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Living with Diabetes Module 06

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6. Module 06: Maintaining a healthy life

Table of Contents

6. Module 06: Maintaining a healthy life .................................................................................................................... 1

6.1 Practicing Self Care: Diet and Lifestyle ................................................................................................. 3

6.2 Nutrition for Diabetes ............................................................................................................................ 4

6.2.1 Balanced Eating - What does it mean? ............................................................................................. 5

6.3 Understanding Macronutrients .............................................................................................................. 6

6.3.1 Carbohydrates ................................................................................................................................... 7

6.3.2 Proteins ............................................................................................................................................. 6

6.4 Fibers, Sugars, and Sodium in the body ............................................................................................... 2

6.4.1 Non-Starchy Vegetables ................................................................................................................... 0

4.3.2 Whole Grains .................................................................................................................................... 0

4.3.3 Sugars ................................................................................................................................................ 0

4.3.4 Sodium .............................................................................................................................................. 1

6.5 Food Shopping and Dining Out ............................................................................................................. 2

6.5.1 Eating out with Diabetes ................................................................................................................... 2

6.5.2 Reading a product label .................................................................................................................... 3

6.5.3 The Healthy Plate .............................................................................................................................. 4

6.6 Developing a Healthy Exercise Routine ................................................................................................ 5

6.6.1 Before you Exercise .......................................................................................................................... 6

6.6.2 Hypoglycemia and Exercise ............................................................................................................. 7

6.6.3 What exercise is best for Diabetics? ................................................................................................. 8

6.7 Diabetes and Sexual Health.................................................................................................................. 0

6.7.1 Physical effects on sexual health ...................................................................................................... 1

6.7.2 Emotions and sexual health .............................................................................................................. 2

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6.7.3 Women’s Sexual Health and Family Planning ................................................................................. 4

6.7.4 Diabetes and Menopause .................................................................................................................. 5

6.7.5 Men’s Sexual Health ......................................................................................................................... 6

6.7.6 Adolescents and Sexual Health ......................................................................................................... 8

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6.1 Practicing Self Care: Diet and Lifestyle

In this module you will be learning about how to manage your diabetes through diet and exercise, and how to

maintain good sexual health. You’ve already learned WHY a clean diet and regular exercise are integral to

diabetes management, but now we’re going to show you exactly how you can put this into effect. What foods

should you be eating? How will you make diet changes that you can stick with? What kind of activities are

most effective? How will diabetes impact your sexual health?

You’ll learn how to make practical and sustainable lifestyle changes that will improve your mental, physical,

and sexual health, and put you on the road to long-term diabetes management.

The following topics will be covered:

Nutrition for Diabetes

Understanding macronutrients – carbs, protein, and fat

Fibers, Sugars, and Sodium in the body

Food shopping and dining out

Developing a Personalized Exercise Regime

Diabetes and Sexual Health

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6.2 Nutrition for Diabetes

For diabetics, food and deciding what to eat may feel like an endless battle. You may find yourself staring at

a restaurant menu or down the aisle at a grocery store forever asking “what CAN I eat?”

You may have heard: “no sugar, no carbohydrates, no dessert, no potatoes, or nothing white”. Or you have a

relative, a cousin, a friend of a friend who knows everything about diabetes nutritional health because they

read a pamphlet about it in their doctor’s office. Any of this sound familiar?

Newly diagnosed diabetics may be particularly nervous about what the disease means for their diet, and they

may feel a sense of “my life is over, I’ll never eat anything delicious ever again!”

We’re here to tell you that isn’t the case, so rest assured. Eating is one of life’s greatest pleasures and quite

frankly, we all should enjoy it – yes, even diabetics. It all boils down to balance.

In this section, you’ll learn how to plan manage your nutrition effectively in a way that still allows you to

enjoy food, but will also help with managing your diabetes.

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6.2.1 Balanced Eating - What does it mean?

It’s important to know up front that there is NO DIABETIC DIET. What this means, that unlike the Paleo

Diet or Atkins Diet, there’s no set of rules, no point system, and no list of approved foods. In general, every

individual has to assess their own needs, their lifestyle, and what their body requires to stay healthy and fueled.

Eating with diabetes does not have to mean feeling deprived. That being said, it also does NOT mean you

have a free pass to eat all the ice cream you want (though ice cream CAN be enjoyed by diabetics!)

So where do we begin?

Balanced eating plays a huge role in blood sugar management, and it starts with meal spacing. Most people

need to eat every 4 to 5 hours, starting within one hour of waking up. This generally looks like three meals

and one snack per day

Why within 1 hour? You have fasted all night long. You need to give your engine some gasoline for energy,

and stop that leaky liver from producing sugar. If you can’t eat a meal within 5 hours, have a snack. Contrary

to popular myths that snacking leads to weight gain, snacks actually help to prevent overeating during meals,

and keep our leaky liver in check.

Here’s what a healthy day of meal planning could look like:

6 am – wake up

7 am – breakfast

12 pm – lunch

4 pm - snack

7 pm – dinner

10 pm - bedtime

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6.3 Understanding Macronutrients

Let’s breakdown meal planning a bit further. Equally as important as regular meals and maintaining a

consistent routine, is what you consume. You may have heard the term macronutrients. These are calorie-

providing nutrients that we need a lot of every day.

Macronutrients consist of:

Carbohydrates

Protein

Fat

Each one plays a vital role in healthy eating and managing your diabetes, and they all offer their own unique

benefit. You’ll find that almost every food contains some degree of every macronutrient, but there’s a

difference in the balance and proportion. When a food contains a majority of one macronutrient over the

others, they are then categorized in that fashion. For example, we refer to avocados as “fatty”, but they also

contain carbohydrates and protein – just in smaller amounts.

When balancing your diet, keep in mind that each food will tick off various boxes, so you don’t have to build

a meal using foods exclusively from each category. If you’d rather not eat meat, for example, you can add

nuts to your meal and tick off both “fat” and “protein”, as nuts are high in both. This is also important to note,

because there are really no foods that will give you all the nutrients you need on their own. You have to learn

how to create meals that address all of your nutritional needs – and this is a huge part of balanced eating for

diabetics.

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6.3.1 Carbohydrates

Carbohydrates can be found in almost every food, and they are the main source of energy for your body. They

literally provide the fuel that your muscles need to function, and for your nervous system to operate effectively.

Carbohydrates have also been linked to brain function – they can influence memory, mood, decision-making,

and learning.

Even though carbs can be found in almost all foods, there are some that are considered “high carb” - meaning

their makeup is majority carb, and compared to other foods, they have a higher overall carb count. These

include:

Starches

Potatoes

Rice

Bread/Bagels

Pasta

Beans/Chickpeas

Squash

Corn/Cornmeal

Taro

Cereals/Oatmeal

Peas

Wheat/Flour

Flour Tortilla

Barley

Crackers

Quinoa

Fruits

Bananas

Fruit Juice

Orange

Applesauce

Mango

Cranberry Sauce

Cherries

Raisins

Pear

Smoothies

Dairy

Ice Cream Low-fat Milk Whole Milk

Flavored

Yogurt

Low-fat

Yogurt

Others

Sugar/Brown

Sugar

Chocolate

Honey

Energy Bars

High-Fructose

Corn Syrup

Candy

Jellies/Jam

Cake/Pie

Soda

Flavored

Coffee

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Carbohydrates and Diabetes

Carbohydrates turn 90 to 100% into blood sugar when we consume them. But that doesn’t mean they shouldn’t

be consumed.

They are what your body uses for energy. By avoiding carbs altogether, it’s comparable to putting a bandage

on a wound. Just because the wound is covered, doesn’t mean it’s not there – and it can still get infected if not

taken care of. Diabetes is the same.

If you eliminate carbohydrates from your diet, or significantly reduce your carb intake below recommended

levels, your blood sugar might look controlled for while. Overtime, because diabetes is chronic and

progressive, your insulin resistance will worsen. And when your body begins to starve, and your brain function

decreases, and every single cell cries out for energy and fuel, you will not reach for broccoli – you’ll reach for

a cake. Your body will be in depravation mode and craving the highest concentration of carbs possible to give

it an immediate boost. This means your diabetes symptoms will not go away, they’ll return with a vengeance.

It is not practical to deprive the body of carbohydrates, nor is it healthy. The most effective way of maintaining

a long-term diet where both your body is happy and you feel fulfilled, is via portion control.

Carbohydrates and Nutritional Value

So how do you eat carbohydrates and still be successful in managing your diabetes and its symptoms? For

starters, know that some carbohydrates are more nutritious than others. This means that in addition to being

high in carbs, they still carry some other nutritional benefits, such as protein, fat, fibre, etc.

Nutritional Value

An example of this is fruit. Fruits are sugary and generally considered to be high carb, but they also have great

nutritional value taken as a whole. Dried fruit like apricots or raisins are high in carbs, but also contain

potassium (which helps to stabilize blood pressure), anti-oxidants (better blood flow, digestion, and can reduce

the risk of disease), and fibres (improved digestive health).

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Empty Carbs

You may have heard the term “empty carbs” being used to describe some foods (usually junk food). Foods

considered to be empty carbs are generally highly processed, which means they contain large volumes of

chemicals, sugars, and synthetic materials like dyes or binding agents. These foods are usually high-calorie,

and provide little nutritional value in the way of vitamins. Potato chips, for example, provide no health benefit

– just sensory satisfaction. But there are also foods that aren’t highly processed that we still consider “empty”

carbs. White rice and white pasta, for example, provide little benefit other than making you full, whereas

making the substitution to brown rice and whole-grain pasta means you’re getting some vitamin K, vitamin

B, fibre, and others while still getting important energy from carbohydrates.

So, can Diabetics still eat carbs?

Yes! But to help control blood sugar, you will have to choose carbs that have high overall nutritional value.

Think of it this way – if you’re going to eat carbs, make them count in other ways too. You’ll also have to

regulate the amount of these foods that you consume.

Substituting Bad Carbs for Good Carbs

Sometimes being “good” is the best you can do when it comes to diet, but when possible, challenge yourself

to do the “best” for your body. If you can strive to at least once a week make a “best” substitution, you’re on

a good path forward, and it will be easier to make those choices more frequently. You will have bad days too,

and keep in mind that some of these foods are not even all that terrible – there are just better options.

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In this table, foods in the “best” section are lower carb alternatives AND they feature additional nutritional benefits:

Not Ideal

White Pasta

White Rice

Potato Chips

Store-bought Flour Tortilla Taco

Tuna Salad on White Bread

Baked Potato

Mashed Potato

Good

Whole Grain Pasta

Brown Rice/Quinoa

Dried Fruit

Homemade Corn Tortilla Taco

Tuna Salad on Whole Grain Bread

Baked Sweet Potato

Sweet Potato Mash

Best

Zucchini Noodles

Cauliflower Rice

Dried Kale or Carrot Chips

Lettuce Wrap Taco

Tuna Salad Served in an Avocado

Stuffed Peppers

Mashed Cauliflower

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Hash Browns

Regular Pepperoni Pizza

Lasagna

Hamburger on Sesame Bun

French Fries

Sour Cream

Ice Cream

Breakfast Cereal

White Sugar (Table Sugar)

Sweet Potato Pancake

Veggie Pizza on Thin Crust

Whole Grain Lasagna

Burger on Whole Wheat Flatbread

Baked Sweet Potato Fries

Cottage Cheese

Sorbet

Oatmeal

Agave

Summer Squash Pancakes

Portabello Mushroom Pizza

Lasagna with Eggplant slices

Turkey Patty on Roasted Eggplant

Baked Carrot and Squash Fries

Natural Yogurt

Frozen Yogurt or Kefir

Steelcut Oats with chia seeds

Stevia or Honey

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Portions for Carbohydrate Consumption

The following chart will help you determine carbohydrate amounts per meal. It’s important to note that these are guidelines, and consulting with a nutritionist

will give you a better sense of what YOUR body needs.

Weight Loss Weight Maintenance Very Active or weight gain

Women

2 to 3 portions

or

30 to 45 grams

3 to 4 portions

or

45 to 60 grams

4 to 6 portions

or

60 to 90 grams

Men

3 to 4 portions

or

45 to 60 grams

4 to 5 portions

or

60 to 75 grams

5 to 7 portions

or

75 to 105 grams

Each portion/serving of carbohydrate is equal to 15 grams of carbohydrates. This will be helpful when reading product labels, and planning your meals.

Here are some portion examples of foods heavy in carbohydrates.

Starches 1 portion = 15 grams

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Flour products – including snacks Cereals and Grains

Bagel 1/4 large Cold, unsweetened cereal ¾ cup

Bread 1 slice Cold, frost cereal ½ cup

Crackers 5 to 7 Cooked cereal, oatmeal, grits ½ cup

English muffin ½ muffin Granola ¼ cup

Sandwich crackers (peanut butter,

cheese) 3

Rice (brown, white or wild),

couscous, barley, faro 1/3 cup

Pita, 6 inches across 1 Pasta, cooked 1/3 cup

Popcorn 3 cups Cold, unsweetened cereal ¾ cup

Pretzels twist mini 12 to 15 Beans and Lentils

Hamburger or hot dog bun ½ bun Beans (black, pinto, etc.) ½ cup

Tortilla, 6 inches 1 Baked beans 1/3 cup

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Waffle, 4 inches

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Lentils ½ cup

Starchy Vegetables Lima beans 2/3 cup

Corn ½ cup Milk/Yogurt (1 portion – 15 grams)

Peas ½ cup Milk (nonfat, 1 %, 2 %, whole) 1 cup or 8 oz

Potatoes (white, sweet, yams)

Boiled

Mashed, hash brown

1/4 large or 1 small

½ cup

Nut milk sweetened (almond,

cashew, flaxseed, etc…) 1 cup or 8 oz

Winter squash (acorn, spaghetti,

butternut) 1 cup Milk (nonfat, 1 %, 2 %, whole) 1 cup or 8 oz

Soy milk 1 cup or 8 oz

Fruit (1 portion = 15 grams)

Apple 1 small (4 oz)

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Berries (black, blueberry, raspberry) ¾ cup

Dried apricot halves 7

Melon (watermelon, cantaloupe, honeydew) 1 cup, cubed or balled

Grapes ½ cup

Cherries ½ cup

Strawberry 1 ¼ cup

Prunes 3 medium

Figs 2

Dried fruit (cranberries, raisins) 2 tablespoons

Juice (apple, pear, orange, etc…) ½ cup

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6.3.2 Proteins

Protein is an essential building block in the body. It helps to build hormones, cells and more, and makes us feel fuller with less food eaten. Because protein

contains no carbohydrates, it has no direct effect on blood sugar levels – with the exception of some high-protein vegetables. Protein is most notably found in

meat, but there are other ingredients that contain high levels of protein that vegetarians and vegans can enjoy to get similar nutritional benefit. A healthy meal has

between 1 to 4 ounces or portions of protein per meal.

Animal Protein Plant Protein Healthiest protein choices

Poultry Beans (also count as starch) Plant proteins

Fish Lentils (also count as starch) Fish

Beef Nuts Poultry (without skin)

Pork Tofu Eggs and low-fat cheeses

Eggs Tempeh Game meat (pheasant, venison)

Cheese Nut butters Broil, bake or roast meats instead of frying

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What to watch out for when it comes to protein consumption, is fat. Most meats contain high amounts of

calories and fat, but some more than others. Even though meat is considered healthy by most diabetics, it’s

important to limit meats high in cholesterol and saturated fat (bacon, ribs, sausage, fatty steak, etc.)

If you enjoy eating meat, it’s best to eat lean meats such as chicken, turkey, and fish over beef

and pork.

Try to limit red meat and fatty meat consumption to once or twice a week, and choose leaner cuts

like the “loin”.

Consider too, how meat is prepared. Avoid frying meat – slow roasting, broiling, boiling, and

barbeque are all low-fat cooking methods.

Eggs, nuts, beans, and low fat cheese are also an excellent source of protein, and require next to

no prep time.

If you choose plant-based sources, just be sure to check if they have carbohydrates.

Fat – the good and bad!

Fat has gotten a bad rap in our diet-obsessed culture. It’s an essential macronutrient in our diet, and did you

know it helps protect our skin, cells, and build hormones? The reason why most people are afraid of fat, is

because it can be a very concentrated source of calories - which contributes to weight challenge. It may also

add to the insulin resistance in Type 2 Diabetes.

Does this mean you shouldn’t eat it? No! Fat can be a healthy part of your meal, and there ARE nutritional

benefits to fat. Aim for a maximum of 3 servings of fat per meal. Here’s how to measure a serving:

1 teaspoon of oil or butter

1 tablespoon sour cream, cream cheese, salad dressing, margarine

6 to 10 nuts

2 tablespoons avocado

10 olives

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Saturated fat

Saturated fat raises your cholesterol, potentially increasing your risk for heart disease and stroke. People with

diabetes are at increased risk for stroke and heart attack. Foods high in saturated fat include lard, bacon, beef,

sausage, full-fat cheese, ice cream, 2% milk, butter, etc. It is typically recommended to keep your saturated

fat to less than 10% of your daily calorie intake. To be safe, read the label! Aim for less than 1 gram per

serving.

Trans fat

Trans fat is also extremely heart unhealthy - worse so than saturated fat. It also raises your bad cholesterol,

but also may potentially harden your arteries. It is so bad for you, that the goal should be to have NO TRANS

FAT in your diet. Trans fats are found in processed foods like crackers, chips, cookies, muffins, margarines,

shortening, etc. You’ll know if a food contains trans fat, because it will be listed in the Nutrition Facts on the

label (in most regions it is a legal requirement). Unfortunately, manufacturers are tricky! If there is 0.5 grams

or less, they can write 0 grams on the label. If you see the words “hydrogenated _______ oil” then it contains

trans fat (the label may also say “partially hydrogenated _____oil”)

Monounsaturated fat

Monounsaturated fats are considered the heart healthiest fat because they do not affect cholesterol. These fats

are primarily found in plant products. Foods with good monounsaturated fats include avocado, canola oil,

cashews, peanuts, olives and olive oil, peanut butter and peanut oil, sesame seeds, etc. Aim for these to be the

primary types of fats in your diet.

Tips:

Try using canola oil when cooking

Put peanut butter on your toast or bagel versus butter

Use avocado on your burrito instead of sour cream

Try oil and vinegar on your salad versus creamy dressings

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Polyunsaturated fats

These fats are the next best options to choose from. You should want most fat from monounsaturated fats, but

you can replace saturated fats with these polyunsaturated fats. These include corn oil, cottonseed oil, safflower

oil, soybean oil, sunflower oil, walnuts, pumpkin or sunflower seeds, salad dressings, mayonnaise, etc.

Omega-3’s

You may have also heard of omega-3 fatty acids. They are known to help improve your risk for heart disease.

Experts usually recommend 2-3 servings per week to increase omega-3 fatty acid intake. Sources of Omega

3’s include: fish (best option), walnuts, tofu and other soy products, flaxseed oil, etc.

6.4 Fibers, Sugars, and Sodium in the body

What is fiber? Fiber is a non- digestible plant substance that contains no nutrients or vitamins. In general, fiber

holds back the carbohydrates in your food, and only allows it to be released a little bit at a time. Fiber also

facilitates easy absorption of nutrients during digestion, so your body doesn’t miss any of the good stuff. A

diet rich in fiber can help lower cholesterol, and also improve over-eating, because fiber-dense foods make

you feel fuller for longer.

Fiber falls into two categories:

Insoluble fibers: help soften stool, facilitates efficient movement of food throughout the body, produces good

digestion, and leads to regular bowel movements. These include:

Beans and lentils

Brown rice

Oats

Wholemeal items (wholemeal flour, pasta, bread, etc.)

Wholegrain items (bread, cereal, etc.)

Fruits with edible seeds (berries, for example)

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Soluble fibers: lowers cholesterol and controls blood sugar. It’s found in all fruits and vegetables, but

especially in:

Apples

Barley

Legumes

Pears, Strawberries, Lemons, Oranges

Carbohydrates will cause a spike followed by a plummet in your blood sugar, which potentially leads to

uncontrollable blood sugars. Fiber stops this, allowing for a slower rise and fall in your blood sugar.

A diet rich in fibre leads to more consistent blood sugar numbers. You should aim for at least 18 grams of

fiber per day, but a good fiber intake is 25 grams per day.

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Here is a rough guide to fiber quantities and portions for some foods that have good nutritional value and high fiber content. Add these to your diet to ensure

you’re meeting your daily fiber needs.

1 cup of cooked asparagus 5.6 grams 1 mango 3.7 grams

1 cup unsweetened applesauce 3.10 grams 1 cup peas and carrots (frozen) 5 grams

1 banana 2.10 grams 1 medium bran muffin (average) 2.6 grams

1 cup baked beans in tomato sauce 7.10 grams 1 cup cooked mushrooms (fresh) 3.4 grams

1 cup of blackberries 7.6 grams 1 cup oat bran 5.7 grams

1 cup of blueberries 3.9 grams 1 cup plain instant oatmeal (average) 3.9 grams

1 cup cooked broccoli (fresh) 4.6 grams 1 medium orange 3.1 grams

1 cup cooked carrots (fresh) 5.2 grams 1 cup raw tomato 2.00 grams

1 cup cashews 4.9 grams 1 cooked parsnip 6.2 grams

1 cup cauliflower (frozen) 4.9 grams 1 cup whole wheat pasta (cooked) 3.9 grams

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1 Tbsp tahini paste 1.4 grams 1 cup dried peaches 13.1 grams

1 cup bran flakes cereal (diff. brands) 4.8-12 grams 1 cup peanuts 13.2 grams

1 cup dried cranberries 6 grams 1 pear 4 grams

1 cup dates 13.4 grams 1 cup cooked green peas 8.8 grams

1 cup cooked eggplant 2.50 grams 1 cup pecans 8.2 grams

1 cup hazelnuts 8.2 grams 1 cup pistachio nuts 13.8 grams

1 cup flax seeds 25.50 1 whole wheat pita bread 3.5 grams

1 cup granola (diff. brands) 6.2-8 grams 1 boiled potato (no skin) 2.8 grams

1 grapefruit 2.8 grams 1 cup prunes 12.10 grams

1 kiwi 2.6 grams 1 cup pumpkin seed 8.8 grams

1 cup of cooked kale 2.6 grams 1 cup raisins 6.2 grams

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1 cup cooked lentils (from dried) 15.6 grams 1 cup raspberries 8.4 grams

1 mandarin 4.5 grams 1 cup cooked brown rice 3.5 grams

1 cup butternut squash (cooked) 3.3 grams 1 cup split pea soup 16.5 grams

1 cup strawberries (fresh) 3.3 grams 1 cup sauerkraut 5.9 grams

1 cup sunflower seeds 13.4 grams 1 cup fresh spinach (cooked) 5.4 grams

1 cup sweet potato (cooked) 7.6 grams 1 cup of trail mix (average) 11.10 grams

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6.4.1 Non-Starchy Vegetables

What are non-starchy vegetables?

Tomatoes, carrots, zucchini, cucumber, lettuce, radish, broccoli, onion, celery, etc. – basically all

vegetables EXCEPT for potatoes, corn, peas, and squashes.

These foods are technically a carbohydrate, but they are so loaded with fiber that they will not affect your

blood sugar.

They are a diabetic’s best friend, and can help you to feel full, energized, and clear-headed, and help to sustain

your blood sugar levels. The great thing about these foods, is that you can eat as much as you want! But if you

are choosing canned versions look for “low-sodium” or “no added salt” on the product label.

Fresh vegetables are generally the better option, as canned or frozen will contain more sodium AND fat. But

they are still a much better choice than most other foods in terms of overall nutritional value and performance.

To maximize the nutritional benefits of non-starchy veggies, include both raw and cooked in your diet

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4.3.2 Whole Grains

Many people aren’t sure of the difference between whole and white grains, and how to tell if a specific item they are buying does in fact contain whole grains.

So, how can you tell if a grain is “whole”? Depending on where you live, some products may have a stamp on the packaging indicating that it is approved by a

council as whole grain or that it is “100% whole grain”.

For other products, you’ll have to look at the ingredients list:

These ingredients indicate whole grains

These means the product may contain some whole

grains If you see these, it means there are no whole grains

Whole grain Wheat/wheat flour Bran

Whole wheat Multigrain Enriched flour

Stoneground whole Organic flour Wheat germ

Brown rice Semolina

Wheatberries Durum wheat

Shopping Tip! Here’s an easy way to tell if oatmeal or rice is whole grain: look at the cook time on the product label. A cooktime of 10 minutes or more indicates

that it is a whole grain.

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4.3.3 Sugars

Added sugars have a significant affect on diabetes. These sugars lack fiber and may spike your blood sugar,

which can then trigger a whole slew of symptoms. When shopping for products, it’s important to read the

ingredients on any label or packaging. While some may clearly state “white sugar”, others use different

terminology that can be confusing to determine.

Words that mean sugar:

Table sugar (also called white sugar or sucrose) or anything with the word sugar

Honey

Molasses

Fructose

Things with the word syrup – maple, corn, brown rice, rice

Agave nectar

Turbinado

High fructose corn syrup (also called corn sugar)

In general, if the food is packaged, there’s a high chance it will contain sugar of some kind. But remember

that some sugars are better than others (honey, coconut sugar, stevia, etc.), so it’s equally important to pay

attention to the following when meal planning:

Overall nutritional value of the item. Foods that may be high in “good” sugar and contain

additional fibre, vitamins, antioxidants, etc. are a better choice than “empty” food with slightly

lower sugar counts.

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The amount of sugar in each serving

Your overall sugar consumption for each meal/day

Each individual’s needs will vary, but in general, you should not exceed:

22 grams of added sugar per day for women

36 grams of added sugar per day for men.

4.3.4 Sodium

People with diabetes are two times more likely to have hypertension or high blood pressure. Blood pressure

is the force of blood against your artery walls. When it is too high, it can eventually cause health problems,

such as heart disease. If you’re diabetic AND hypertensive, it can be a dangerous combo. In order to decrease

your risks of any heart related problems, or stroke, it’s important to keep blood pressure steady and stable at

all times. One of the ways you can achieve this through diet, is by lowering your sodium intake.

Sodium is a mineral found in foods – it doesn’t just come out of a salt shaker. The body processes sodium via

the kidneys – and when there’s too much sodium in the body, the kidneys compensate by pulling extra water

from your blood, which means you then have a higher volume of blood running through vessels. When we

say high blood pressure, it’s literally the pressure of too much liquid trying go move through a small space.

Your blood vessels may become damaged as a result, you can get plaque built up due to decreased flow, and

the strain can tire our your kidneys and heart.

High levels of sodium are mostly found in processed foods. It’s added as a preservative, flavor enhancer, and

to get us to eat more (our taste buds love salt, which is why we crave snacks like potato chips and French

fries).

Your goal should be to consume less than 2400 mg per day. But in addition to lowering overall intake, you

should also aim to be consistent in your sodium intake throughout the day. If you’re following a 3-meal per

day plan, aim for 800mg per meal, so there are no dramatic spikes in blood pressure.

Read the label on processed food. Aim for less than 150 mg per serving.

Also try, adding more fresh foods! Your sodium intake will likely go down as a result!

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6.5 Food Shopping and Dining Out

6.5.1 Eating out with Diabetes

Despite the need for diabetics to have strict control of their diet at all times, it is still possible to eat out. There

are just some guidelines to follow to ensure that you’re being diligent and making the right choices:

Know your carbohydrate goal

o Know what portion approximately look like

o Look at the nutrition information for total carbohydrates

Know where carbohydrates come from to identify them in your meal

Eating out means bigger portions

o Don’t eat all at once – bring leftovers home

o Split a meal with a friend

Ask the waiter about portion sizes. You can often request a specific portion size.

Be wary of sauces with added sugar, such as teriyaki or sweet and sour

Always have a non-starchy vegetable on your plate

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6.5.2 Reading a product label

1. Start with serving size – everything on that label is based on serving size.

2. Servings per container – important to know if you are eating the whole container. The Nutrition

Facts numbers must be multiplied by that number.

3. Total Carbohydrates – this will keep you on track with your goal for grams of carbohydrates per

meal. (sugar and fiber are included in this number)

4. Other areas you may look - fiber (more than 3 grams ideal), sugar (ingredients), calories (if you

are trying to lose weight), fat (types of fat) and sodium (less than 150 mg)

Credit: Image sourced from the Diabetes Teaching Center, University of California

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6.5.3 The Healthy Plate

An easy way to start managing your blood sugar and eating without having to think too much is

the HEALTHY PLATE*.

Steps:

1. Cut your plate in half and fill half of it with non-starchy vegetable

2. Cut the other half in half (make it a quarter) and fill one side with whole grains/starches and the

other with a source of protein (plant-based or animal)

3. Add whole fruit

4. Potentially add milk or yogurt

This technique will balance your meal without much thought!

*This method may not be appropriate for individuals with Type 1 Diabetes who need to match their insulin to

grams of carbohydrates.

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6.6 Developing a Healthy Exercise Routine

As we stated in earlier modules, exercise is an important part of diabetes management and overall health. In

order to help motivate yourself and think positively about exercise, consider it a medication. It’s not just a

recreational activity or something you to do lose weight – it’s also an important way to lower blood sugar, a

treatment for symptoms, and a way to prevent complications and long-term damage. The more you do and the

more often you do it, the more benefits you will get.

Positive effects of exercise on a diabetic body:

Improves blood sugar

Improves cholesterol

Strengthens your heart

Lowers blood pressure

Helps with depression

Makes you feel good

Gives you energy

Helps with pain

Helps with sleep

Exercise and Diabetes

1. Improves insulin sensitivity, allowing insulin to work more effectively

2. Muscle contraction during exercise allows your cells to take in sugar for energy, regardless if

insulin is there or not.

3. Some individuals experience an increase in blood sugar due to the hormones released during

exercise.

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The benefits of a single workout may last up to 24 hours. It’s an easy, cheap, low-maintenance, and effective

way to manage symptoms and feel better almost instantaneously – as well as for long-term care and prevention.

Your individual response to exercise is based on a few different things, including blood sugar before you start,

intensity of your workout, length of time exercising, any recent medication changes. The type of exercise you

do may also affect you differently, for example: with weight training, your blood sugar may go up, while with

cardio it may go down

6.6.1 Before you Exercise

It is extremely important to understand how your blood sugar reacts to exercise! If you are just starting a new

exercise routine or are new to diabetes, follow these steps:

1. Test before you exercise.

Know where your number starts

If you are less than 100 mg/dL you may need a small snack of 15 grams of carbohydrates

If you blood sugar is high (>250 mg/dL generally)– you may need to test for ketones

o If it is positive – avoid vigorous activity

o If it is negative – proceed but be sure to stay hydrated and stay on track for testing during

exercise

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2. Test every hour during exercise.

Keep you safe from hypoglycemia

Let you know what is going on

Help you see what different exercises may do

Different exercises can do different things to your blood sugar

3. Test every 4 hours after exercise for up to 12 hours after.

Exercise can affect your blood sugar for up to 24 hours after activity.

6.6.2 Hypoglycemia and Exercise

Hypoglycemia can happen during or after exercise.

A few things that can increase your chance of hypoglycemia:

Taking insulin

Skipping a meal

Not eating within 30 minutes to 2 hours after exercise

Exercising for a long time

Strenuous exercise

Hypoglycemia is less likely to happen to people with Type 2 Diabetes.

Insulin and Exercise

Adjustments may need to be made to your insulin during exercise – but do not make changes to insulin without

first consulting your health care team. This is why it’s important to record your readings before, during, and

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after you start a new exercise routine, so you can share these results with your doctor, and they can make a

meaningful adjustment to your dosage.

If you participate in specific sports, it’s possible that your doctor can provide specific guidelines on how to

adjust your insulin based on the sport and level of activity.

Food and Exercise

Many non-diabetics adjust their carbohydrate intake when they exercise or participate in sporting events to

increase performance. For diabetics, you should consult a dietician or nutritionist before making any

adjustments to your diet, to see if this is right for you.

6.6.3 What exercise is best for Diabetics?

Generally, there are three main categories that various exercises and activities fall into:

1. Cardiovascular

2. Strength training

3. Flexibility

The best routine will combine all 3 types of exercise to ensure you’re training every part of your body. A little

from each will give you the best results, and it’s up to your individual needs, abilities, and preferences as to

how to distribute them, and what types of activities to try.

But it’s important to know that any movement will influence your blood sugar – including walking around the

house, the movements we use to eat, brush our teeth, fold laundry, etc. If you are having a hard time getting

into an exercise routine, either because of physical impairment, mental health issues, or lack of resources, just

aim to move! Don’t take shortcuts. Take stairs instead of an elevator. Walk short distances instead of driving.

Buy or borrow a bike and go for a short ride around the block each day. Keep a set of small weights beside

the couch and do some small lifts while you sit and watch tv.

Even a little bit of movement every so often can have tremendous effects on your blood sugar.

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Cardiovascular exercise

Benefits

Strengthen your heart

Improve blood sugar

Burn calories

Decrease cholesterol

Strengthen bones

Goal

Heart health = 150 minutes per week

Weight loss = 240 minutes per week

Blood sugar management = ANY! even 5 minutes will improve your sensitivity to insulin

Intensity On a scale of 0 to 10 (0 = sitting on the couch, 10 = running from a bear) = be at a 7 to 8

Types

Swimming

Running, jogging, walking

Dancing, aerobics, zumba, gymnastics, etc.

Treadmill, elliptical, stationary bike, step climber, etc.

Sports – tennis, squash, soccer, martial arts, cross country skiing, skating

Cycling, skateboarding

Rhythmic and continuous is key!

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Strength training

Benefits

Strengthen all your muscles

Boost your metabolism

Burn fat or calories at rest

Prevent injury

Goal

2 to 3 days per week total body

Never do same muscle group two days in a row

Give the muscle group 48 hours to recover and rebuild

Intensity

Sets (series of reps) = 1 to 3 times

Reps or repetitions (rep = single movement or motion the exercise) = 8 to 15 movements. Example: Bicep curls – 2 sets of 10 reps

Types

Weight lifting, machines

Calisthenics - exercises using own body weight (push-ups, etc.)

Rock climbing, wall climbing

Yoga

Cross-fit training

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Flexibility

Benefits

Prevents injury

Helps to stabilize joints

Improves circulation and blood flow

Good for people with asthma, joint pain, and other conditions

Goal 2 to 3 days per week total body

Intensity

Each stretch 1 to 3 times

Hold the stretch for 15 to 30 seconds

Types

Stretching – at home or in a fitness studio

Yoga – any kind

Pilates

Dance – ballet, jazz, etc.

Gymnastics

Tai-Chi

Water aerobics

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6.7 Diabetes and Sexual Health

This maybe an uncomfortable topic, but understanding the effects of diabetes on your sexual health can have

a huge impact on your overall well-being. Over 75% of men, and 35% of women with diabetes report some

issues related to sexual dysfunction.

Many diabetics, especially when they are first diagnosed, underestimate the way diabetes affects their sexual

organs. They may experience symptoms that are difficult to notice at first, or they may attribute them to other

factors (i.e. low sex drive to low physical attraction to their partners, or decreased libido due to poor

performance). For many, this can lead to detrimental thinking and self-doubt, and can put a damper on self-

confidence.

Diabetes can affect physical sexual health

Diabetes can affect emotional feelings and the way you think about your sexual health

What’s important to note, is that there are many factors responsible for sexual dysfunction. In this context, we

refer to sexual disjunction as any of the following:

Decreased libido or sex drive

Decreased sensation during sexual activity (in genitals and other areas)

Difficulty becoming and staying aroused

Difficulty reaching orgasm

This will vary across individuals, and there is no true measure of sexual dysfunction. You know your body,

and you know what is “normal” for you (law of averages). When you experience a change, this is considered

abnormal. Unfortunately, there are many factors that can contribute to sexual dysfunction, which can make

pinpointing the precise cause difficult – and often it’s several things working together to cause the issue. Let’s

examine the ways in which physical and emotional effects of diabetes can impact sexual health.

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6.7.1 Physical effects on sexual health

There are a few different ways in which diabetes affects your physical sexual health.

Neuropathy: If you have peripheral or autonomic neuropathy, you may feel decreased sensation in your body,

including in your sexual organs. This means you may have trouble feeling aroused because you do not

experience physical sensations due to nerve damage. Talk to your doctor abut treatment for neuropathy, as

methods will vary for each individual.

Nerve and Artery damage: For women and men, this can decrease the blood flow to the genitals and impede

arousal. For men, it may mean they have trouble getting or sustaining an erection due to low blood flow to the

penis (your doctor can recommend solutions based on your individual needs). For women, it may result in

lack of lubrication and vaginal dryness (this can usually be remedied with water-based lubricants).

Blood glucose levels: You may experience low sex drive due to high blood sugar or poor overall glucose

management. The only way to fix this is to improve your overall glucose levels and maintain consistent blood

sugar using the appropriate medication/doses, diet, and exercise.

It is also important to understand how sexual intercourse itself can have an affect on blood sugar; it is exercise

and you may run the risk of hypoglycemia or low blood sugar during or after the act. It is therefore important

that your partner is aware of your diabetes, and knows the symptoms and ways to treat hypoglycemia.

When it comes to sexual dysfunction, your doctor is the best person to communicate with to find solutions.

They will determine whether the problems are physical, and recommend appropriate treatments, or whether

emotional problems may be the root of the dysfunction. In most cases, it is a combination of both. What is

important to remember, is that these things are beyond your control, and you should never blame yourself or

your partner. Doing so may result in emotional turmoil that will only worsen the sexual dysfunction.

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6.7.2 Emotions and sexual health

As we’ve discussed, diabetes can sometimes cause mental health issues ranging from mild stress and

emotional burnout to severe depression. Many diabetics report feeling too emotionally drained to entertain

thoughts of sexual activity, as they are too focused on other parts of life – overall health, work, managing a

household, etc. Some individuals, particularly newly diagnosed diabetics also fee disconnected from their

bodies, and therefore struggle to perceive themselves as attractive, to feel arousal, and to use their bodies for

sexual pleasure. Some of the emotional issues that lead to sexual dysfunction can be remedied by first

identifying them, and then making behavioral changes, but others may require therapy and counseling to help

the individual overcome more deeply seeded and complex emotional distress.

Emotional issues that affect sexual health for diabetics:

Depression

Anxiety

Stress

Fatigue and low energy

Low self-confidence and insecurity

Poor communication with partner

Feeling unsupported by partner

Conflict with a partner

Feeling disconnected from those around you

Poor body concept

These emotions can affect your personal relationships, including intimacy and trust. They may also lead to

being withdrawn or distant, maybe due to fear of failure or lack of enjoyment. You also have to consider the

effect they may have on your partner; they may feel stressed out by the changes in the relationship, or fear

you are losing interest. While you should never feel guilt for experiencing these emotions, it is important to

communicate to your partner what you are going through. It is the responsibility of both partners to express

their concerns, offer support, and come up with solutions together.

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How can I help manage these emotions?

Practice stress management – exercise, deep breathing, meditation, journaling

Talk to someone you can vent to about things that bother you (not your partner)

Communicate effectively with your partner. This means not bottling up or repressing emotions.

Tell them how you feel, do not blame them or accuse. Tell them how they can help you.

Seek out professional help if you suspect depression or anxiety, or if problems persist/worsen.

Work on your sleep and make sure you have enough energy

Practice self-care and maintain positive body image – eat healthy, get regular exercise, and

manage your symptoms

When you feel frustrated, do something you enjoy. Do not blame yourself.

The key is do something! When you don’t act, your emotional problems will intensify, leading to

more issues.

If these emotions do not improve within two weeks, it is extremely important to seek out professional help

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6.7.3 Women’s Sexual Health and Family Planning

Menstrual cycle/hormones: Your menstrual cycle may make it hard to keep you blood sugar on track.

Hormone levels may cause you blood sugar to go up and down. If you notice large shifts in your blood sugar,

unusual number or sudden changes it is important to do something. Try tracking the days of your menstrual

cycle in your blood sugar log book.

This can help your health care team create a plan to help you keep your blood sugar on track before, during

and after your periods.

Your health care team may consider hormone replacement therapy to help you.

Birth Control: If you do not want to get pregnant, birth control may be an important part of your sexual

health. Most forms of birth control are considered safe for women with diabetes.

Family Planning: Having a child maybe an important part of your life and diabetes does not have to change

this goal! The key is having a conversation with your health care team. You and your team want to ensure you

and your baby are as healthy as possible! Things you may want to check include:

Hemoglobin A1c

Blood pressure

Heart

Kidneys

Pregnancy : If you are pregnant and diabetic, you absolutely must disclose this to your OBGYN and your

primary doctor, so they can recommend the right strategy to manage your diabetes during pregnancy. If you

are on diabetes pills, you may be switched to insulin - this is to protect your baby from the side effects of

diabetes pills. It is also important to keep your blood sugar in range before and during pregnancy to avoid the

negative side effects of hyperglycemia on your baby.

These include:

Premature birth

Large baby

Potential birth defects

Hypoglycemia at birth

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There are also risks to you. These include:

Preeclampsia – high blood pressure during pregnancy

Increased chance of infection

Premature delivery

Need for caesarean section

Women with diabetes can have happy healthy pregnancy and it starts with good communication with your

health care team.

6.7.4 Diabetes and Menopause

Menopause can offer challenges for women with diabetes. During menopause and the years leading up to it,

your body with making less of the hormones estrogen and progesterone. These hormonal changes may affect

blood sugar; every person is different.

Your blood sugar may become more unpredictable and irregular; sometimes having large increases and

decreases in blood sugar. The hormonal and blood sugar changes may increase menopausal symptoms

including mood swings, fatigue or hot flashes. It is important to closely monitor your blood sugar during these

times.

Menopausal symptoms can mask or mimic the symptoms of hypoglycemia (low blood sugar).

Such as:

Hot flashes

Moodiness

Memory loss

How do you know what the symptoms are from?

TEST your blood sugar!

You do not want to treat if you do not need to.

Or you may have low blood sugar, especially at night, and you need to be sure to treat this!

Night hypoglycemia can also cause decrease in sleep. This can cause blood sugar to be even more difficult to

control.

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What do I do?

Be sure to talk with your health care team to help you through this time!

Hormone Replacement Therapy during Menopause

This can be a safe option for individuals with diabetes. It is a personal and complicated choice.

Pro’s:

Decrease risk of osteoporosis

Decrease risk of vaginitis

Alleviate hot flashes

Cons

Increase risk of breast cancer

Increase risk of uterine cancer

Increase risk of heart disease

Increase risk of stroke

Current recommendations include:

Take the smallest dose for the least amount of time

Every 6 months reevaluate

If you have a history of breast cancer, heart disease, or blood clots try to avoid use of hormone replacement

6.7.5 Men’s Sexual Health

Erectile Dysfunction

Impotence or erectile dysfunction (ED) is a very real possibility for men with diabetes. Over time, there can

be damage that happens to the blood vessels and nerves in the penis. This can be the result of many things,

including long term elevated blood sugar, heart disease or vascular problems.

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Some conditions may also cause ED including:

Prostate or bladder surgery

Certain medications including blood pressure, stomach ulcer or heart burn meds

Depression

Lifestyle, including smoking, being overweight or being inactive

It is important to talk to your health care team to discuss potential causes and treatments. Sometimes is can be

hard to accept that you have ED and even more difficult to talk about it. But talking is the only way to get

help! Do not be embarrassed. Your health care team wants to help you feel better. Things to discuss:

What are your symptoms?

What are you concerns?

Could it be ED or another sexual disorder?

Have you had any emotional or physical changes?

What are your options

Lifestyle changes can potentially decrease your risk of having ED. But there are options for treatment out

there!

They include:

Prescription medication

A medication called prostaglandins put in your penis

A vacuum tube and pump to draw blood into the penis

Surgery to place a device in the penis or fix blood vessels to increase blood flow

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Low Testosterone

Men with Type 2 Diabetes are twice as likely to suffer from low testosterone. This can be a condition that will

often go undiagnosed, as the symptoms can appear to be caused by other conditions. Symptoms include:

Decrease in sexual interest

Erectile dysfunction

Decrease lean body mass or muscle

Lack of energy

Depression or low mood

It is important to talk to your health care team if you notice any of these things. A simple blood test can tell

you if you have low testosterone, and it’s a relatively easy fix that can alleviate many sexual health problems.

There are several treatment options available.

They include:

Patches

Gels

Injections

These aim to increase testosterone in your body. A referral to a doctor who specializes in low testosterone

maybe needed; they include endocrinologist or urologist.

6.7.6 Adolescents and Sexual Health

Adolescents face some specific challenges regarding their sexual health and development, and their overall

diabetes management. During puberty, hormones start to change, which may make it more difficult to manage

blood sugar – particularly for an individual who was diagnosed with diabetes prior to puberty. The hormones

may make it difficult to manage your blood sugar, which may result in large upswings or downswings in blood

sugar. This means that insulin needs may also increase during puberty. Adolescents starting puberty should

be in regular contact with their health care team to adjust blood sugar management and lifestyle as needed. It

may take some trial and error to strike the right balance, and they may have to change up their management

and treatment plans often to accommodate their developing bodies.