adhere to a healthy lifestyle, but remember the potential rewards: a long and healthy life.,

-- Maria L. Collazo-Clavell, M.D., Endocrinology, Mayo Clinic, Rochester, Minn., and medical editor of "Mayo Clinic on Managing Diabetes."