Receiving a diagnosis of diabetes can mean making some big changes, especially in your diet. Dr. N. Spencer Welch, MD, endocrinologist at Piedmont Healthcare, answers the most common questions he hears from his patients about managing diabetes with diet. 1. Q: What do diabetics need to be aware of when thinking about their diet? A: Diabetics need to be aware of their blood sugar and sometimes need to aim for weight loss. People with diabetes either don’t make enough or don’t make any insulin, which is a hormone that regulates the level of sugar in the blood. That means people with diabetes have to change their diet to avoid spiking their blood sugar levels. Things like carbohydrates, sugary drinks, fruits, and baked goods all contain sugar that can increase a diabetic’s blood sugar substantially. Eating the right foods is important, but just as important is watching portions and eating appropriate portion sizes. I find a lot of people choose the right things to eat, but they eat too much of those things so they don’t lose weight. Losing weight can significantly help someone with diabetes manage it better. 2. Q: What does it mean to "count carbs"? A: Carbohydrates are one food group that can really increase blood sugar, so diabetics need to be aware of how many grams of carbs they’re eating. Counting carbs helps people understand what portion sizes should be and what the typical serving of carbs is. If you take mealtime insulin, you’ll need to know how many grams of carbs you’re eating so you can give yourself the right amount of insulin. 3. Q: How does mealtime insulin work? A: My patients that take mealtime insulin give themselves insulin through a pump, injector, or inhaler. Examples of mealtime insulin include aspart (NovoLog), lispro (Humalog), and glulisine (Apidra). With my patients, I calculate how much insulin they need each day to keep their blood sugar under control. That helps us figure out what’s called the insulin-carbohydrate ratio, which measures how much insulin they should give themselves based on how many grams of carbohydrates they’re about to eat. It sounds like a lot of math, but what usually happens is people don’t have a huge variety of meals to eat over a week’s time, so they learn how much insulin to give based on those standard meals. Eating out can be harder, so they’ll need to use carb counting to determine how much insulin to give themselves. 4. Q: Do you have to be good in the kitchen to succeed on a diabetic diet? A: I tell folks that there’s no difference between diabetic meals and meals that someone without diabetes eats. Good nutrition applies to everybody. And you don’t have to be a great cook to bake or broil chicken or fish. Some of my patients like to use diabetic cookbooks and experiment with different spices and seasonings to make their food delicious while at the same time not adding unnecessary calories. 5. Q: What meals or ingredients do your patients have the most trouble with? A: The key thing, especially if you’re eating out, is to be aware of sauces. There are a lot of calories in sauces that we don’t think about. And there are specific types of food that are harder to measure, like Mexican food – nobody knows how many chips they’ve actually eaten. Or Chinese food – nobody knows how much rice they’ve eaten. Also with Chinese food, the vegetables are in sauces and they often use cornstarch as a thickener, so there are extra carbohydrates there that people aren’t aware of. Pizza is a tricky one too, because it’s a combination of carbs and fat. Sometimes people have a hard time figuring out exactly how to dose their insulin with pizza since the carbs are absorbed slower because of the fat. 6. Q: What do you wish your patients knew about managing their diabetes? A: I want them to understand that treating diabetes is not just the use of medications; it’s improving your nutrition and exercising, too. Diabetes is not only a disease—it’s a lifestyle. And it is not a death sentence. It takes some adjustments but you have to adapt to a healthier lifestyle so you can control your diabetes better.