Living With Diabetes
By: Roger E. Hernández Source: AARP Segunda Juventud Date Posted: October/November 2007
When my doctor called two years ago to say my blood sugar was 240, I wasn’t sure what the number meant. But I suspected it wasn’t good news.
I’d just turned 50, the age at which my father and two uncles were diagnosed with diabetes after decades of eating lots of sugar, pan cubano, and the mandatory mountain of white rice at dinner—a dietary tradition I had continued. And I had been thirsty and waking up at night to urinate—classic symptoms of diabetes.
It turns out that in middle-aged adults, 126 milligrams/dl (per deciliter) or higher of blood glucose after fasting overnight is considered diabetes, according to the American Diabetes Association (ADA). My level—which was almost twice that—didn’t make me scared of dying. I knew diabetes could be controlled because my dad, then 82, was eating a lot less of everything and, as a result, had not experienced complications from the disease.
Instead, I was scared of living. Enjoying tasty meals with family and friends had become a great pleasure in my life.
I talked to my doctor and did research to see if I could still savor the food I loved but in ways that wouldn’t blind me, make me lose a limb, or kill me—all possible with diabetes. Then I put together a meal plan. Each item had to meet two conditions: it had to be delicious and healthful. I was an expert on identifying the former but clueless about the latter.
So are a lot of other Hispanics. Overall, we’re more than one and a half times more likely than non-Hispanic whites to suffer from diabetes. Genetics may play a role, according to experts. Yet an axiom among people in diabetes education is, “Heredity loads the gun, environment pulls the trigger.” Environment means exercise and diet. Although our eating habits vary, diabetes experts agree that many U.S. Hispanics eat too much refined flour and sweets—carbohydrates that pull the trigger. (Too many Hispanics are also overweight, but more about that later.)
Lorena Drago, who wrote the ADA’s Spanish-English guide for Hispanic diabetics, Algo mas que arroz con frijoles: La guía caribeña de alimentos saludables para personas con diabetes/Beyond Rice and Beans: The Caribbean Latino’s Guide to Eating Healthy With Diabetes, says Hispanics “put too many processed foods in our mouth.” My goal was to follow Drago’s recommendation of 60-75 carbohydrate grams a meal, based on three meals a day, for diabetic men. (She recommends 45-60 for women.)
I cut the easy stuff first. I don’t have a sweet tooth, so skipping dessert took zero effort. More difficult was reducing the half plate of rice I had eaten almost daily for as long as I could remember; I went down to a third of a plate. Bread was difficult, too, after decades of gorging on two basketfuls at a time; my new limit became four pieces at dinner.
I didn’t worry about calories. Though I knew obesity makes diabetes worse, I didn’t think I had a weight problem. At five feet nine inches, I weighed 175 to 180 pounds. I figured keeping calories around 2,000 per day would be fairly easy.
Then I designed a diet based on six fundamentals:
| 1. | Eat less of everything except vegetables. |
| 2. | Eat more veggies, following this standard guideline: fill half a dinner plate with vegetables; one quarter with carbohydrates such as rice, beans, or a tortilla; and one quarter with meat, chicken, fish, or other protein. |
| 3. | Give up what I don’t miss—soda, candy bars, and cake—to make room for carbohydrates I enjoy. |
| 4. | Substitute whole- or sprouted-grain bread for Italian baguettes and pan cubano. Eat whole-grain tortillas, wraps, and cereals. |
| 5. | Mix green, red, yellow, white, and black or dark-blue foods, which provide a range of nutrients and look appetizing. |
| 6. | Go organic Hispanic. As often as possible, eat natural food not treated with chemicals. The staple beans of Latin America and Mexican tortillas are now available in organic versions. |
The meal plan combined my traditional Cuban food with a touch of international fine dining. I stayed on this diet for two years, and though I didn’t exercise much beyond the occasional walk, with the help of medication, my blood sugar remained under control. I was reasonably confident I was making good food choices.
But while writing this article, my doctor called to say my quarterly test showed that the glucose “sticking” to red blood cells (called glycocylated hemoglobin or hemoglobin A1c) was elevated—6.5 percent. Many doctors, including mine, like it below 6 percent; the ADA recommends below 7 percent.
I’m not facing a diabetic emergency, but I am going to follow doctor’s orders: I must push my number back down.
Was something wrong with my meal plan? I asked Drago and Maria Alamo, president of Salud Consulting, both registered dieticians who specialize in the diet of Hispanics with diabetes, to suggest improvements. Call it a pantry makeover.
Alamo entered my menu items into a computer program that measured carbohydrates, calories, vitamins, minerals, amino acids…everything. She said overall my plan was decent, but I needed to make better choices.
The real problems, the analysis revealed, were the so-called “good carbohydrates,” including whole grains and beans. I assumed their high fiber content meant I didn’t have to cut back. I was wrong. Alamo and Drago taught me that both the type and amount of carbs are important for controlling blood sugar.
All carbohydrates, they said, have an impact on blood glucose (sugar) levels—whether from whole grains, pan cubano, or Wonder Bread—and that my personal carbohydrate maximum should be 70 grams at each meal. My breakfast and lunches had been below that, but my dinners were higher. So from now on: three pieces of bread instead of four; one-third, not one-half, cup of cooked beans; and one-quarter, not one-third, cup of cooked white rice.
I also underestimated the importance of calories. Alamo suggested a goal weight of 165, because research shows that losing 10 to 15 pounds can lower blood sugar and blood pressure, even for people who aren’t obese. “Start by reducing your calories by 100 per day,” she said, adding that exercising more would help. Now six days a week I wake at 5 a.m. to run, lift weights, and do abdominal crunches. I’ve lost 10 pounds in a month, mostly from my waist, and put on muscle.
So I’ve revised my plan. Exercising and eating this way is now a must, though I cheat a little. The other day, for the first time since my diagnosis, I ate churros. Two churros every two years won’t hurt me physically, and eating sensibly every day won’t hurt me emotionally. I still enjoy meals with my loved ones. Diabetes has forced me to make changes, but I’m no longer scared of living.
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