Cooking for Diabetics

[dawnie2u]

I have my in-laws visiting for a week, and my SIL is insulin dependant diabetic, and MIL is pre-diabetic, which I don't really understand, aren't we all? Anyway, I am cooking for everyone for the next 6 days. I need recipes and ideas, please.

I have spent the last few days cleaning, so now I have no menus. I request low carb and/or low glycemic index recipes. I know this sucks, but when it comes to someone's health, I do try to tread the line.

Oh and yes, I am on my second martini. Thanks!

Edited June 18, 2006 by dawnie2u (log)

[SuzySushi]

My husband and my daughter have insulin-dependent diabetes, and I cook for all of us.

Best thing you can do is find out from SIL and MIL exactly what their dietary restrictions are. Are they on a fixed carb diet? Is SIL counting carbs and adjusting her insulin to fit? Do they have other dietary restrictions? (A lot of "low-carb" recipes promoted during the low-carb craze are very high in fat, which is not good for diabetic diets.) Are they using sugar substitutes instead of sugar in recipes?

[mrsadm]

I have my in-laws visiting for a week, and my SIL is insulin dependant diabetic, and MIL is pre-diabetic, which I don't really understand, aren't we all?  Anyway, I am cooking for everyone for the next 6 days.  I need recipes and ideas, please. 

I have spent the last few days cleaning, so now I have no menus.  I request low carb and/or low glycemic index recipes.  I know this sucks, but when it comes to someone's health, I do try to tread the line.

Oh and yes, I am on my second martini.  Thanks!

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No, this doesn't suck!

Good idea from suzi to check with them directly. I always do that with guests I don't know well in case there is an allergy.

You can check out low carb recipes at http://www.lowcarbfriends.com/recipereview/

I have never cooked for diabetics but there are many healthful tasty recipes there; as suzy said, avoid the ones that are high-fat. Think lean meats, veggies, and salads.

[deltadoc]

Before I was marreid, I had a girlfriend who was diabetic. We'd make pizzas by pushing the hamburger down inside a pieplate, as though it were the crust. Then I added chopped onions, tomato sauce and some mozzarella, and baked like a regular pizza. She could eat the whole pie!

doc

[Gifted Gourmet]

an excellent resource

Each recipe comes with the "diabetic exchanges" listed .. these tell the guest how to measure items within a dish and how to count them as part of their daily routine.

They will understand this process from their experiences.

[rlibkind]

It really isn't that difficult. Just avoid foods that are heavy carb based. While most diabetics can incorporate a moderate side dish of carbs into their meal plan, avoid carbs as a main course -- pasta or pizza, for example -- or serve pie, cake or cookies for dessert.

It's June: buy lots of great fresh vegetables and fruits. Make salads. mrsadm got it right: meat, poultry and fish. Fire up the grill for both the protein and the veggies. And don't forget the incredible, edible egg: omelets and frittatas incorporating spring's bounty. Fruits have carbs too, of course, but they are considerably less dense than what most Americans consume for dessert and easily accommodated in most diabetic diets.

But again, the key is to ask the guests what they'd like and what works for them, including items to have available for snacks.

[dawnie2u]

Thanks for your suggestions. What I have discovered is that my SIL hasn't a clue as to what she is doing with her diet. She eats what she wants and then gives herself a shot of insulin. Since she has been here, she has had low blood sugar twice and had to eat something sweet to counteract it. I am cooking low carb with lots of salads and veggies. I am trying to keep it low fat also. Breakfast is the hardest for me because it seems like breakfast food are high in cholesterol and fat. Thanks again. Dawn

[scott123]

What I have discovered is that my SIL hasn't a clue as to what she is doing with her diet.  She eats what she wants and then gives herself a shot of insulin.

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It's very sad, but this approach is fairly common in the diabetic community. As you are probably guessing, it's not the healthiest approach. It is her life and telling people how to eat can be tricky business, especially siblings, but if you could suggest to her an alternative approach, you might very well be adding years to her life.

Diabetes doesn't have to be that restricting but it should involve some moderation and a certain amount of self awareness.

[HVRobinson]

After 49 years of eating EVERYTHING... and frequently NOT in moderation the doctor informed me that I have crossed the line from pre-diabetic to full blown DIABETIC. It isn't the end of the world. There's lots of wonderful food to eat. Desert can be tasted in very small quantities... a nibble from all plates in a group is fair. BUT... I do miss some of the high fat cooking that I have done for most of my life, and there isn't a carb on the planet that isn't my close personal friend. As such I'm opening a thread to as anybody who IS diabetic, who COOKS for diabetics, who has STUDIED the field... or has any worthwhile observations---for your thoughts and ideas. Here's what I really am looking for:

1) resources for menu planning (especially for lunches and dinners for one at the office)

2) ideas about eating out at higher end restaurants without insulting or stressing the chef or server(s).

3) ideas about what works as staples and mise en place for plan ahead weekly cooking

4) how to best entertain without "inflicting" my needs on my guests

Other than that, Mrs. Lincoln, how did you like the play? At 51 I plan on enjoying myself for many more years. One more important lesson. DON'T prepare your peppers without gloves right after testing your blood sugar. It really burns. Especially the Scotch Bonnets. Wowzers!

hvr

[SuzySushi]

First of all, my commiserations. But then again, it's not the end of the world -- not even the world as you know it.

My husband has Type 1 diabetes, which was diagnosed when he was in his 30s. Our 11 year old daughter was diagnosed with diabetes 2 years ago. I cook for both, we all eat out, and enjoy almost everything IN MODERATION.

Key one is that everything can be worked into a so-called "diabetic diet" -- starchy carbs, sugar, fat -- as long as you keep your diet reasonably balanced and you've taken enough medication (insulin or whatever other medication you're on) to balance your carb intake.

Your doctor should have given you a basic diet plan. You should also work with a dietician so that you understand how much fat, protein, and especially how many carbs you can eat per meal. As long as you keep these numbers reasonably close to your goal, WHAT you eat doesn't especially matter. Sure, it would be unsound nutritionally to make an entire meal of desserts, but there are no inherently "bad" foods.

Your dietician can also help you work out meal plans for lunch.

Counting carbs is the most accurate way of measuring your carb intake, and there are plenty of guidebooks as well as online guides. However, your dietician may also give you an "exchange diet" where approximately 15 grams of carbohydrates = 1 exchange. That means 1 slice of toast bread, 1/2 a small bagel, 1/3 cup of cooked rice, a scant 1/2 cup of cooked pasta, or 1 small (3 ounce) potato is one exchange. Milk, BTW, is counted as a carbohydrate (12 grams of carbohydrates per cup). Multiply this by the number of exchanges you're allowed per meal to figure out your carbs.

If you have a good eye for cooking, you'll quickly learn to eyeball portion sizes and be able to estimate their carb counts. Again, for more accuracy, popular dishes at many fast-food and chain restaurants are listed in guidebooks, or the restaurants will have nutritional data available (but I wouldn't expect this in a fine restaurant.

A couple of other recommendations:

Become a member of the American Diabetes Association (and through membership, a automatic subscriber to their excellent magazine, Diabetes Forecast). Through them, we've been aware of some new medical developments before our primary care physician!

And when you're doing your fingersticks for glucose tests, use the sides of your fingertips -- they have fewer nerve endings than the tips themselves and are less sensitive to pain.

Best wishes, and feel free to email me for more detailed information. I posted here when my daughter was diagnosed and I got some invaluable help and reassurance from other eGullet members!

Edited November 1, 2007 by SuzySushi (log)

[helenjp]

I try to take dinners to a family friend who has diabetes, as it is hard for him to make food that suits both himself and his teenage son.

...it was not too hard when he was simply on medication, but it is VERY HARD now that he is on dialysis. I really can't cook confidently for him without specialized advice from a hospital nutrition consultant. As an outsider, it's not really my right to comment, but it looks as if any effort that keeps a diabetic from needing dialysis is totally worth it.

Japanese nabe are almost ideal, though - a hot pot of water or broth has seafood or finely sliced meats, tofu, vegetables cooked in it by diners who pull out what they want, and dip it in a sharp mixture of soy sauce and citrus juice, adjusted to individual tastes with chili paste, sesame seeds, spring onions, etc etc. Finish by spooning some of the broth over a small bowl of rice (the rice will swell in the broth), or cooking some udon noodles or beanthread vermicelli in the hot pot of broth.

Since it is a tasty way to eat pale vegetables like Chinese cabbage or beansprouts, it seems to be a good dish even for dialysis patients who have to watch their mineral intake, and for regular diabetics or pre-diabetics, it is a healthy but tasty way of eating, and one that doesn't require you to forego what everybody else is eating.

Good luck!

[MarketStEl]

I try to take dinners to a family friend who has diabetes, as it is hard for him to make food that suits both himself and his teenage son.

...it was not too hard when he was simply on medication, but it is VERY HARD now that he is on dialysis. I really can't cook confidently for him without specialized advice from a hospital nutrition consultant. As an outsider, it's not really my right to comment, but it looks as if any effort that keeps a diabetic from needing dialysis is totally worth it.

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I find myself in the same situation with a diabetic roommate (Type 1, had it all his life) whose kidneys have now failed.

Next to the stove are a couple of lists with all the foods he must avoid or severely restrict. It makes buying food tricky, more so as I am the chief cook too and he doesn't do that much cooking for himself. He must avoid or restrict his intake of foods containing sodium, potassium and phosphorus.

There is one category where I'm puzzled here: the list includes tomato products -- tomato sauce, juice and paste -- but not fresh tomatoes as foods to avoid due to their high potassium content. (Tomato and vegetable juice are also on the should-avoid list for sodium content too.) I know that processing increases the amount of lycopene in tomato products vs. tomatoes; does it similarly increase the potassium concentration? And what if I prepare a homemade sauce from fresh tomatoes? Does the same process take place?

A friend of mine told me that there is one variety of deli cheese -- Finlandia Muenster -- that is made in such a way that it does not contain the high levels of potassium and phosphorous that put cheese on the should-avoid list for these two substances. Has anyone else heard this?

[Toliver]

There is one category where I'm puzzled here: the list includes tomato products -- tomato sauce, juice and paste -- but not fresh tomatoes as foods to avoid due to their high potassium content.  (Tomato and vegetable juice are also on the should-avoid list for sodium content too.)  I know that processing increases the amount of lycopene in tomato products vs. tomatoes; does it similarly increase the potassium concentration? And what if I prepare a homemade sauce from fresh tomatoes?  Does the same process take place?

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Chris, I hope a true SSB weighs in on this but I think you're on the right track. The tomato sauces, juices and pastes are concentrated due to reduction. It's natural that they would have highers concentrations of those chemicals due to the reduction process.

[SundaySous]

Wow what a timely topic, my dad is borderline Diabetic and we're in the same boat.

Heavy into research right now. One thing he likes is rice made with 1 cup water and 1 cup chicken broth. We use use Orrrington Farms. 1/2 cup cooked this way with Turkey, Chicken or fish (still trying to find a way to sneak fish in there) is pretty filling. Kinda think it reduces cravings too.

I know rice is on the list to avoid but for the benefit of feeling full it's a good starch exchange (moderation).

This guy has opened my eyes. Something called Glycemic Load.

The glycemic load (GL) is a relatively new way to assess the impact of carbohydrate consumption that takes the glycemic index into account, but gives a fuller picture than does glycemic index alone. A GI value tells you only how rapidly a particular carbohydrate turns into sugar. It doesn't tell you how much of that carbohydrate is in a serving of a particular food. You need to know both things to understand a food's effect on blood sugar. That is where glycemic load comes in. The carbohydrate in watermelon, for example, has a high GI. But there isn't a lot of it, so watermelon's glycemic load is relatively low. A GL of 20 or more is high, a GL of 11 to 19 inclusive is medium, and a GL of 10 or less is low.

I really hope this GL thing is a good guide because it makes menu planning much easier.

A word of warning if you bake with Splenda, it will grind your mixer to a halt. If you are using a stand up mixer made after 1980 I suggest buying a hand held for Splenda. Buy two so you have one in reserve when the first one goes.

Chocolate chip cookie dough should be on the list of lethal weapons. If someone breaks into my house while I'm making cookies trust me I'm going to win.

[SundaySous]

What I have discovered is that my SIL hasn't a clue as to what she is doing with her diet.  She eats what she wants and then gives herself a shot of insulin.

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It's very sad, but this approach is fairly common in the diabetic community. As you are probably guessing, it's not the healthiest approach. It is her life and telling people how to eat can be tricky business, especially siblings, but if you could suggest to her an alternative approach, you might very well be adding years to her life.

Diabetes doesn't have to be that restricting but it should involve some moderation and a certain amount of self awareness.

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Wow this describes the three Diabetics closest to me right now. I have a lot of control over my Dads diet though. He doesn't know it yet but he's about to start eating Mediterranean.

[GTO]

...my SIL is insulin dependant diabetic, and MIL is pre-diabetic, which I don't really understand, aren't we all?...

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I just thought that was brilliant!

"Can I take the car now? I'm a Pre-Lottery winner."

[Dave Hatfield]

Not one to give medical advice, but I would suggest that you look at the Montignac Method. (links available on various forums & my blog.)

I've had several diabetic friends go onto this with excellent results. It may not be the whole answer, but can certainly be a large part of the answer.

Its easy to learn, easy to follow and easy to shop & cook for.

Have a look.

[Fresser]

Dear HVR,

Welcome to the Glucophage Groupies, an informal support group and band of cyber-kvetches.

I've been diabetic since age 33 (I'm 40 now) and faced the trials of a diabetic diet. Read about it here at You'll eat it and you'll LIKE it!.

[Kayakado]

My mother was an insulin dependant diabetic for a few years. She off the medication thanks to Atkins. Focus on good carbs and stay away from starches and sugar. Up until recently, the ADA had no idea how to advise these folks to eat, so this eat what you want and adjust the medication is their fault. Atkins got a lot of bad press due to people who never read the books and decided his diets were all meat. This is our favorite recipe site, especially the almond pound cake! Also George Stella has some great recipes and cookbooks.

http://www.lowcarbluxury.com/lowcarb-recipes.html

[Soupcon]

As a nurse I can tell you that diabetic exchanges are a thing of the past. People are taught to take their blood sugar prior to eating (at least four times a day - before breakfast, lunch, dinner, and bedtime snack) and a give themselves the required dose(s) of insulin for that blood sugar level. Diabetics keep blood sugar diaries so that they become familiar with their eating patterns and their insulin requirements based on food intake and exercise (assuming they exercise which many nowadays do not). Hospitals, diabetic clinics, and endocrineologists spend hours working out the required types of insulin, doseages and timing of these doses to manage each individual well over many months. I have many new diabetics where I work and do most of the diabetic teaching for my patients and diet is a very small part of the management of diabetes today.

So prepare what you would normally for any guest as they (your guest) will manage their diabetes as they do normally at home.

[nibor]

As a nurse I can tell you that diabetic exchanges are a thing of the past. People are taught to take their blood sugar prior to eating (at least four times a day - before breakfast, lunch, dinner, and bedtime snack) and a give themselves the required dose(s) of insulin for that blood sugar level. Diabetics keep blood sugar diaries so that they become familiar with their eating patterns and their insulin requirements based on food intake and exercise (assuming they exercise which many nowadays do not). Hospitals, diabetic clinics, and endocrineologists spend hours working out the required types of insulin, doseages and timing of these doses to manage each individual well over many months. I have many new diabetics where I work and do most of the diabetic teaching for my patients and diet is a very small part of the management of diabetes today.

So prepare what you would normally for any guest as they (your guest) will manage their diabetes as they do normally at home.

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Dear Soupcon,

How well do you find this new system to be working?

[SuzySushi]

As a nurse I can tell you that diabetic exchanges are a thing of the past. People are taught to take their blood sugar prior to eating (at least four times a day - before breakfast, lunch, dinner, and bedtime snack) and a give themselves the required dose(s) of insulin for that blood sugar level. Diabetics keep blood sugar diaries so that they become familiar with their eating patterns and their insulin requirements based on food intake and exercise (assuming they exercise which many nowadays do not). Hospitals, diabetic clinics, and endocrineologists spend hours working out the required types of insulin, doseages and timing of these doses to manage each individual well over many months. I have many new diabetics where I work and do most of the diabetic teaching for my patients and diet is a very small part of the management of diabetes today.

So prepare what you would normally for any guest as they (your guest) will manage their diabetes as they do normally at home.

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True, "exchange diets" are mostly a thing of the past because they are at best estimates. They have been replaced by "carb counting," especially for those on insulin pumps.

But I am puzzled when you say diet is a very small part of diabetes management -- especially for insulin-dependent diabetes (which both my husband and our 11 year old daughter have). Yes, they test their blood sugar and give themselves insulin before each meal and snack. BUT, they are on a sliding scale that depends not only on correcting their blood sugar level, but on how many carbohydrates they expect to eat at that meal.

[Sony]

As a nurse I can tell you that diabetic exchanges are a thing of the past. People are taught to take their blood sugar prior to eating (at least four times a day - before breakfast, lunch, dinner, and bedtime snack) and a give themselves the required dose(s) of insulin for that blood sugar level. Diabetics keep blood sugar diaries so that they become familiar with their eating patterns and their insulin requirements based on food intake and exercise (assuming they exercise which many nowadays do not). Hospitals, diabetic clinics, and endocrineologists spend hours working out the required types of insulin, doseages and timing of these doses to manage each individual well over many months. I have many new diabetics where I work and do most of the diabetic teaching for my patients and diet is a very small part of the management of diabetes today.

So prepare what you would normally for any guest as they (your guest) will manage their diabetes as they do normally at home.

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Coming from what is undoubtedly a biased view (as a professional in dietetics), I think that lumping diet and drugs (insulin, hypoglycemics, supplements, etc.) into the same category and saying that one diminishes the other's importance is not quite accurate. Diet and drugs are hopefully worked out in combination for diagnosed diabetics if the condition is not simply controlled through diet and exercise alone. I've unfortunately seen/heard of too many people who were prescribed meds and take them regularly, but without any professional guidance on diet. They might then combine their regular drug regimen with a low-carb diet.....and the result can be too-frequent bouts of hypoglycemia (low blood sugar).

The systems that I have worked in and observed second-hand have not diminished the importance of diet in controlling diabetes. I'm wondering if those doses of insulin that people take before every meal (after checking blood sugar) have anything to do with the food that they intend to eat? I suppose it depends on the system you work in and the insulin regimens people under your care receive.

Diabetic exchange diets are certainly becoming less common- carbohydrate counting (actually being a given range of grams of carbohydrate to eat for meals/snacks, and recommending times to eat- ESPECIALLY when on meds) is becoming more common than the exchange system, which has problems keeping up with the variety of food products available.

For example, the exchange system may consider 1 oz. of crackers (listed generically) as an "exchange" (15 g carbohydrate). However, think about a new "honey harvest" variety that contains 15 g of carbohydrate in only 0.5 oz. This is where carbohydrate counting can pick up where there's shortcomings in the exchange system- it assumes that a person will read labels of specific products and control portions to stay within that ideal range of carbohydrates . The place where the exchange system outshines carbohydrate counting is it builds in eating a variety of foods and portion sizes. For people who are turned off by label reading and simply trying to focus on variety and portion control, the exchange system is still being recommended (at least in various parts the state of NY).

Recommendations for checking blood sugar is also something that can differ. Checking blood sugar 4 times a day sounds like a great system for motivated people who have the resources and mindframe to do so. Sadly, I know of people in some healthcare systems where they aren't given ANY guidance about how often to check blood sugar.

Since everything is so variable, it sounds like anyone really ought to find out as much as possible about what guests have received as guidance from their heathcare providers and go from there. Dawnie2u, the fact that your your MIL has had low blood sugars twice in what I'm assuming is a relatively short timeframe....it concerns me because a care plan (including meds, diet, and/or exercise in any combination) should prevent those lows. I hope that she has the support, motivation and guidance she needs (it sounds like she's getting plenty of support from you!) to manage her diabetes and live a fulfilling life.

ETA: Suzy Sushi, sorry if I repeated anything you said! I was probably finger-babbling while you were posting

Edited November 3, 2007 by Sony (log)

[Soupcon]

I was not tring to diminish the importance of diet at all. I was stating in fact what happens in hospitals these days. Over a period of time using the blood sugar history and how a particular patient reacts to specific doses of the prescribed insulin, diabetic teaching nurses - specialists in their field - in conjuntion with endocrinologists will determine the insulin needs of their patients. Over time, some patients will learn to manage their diabetes better than any endocrineologist or diabetic teaching nurse. However the vast majority of patients are given specific insulin dosages for specific times of day (depending on the type of insulin(s) presribed) based on their blood sugar diary. Patients are prescribed an 1800 cal/kilocal diabetic diet routinely but many pay no attention to calories and physicians increase insulin doses over time to compensate for the increased caloric intake of their patients. New diabetics who are overweight lose weight initially but many find that having their insulin doses increased compensates for their desire to continue to eat as before and the weight is regained. Many patients on the other hand do watch what they eat and limit their carb and protein intake accordingly.

[Sony]

I was not tring to diminish the importance of diet at all. I was stating  in fact what happens in hospitals these days. Over a period of time using the blood sugar history and how a particular patient reacts to specific doses of the prescribed insulin, diabetic teaching nurses - specialists in their field - in conjuntion with endocrinologists will determine the insulin needs of their patients. Over time, some patients will learn to manage their diabetes better than any endocrineologist or diabetic teaching nurse. However the vast majority of patients are given specific insulin dosages for specific times of day (depending on the type of insulin(s) presribed)  based on their blood sugar diary. Patients are prescribed an 1800 cal/kilocal diabetic diet routinely but many pay no  attention to calories and physicians increase insulin doses over time to compensate for the increased caloric intake of their patients. New diabetics who are overweight lose weight initially but many find that having their insulin doses increased compensates for their desire to continue to eat as before and the weight is regained.  Many patients on the other hand do watch what they eat and limit their carb and protein intake accordingly.

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I don't doubt that what you're saying is true for the healthcare system than you work in, as well as many others. However, to simply prescribe higher insulin dosages to compensate for higher-than-necessary caloric intake....it may promote insulin resistance, regardless of whether it's Type 1 or Type 2.

It just seems curious to me why the person prescribing increased insulin would not recommend further diet therapy. Maybe they do? Also wondering what kind of practical guidance your patients get for their prescribed kcal diet.....

Thanks you for clarifying what you meant. Forgive me if I'm coming off as critical or judgmental- I don't mean to. I truly just want to find out more information about how your health care system works, especially with regard to the guidance people get in converting "diets on paper" into actual food to eat. (Please feel free to PM me as well, especially if I'm asking for responses that are off-topic for this forum ).

Edit to fix my spelling...

Edited November 3, 2007 by Sony (log)