Sherri Shafer

Cheat Sheet / Updated 04-05-2022

Diabetes is a condition that is largely self-managed. Successful management hinges on discovering how what you eat affects your blood-glucose levels and your overall health and well-being. Carbohydrate foods are digested into glucose, which is the primary fuel used by your brain and muscles as well as other tissues and organs. You can employ carb counting and portioning tools such as the plate method to assure you get the right amount of carbohydrate to meet your needs. Your food choices impact more than just your blood-glucose levels; your overall diet affects your quality of life and long-term health. You can enjoy eating while optimizing nutrition. Here are some tips for improving selections within all food groups.

Article / Updated 06-18-2019

Looking at the Total Carbohydrate amount on food labels is important because carbohydrates digest and eventually turn into glucose, which ends up in the bloodstream. Having diabetes means you should be paying attention to how much carbohydrate you're eating. Food labels help you do just that, but you need to look for the grams of carbohydrate, not the %Daily Value. You want to focus on the grams of carb, not the %Daily Value, because insulin dosing is based on the actual grams of carb, not the percent. Carbohydrate grams and %Daily Value are listed on the same line on Nutrition Facts labels, as you can see here. Because %Daily Value is written in bold and off to the right side of the label, and lined up neatly with the actual amount, it is easy to allow your eye to zero in on the %Daily Value rather than the actual amount in grams. However, knowing that you're getting 26 g of carbohydrate is far more important than knowing that you're getting 9% of the Daily Value for a person who should be eating 2,000 calories per day. (That is, unless you're in the subset of people who happen to need exactly that many calories and therefore fall into the "reference range.") The %Daily Value on the Nutrition Facts label is useful when you're trying to determine whether a product is high or low in a given substance. Note that 5%DV or less is considered low in that nutrient, and 20%DV or more is considered high in the nutrient. When looking at total fat, saturated fat, cholesterol, and sodium, it pays to choose foods that are low (5%DV or less). When looking at fiber, vitamin A, vitamin C, calcium, and iron, it is a good idea to aim for choices that are high (20%DV or more). Viewing versions of traditional food labels Several versions of the Nutrition Facts labels are currently in use. The most extensive label includes additional information at the bottom of the label. This footnote section is often a source of confusion. This figure points out the lower segment of the label, which provides the reference information in a footnote. Notice that target intakes are provided for two calorie levels. One column heading is for a 2,000-calorie intake target, and another column heading is for a 2,500-calorie intake target. Total fat, saturated fat, cholesterol, sodium, total carbohydrate, and fiber daily targets are set for the two reference calorie levels. The upside of this information is that it allows consumers to have a rough idea of what intake targets to aim for in a day. The downside is that lots of people simply don't fall into those calorie target ranges. An abbreviated version of the food label is also acceptable for manufacturers to use. Some food packages use a version that omits the footnote details from the bottom of the label and simply provides the key nutrition facts. Taking a sneak peek at newfangled food labels The current food label imagery has been in use for more than 20 years. The Nutrition Facts label has recently been redesigned, revamped, and improved. Changes reflect the latest scientific, nutrition, and public-health research. Health experts and the general public provided feedback, which helped shape the label transformation. The new design should make it easier for the public to make informed decisions about what they are consuming. Manufacturers have some time to gear up and get the new image rolling, but they are mandated to go live by July 2018. Smaller companies have an additional year to make the changes. This figure shows the old and the new, in a side-by-side view. The label on the left is the design currently in print. The label on the right is the sneak peek of the upcoming new and improved label. Here's the scoop on what you can expect to see: More realistic serving sizes: The first line on the new label specifies the number of servings in the container. Suggested serving sizes have been reconsidered on various foods. Changes have been made so that suggested serving sizes will be more likely to reflect actual intake. For example, the serving size on the new label will reflect the reality that a 20-ounce beverage is likely to be sucked down by one person, not 2.5 people. However, a 12-ounce beverage will also indicate that the container holds one serving. Let's be honest; most of us don't tend to share our beverages, and once the beverage is opened, it's usually finished off in one sitting. Per serving versus per package notation: Some labels will provide dual columns to show nutrition information for per serving as well as per package. For example, if you eat the whole pint of ice cream, you'll be able to easily identify calories and nutrition facts for not only one portion but also the full container. Being more aware may help people to limit their intake to the suggested "one serving." Bigger, bolder serving-size and calorie fonts: Looking further at the new label design, on the right, you may notice how the serving size will be noted in large, bold font. The calorie level will be in even larger and bolder font. They want to make sure everyone knows that one large bag of potato chips isn't a single-serving container. No inclusion of calories from fat: The calories from fat will no longer be listed. There will still be a requirement to identify the Total Fat grams and the amount of unhealthy Saturated and Trans Fats. Specification of "added" sugar: One significant change coming to the new label relates to sugar. Current labels already list the amount of sugar in the product, but the new food label will add more clarity. It will not only list the total amount of sugar per serving, but it will also tell you how much of the sugar is "added" versus naturally present in the food. Added sugars are going to be identified on the new labels to help consumers be more aware. Added sugars, honey, syrup, and other processed sweeteners tend to add too many "empty calories." Those calories, if not kept in check, can lead to unwanted weight gain and a rash of other health concerns, not to mention the impact on blood-glucose control if you have diabetes. Updated %Daily Value targets: Daily values for nutrients like sodium, fiber, and vitamin D are being updated based on newer scientific evidence from the Institute of Medicine and other reports such as that from the 2015 Dietary Guidelines Advisory Committee. Inclusion of micrograms and milligrams for vitamins and minerals: Old labels fall short, as they currently list only the %Daily Value for vitamins A and C and for the minerals calcium and iron. Current labels don't indicate exactly how many milligrams of calcium, for example, are provided. The new labels will continue to list information on calcium and iron, and will start to list the specific amounts in milligrams in addition to the %Daily Value. Addition of vitamin D and potassium info: Another notable change will be the addition of vitamin D and potassium information: Vitamin D is critical for bone health, and lab results are showing that many of the people who are being screened have low blood levels of this crucial vitamin. Vitamin D content will be listed in micrograms and in %Daily Value. Listing potassium on the new label will bring more attention to this important mineral, which, among other things, helps with blood-pressure regulation. Potassium content will be listed in milligrams, which will be useful for individuals with kidney failure who need to limit or track their intake of potassium. The %Daily Value will also be listed. Omission of vitamins A and C: New labels will no longer be mandated to include details on vitamin C and vitamin A. You may wonder why those two nutrients are being booted off the new label. It's simply because deficiencies are far less frequent these days as most individuals have adequate intakes for both vitamins A and C.

Article / Updated 06-06-2017

For decades, people with diabetes were told not to eat sugar. Avoiding sugar won't automatically keep blood-glucose levels in range if there are no controls on the overall carb intake. Skipping the cookie doesn't erase the carbs in the rest of the meal. Managing carbs for diabetes means all carbs in the meal need to be accounted for, not just the dessert. Certainly, having diabetes makes it very important to limit sweets, treats, and desserts. Sugar is concentrated in carbs, and desserts can easily blow the carb budget. For example, at a popular restaurant the flan had over 120 grams of carb per serving. Another dessert on the menu had nearly 200 grams of carb! To put that in perspective, a cup of white granulated sugar has 200 grams of carb. Nobody with diabetes is going to tolerate a dessert like that. That particular dessert had more than 1,200 calories, making it an unhealthy choice for anyone, with or without diabetes! Estimating carbs in desserts can be tricky. Some can be deceptively high in carbs, while others may not have as much as you'd think. If you underestimate the carbs in the dessert, your blood glucose goes sailing. On the other hand, if you overestimate the carb counts and end up taking too much insulin, you can end up with hypoglycemia. Making your own treats One option for having dessert when you have diabetes is to make your own goodies. When baking treats at home, you can closely estimate carb counts in your recipes. For ingredients that contain carbs, use the Nutrition Facts food labels on the package. If you don't have access to the package or you buy in bulk, simply look up the item online. Check CalorieKing or use your search engine to look up individual ingredients. You can then calculate the amount of carb per serving in your homemade desserts (or any recipes for that matter). Tally up the amount of carb in each ingredient in the recipe. Consider these ingredients in a cookie recipe: One cup of white flour has 92 grams of carb, and one cup of white granulated sugar has 200 grams of carb. The butter, eggs, baking soda, vanilla, and salt don't have any carbs. Figure out how many carbs are in one cookie by dividing the total carbohydrate count by the number of cookies baked. When baking at home, you can make the recipe healthier by cutting down on the sugar and fat in the recipe. You can also find recipes that incorporate sugar substitutes by looking online. Dressing up healthy fruits Fruits are naturally sweet and satisfying, and they are a healthy alternative to dessert. Here are some tips for making outstanding fruits stand out: Make fruit kabobs by skewering cubes of cantaloupe, honeydew, watermelon, strawberries, pineapple, and grapes. Impress your guests with a fruit salad melon boat. Cut a watermelon in half and use a melon ball tool to scoop out the flesh, leaving the hollowed empty shell. Refill the empty shell with a colorful mixed fresh-fruit salad. The melon shell is the serving bowl. Bake apples instead of an apple pie. Core the apples, leaving enough of the core at the base of the apple to hold the filling. Fill each apple with 1 teaspoon of butter or margarine, 1 teaspoon of brown sugar or agave nectar, 1/4 teaspoon of cinnamon, and 1 teaspoon of minced pecans or walnuts. Place the apples upright in a baking dish with about 1/2 inch of water in the bottom of the pan to prevent scorching. Bake at 375 degrees for one hour or until desired tenderness. Freeze grapes for a refreshing treat. Melt dark chocolate in the microwave. Dip fresh strawberries into the melted chocolate and then refrigerate until the chocolate is firm. You can do the same with banana chunks, sprinkling them with minced nuts. Use a glass parfait dish or a wine glass to layer fresh berries and nonfat yogurt. Sprinkle the top with a tablespoon of granola. Make sugar-free gelatin and mix in sliced fresh fruit. Refrigerate until firm. Serve with whipped topping (optional). Enjoying dessert while controlling the carbs Desserts can be high in calories, fats, and carbs. Choices matter, and portion control is important. Here are a few tips for enjoying dessert and controlling the impact it has on your health: Sharing: When in restaurants, consider ordering one dessert for the table and sharing it. If the restaurant is a chain, ask your server or the manager for the nutrition information so you can look up the carb and calorie counts. Another option for chain restaurants is to check their website for the nutrition facts. The website is usually easy to locate by the restaurant's name. Stocking the best bets at home: Fudgsicles are low-fat frozen delights. They contain about 40 calories, 10 grams of carb, and 1 gram of fat. Pudding cups are also appropriately portioned. Buy yogurt in tubes and freeze them. Cut the end of the yogurt tube and squeeze from below for a yogurt push-up. Sugar-free gelatin is virtually free of calories and carbs, so you can have it anytime. If you do buy ice cream, consider frozen yogurt or the lower-calorie ice creams. Read the Nutrition Facts labels to compare calories, carbs, and fats. Limit your serving to one scoop. Don't stock up on treats at home if they are too tempting and you can't control portions. Maintaining carb control at mealtime to make room for dessert: Maintaining control of blood-glucose levels is easier if dessert is consumed after a lower-carb meal. For example, if your meal is a salad with greens, vegetables, and protein, you have more room in the carb budget to enjoy a dessert. Having your cake and eating it too: A thin slice of angel food cake with a couple of sliced strawberries and a spritz of light whipped cream is far lower in carbs than your typical frosted cake. If you're celebrating a special occasion that calls for cake to be served, you can opt to go mini. Boutique cupcake stores and even big-box supermarkets offer mini cupcakes, or you can buy mini muffin tins and make your own. The trick is eating just one. You can also use mini muffin tins to make mini banana bread or zucchini bread muffins that don't require any frosting. Cake pops are another alternative to a full-sized cake. Cake pops are cake balls on a stick, similar to lollipops. Walking it off: Adding some extra exercise after consuming dessert helps burn off some of the glucose in your blood. Exercising regularly improves overall health and assists in weight management.

Article / Updated 06-06-2017

Carbohydrate requirements can change throughout life. Your carb demands may even change seasonally if your activity levels vary according to the time of year. The following discussion explores situations that may call for making adjustments to your carb intakes. Changing carb needs throughout the life cycle Childhood and adolescence are times when dietary needs are constantly changing. It is important that children with diabetes get the same amount of nutrition and carbs as recommended for all children. Hormones and changing activity patterns call for more frequent visits with the diabetes team to make sure insulin and other medications are adjusted as needed to support a balanced and adequate diet. Pregnancy and breastfeeding increase the demand for carbohydrates and other nutrients, so close monitoring is required with a team of experts who specialize in high-risk pregnancies. Elderly individuals typically see a decrease in their calorie and carbohydrate needs as metabolism changes. Their vitamin and mineral needs don't shift much, however, so they need to focus on nutrient-dense food choices. Altering carb intake to account for activity Varying activity is a typical reason for adjusting carb intake. Exercise uses up more calories in the forms of carb and fat, so needs change on active days. If you aren't at risk for hypoglycemia, you may not need or want a snack, especially if you're trying to lose weight. If you're at risk for low blood glucose due to insulin use or other medications, you can monitor blood-glucose levels to decide whether you need to add a snack to prevent hypoglycemia. You should always carry carbs to eat as needed and quick forms of sugar or juice for treating lows. Insulin doses can be adjusted on active days to reduce the risk of hypoglycemia. Speak to your healthcare provider for tips on medication. Adjusting portions when blood glucose is out of control The American Diabetes Association sets pre-meal blood-glucose targets at 70–130 milligrams per deciliter (mg/dl) and post-meal blood-glucose targets at under 180 mg/dl. What should you do if your blood glucose level is significantly elevated, perhaps even above 180 mg/dl before eating? Your own insulin, as well as any insulin that is injected, doesn't work as effectively when you're hyperglycemic. Follow your doctor's advice about how to adjust insulin to correct glucose elevations. Limit carbs and fill up more on salad, nonstarchy vegetables, and protein foods to give your blood glucose a chance to return to target levels. If you're frequently above target before meals, you likely need a medication tune-up and should see your doctor for advice. You can't be expected to skip carbs on a regular basis. Managing sick days Being sick can make diabetes management a real challenge. Talk to your healthcare providers in advance to make a plan about how to manage illness. Your body responds to illness with stress hormones, which can cause blood-glucose levels to rise. Monitor your blood-glucose levels more frequently when you're sick. People with type 1 diabetes should be monitoring their glucose levels at least every four hours, and people with type 2 should check at least four times daily when sick. Illness increases the risk of producing ketones, so people with type 1 diabetes should have supplies for checking ketones. You're less likely to have ketones if you have type 2 diabetes, but it is possible if you're very ill. Stick to your usual meal plan if possible. Staying hydrated is important, but that can be difficult to do if you have vomiting or diarrhea. Keep sipping fluids. Choose noncarb fluids, including water, diet drinks, broth, and tea. If you can't eat normal foods, try substituting bland foods such as crackers, toast, cooked cereals, boiled potatoes, soups, yogurt, pudding, applesauce, and canned fruits. If you can't handle solids, get your carbs from liquids, such as diluted fruit juices, sports drinks, gelatin, popsicles, sherbet, and soft drinks (regular — not diet — in this case). Vomiting, diarrhea, persistently elevated blood-glucose levels, difficulty breathing, dehydration, or having ketones are all reasons to seek medical attention. Discuss sick-day management with your doctor. Make a plan in advance. Ask your doctor for the appropriate phone numbers for whom to contact after hours and on weekends. Don't stop taking your diabetes medications when you're sick. Illness can cause blood-glucose levels to rise even if you aren't able to keep any food down. People with type 1 diabetes may require even higher than usual doses of insulin during illness.

Article / Updated 06-06-2017

The Dietary Reference Intakes (DRI) for Americans minimum for carbohydrate is 130 grams per day, and the suggested carb intake range is calculated at 45–65 percent of caloric targets. Some people with diabetes opt to go somewhat lower, such as 40 percent. Targets should be individualized based on preference and health considerations. After you've estimated your caloric needs or by using an online calorie calculator, you're ready to use the chart in the following figure to estimate carbohydrate intake targets. Find your desired calorie level in the left column. Decide what percentage of your daily calories you want to allocate to carbohydrate as indicated along the top row, from 40–65 percent. (Note the suggested minimum carb intake per DRI guidelines is 130 grams per day, so the table doesn't go below that number.) If your blood-glucose levels are running above target, it may be wise to choose a lower level of carb until control improves. Gaining control of your diabetes may require diet modifications, exercise, and medications. Once medications are properly adjusted, start with 45–50 percent of daily calories as carbs. If you prefer a lower carb intake, 40–50 percent is fine. The lowest carb intake in the table is 130 grams per day to comply with the minimum dietary intake recommended by the National Institutes of Health. If you're active and can control blood-glucose levels while eating more carbs, then you may aim for carb intakes of 50–55 percent of calories. It may be difficult to control blood-glucose levels with 60–65 percent of your calories from carb unless you are an athlete who is getting a lot of exercise. Here's an example: Consider a moderately active person who wants to eat 1,600 calories each day and opts for 40–50 percent of calories to come from carbs. Locate the 1,600-calorie level in the far left column. Find the column headings for 40–50 percent. Line up the horizontal 1,600 calorie line with the vertical 40–50 percent columns. The daily carb intake goal would be 160–200 grams. Blood-glucose levels will be best controlled if the carbs are budgeted between meals and snacks.

Article / Updated 06-06-2017

Sugar alcohol is a modified form of carbohydrate. Many products that claim to be sugar free are sweetened with a substance known as sugar alcohol (or polyol). Despite the name, sugar alcohol does not have any sugar, and it does not have any alcohol. Hydrogen is added to various forms of carbohydrate and chemical bonds are shifted, and then voilá — you have a new form of carbohydrate known as sugar alcohol. Many candies, cookies, ice creams, puddings, and syrups claim to be "sugar free." That doesn't mean they are carbohydrate free or calorie free. The label claim on the front of the package doesn't necessarily tell the whole story. Because technically the sugar has been altered, the product can be labeled as being "sugar free." The resulting sweetener is renamed "sugar alcohol." When you view the Nutrition Facts on food labels, the total carbohydrate count doesn't change much, if at all. It may say "0" grams of sugar, but look below that to find the grams of sugar alcohol. Either way, the total carbohydrate is what you need to focus on. Many so called "sugar-free" sweets are still high in carbs, fats, and calories. In fact, the counts are often comparable to their regular sugar–containing counterparts. Beware: Some people experience gas, cramping, or loose stools because sugar alcohol can be difficult to digest and absorb. The portion that remains undigested is fermented by bacteria in the large intestine. Unfortunately, that can result in problems such as gas, cramping, bloating, and perhaps diarrhea. Sugar-free gum has only a small amount of sugar alcohol, so digestive complaints are rare. If you eat too much sugar-free candy or ice cream, you may end up regretting it. Tolerance is variable and dose dependent. Some people have no adverse symptoms at all. Not all types of sugar alcohol are the same. Some are better tolerated than others. Products sweetened with mannitol or sorbitol are required to carry a label warning stating that some users may experience a laxative effect. The other sugar alcohols don't need to carry such a warning. Sugar alcohol can be created from single units of sugar, double units of sugar, or chains of sugars: Single sugars (monosaccharides) such as glucose and fructose are modified to make sorbitol and mannitol respectively. Double sugars (disaccharides) are also used to produce sugar alcohol. For example, the lactose from milk can be turned into lactitol. Starch fragments (polysaccharides) are modified to create hydrogenated starch hydrolysates. The table shows examples of sugar alcohols. Examples of Sugar Alcohol Made from Monosaccharides Made from Disaccharides Made from Polysaccharides Sorbitol Maltitol Maltitol syrup Mannitol Isomalt Hydrogenated starch hydrolysates (HSH) Erythritol Lactitol Xylitol While entirely safe for humans, xylitol is toxic to our canine and feline friends, so make sure your dogs and cats don't eat any products sweetened with xylitol. This particular sweetener stimulates the release of insulin in pets, which can lead to hypoglycemia, seizures, liver problems, or death. This doesn't happen to humans, so you're not at risk. Pet owners must be made aware, though. Why do food scientists go through all of this trouble to create sugar alcohol out of sugars and starches? Well, there are a few benefits. For one thing, sugar alcohol doesn't promote cavities. Secondly, there may be a reduced effect on blood-glucose levels when using sugar alcohol rather than other caloric sweeteners. Because sugar alcohol is not well digested, fewer calories are absorbed (but with that comes the risk of gas and diarrhea). Sugar alcohol adds texture, bulk, a desirable "mouthfeel," and retention of moisture to the products that incorporate it. Nonnutritive sweeteners do not offer those properties. If you count carbs and base your insulin dose on the grams of carbohydrate you eat, then you may consider a modified approach when eating a product made with sugar alcohol. Because sugar alcohol is not fully digestible, take insulin for only half the amount of sugar alcohol in the product. You can also deduct the grams of fiber from the total carbohydrate because fiber doesn't digest. Discuss the concept with your healthcare providers before changing the way you calculate your insulin dose. See the figure for tips on deciphering digestible carbohydrate when reading Nutrition Facts food labels on items that contain sugar alcohol. One thing to consider, especially if sugar alcohol gives you abdominal discomfort, is that you can choose to buy the regular version of the product, which in the example happens to be cookies. If it turns out that the regular sugar–containing version has 20 grams of carb, then you would simply take the dose needed to cover the 20 grams of carb.

Article / Updated 06-06-2017

A common misconception about alcohol is that many people assume alcohol turns to sugar, or alcohol will raise their blood-glucose levels. Actually, hard liquor doesn't have any carb, wine is very low in carb, and beer has about as much carb as a piece of bread: Hard alcohol (distilled spirits) doesn't have any carbs, except for whatever it's mixed with. Most wines have only 3–5 grams of carbohydrate per 5-ounce glass. The sugar from the grape juice turned into alcohol during the fermentation process. Beer has roughly 13 grams of carb per 12-ounce portion. The carbs in beer come from wheat, barley, or malt. However, if your drink comes with a cherry and an umbrella, it has carbs, probably lots. Mixed drinks can be especially high in calories when you consider the alcohol and the mixers. Sugary mixers, soda, or juices can lead to a rise in blood glucose, at least temporarily, because the liquid carbs get into the bloodstream fast. But blood glucose may end up plummeting later. Insulin users may wonder whether they should "cover the carbs" in their alcoholic beverages with insulin. That may work okay at mealtime for one drink: for example, if you have a beer with a carb-containing dinner. Say the beer has 13 grams of carb and the meal has 55 grams of carb. You may be fine counting the total as 68 grams of carb and taking the appropriate dose of insulin. The food and the insulin both last about four hours. The alcohol should be done processing within about two hours. That's why you're less likely to get low blood sugar if you have your drink with a meal. However, drinking on an empty stomach is a different story. Consider this: If you take insulin to cover the carbs in an alcoholic beverage, the rapid-acting insulin will last about four hours, but the liquid carbs in a beer or in carb-containing mixers will be digested very quickly — within 15 minutes of drinking. On an empty stomach, alcohol has a blood-glucose-lowering effect for two or more hours per drink. The carbs won't last as long as the alcohol and the insulin, which increases the risk of having hypoglycemia. Talk to your doctor about insulin and alcohol. The discussion in this book is conceptual and not meant to provide insulin dosing instructions. Medication use and adjustments must be discussed with your doctor. Some alcoholic beverages have carbs, but all of them have calories. Alcohol has 7 calories per gram, protein and carbohydrate have 4 calories per gram each, and fat has 9 calories per gram, so fat and alcohol are the most calorically dense. Alcohol can contribute to weight gain, so it's important to account for the calories consumed. The table lists popular alcoholic beverages and their average carb and calorie counts. Extra stout beers would have more carbs and calories than listed, and beers in general vary by brand. Mixed drinks have a wide range of carb and calorie counts — too wide to mention here — but some frou-frou drinks push upwards of 500 calories up that straw. The Carb and Calorie Counts of Common Alcoholic Beverages Beverage Grams of Carb Calorie Count 80 proof spirits — 1.5 oz. 0 100 Wine (red or white) — 5 oz. 3–5 125 Beer (light) — 12 oz. 5–6 100 Beers (average) — 12 oz. 11–15 150 The numbers listed in the table represent some averages across the categories mentioned, but there is certainly variation. Check labels, look online, or contact manufacturers for details.

Article / Updated 06-06-2017

Simply put, alcohol impairs glucose regulation. It is important not to drink alcohol on an empty stomach. A mini physiology review may shed some light on why it's so important to have carbs digesting when you have a drink. Blood-glucose levels are at their highest typically one to two hours after eating a mixed meal. (A mixed meal is a meal that contains carbs, protein, and fat.) Protein and fat cause the carbs to digest slower. A mixed meal takes roughly four hours to finish digesting. During digestion, carbs are breaking down into glucose and entering the bloodstream. Normally, some of the glucose from the meal is packed away in the liver and saved, to be used later as needed. When the meal is completely done digesting, the liver is supposed to release the glucose that was previously stored. Your body must always have glucose in the blood to keep the vital organs functioning properly. Alcohol goes to the liver to be detoxified, processed, and broken down into safe byproducts. While the liver is breaking down the alcohol, it may not be able to release glucose normally. If the glucose release from the liver is compromised, then the insulin (or certain diabetes pills/medications) may continue to push the blood-glucose levels lower and lower. A single drink can take two or more hours to be processed by the liver, so glucose regulation may be impaired for that amount of time or longer. The liver stays busy for two hours or more per drink, so the more drinks you consume, the longer you are at risk for low blood-glucose reactions. The figure helps clarify the concept. The gray shaded area represents the rise and fall of the blood glucose after eating a meal. When foods are finished being digested and absorbed, the liver's job is to release glucose that had been previously stored. Alcohol impairs that process because the liver preferentially breaks down the alcohol. Hypoglycemia may ensue. If you drink on an empty stomach, that means there is no carb digesting, so there's no glucose supply via digestion. Your liver is supposed to release glucose between meals. If alcohol impairs the liver from releasing glucose, you cut off your only glucose supply. Your meds can make your blood glucose drop too low.

Article / Updated 06-05-2017

Fruit digests quickly, which is why it's usually better for blood-glucose control to eat smaller amounts of fruit throughout the day rather than too much at one time. Fruit juice digests even faster than whole fruit. You can measure the effect on your blood glucose about 15 minutes after the time you drink it. That's right, from lips to fingertips in just a few minutes. The effect occurs so rapidly because liquids digest faster than just about anything else. When you drink juice on an empty stomach, it races through the digestive system like water disappears down the drain. Just as water empties from a sink into the drain, fluids move through the stomach and into the intestine, where the sugars are quickly transferred to the bloodstream. But wait — you may say, "I thought fruit juice was healthy!" Although it's true that fruit is filled with vitamins, minerals, antioxidants, and many nutrients, fruit juice also contains a lot of natural sugar in liquid form. Eating fruit is part of a healthy, balanced diet, but it's better to eat the fruit, not drink the juice. Eating a serving of fruit two or three times each day is recommended, but don't eat all three portions at one time because large portions of fruit consumed in one sitting can cause a sharp rise in blood-glucose levels. When you drink a glass of fruit juice, you are having multiple servings of fruit at one time. The juice of one orange may fill your glass about one inch. A glass of juice is more like several fruits at one time. Vegetables have many of the same vitamins and minerals that fruits have but with lower sugar content. You may find that you can enjoy a glass of vegetable juice without the same blood-sugar spike that fruit juice often causes. Portion size matters, so aim for about 4–8 ounces of vegetable juice at a time. An 8-ounce portion may contain close to 10–15 grams of carbohydrate, so you may not want to drink large volumes. Before you nix juice completely, think about this: Fruit juice can actually come in handy in a couple of key situations. There's no need to keep large bottles of juice in the fridge, though. Single-serving (4–6 ounce) containers can be used for treating and preventing low blood-glucose levels.

Article / Updated 06-05-2017

If you're looking for flavor, lots of low-carb options provide a little pizzazz and still don't drive the blood-glucose levels up. If you want a soda, you're better off with a diet version than a regular sugary soft drink. If you aren't looking for fizz, try drink mixes in powdered or liquid form that can be mixed up in a minute: Lemonade: Lemons and limes have very little carbohydrate. Make homemade lemonade by mixing freshly squeezed lemon juice with water and sweeten to taste with your choice of noncaloric sugar substitutes. Start with 2 tablespoons of lemon juice to 8–12 ounces of water, or make it by the pitcher with 1/2 cup of lemon juice per quart of water, and sweeten according to taste. Try freezing a more concentrated version of your lemonade in ice-cube trays to add flavor to your water anytime. Tea: Whether you like herbal, green, or black, caffeinated or caffeine-free, there are countless options. Steep it and drink it hot or chill it for a tall glass of iced tea. Try mixing half a glass of iced tea with half a glass of the lemonade you made in the preceding entry. Diet drinks: Most sugar-sweetened soda brands offer a diet version. Diet is the way to go when you're watching your blood-glucose levels. (Regular soft drinks wreak havoc.) Nobody benefits from getting hundreds of empty calories from beverages sweetened with sugar or high-fructose corn syrup. Diet sodas shouldn't displace nutrient-rich milk or other calcium-fortified milk replacements, but a diet soda here and there isn't going to hurt. Sugar-free drink mixes: Check your supermarket shelves for sugar-free drink mixes that you can mix up by the glass or by the pitcher. They come in powdered form or in liquid drops. Look for resealable, multi-serve containers as well as boxes with single-serve packets. Or, buy sugar-free beverages bottled and ready to drink. When dining out, carry single-serve, sugar-free powdered drink mixes to stir into your glass of water. Stir up a serving of no-sugar-added lemonade or a fruit-flavored beverage. You win in two ways: You get a noncaloric diet drink that doesn't raise your blood sugar, and you save money. You can also carry the brands that come in liquid concentrate and plop a few drops into your ice water. Coffee: Don't worry. Plain, brewed coffee doesn't affect your blood sugar, whether it is caffeinated or not. It boils down to what you put in it. A packet of your choice of sugar substitute doesn't add carbohydrate. A splash of milk or half and half doesn't add up to very much carb (unless you drink cup after cup). So just check the labels on what you're stirring into your coffee. The latte or café con leche carb count depends on the amount of milk you use, whether it's the moo kind or the soy variety.