The American Diabetes Association 2009 Position Statement regarding diabetic diet planning includes the following: "Although numerous studies have attempted to identify the optimal mix of macronutrients for meal plans of people with diabetes, it is unlikely that one such combination exists. The best mix of carbohydrate, protein and fat appears to vary depending on individual circumstances.".... "regardless of the macronutrient mix, total caloric intake must be appropriate for the weight management goal."

The individual must actively manage energy intake/output to maintain good glycemic control, thereby reducing the risk of diabetes mellitus (DM) and associated disease. Intensive and ongoing diabetic self-management education (DSME) is required to alter common lifestyle behaviors and practices that increase the risk of DM and its complications. DSME provides information, tools and support to improve glycemic control within a evidence based framework that reflects: personal preferences as well as physical, social and economic circumstances.

Although DSME is intended to meet the needs of the diabetic, much of the science is also applicable to the general population. Assimilating the healthy lifestyle changes promoted by DSME can reduce the risk of pre-diabetes, cardiovascular disease and stroke for most people in the developed world. If you are interested in improving your own health and that of your family, a good source of support and assistance may be as close as your diabetic colleague or friend.

A number of rules and tools have been developed to assist the diabetic to plan meals and manage of caloric intake. They include: macronutrient recommendations, carbohydrate counting, glycemic index, exchange lists, portions models, etc. The patient's DM certified registered dietician may use some of the following rules and tools as part of the DSME to assist the patient to make healthy eating choices that best control his/her A1c.

General Adult Macronutrient Recommendations

• U.S. Department of Health and Human Services - National Diabetes Education Program
  • An integral part of a healthy, sustained weight loss program is the subtraction of calories each day from the diet. For most people, weight loss diets should supply at least 1,000 to 1,200 kcal/day for women and 1,200 to 1,600 kcal/day for men.
  • Total fat should be 25 to 35 percent of total calories and saturated fat less than 7 percent.
  • Portion control is essential for weight loss.
• American Diabetes Association
  • Daily servings: grains and starches 6-11 , vegetables 3-5, fruit 2-4, dairy 2-3, meat or substitute 4-6 oz., fats-sweets-alcohol in small portions on special occasions. Lower number of servings yields 1600 calories, higher number yields 2800 calories
  • Either low-carbohydrate or low-fat, calorie restricted diets are acceptable for the purpose of weight control
  • Fiber 14g/1000 kcal
  • Limit saturated fats to 7% total calorie
• National Diabetes Information Clearinghouse
  • Small to medium sized women (depending on physical activity and weight loss goals)
    • 1,200 to 1,600 calories/day
    • 6 starches, 3 vegetables, 2 fruits, 2 milks, 4-6 oz. meat or substitute, up to 3 fats
  • Large woman, small to large man (depending on physical activity and weight loss goals)
    • 1,600 to 2,000 calories a day
    • 8 starches, 4 vegetables, 3 fruits, 2 milks, 4-6 oz. meat or substitute, up to 4 fats
  • Medium to large man or woman who exercises a lot or has a physically active job, large man at healthy weight
    • 2,000 to 2,400 calories a day
    • 10 starches, 4 vegetables, 4 fruits, 2 milks, 5-7 oz. meat or substitute, up to 5 fat

• one fat exchange provides 5 grams fat equaling 45 calories. 6 walnuts, 5 olives, or 1 strip of bacon all provide one fat exchange.
• one bread exchange (15 grams carbohydrate, 2 grams protein, and 70 calories) is contained in 1 tortilla or 1/2 cup potatoes or 5 crackers.

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