Newly diagnosed with diabetes and need help with diabetic exchange diet
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KnitterNotAQuitter
Posts: 67 Member
I was diagnosed as Type 2 on Thursday. I’m supposed to adhere to a 1,200 calorie a day diet based on the diabetic exchange plan, and my doctor gave me this sheet. And I totally don’t understand how this works.
Am I missing something? Where are the vegetables? How does one exchange equal three ounces of chicken in the example? Do you have to eat the same for every meal (e.g., breakfast is always one fruit, one meat, etc.)? I was so shocked and scared when the NP that handed me this and shortly explained it, I thought I understood it, but then she started looking at my feet and couldn’t feel a pulse and ordered a scary ABI test (which I had yesterday and don’t feel it went well).
So far, I’ve just been keeping to 1,200 calories, and going to the gym every day to walk for an hour, but I feel like not following the diet is not really following instructions.
Sorry if this is rambling, I’m waffling between being devastated to tears, feeling confident (“I got this!”) and “What the f*** does it matter what I eat? This is basically a death sentence I brought on myself anyway.”, which brings more tears and the cycle starts all over again.
And in the middle of all this, my friends are asking what’s going on with me and I’m too embarrassed to tell them, I’ve just been hiding at home since Thursday. I’ve only told my mom and sworn her to secrecy, but I’m visiting my family for Thanksgiving for the first time in years, and she’s already implied that it is now ruined.
I feel so scared and alone. If I could get my eating on track, at least I’d have that. Thanks for any help.
Am I missing something? Where are the vegetables? How does one exchange equal three ounces of chicken in the example? Do you have to eat the same for every meal (e.g., breakfast is always one fruit, one meat, etc.)? I was so shocked and scared when the NP that handed me this and shortly explained it, I thought I understood it, but then she started looking at my feet and couldn’t feel a pulse and ordered a scary ABI test (which I had yesterday and don’t feel it went well).
So far, I’ve just been keeping to 1,200 calories, and going to the gym every day to walk for an hour, but I feel like not following the diet is not really following instructions.
Sorry if this is rambling, I’m waffling between being devastated to tears, feeling confident (“I got this!”) and “What the f*** does it matter what I eat? This is basically a death sentence I brought on myself anyway.”, which brings more tears and the cycle starts all over again.
And in the middle of all this, my friends are asking what’s going on with me and I’m too embarrassed to tell them, I’ve just been hiding at home since Thursday. I’ve only told my mom and sworn her to secrecy, but I’m visiting my family for Thanksgiving for the first time in years, and she’s already implied that it is now ruined.
I feel so scared and alone. If I could get my eating on track, at least I’d have that. Thanks for any help.
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Replies
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I'm type 1, but had lots of time on exchanges for that and for another condition. I'll take a crack at this as best I can.
So for vegetables -- in the diabetes exchange diet, those are off of your free-food list. (This is part of why vegetables get a reputation for being "free" foods.) Eat what you like of the non-starchy veg, within reason, and as your calorie count allows.
I'm not sure how their sample meal plan is getting 3 oz of chicken for one exchange. I was always taught that one exchange = 1 oz, and that's what everything I google is telling me as well (I double checked just in case I was misremembering).
Yes -- you don't need to eat the same *foods* for every meal, but you need to eat the number of changes the same as they are prescribed. So that'll mean one fruit, one carb, one meat, and one fat for each breakfast. Ditto with how the lunch, dinner, and snacks are set up. At this point, at least. I was usually given a little more flexibility, but part of the key with type 2 is *consistent* carbs -- so that's why things are set as they are.3 -
I would ask for a referral to a nutritionist for help....most Dr's have little training in nutrition in med school. I don't blame you for feeling scared...diabetes is an insidious disease that can cause a lot of health problems if not properly taken care of. I think there are some diabetes forums here.1
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Don't ask for a referral to a nutritionist. You need to talk to a Certified Diabetes Educator, who usually is also a Registered Dietician. They may teach you how to count net carbs. My mom has Type 2 and can have 45 grams of net carbs per meal. It is really easy to figure that out just by reading the label on the package of food. Net carbs are just grams of carbs minus grams of fiber.
But ask to be referred to the Diabetes Educator. Most hospitals have one on staff.10 -
I'm sorry you're facing this situation. It is scary, but it's not a death sentence. You can definitely improve your condition with diet and exercise. What meds are you on? Are any of them glucose lowering, such as glimeperide and insulin? That makes a huge difference to whether you need to keep your carb intake constant or not. What was your A1c? How often are you testing your glucose?
With respect, the diabetes exchange diet is baloney and will keep you getting worse and worse. It's based on outdated information and the idea that most people don't have sense enough to eat right. Use it as a starting point to get an idea of how to design a balanced meal. Then use MFP's logging to look at exact net carb counts - that's what matters, not some estimate based on "carb points" and "exchanges." Depending on your own personal responses to glucose, you can probably eat between 30g and 50g of net carbs per meal, with a meal covering about a three hour period. But you won't learn the exact numbers until you start testing your own blood and seeing for yourself.
I'm a type 2 and I've lowered my A1c from 11 to 4.7 by doing what's called "eating to the meter." You buy a blood glucose meter, and you test after every meal, until you know how different foods affect your blood glucose levels. Then you keep your levels in check by eating food that doesn't cause your blood sugar to spike.
There's a diabetes support forum here with many experienced people, and we'd love to have you join.
As far as Thanksgiving is concerned, you need to be brave and strong. Remind your mother that visiting family is supposed to be about people who love us and care about us, and that she should be more concerned that you are getting what you need to be healthy than about stupid details. The meal will be in your mouth one day and in the toilet the next. Your life is more important. You did not bring this on yourself - no one chooses to have a dangerous disease.
I hope I'm not just confusing you worse. Please feel free to message me with specific questions.12 -
I was looking at the handouts they gave you, and wondering why so many foods are crossed out. Did anyone explain this?1
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Thank you music fan for correcting me...there can be some crazy nutritionists out there and I don't think they are regulated as Registered Dietician are.2
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@rheddmobile I forgot to mention, the scribbling was me — on the front, trying to figure out how the diet worked, and on the back, crossing out food I don’t really care for or probably won’t eat. Sorry for the confusion.
Regarding my vitals, I’m on Januvia 100mg, my A1C was 6.4 and my blood glucose was 155. The NP said I don’t need to test ... yet. She gave me the diet and only 90 days worth or medication. I have a follow-up appointment in a month and new labs in three months. I think she wanted to give me tough love which she referred to as “medical blackmail.”0 -
It's been nearly 20 years since I've seen anyone using the exchange diet; so I'm surprised your NP resurrected this out-dated method.
Each "exchange" of carb-heavy foods (grains/starch, fruit, milk) is approximately 15g of carbs; except the milk exchange is closer to 12g and has a small amount of protein. IIRC, a "meat" exchange is generally around 7g-10g of protein. The veggies are supposed to be non-starchy veggies (starchy vegetables such as corn or potatoes come out of your starch exchange). As such, they should be primarily fiber and have pretty close to 0 net carbs.
I'm a type 1 and started with the exchange diet in 1995. Everyone switched to counting carbs in the late '90's or early '00's. It is simpler, more accurate, and provides greater flexibility for most of us. As have others, I'm going to suggest seeing a CDE (Certified Diabetes Educator).6 -
I would ask for a referral to a nutritionist for help....most Dr's have little training in nutrition in med school. I don't blame you for feeling scared...diabetes is an insidious disease that can cause a lot of health problems if not properly taken care of. I think there are some diabetes forums here.
This would be a helpful option.1 -
I just hate when the MD throws you a book and says....there you go! Diabetes educator and nutritionalist should be referred for you and demand it!3
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The good news is that 6.4 is not that high! You are very lucky to have been diagnosed at an early stage.
I urge you to disregard the recommendation not to test. I'm not sure why doctors do this, mine did it too, but he sure changed his tune after seeing my lab results. Without a meter you are shooting in the dark. A cheap meter costs ten dollars at Walmart, and you can get the best rated one available with everything else required to test for forty on Amazon.
I've never been on Januvia, but Januvia supposedly doesn't cause low blood sugar, so it's not as critical for you not to skip meals as it would be for someone on insulin or a sulfonylurea like glimeperide. What you need to worry about is not eating too many carbs at one time, and especially not eating too many quick acting carbs such as refined grains and added sugars. Slow acting carbs such as the ones in fruit or beans affect different people very differently, which is one reason to test - for example, I can eat a huge serving of potatoes with no problems, but only a small amount of rice spikes me. A friend of mine has trouble with fruit which I am fine with. Unless you test, you are just guessing. The goal is to keep your blood glucose within safe levels.
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You did not ruin Thanksgiving. Everyone can bring what they want and eat what they want. I'm sorry your mother said that. It DOES matter what you eat, that you lose weight, and that you exercise. Even 10-20 lbs weight loss and exercise can start to reverse diabetes. It is a death sentence only if you do nothing to address it. T2DM is completely reversible with lifestyle changes. You've gotten much good advice above so I won't repeat it. You can tackle this, for sure!6
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By the way, Thanksgiving is a terrible meal to have to figure out for diabetics! What a time to be diagnosed. But turkey is carb free. See if you can bring some sugar free cranberry sauce if you like cranberry sauce, and make sure there are some non-starchy vegetables available that aren't drenched in gravy or marshmellows.1
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Unless I'm reading it wrong, it looks like on Thanksgiving you could have a serving each of turkey, a dinner roll, mashed potatoes, milk, and free vegetables with a serving of fat to cook your veggies or for salad dressing.
For your "bedtime snack" you could make pumpkin mousse by whipping up a serving of condensed milk and folding in a serving of pumpkin with some pumpkin spices.
And if your family eats Thanksgiving dinner like mine, we linger around the table talking long enough that maybe you'll have a long enough time at the table for it to be lunch, then your break, then dinner.
I don't know much about the exchanges (even though a few people close to me have diabetes), so don't take my suggestions too literally! Definitely take everyone's advice and see a proper nutritionist! But I wanted to give you some hope that Thanksgiving is not ruined. 2 -
Have some talks with your mom so she can be chilled out by Thanksgiving. Geez.
Yes, regarding meals being mostly the same everyday on this plan.e.g., breakfast is always one fruit, one meat, etc.)
You have veggies available to you: Bean sprouts, green beans, broccoli, carrots, celery, cooked mushrooms, onions, red or green peppers, cooked spinach, tomato, cooked zucchini, spinach, cucumber, zucchini, dill pickles.
Good luck. The beginning of any new experience can feel overwhelming. It will get better.
If you can find a Registered Dietician, you would (I hope) get someone who explains things to you better.
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That is just heartbreaking that your mother would say that you ruined Thanksgiving. I’d be tempted to tell her to go ahead without me and spend the day on a nice long walk and time to reflect on what you need to do to get your health back on track.
As @lorrpb said, you can absolutely get that A1c down by losing 10-20 lbs to start (you don’t say how much you need/want to lose).8 -
Oh, honey. It's going to be okay. Diabetes is not a death sentence. You absolutely have it in your own hands to improve your condition. I was diagnosed with T2 eighteen months ago. I came to MFP with the intent of monitoring my sugars and starches, and soon moved to keeping track of my calories as well. Over the past year my A1c has gone from 7.9 to 5.4, and serum glucose from 157 to 94. Today I'm below the diabetes threshold and even the pre-diabetes threshold.
Insist on that referral to a Diabetes Educator and RD. That diet sheet you were given is definitely outdated. There are lots of people on this forum who have their diabetes well under control by diet alone, but even if you need medication, you can still make your life very comfortable and healthy. You're not alone.
And that was an awful thing for your mother to say. One person's diet is not what ruins Thanksgiving -- unkind and rigid attitudes do.3 -
I've never heard of the "exchange' thing so I can't comment on that but eating a low carb diet will definitely help you loose weight and quite possibly reverse your diabetes. Like another poster had pointed out, 6.4 is really not that high for an A1C and a b/s reading of 155 is a little high but not that high. Really, what you should be eating is protein (meats, eggs, cheese, etc.), complex carbs (non-starchy veggies), and fat. I would stay away from the carrots, along with the corn, as they are both pretty high in carbs. Some people seem to think switching to whole wheat pasta is okay if your diabetic but, honestly, it doesn't matter what kind of pasta it is....... whole wheat might be a little healthier but, it all turns to glucose (sugar) once it enters the body and it will cause your sugar to spike. As far as I know, I am not diabetic but it does run in my family. For this reason, I choose to follow a low carb way of eating. I try to keep my carbs below 60 net grams for the day. For breakfast (if I don't have to work), I'll have bacon or sausage, eggs, and maybe one slice of low carb bread with butter. Lunch could be anything from a cup of homemade chili, or turkey/cheese rolled up around a slice of pickle, or a cup of homemade broccoli cheddar soup, or a salad with a can of tuna or chicken added or pizza (sauce, cheese, pepperoni baked/broiled on a low carb wrap) or fried cauliflower rice. Dinner is usually some kind of protein (chicken, fish, beef, pork) along with a non-starchy veggie and, my new favorite thing to eat, mashed cauliflower (instead of potatoes). I usually eat 3 meals a day and 2 snacks. My go-to snack now is a pumpkin/cheesecake bake which I make just about every 2 weeks. It's really easy and simple. It's just cream cheese (softened), 15 oz. can pumpkin (not the pumpkin pie filling), 1 cup Splenda, 5 eggs, 1 1/2 tsp. of pumpkin pie spice, 1 tsp. cinnamon, and 1 tsp. of vanilla. Beat the cream cheese to get any lumps out, add the remaining ingredients, beat until smooth and pour into a glass pie dish which has been sprayed with any kind of cooking oil spray. Bake it at 350 degree oven for about 50 minutes. I also put a 9 x 11 Pyrex pan filled with water on the bottom rack of the oven with the pie on the center shelf to bake. The moisture from the water seems to keep the pie from cracking. I cut this into 8 slices once it cools and have a slice just about every night with Reddi-Whip whipped cream and a sprinkle of cinnamon for a total of 6g net carbs per slice....... There are so many different recipes out there you can make and keep your carbs down. One of my favorite sites is Linda's Low Carb Menus and Recipes.
And, also, I'm sorry your Mom said that to you. I'm sure it really hurt your feelings, as if having to deal with diabetes was not enough, but there are plenty of things you can do for Thanksgiving. Personally, I am making a bowl of mashed cauliflower to bring to my sister's house along with my Pumpkin/Cheesecake Bake. While everybody is eating mashed potatoes, I will be eating my mashed cauliflower and, instead of Pumpkin Pie, I will have my Pumpkin/Cheesecake Bake. I'm also thinking of making some low carb cranberry sauce to take along with me. I'm going to do a test run this week to see how it comes out. The recipe I found online seems easy enough. It's just 1 bag cranberries, 1 cup of water, 1 cup Splenda, and orange zest. Anyway, wishing you all the best. Feel free to send me a friend request.6 -
First of all, if I were to pick a chronic disease, I’d pick diabetes. Control is all in your hands. Monitor and control your eating and you can postpone the effects of the disease for decades.
The meal plan is reasonable. There are lots of veggies in there and I suggest you treat them as practically “free”.
Mom needs to get a realty check. The typical thanksgiving menu has everything a diabetic needs. You’ll just have to skip dessert. Your portions will be different. Load up on the salad and pick your carb. The carb will be the bun OR the potato OR the dressing. Turkey is terrific.
I am not a fan of the tough love approach. People don’t get smart when they are afraid. Frightened people make poor decisions and can rush right off a cliff edge.
I’m a fan of breaking down tough jobs in to manageable pieces.
Don’t get me wrong. I don’t have much patience with people who ignore this disease. I just want to be effective in explaining that a life makeover is very possible.
I am in remission now but the decade and more that I was diabetic I avoided the nerve damage and other scary things that comes from uncontrolled diabetes.8 -
The main part of the exchange diet you should focus on is the carbs, since that is what will cause your blood sugars to go up the most. The simplest way to count carbs is to remember that 15g carb = 1 carb exchange, so take the carb information from the Nutritional Facts label and divide that by 15. That's how many carb exchanges the food has. Fruit exchanges (if you have any) are also 15g carbs each but are exclusive to fruits. Meat exchanges (I'm assuming that 1oz = 1 meat exchange) are 7g protein, but only if there's actual meat in it as carb exchanges can also include 2g protein.2
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