Diabetes Basics:Tuning up Your Skills

Take this true-or-false quiz to see what you know
By Tracey Neithercott with Erika Gebel, PhD
As any sympathetic diabetes educator will tell you, things aren’t always black and white when it comes to diabetes management. Sure, there are practice guidelines and recommendations for ideal care, but people are imperfect and sometimes life throws you for a loop. Which is why many educators have realistic expectations.

In fact, after getting the skinny on eight oft-repeated self-care tenets, you may be surprised at how flexible diabetes management really is. Plus, you’ll take away some basic knowledge you may have forgotten since you were diagnosed. And experts say everyone could use a refresher now and again. “Medications change. Recommendations change,” says Dawn Sherr, RD, CDE, a diabetes educator with the American Association of Diabetes Educators. “It’s always good to brush up … every few years.”

① True or False?
“The exchange lists for diabetes is the best meal plan.”
Truth: Carb counting is more precise, and the plate method is easier.

Tip #1

Get familiar with portion sizes by using measuring cups while eating at home.
In the past, most people with diabetes followed the exchange system meal plan. Here’s how it works: Nutritionally similar foods are grouped into categories—carbohydrate, fat, and protein—and then into subcategories such as meat, fruit, and starches. Each food on a given subcategory list is interchangeable with the rest, so you could exchange a half cup of corn with eight animal crackers or a quarter of a bagel. You can eat “free foods,” which have 5 grams of carb or fewer and are under 20 calories, as often as you like without worry.

Though there’s little math involved in the exchange system (compared with carb counting), educators don’t often recommend it. “I can’t remember the last time I thought of the exchange system,” says Janet Zappe, RN, MS, CDE, a nurse and diabetes educator at the Diabetes Research Center at the Ohio State University Wexner Medical Center. That’s because carbohydrate counting allows for more precise insulin dosing and the plate method is even easier to understand than the exchange system. The plate method allows one quarter of a 9-inch plate for lean protein, one quarter for grains or starches, one half for nonstarchy vegetables, and a serving each of fruit and lean dairy on the side. Plus, both give people with diabetes more freedom in their meal planning than the exchange system does.

Does that mean you should drop the practice if it’s working for you? Not necessarily. “It’s important to understand that the plan you’re on is specific to you, and yours might be entirely different [from someone else’s],” says Amber Wilhoit, RD, LDN, CDE, CPT, a registered dietitian and diabetes educator with the University of Florida Diabetes Center of Excellence. That said, you may want to talk to a diabetes educator or registered dietitian about whether a different meal plan may be more effective for you.

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