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Maggie Davey's Letter.

This letter posted by Maggie Davey, an acquaintance from my participation on alt.support.diabetes.uk in the early years after my diagnosis, has disappeared from the web but I was able to find it on the Wayback Machine. It is long but well worth reading. I have had to cut some sections including Resources to meet reddit limits; those will appear in the first post.
An open letter to the newly-diagnosed type 2 diabetic
Copyright © 2004 RJM Davey
Permission granted to reproduce freely for personal and educational use only.
Commercial copying, hiring, lending is prohibited.
In all cases this copyright notice must remain intact.
You've had the bad news: you've got diabetes. Now, here's the good news: you've got diabetes. Of all the chronic conditions there are, diabetes can be controlled very effectively, and you can live a pretty normal life with it. But, you have to work at it, there's a lot you need to learn, and you've got to make the decision to take charge and do what's necessary to control it. Once you have brought your diabetes under control, you'll find that there are definite bonuses that go with it: you'll probably be more fit than you've ever been in your life, you'll have energy that you maybe thought had gone forever, and you're likely to be in better mental shape as well.
None of what I'm about to tell you is original with me. I got this information from reading books, surfing the internet, and talking to other diabetics in my support group, and it has taken me a long time to locate the information and resources I needed, and that you need now. This letter is an attempt to boil that information down to the minimum amount you need to give you a better start at controlling your diabetes than I had.
This is not meant to be a criticism of my GP. We too often forget that a GP is just that: a General Practitioner. While many practices have a GP who has had additional training in dealing with diabetes, he or she is not a specialist. Given that, in most surgeries, the GP can only give you 7, or 10, or 12 minutes for an average appointment, there are going to be limits on how much information you can get about your condition. That's the point of this letter: to give you some of the information you need now.
I'm going to describe how I came to control my diabetes, by changing my diet and lifestyle, and then I'm going to suggest what I think would have been a better way, if I had known then what I know now. This applies to the type 2 diabetic [may use, but is not dependent on, insulin injections], which is what I am, but it could be adapted for the type 1 diabetic [must have insulin injections]. If you need to inject insulin, you would have to talk to your doctor to decide how to proceed.
What follows is what worked for me. Whether it will work for you or not will depend on lots of things: whether you have other medical conditions that need to be taken into account, whether you're employed full- or part-time, whether you have a family to consider, how comfortable you are in the kitchen [and whether or not you have kitchen facilities available to you], probably lots of other things that I haven't thought of. If you can't do things the way I've done them, for whatever reasons, the information and basic principles outlined here should enable you to make some changes to your diet and lifestyle to help bring your diabetes under control.
I'll also give you a short list of resources to find out more about your condition. Some of these are books, some are internet websites. All are resources I have used myself and found helpful. Be warned: some of these resources will frighten you half-way out of your wits – mainly because the complications that can accompany diabetes are terrible and frightening things. That said, I cannot emphasise strongly enough that knowledge is the best tool you can have to control your diabetes and minimise your risk of suffering those complications.
Oh, and there's a brief glossary, so you can look up the terms you don't know.
What happens when you eat?
This is the Janet-and-John version:
Through digestion, your food is broken down to glucose [and other stuff, which we'll ignore for now]. Glucose is the fuel your cells need to provide the energy for you to catch the bus, breathe, fly a kite, walk the dog, get the shopping in, think, go to school/work, and all the other things you do. Insulin is a hormone that most of your cells need to use the glucose. You get glucose from carbohydrates [sugary and starchy foods] and proteins [meat, poultry, fish, some plant foods].
There are very complicated mechanisms for controlling the amounts of glucose and insulin that are floating around in your bloodstream, available for the cells to use. When you have diabetes, these control mechanisms have gone wrong, and you end up with too much or too little glucose. Too much and too little are both Bad Things. If you aren't diabetic, your blood glucose level will be between 4 and 7 mmol/L [the scale used to measure blood glucose levels: don't worry about what that means right now, you just need to remember the numbers]. When you have diabetes, your blood glucose level can fall below 4 and go well over 7. Go too far below 4, your body doesn't have enough energy to keep working, you can slip into a coma, and, if this state of affairs continues too long, you can die. Go too far above 7, and you're likely to get one or more of the complications of diabetes, and you can end up a blind amputee on dialysis before you die. [I told you they were terrible and frightening.] THIS DOES NOT HAVE TO HAPPEN!
That's so important that I'm going to repeat it: This does not have to happen. When you can't rely on your body to keep your blood glucose level in that 4–7 range, you can control it in other ways. It might mean taking medication – injecting insulin, or taking tablets of some kind – or it might be through the diet-and-exercise route, which is how I control my blood glucose levels. With or without medication, you need to understand how the food you eat affects your blood glucose [BG] levels.
You probably know that your body needs a certain amount of carbohydrates, proteins, and fats, as well as vitamins and trace minerals, to work well. The carbohydrates and proteins are the things we'll concentrate on, since these are the things that most affect the glucose in your bloodstream.
Sugars are the simplest forms of carbohydrate, and are the easiest for the body to break down. They send your BG levels soaring quickly, which is why you've [probably] been advised to avoid them.
Starchy foods – potatoes, rice, pasta, sweet corn, breads, crisps, and such-like – are sugar molecules joined together to make more complicated chains of molecules [think of joining lego blocks together to make a one-room house – sugars – then adding more lego blocks to turn it into a 16-room castle – starches]. These take longer for your body to break down than sugars, so it takes longer for your BG levels to peak, the levels are not likely to get quite as high as with sugars, and the levels take longer to come down.
Protein digestion is even more complicated: your body breaks down the proteins and then uses the products to make glucose in the liver. This process can take anywhere from several hours to a couple of days, and produces very little rise in BG levels.
Current scientific thinking is that frequent and sustained high BG levels cause the damage that leads to complications, and that keeping BG levels as near to the normal range as possible can prevent complications from happening, or prevent complications you might already have from getting worse. How high is too high? There's a lot of debate about that. From my reading, I've come to think that up to 8 is acceptable, up to 9 is not good, and 10 or over is seriously bad. Other folks think anything over 8 is too high. I don't have the expertise to say anything definite about this, so I'm not going to try. I just aim at keeping my BG levels as close to the 4–7 range as possible, accept it if it goes up to 8, and take action if it goes higher than that. And it has worked: over the last week, my highest reading was 6.7, my lowest was 4.3, and the average was 5.5.
"So how do you go about getting BG levels in the 4–7 range and keeping them there?" you ask. Well, when I first got my BG test meter [more about meters – and strips – later] in January 2004, I tested first thing in the morning, before and after meals, and at bedtime, sometimes 10 or 12 times a day. I didn't really know what I was doing, so a lot of those tests were a waste of time and test strips. However, I wrote down everything I ate and at what time, and what the test results were and at what time, and I started finding out how my body was reacting to the foods I was eating.
I kept up my reading, and I found the wonderful folks at ASDUK, a support group on Usenet. [There's more information about them under Resources.] Between the various things I was reading and advice from the ASDUK crowd, I decided to test as follows: on getting up; just before each meal; 1 hour after the start of the meal; 2 hours after the start of the meal. I carried on recording all this information, then looking at my results and working out which foods made my BG levels shoot up, and which ones made them rise just a bit.
As I cut out the foods that caused spikes in my BG levels, and increased the ones that didn't, my BG levels came down steadily and stayed there more of the time. I still get the occasional spike, but, for the most part, I don't go much over 8 these days. And, since I now know what I can eat without raising my BG levels too much, I don't have to test nearly so often: first thing in the morning every other day as routine; on some days when I don't do an FBG, I'll do an odd reading one or two hours after a meal; a full day's profile about once a fortnight; or when I'm adding a new food item to my diet: just before, and one and two hours after eating the new food.
The results: I feel physically much better; I have bags more energy; I no longer have wild mood swings [although my husband might argue with that!]; I've lost a lot of weight; and I am much less likely to become a blind amputee on dialysis before I die. I've also reduced my risk of heart attack a lot.
Next question: Is there a better way to get your BG levels under control? I think a more structured testing regime, right from the start, would have made it a lot easier to get where I am now, a lot sooner, and with less wastage. So, if I were starting today to bring my blood sugars under control, here's how I would go about it.
First off, I would get a blood glucose test meter [a machine that measures the glucose in a tiny drop of your blood – there's a website listed under Resources which discusses different types of meters]. After all, you can't begin to change your diet to adjust your BG levels until you know what those levels are right now. Meters are available in any chemist's shop, and your GP or diabetes clinic nurse can show you how to use it. [Pay particular attention to the use of the finger-sticker – the manual that came with my meter didn't explain that nearly well enough. Or read Alan's instructions, which appear later.]
I would also decide how I was going to keep track of all this information - it's far too much, especially in the beginning, to remember it all. A notebook of some sort would do. If you have a computer, you can download the Health Diabetes software [see Resources], which makes it easier to keep track of it all and produces graphs of everything and is free. If you're a computer nerd, you could use a spreadsheet programme, and if you're seriously geeky, you could build your own programme. You need to decide whether you'll go high- or low-tech, whatever you feel most comfortable with. [If there's a computer in the household, but the only people who can use it are your teenagers, get them to download the Health software and show you how to use it – it will get them involved in your care, and they'll maybe gain some understanding of what you're trying to do.]
A note about testing: Wash your hands with warm water before testing, not only from the cleanliness angle, but because you're more likely to get a good-sized drop of blood for the test. Blood flows better when it's warm. You'll also avoid the risk of contaminating the sample drop with anything that might affect the test result. I once took a load of bottles and jars for recycling. One of the jars had contained mango chutney. I didn't wash my hands before my next test, and was shocked to get a reading of 13.7! So I washed my hands thoroughly, tested again a few minutes later, and it came up 7.6. It only took a tiny bit of chutney from the jar, so small I wasn't aware of it, to give a false reading.
Now for the method:
Week 1
This week, I wouldn't worry about changing my diet too much [other than cutting back on sugars]. I would test when I first get up, and write it down in my notebook. Then I'd write down what I have for breakfast, food and drink both, and what time I start eating. Then I would test an hour after that start time and write that down in my notebook, and again at two hours after breakfast. Test just before I eat lunch, write that down, write down what I have for lunch, then test at one and two hours after lunch, and recording those results. I'd do the same for dinner. Finally, I would test just before I go to bed. I know that's a lot of poking of your fingers, but there is a reason for it. At the end of the week, I would look at those results: did they go highest at one or two hours after eating? was there a big difference between last thing at night and first thing next morning? which foods pushed them highest? were there any foods that didn't raise them very much? This is the baseline information you need to start changing your diet to get your BG levels down to or near the normal range.
Also in the first week, I would start an exercise programme. One of the big problems for anyone with T2 diabetes is a thing called Insulin Resistance [IR]. Remember I said that most of the cells in your body need insulin in order to use the glucose? When you have Type 2 diabetes, the insulin doesn't do it's job properly, and your cells don't get the glucose they need. This is known as Insulin Resistance. When you exercise, the insulin in your bloodstream becomes much more efficient – no one understands why – so the cells can sop up the glucose floating around in your bloodstream without needing so much insulin. So any exercise you can add to your day will help to bring your BG levels down.
If you're seriously overweight, like I was, you'll need to start very gently, to avoid putting too much strain on your heart. Try a 15-minute walk, and see how you get on. If that's okay, try it twice a day. If 15 minutes is too much for you, then start with a 10-minute walk. After a while, if you stick with it, it will get easier, and you'll be able to stretch it to 15 minutes. Once you're comfortable with your 15-minute stroll, try a slightly brisker walk, which will take you a bit further. Don't push yourself too hard, but do keep it up, every day – it will pay off in the end. If you can swim, and there's a pool anywhere near you, that's probably the best possible exercise for the overweight person. The water supports your weight, thus reducing the strain on your heart, while allowing you to carry out some fairly vigorous exercise that will reduce your IR, sop up a fair bit of glucose from your bloodstream, and generally improve your overall circulation while you're at it.
Week 2
For the second week, I would cut out of my diet as many sugars and starches as I could: no spuds, parsnips, swedes or turnips, pasta, rice, fruit and fruit juice, bread, cereal, crisps, the lot. Instead, I would eat more non-starchy vegetables: broccoli, brussels sprouts, spinach, cabbage, cauliflower, spring greens, fine beans. Rather than have any kind of cereal for breakfast, I'd have an egg and a couple of turkey rashers or one bacon rasher. I never did use too many convenience foods, but I would check the labels of any that I did want: if it listed more than 10 grams of carbohydrate per 100 grams of food [this is the usual nutrition information given on packets], I would pass it by. I would still write down everything I ate and drank, but I would do my testing as follows: on first getting up, at one and two hours after each meal, and before bed. Then I would compare this week's readings with last week's. I would expect them to be a lot lower. As I said earlier, carbohydrates are chains of sugars, and are broken down by digestion into glucose, sending the BG levels up.
A note about hypos: Do not let anyone tell you that you can't have a hypoglycaemic episode [generally called a hypo] unless you're injecting insulin. A hypo occurs when your BG level goes below 4, you get the shakes, you feel rotten, you're not steady on your feet, you can pass out, and it can happen even if you don't have diabetes. It can be dangerous, and it needs to be addressed urgently. However, you can get some or all of these symptoms if your BG level drops a lot very quickly. The only time I had a hypo, I don't think I had a "genuine" [below 4] hypo, I think I had what is called a "phantom hypo", where you get hypo symptoms because your BG level drops fast. A phantom hypo isn't as dangerous as a real one, but it feels just as rotten, and a bit of bread or a biscuit or two will ease it. Once I realised what was happening, I ate a piece of bread with some margarine; I was okay an hour or so after that. If you're going to experience this, it's likely to be in this week, because of the big change in your diet. Keep a small container with a few biscuits, or maybe a cereal bar, in your pocket or on your bedside table. If you know this might happen, you can prepare for it, and you'll be better able to deal with it. [And it might not happen, after all.]
On a general note: This is the week that you're most likely to have to deal with cravings: "oh I'd love that piece of chocolate cake / bag of chips / glass of squash", whatever. This is largely because your body isn't getting the kinds of foods that it's used to having: it's gotten used to having much higher levels of glucose in the blood than it really needs, and when you start bringing that level down, it signals that it's "starving to death!". The brain, while being a pretty useful thing generally, doesn't know that this is a complete fake-out, so goes along with the starving-to-death routine, and signals intense hunger [think of the puppy that's just had it's dinner, but then sees you eating a ham sandwich or chocolate bar, and whimpers like it hasn't been fed in a week]. BUT, this is usually experienced as a craving for a particular food, not as a general kind of hunger. These cravings will appear periodically, but lessen in time as your body gets used to the new, healthier level of blood sugars. If you really, really can't do without that Mars bar, buy the smallest size bar you can find; take two bites, chew them very slowly, then throw the rest away and take a brisk walk for about half an hour. Then do a BG reading with your test meter. If it's still over 8 at that point, go for another half-hour walk, then test again.. Repeat until you test under 8. Relax.
This week, I would also keep up my exercise programme – extending the distance I'm walking [or swimming], and picking up the pace a little bit, as much as I can.
Weeks 3–8
I've now found out that starches and sugars shove my BG levels into orbit. I also know that I need some sugars and starches in my diet, along with the proteins, fats, vitamins and minerals, to keep my body working well. So now I've got to work out what kind of diet I can follow that will provide my body with all the stuff it needs without sending my BG levels to the moon.
The trick is to find out what I can eat, day in and day out, to keep these factors in a reasonable balance, that won't bore me witless. And I emphasised the "I" there because, amongst other things, diabetes is very much a "your mileage may vary" condition. Something I've learned from the support group [ASDUK again] is that some people can eat some things that other people can't. And there are some things that you can eat at certain times of day but not at others. For instance, some people can eat their favourite breakfast cereal as an evening snack, but can't touch it as breakfast. Some people can eat a small banana, but others can't have more than about an inch-worth of a small banana without problems. Portion size is also important: I've found that I can have about 3 ounces of steamed new potatoes, but only about 5 or 6 chips, and no more than 2 ounces of pasta or rice. And different food combinations can have different effects: I can't eat a handful of raisins by themselves, but a handful of raisins in a curry is okay. So I can't give you a specific diet to follow: you'll just have to test to find out what you can eat, and when, and what you can't touch without planning a long, brisk walk, or some other exercise.
And that's a terribly important point, and one that you need to know: if your BG level goes above 8 [or whatever your target is], you can bring that level down fairly quickly, and safely, by going out and taking a brisk walk, enabling the cells in your body to suck up all that loose glucose in your bloodstream, and getting it down below the levels that cause damage to your eyes, your limbs, and your kidneys. And this is why testing with a blood glucose meter is necessary: the meter tells you what's going on in your bloodstream right now, when you can do something about it. Urine-test strips tell you what happened several hours ago, when it's too late to do anything. And it's in those hours of raised BG levels that the damage happens.
While I can't give you a particular diet, I can give you some guidelines that will help you choose foods that will give you all the nutrition you need and will help keep your BG levels in or near the normal range. [This is nowhere near a complete list, but should be enough to get you started.]
I don't think anyone has ever over-dosed on leafy green vegetables. Salads are great, because you can disguise things that you wouldn't normally eat, but you know are good for you. [I don't much like celery, but diced up in a salad, I don't notice it that much, and it's got plenty of fibre and adds bulk to the meal.] Cabbage or spring greens can be sliced very thinly, then steamed and used as a "spaghetti substitute". An even better spaghetti substitute, although it's only available occasionally, is spaghetti squash.
Approach root vegetables with some caution, since they tend to be much starchier than green veg. These include potatoes, sweet potatoes, parsnips, swedes and turnips [there are others]. Some people have problems with carrots, some don't. Eat some as part of a meal that has only green veg and some kind of meat or poultry, test, and see what happens in your bloodstream.
Other vegetables to treat with some care: sweet corn, peas, tomatoes, sugar or snap peas, onions [except spring onions], capsicum peppers [especially the red and yellow varieties] and beetroot. These tend to have a higher sugar content, and you may have to limit them to small-ish portions. Again, eat, test, and see.
Other vegetables that can usually be used fairly freely: mushrooms, celery, broccoli, cauliflower, asparagus, spring onions, green and runner beans, cress. As with everything else, eat, test, and see what happens.
There are no blanket guidelines for fruit, because, by their very nature, they contain a lot of natural sugars when ripe. I find I can have most berries, cape gooseberries [physalis], a small plum or pear, half a nectarine. Apples and large pears are too high in sugars for me, and I can't even look at a banana or grapes. I'm allergic to citrus fruit, so don't eat those anyway, and can't comment on how they might affect BG levels. Eat, test, and see.
Fruit juices are usually best avoided: they're processed, so the sugars in them go straight to your bloodstream, without there having to be too much digestion going on. If you really, really can't give up fruit juice, have it later in the day, with or after a meal, and have a very small portion, maybe diluted with water. Test to see what happens to your BG levels.
For the carnivores, choices in order of preference would be poultry [skinned – most of the fat in chicken and turkey is just underneath and in the skin] or oily fish, lean beef, lamb, pork. Trim as much fat as possible from any beef and pork. These are high in saturated fats [more about fats later], and so can cause problems for your heart. Preferred methods of cooking: grill, poach in water or wine, fry lightly in a little olive or rapeseed oil. If you fry minced beef or pork, drain thoroughly before adding any other ingredients.
For the vegetarians, tofu and tempeh are good sources of protein. So are nut roasts and nut cutlets. However, check the nutrition information on the label of any prepared products. Look for things that have a low carbohydrate content in order to keep BG levels in order. [I'm not a vegetarian, so I don't use these sorts of products much and can't really comment beyond this. Eat, test, and see.]
Go easy on processed meats, such as sausages, tinned ham, salami, and hot dogs. They tend to be high in saturated fats and sodium, sausages are almost always padded out with cereals, and tinned hams frequently have sugar added to them. You can now get poultry-based items that can be used instead: turkey rashers [take care not to over-cook, or they get like cardboard], turkey sausages and turkey ham. These are much lower in fat than the pork and beef versions, while still low in carbohydrates.
Eggs have had a very bad press over the last few years because of salmonella scares, and before that because of cholesterol. Yet they are fairly high in omega-3 fatty acids, which is the stuff in oily fish that's supposed to be so good for heart health. I have an egg for breakfast four or five times a week, usually with a couple of turkey rashers, less often with bacon, occasionally with a sausage, and my cholesterol levels are pretty good.
These, along with sugars, are the things we're restricting to keep BG levels under control, but we do need some in the diet. Portion control is very important here, just as it is with fruits, but it also makes a difference in what kind of carbohydrates you eat. There's a lot of information on the glycaemic index [GI] and on glycaemic load [GL] on the web, and it's much too complicated to go into here: it's enough to know that you want lower-GI foods rather than higher. Under Resources, I give a couple of web links so you can find out more about it, if you wish to, but for now:
· wholemeal breads tend to be lower GI foods than white breads
· wholemeal pastas tend to be lower GI foods than white pastas
· basmati and brown rices tend to be lower GI foods than other rices
Most root vegetables are very starchy, and so tend to push up BG levels fairly high for rather a long time. Be aware that you may well have to limit these foods to fairly small portions. Eat, test, see.
There are an awful lot of myths about fats out there. Like all the other foods I've been talking about, you need some fat in your diet, but the critical thing seems to be the proportion of what kinds of fats. Saturated fat clogs up your arteries, so you want to reduce the percentage of saturated fat and increase the unsaturated fats. With this in mind, choose olive oil or rapeseed [canola] oil for cooking, and choose moderate fat cheeses [edam, gouda, maasdamer – look for 30% or less fat, that's 30 grams fat per 100 grams cheese]. Small amounts of walnuts, brazil nuts, and almonds are good snack foods, and have good saturated-to-unsaturated fat ratios. Butter is high in saturated fat, so is best avoided; however, many margarines are high in trans-fatty acids, which are also not good for the heart, so a better choice would be an olive-oil-based spread, or a marg that's formulated for lower cholesterol.
Booze [and other drinks]
A glass or two of red wine with a meal several times a week is supposed to be good for your heart, and is, in my opinion, very good for your taste buds and brings ease to the soul. It won't hurt your BG levels, and neither will spirits. But beer, lager, bitter, cider, and such like have a high percentage of carbohydrates, and as such should be limited – perhaps a half-pint or a pint with a meal. Note: If you don't like alcohol, ignore this paragraph. Another note: This is not a licence to get rat-faced every night! There's not much point in sorting out your BG levels if you're then going to muck up your liver.
Fizzy drinks, such as Coke and Pepsi, are all high in sugars, and don't provide anything of nutritional importance.
Be wary of mineral water drinks with "a touch of" some kind of fruit. They tend to have sugars, and some have rather a lot of sodium in them. If you like them, try, test and see.
Caffeine can raise blood pressure [another issue for T2s], so be moderate in the amount of coffee and tea you drink.
Sauces and Relishes
Check the labels of any sauces and relishes you use. Many of them have added sugars and sodium, both for flavour and as preservatives. Most mustards and picallilis are okay, but things like tomato and brown sauces, and some pickle relishes should be used sparingly.
A note about supplements: A single daily multi-vitamin and -mineral supplement will do no harm, and if you've been eating a "rubbishy" diet for any length of time, may well help to replenish any of these trace elements that may have been depleted. But it's strictly optional. Unless you have a definite deficiency in something, you shouldn't need anything else.
How much food is enough?
I've mentioned portion control several times, but I haven't said much about how big the portions should be. That's because I can't. How much food you need depends on how big you are and how much physical activity you do. Someone who's 6'3" is going to need more than someone who's 5'1", just because there's more of you to fuel. And someone who stacks shelves in the supermarket or does landscape gardening for a living is going to need a whole lot more calories than the checkout person or a secretary. So that's another part of this experiment that you're going to have to work out for yourself.
There's a website in the Resources section where you can calculate how many calories you need daily to maintain your current weight. Subtract [or add] 500 calories from that daily total to lose [or gain] a pound a week.
To give you some ideas, I'll tell you what I eat as routine. I'm 5' tall, weigh 11 1/2 stone, and I've been on a weight loss diet for nearly three years, the last year of which I've been eating according to my BG meter. I've lost a total of 6 1/2 stone [3 stone in the last year], and I'm looking to get down to about 10 stone. I'm still trying to eat fewer calories than I use each day, since that's one way to get rid of extra weight. I'm a secretary, and you don't use up a whole lot of calories typing. I walk a minimum of 2 miles every day, more at weekends. This is the diet that is producing a weight loss of 1 or 2 pounds a week:
Breakfast: a cup of coffee with 2 tbs single cream; 2 rashers turkey bacon; 1 egg, usually scrambled with 1 tbs single cream and a bit of spring onion; 1 large-ish mushroom, lightly fried. Oil for frying: a smear of olive or rapeseed oil [a good non-stick frying pan is wonderful].
If pressed for time, I'll have the turkey bacon rashers plus a Corny cereal bar [about 10 g carbohydrates, available at Lidl], but that's usually on a work morning, so I pretty much walk that off during my commute to work.
Mid-morning snack: 2 or 3 Ritz or water crackers and about 1 oz of moderate-fat cheese cubes.
Lunch: 3-4 oz of some kind of sandwich meat [turkey ham, roast beef, chicken or turkey slices] or a [drained] tin of tuna [about 5 oz], plus a one-pint container filled with salad made up of lettuce, celery, spring onion, radishes, 1 or 2 cherry tomatoes, a few mushrooms, up to 2 tbs diced capsicum or beetroot, up to 2 tbs basmati rice or small pasta shells, with a dressing made up of 2 tbs of half-fat mayonnaise plus 1 tbs of half-fat dressing [1,000 Island, French, Italian, Caesar]. Occasionally, the dressing is plain olive oil and vinegar.
Mid-afternoon snack: up to 2 oz walnuts or brazil nuts with 1 oz dark chocolate [70% or more cocoa solids].
Dinner: a cup of green tea, a 3-5 oz piece of meat [chicken, turkey, lean beef or pork, occasionally lamb] with at least one leafy green vegetable [spinach, spring greens, cabbage], and one or two other vegetables: broccoli, cauliflower, green beans, courgette, for a total of 8–10 oz veggies. If I have potatoes [a couple of times a week], it's no more than 3 oz of new potatoes, with 6 or 7 oz of other [non-starchy] veggies. On evenings when I don't have potatoes, I'll have 1/2 a small wholemeal pita bread or 1/2 slice of buckwheat bread. Three or four nights a week, I'll have a couple of glasses of red wine with my meal.
I drink water throughout the day, between 2 and 3 litres, using those sport-top bottles.
This is enough to maintain an average weight loss of a pound or two a week for me, and, while I feel hungry when I wake up and for a little while before meals, I don't generally have serious hunger pangs. If I had a job that involved more physical work, I'd have to eat more stuff to fuel that work. And, if I'm doing serious gardening or a long cycle ride at the weekend, I eat more vegetables, a little bit more protein food, and a little bit more starchy food. The only way you'll know how much is enough for you is to try out different amounts of different foods, get on the scales once a week, and adjust your portions to get the weight loss [or gain] you want - or to maintain your weight, if you don't need to lose [or gain] any. Don't try to lose more than a pound or two a week: if you do, you'll get serious hunger pangs and feel ratty a lot of the time. A small weekly loss will "hurt" less and you'll be able to keep it up.
Back to exercise
By now, if you've kept up the daily walking, you should be walking about 2 miles a day, or nearly so. That's really the minimum needed to bring down insulin resistance [and help with weight loss and muscle tone], but if you can manage a bit more, that's all to the good. I'm a big fan of walking as exercise because it's free, the only equipment you need is a decent pair of shoes, and you can do it anywhere. I freely admit that it's not the most exciting or interesting exercise you might do, unless you live near somewhere that's nice to walk – a big park, or someplace with neat architecture to look at. So I "sneak" a lot of my walking into my daily routine. I get off the bus two stops early and walk the rest of the way to work. There's a small "pocket park" near my job, so I walk twice around that during my lunch hour. Then I walk past two bus stops when I leave work, and that all adds up to about 2 1/4 miles. At weekends, I walk to and from shops where I would once have ridden a bus to get to them. If I'm visiting friends or family, I walk to their homes, rather than take a bus or train. And if the weather is good, I'll go to one of the local parks: Grange Park in Thornton Heath and South Norwood Country Park are both nice places to walk, and easy enough for me to get to. See if there are any such places near you.
But you might well be at a stage now where you want to find something more interesting to do.
I also cycle at weekends, if the weather is good. It's more fun than walking, and is just as good exercise. If you want to try it, see if you can borrow or hire a bicycle and see how you get on with it.
Or, if you've always wanted to try some particular sport, now would be a good time to learn it. Look in your local phone book and see if there's a tennis club, or bowling lanes, or a skating rink, or golf course, or whatever you think you might like, and find out what it would cost to get some lessons and use the facilities. Hire rather than buy any equipment needed at first; you can always buy stuff later, once you've found something you like doing enough that you'll keep it up. Get your partner or a friend to go with you, so it's a social occasion. Try line dancing or salsa dancing, or even ballroom dancing. See if there's a tai chi or yoga class near you. Joining a good gym has the advantage of having all kinds of equipment, and many have professional trainers who can advise on various kinds of exercise; some of them also have swimming pools. Any kind of physical activity will bring down your insulin resistance, help control your diabetes, and be good for your heart and circulation.
That's it. I've laid out how to do in eight weeks what took me four or five months to do, because no one gave me this information to start with. It might take more than eight weeks for you to get to a settled diet that works for you, and you may or may not need medication of some kind to help you. But once you have brought your BG levels into or very near normal levels, you won't need to test nearly so often, maybe every other day or so, with the occasional full-day's testing to make sure you're still on track, and whenever you try a new food item. [Unless you're taking insulin – that's a whole different ball-game, and I would suggest talking to your GP or diabetes clinic nurse, then talk to the ASDUK T1s for information about balancing diet and insulin. There's a couple hundred years' worth of combined experience there.]
Diabetes is a progressive disease, so, even if you can manage without medication to start with, you will probably need medication of some kind eventually. I expect to need medication one day, but I intend to keep off it for as long as I can keep the BG levels at or near normal, so there's no damage leading to complications. When I can't keep the levels down with diet and exercise, I'll talk to my GP about medication, and that will mean more adjustment of diet and exercise. But that's another story.
Take control of your diabetes and your life, and drop in at ASDUK any time. You'll be more than welcome.
Maggie Davey
yankee fiddler gmail com

Diabetes is a chronic, incurable condition that can cause terrible complications, but that can be controlled through diet and lifestyle changes and medication.
There is no "average diet" that is good for all diabetics; each person's body chemistry is different from anyone else's, and your dietary needs depend on how big you are, your daily activity levels, and whether you want to gain or lose weight.
Digestion is a series of very complicated processes, of which you only need a small understanding to be able to make effective changes to your diet to control your diabetes.
An intensive, structured testing regime can help you work out a diet that you can live with and that will control your diabetes.
Exercise is a very important tool in controlling diabetes.
There are resources available that can help you learn more about your condition, and support groups that are willing to help.
You will have diabetes until the day you die, so you need to become an expert in your diabetes if you want to keep the best quality of life that you can, with the fewest complications.
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