Help Patients with T2D Eat Healthy During the Holidays

Sara Hunt, MSN, RN, PHN, FNP-C, is a licensed and board-certified family nurse practitioner, a public health nurse, an adjunct assistant professor of health policy, and a doctor of nursing practice student at the University of California, San Francisco. She was the spring 2015 health policy fellow at the American Association of Nurse Practitioners’ Government Affairs Office in Washington, DC.

The holidays are a wonderful time for fellowship with family and friends and bonding over delicious meals.

Although this time spent bonding is actually good for one’s health, many of the tasty treats can wreak havoc on those with diabetes.

Sometimes, people feel like throwing in the towel when it comes to a healthy diet during the holidays and then backtrack on their diabetic control. But people with diabetes can still enjoy the holidays and tasty meals without letting their sugar get completely out of control. This is especially important for people who have uncontrolled diabetes.

The latest nutrition recommendations, as of October 2019, for people with diabetes recommend that their diets should be individualized and take into consideration their cultural backgrounds, lifestyles, motivation, and socioeconomic factors.¹

Here is a general list of ways to help keep blood sugar under control during the holidays. As always, follow patients with diabetes should follow the recommendations of their health care providers.

Watch the Alcohol

Alcohol can lead to high and low swings in blood sugar. Those who drink should do so in moderation. Safer alcoholic bets for those with diabetes include champagne; light beers; liquor with seltzer, a sugar-free drink, or water; plain liquor; sugar-free mixers; and wine.²

Limit Carbohydrates

Carb management varies from person to person and depends on co-occurring health conditions, health status, and medications. For example, low-carb diets are not recommended for lactating or pregnant patients, people at risk for eating disorders, or those with kidney disease.¹In general, however, people with type 2 diabetes should monitor carbs.

Other tips include:

• Avoid liquid calories, especially from drinks with sugar. This includes fruit juice. In addition to spiking blood sugar, they increase the risk of cardiovascular disease, fatty liver, and weight gain.¹
• Eat dairy products, fruits, legumes, and whole vegetables, which are nutrient-dense, instead of chips, crackers, and processed snacks.¹
• Try bulgur, faro, hulled barley, millet, quinoa, and wheat berries, instead of white bread or rice.¹
• Those prescribed flexible insulin therapy should carb count and consider fat and protein content¹and follow their health care provider’s recommendations.
• For those with fixed-insulin dosing, a regular pattern of carb intake may improve glycemic control.¹They should follow their health care provider’s recommendations.

Eat Smaller Portions

Americans generally eat too much. There are federal portion-size standards, which many people exceed. Portion sizes in the United States began to increase in the 1970s and got dramatically larger in the 1980s, which could be contributing to the US obesity epidemic.³

Here is what should be on a typical plate, according to ChooseMyPlate.gov:

• Half a plate of vegetables
• One-quarter of a plate of healthy protein
• One-quarter of a plate of whole-grain starch or even less, in some cases
• 1 serving of dairy
• 1 serving of fruit

Examples of recommended serving sizes include:

• 3 dices = 1 serving of cheese
• 1 cassette tape = slice of bread
• 1 deck of cards = 1 meat serving
• 1 to 2 cups = 1 serving of vegetables
• ½ cup = 1 serving of cooked pasta or rice
• 2 tablespoons = 1 serving of nut butter

Eat High-Volume, Low-Calorie Food

Those who eat higher-volume foods that are low in calories can feel full and not deprived. This is typically done by eating foods that are high in fiber and/or water, such as fruits, high-fiber whole grains, and vegetables. High-fiber foods also expand in the stomach, and drinking water with meals can boost the effect. When the contents of the stomach begin to put pressure on the wall of the stomach, it stimulates nerves to signal to the brain that one is full.

Fiber, Water, and Slower Eating

Not only does fiber help people feel fuller for longer, it also can defend against obesity, help blood sugar levels and prevent colon cancer and heart disease.¹Drinking water makes one feel full, which helps with weight loss. Eating more slowly can allow the brain time to process satiety signals. It can take up to 20 minutes for the brain to realize the stomach is full. So, slow down. This also helps prevent indigestion.

Get Up and Play

Bodies need to move. Physical activity can dramatically increase the body’s sensitivity to insulin, protect tissues from oxidative stress, and reduce the risk of colon cancer, coronary heart disease, and inflammation.⁴

Do Not Forget Medication

Although this might sound obvious, forgetting to take a dose or running out of medication can pose real problems for patients with diabetes. They should make sure to call for a refill before running out of medication. Traveling can make refills difficult, as there are rules about prescribing out of state, and if a primary-care provider cannot refill a medication, the patient is at the mercy of any urgent-care or walk-in clinic capable of refilling it.

See a Nutritional Expert

Finally, those with diabetes should see a nutritional expert. Diabetic care is best managed by a team that includes a registered dietitian or registered dietitian nutritionist or a referral to a diabetes self-management education program that includes instruction on nutrition therapy.¹

References

1. Gray A, Threlkeld RJ. Nutritional recommendations for individuals with diabetes. In: Feingold KR, Anawalt B, Boyce A, et al, editors. Endotext [Internet]. South Dartmouth, MA: MDText.com, Inc; 2000-2019 Oct 13.
2. Diabetic drinking guide: holiday edition. cocktails, wine, mixers and more.Diabetic Gourmet Magazine.diabeticgourmet.com/articles/diabetic-drinking-guide-holiday-edition-cocktails-wine-mixers-and-more/. Accessed December 3, 2019.
3. Young LR, Nestle M. The contribution of expanding portion sizes to the US obesity epidemic.Am J Public Health.2002;92(2):246—249.

1. Venkatasamy VV, Pericherla S, Manthuruthil S, Mishra S, Hanno R. Effect of physical activity on insulin resistance, inflammation and oxidative stress in diabetes mellitus.J Clin Diagn Res. 2013;7(8):1764—1766. doi:10.7860/JCDR/2013/6518.3306.