Introduction
Food gives us energy and provides essential nutrients for good health, but eating food is also something we enjoy and look forward to. It's hard to imagine breaks at work, a trip to the movies, watching sports, and gathering together for holidays, birthdays, or picnics without our favorite foods!
When you (or a family member) is diagnosed with diabetes, you may have concerns and questions about your eating habits and whether or not you can eat your favorite foods.
Having diabetes does not mean giving them up entirely, but you may need to eat some foods less often or in smaller amounts and you may need to buy or make more healthful versions of some of the foods you enjoy.
Remember: the food that is good for you is the same food that is good for people without diabetes. You won't need to spend more time in the kitchen chopping, mixing, and preparing special meals. Your family and friends can enjoy the same healthful foods that you are eating and enjoying. Take a look through this book -- you're sure to find some family favorites.
The recipes in the cookbook are easy to prepare, and the ingredients are readily available in supermarkets or well-stocked grocery stores. Whether you love to cook or are just learning how, this book can help you manage your diabetes.
About the Recipes
The 400 recipes in this book are the best of the best from the Family Cookbook series, volumes I to IV, published by the American Diabetes Association and The American Dietetic Association. To create the most delicious and healthful dishes, the recipes chosen for this collection were revised, updated, and taste-tested to make sure they are consistent with the latest diabetes recommendations and make the best use of new food products available in the marketplace today.
The updates and changes to the recipes include the following:
- Recipes use new lower-fat ingredients whenever possible.
Most Americans eat too much fat, which can contribute to the development of diabetes, heart disease, cancer, and obesity. In this book, the ingredient chosen for a recipe is the lowest-fat product that could be used to create a dish with the best taste and texture. For example, each recipe that uses salad dressing, mayonnaise, or sour cream was tested with light, low-fat, and fat-free variations. If you want to eat foods with a minimal amount of fat, you can use fat-free products in recipes that call for the low-fat versions. The texture and taste of the dish may change but the recipe will still taste fine. Remember, however, that fat-free does not mean carbohydrate-free or calorie-free.
- Recipes use unsaturated fats whenever possible.
Monounsaturated fats (olive or canola oil) and polyunsaturated fats (sunflower and other vegetable oils) are better for your heart than saturated fats (butter or meat fats) and trans fats (many processed foods). Eating too much saturated fat, trans fats, and cholesterol can increase your risk of cardiovascular disease. To further lower the cholesterol in the recipes, use egg substitutes or egg whites instead of whole eggs.
- Most recipes use sugar instead of sugar substitutes.
Nutrition guidelines for diabetes management allow sugar as part of a healthful eating plan. Sugar has the same effect on blood glucose levels as other carbohydrate, such as rice or potatoes. But keep in mind that sugar doesn't contain the nutrients (vitamins, minerals, and fiber) that are in other carbohydrate-rich foods like rice and potatoes. That's the main reason to eat only small amounts of sugar. Foods containing sugar count as part of the total amount of carbohydrate in your eating plan. For blood glucose control, the amount of carbohydrate you eat is more important than the source of carbohydrate.
- In recipes with more than 480 milligrams of sodium, the amount of sodium is set in bold type and there is an arrow c pointing to the sodium line.
Eating too much sodium may contribute to high blood pressure in sodium-sensitive individuals. Table salt is the most common form of sodium in our diets. However, many foods contain sodium. Sometimes you can taste it, as in pickles and bacon. Other times you cannot. There is "hidden" sodium in many foods, such as cheese, salad dressing, tomato sauce, and canned foods. If you need to reduce the amount of sodium you eat, omit the salt from a recipe and/or use low-sodium versions of canned foods, such as vegetables, broths, and sauces. To boost the flavor of the dish, experiment with herbs or spices. Not everyone should use salt substitutes. Check with your doctor or dietitian before using them.
- Recipes provide a choice of fresh or dried herbs.
You may like the flavor of garden-fresh herbs that you buy at the supermarket or grow at home. Or you may like the convenience of dried herbs. Whichever you prefer, the amounts for both forms are listed in the recipes.
- Each recipe has a nutrient analysis and the latest diabetes choice information.
The recipe nutrient and food choice information is for 1 serving. Measure your serving size the first time you make a recipe. Portion size is an important factor in controlling your weight and blood glucose level. As time goes on, you'll develop an ability to estimate portion size visually without measuring and weighing.
Nutrient Analysis
Each recipe includes a complete nutrient analysis with the same nutrient information you find on the Nutrition Facts label on food packages. When a recipe lists a choice of ingredients, the first choice was used for the nutrient analysis. The analysis does not include optional ingredients and garnishes.
"Count as" information
Each recipe provides the most up-to-date information for people who use an individualized meal plan based on the Food Choice method (formerly called exchanges -- see Appendix). In this meal plan method, food lists are grouped together because they are alike. Each serving of a food has about the same amount of carbohydrate, protein, fat, and calories as the other foods on that list.
If you use the "count as" information in the recipes, it will be helpful for you to know the following:
- Only whole or half choices are listed, not smaller fractions such as quarters.
- Foods from the carbohydrate group (starch, fruit, milk, sweets, dessert, and carbohydrates) may be interchanged. Each food group contains about 15 grams of carbohydrate.
- If a recipe is a "free food," it has no more than 20 calories and no more than 5 grams of carbohydrate per serving.
- If beans, peas, or lentils are the main ingredients in a recipe, the "count as" information may include both starch and lean meat to help plan vegetarian meals. If the recipe contains beans, peas, or lentils as one of the many ingredients, they are included as a starch only.
What Is Diabetes?
Your body produces glucose from the foods you eat and uses this glucose as fuel. Glucose travels around your body in the bloodstream, but it has to get into your cells before you can use it. Insulin, a hormone made by the pancreas, is the key that opens the door and lets glucose into the cells. People who have diabetes either do not make enough insulin or cannot use the insulin that they make. Therefore, the glucose cannot get into their cells, so their blood glucose levels increase. Untreated diabetes causes great thirst, frequent urination, blurred vision, weakness, sudden weight loss, fatigue, and irritability.
If your diabetes is not discovered or is not managed properly, the high blood glucose levels damage body tissues and blood vessels over time. This is why people with diabetes are more likely to have heart and blood vessel disease, and kidney, eye, and nerve damage. If you keep your blood glucose levels close to normal, you can avoid many of these complications. Therefore, it is important for you to learn how food, activity, and medications affect your blood glucose level and what you can do to manage it.
Presently, over 20 million people in the United States have diabetes, but more than 6 million of them don't know it. About 1.5 million people a year are diagnosed with diabetes. You are more likely to develop diabetes if you are overweight, inactive, 45 years of age or older, or have a relative with diabetes. Also, people of African-American, Hispanic-American, Native-American, Asian-American, and Pacific Island backgrounds are especially at risk. Women who have had a baby that weighed more than 9 pounds also have a higher risk of developing diabetes later in life.
People with type 1 diabetes do not produce any insulin, and need insulin injections. If you have type 1 diabetes, you need to coordinate your insulin with what you eat, when you eat, and your physical activity. Your insulin injections and meals are planned so that the insulin is available when you need to get glucose from your bloodstream into your cells. This helps you keep your blood glucose levels close to normal and prevent the damage that results from high blood glucose levels.
People with type 2 diabetes may make some insulin but cannot use it properly. Many people with type 2 diabetes can keep their blood glucose levels close to normal by eating healthful food choices and getting daily exercise. Some people with type 2 diabetes need to take medication to help their bodies use more of the insulin they make.
Others take another kind of medication that slows carbohydrate absorption so that glucose does not surge into their blood after a meal. And some people with type 2 diabetes need insulin injections to keep their blood glucose levels near normal.
Managing Diabetes
So far there is no cure for diabetes. But you can manage your diabetes so you prevent long-term complications and feel well day-to-day. The management of diabetes involves three things:
Generally speaking, food raises your blood glucose level; exercise and medication lower it. You need to balance these three to keep your blood glucose level close to normal.
Food
You can make a difference in your blood glucose control through your food choices. You do not need special foods. In fact, the foods that are good for you are good for everyone. However, it's usually best to eat about the same amount of food -- especially carbohydrates -- at the same time each day. Regardless of the level of your blood glucose, avoid skipping meals or snacks, as this may lead to large swings in blood glucose levels.
Your dietitian will take into consideration your age, lifestyle, activity level, food preferences, and health goals to determine your calorie, carbohydrate, protein, and fat needs. Your dietitian can then translate your nutrient needs into a meal plan to get the right balance among your food, medication, and exercise. Also, your dietitian can help you prepare for times when you are sick or for emergencies when you can't eat healthful foods, or can't eat them at the right time. It's always a good idea to visit your dietitian any time your schedule changes or when you have a life change, such as going off to college, starting a new job, having a baby, or retiring, or whenever your meal plan isn't working for you.
Remember, the more information you provide about what you eat and what you are willing to change, the better your dietitian can tailor your meal plan, and the more likely you are to follow it.
Exercise
Your body uses insulin more efficiently when you exercise, whether or not you have diabetes. That's why people with type 2 diabetes can sometimes manage their blood glucose levels with just food and exercise. Also, if you take insulin or diabetes pills, you may need a lower dose if you start to exercise regularly. Exercise also makes your heart healthier. This is important because people with diabetes are more likely to get heart disease.
You don't have to jog or take an aerobics class every day. Start slowly and do whatever type of exercise you enjoy, such as walking, dancing, or swimming. You could start by walking for 5 minutes each day and work up to 30 minutes a day by making your walk 5 minutes longer each week. The important thing is to do something each day, for a total of 30 minutes of activity. Your body works best when you use it.
Medication
Your diabetes care team, which includes your doctor and dietitian, will decide whether you need insulin and/or other diabetes medication. If you need either one, they will teach you how and when to take them and how to balance the medication with your food and exercise.
Your diabetes care team will show you how to test your blood glucose level and schedule tests for your A1C (a test that estimates glucose levels over a 3-month period). They will also help you learn to adjust your food, exercise, and medication to keep your blood glucose level close to normal throughout the day.
Meal Planning
An individualized meal plan is one of the most important tools for managing your diabetes. Your meal plan will serve as a guide to help you know what to eat, when to eat, and how much to eat at each meal or snack.
There are several meal-planning approaches your dietitian may recommend. The most common "tools" are based on food choice lists or counting grams of carbohydrate. These help you eat similar amounts of carbohydrate, fat, protein, and/or calories at the same times each day. Your meal plan will also help you learn about foods and how their nutrient content affects your blood glucose and lipid levels. A registered dietitian can help decide which tool will work best for you.
Food choices
Good health depends on eating a variety of foods that contain the right amounts of nutrients. For teenagers and adults, a healthy daily meal plan includes at least
- 2 to 3 servings of nonstarchy vegetables
- 2 servings of fruit
- 6 servings of grains, beans, and starchy vegetables
- 2 servings of low-fat or fat-free milk
- about 6 ounces of meat or meat substitutes
- small amounts of fat and sugar
The actual amounts of each depend on the number of calories you need, which in turn depend on your sex, size, age, and activity level.
The American Diabetes Association and the American Dietetic Association have worked together since 1950 to help people with diabetes choose the right amounts of all types of food and develop meal plans for good health. To do this, food choices are placed into lists of similar foods. The lists divide foods into three main groups: Carbohydrate, Meats and Meat Substitutes, and Fat. Every food on a list contains about the same amount of carbohydrate, protein, and fat in the serving size listed. Depending on your daily nutrient needs, you can replace one food on a list for another food on the same list. The most recent lists have many choices to make your meal plan flexeble and enjoyable.
The Carbohydrate group has five lists: starch, fruit, milk, sweets, desserts and other carbohydrates, and nonstarchy vegetables. In this group, foods from all but the nonstarchy vegetables contain 60 to 90 calories and 12 to 15 grams of carbohydrate in one serving. Therefore, these foods can be substituted for one another occasionally. For example, if you are at a restaurant and fruit is not available, you can choose an extra serving of bread instead. If you use a lot of foods from the sweets, desserts, and other carbohydrate lists in your meal plan, you may not get all of the nutrients you need. You can, however, enjoy an occasional serving of these foods to replace a starch fruit of milk on your meal plan and still keep your diabetes under good control.
The foods in the nonstarchy vegetable list contain 25 calories and 5 grams of carbohydrate per serving.
The Meats and Meat Substitutes group has four lists of meats and other protein foods: lean, medium-fat, and high-fat meats, and plant-based protein. One serving of each of these foods contains 7 grams of protein. Only the plant-based proteins have carbohydrate. The fat content varies from 0 to 3 grams for lean meats and plant-based proteins to 8 grams for high-fat meats and plant-based proteins.
Foods in the Fats group are divided into three types: monounsaturated, polyunsaturated, and saturated. Monounsaturated and polyunsaturated fats are more heart-healthy than saturated fats, but all three types contain 5 grams of fat, no carbohydrate, and 45 calories per serving.
There is also a list of Free Foods. One serving of these foods does not provide enough calories or carbohydrate to be counted in your meal plan. As with all foods in any of the food choice lists, it's important to check the serving size. Additional lists include Combination Foods and Fast Foods. These foods include popular dishes and meals that don't fall into a single choice category.
Carbohydrate Counting
Carbohydrate counting is a sophisticated meal-planning approach that can offer a lot of flexibility. This approach is based on the main influencer of blood glucose -- grams of carbohydrate in foods. Your dietitian will develop a meal plan that indicates the amount of carbohydrate to be eaten at meals and snacks. If you know how much carbohydrate you are eating, you have a good idea of what your blood glucose level will be.
Carbohydrate is found in starches and sugars. Foods that contain carbohydrate include:
- breads, crackers, and cereals
- pasta, rice, and grains
- vegetables
- milk and yogurt
- fruit and juice
- sugar, honey, syrup, and molasses
All sugars are carbohydrate. Sugars are added to foods such as baked goods and frozen desserts and are present naturally in foods such as milk and fruit. If you look at the Nutrition Facts labels on some unsweetened foods, such as unsweetened yogurt, you will see sugars listed because of the natural sugar (lactose) in the milk. The Nutrition Facts label gives one value for the total amount of natural and added sugar in a food. However, keep in mind that all carbohydrate turns into blood glucose sooner or later. The kinds or sources of carbohydrate are less important than the total amount of carbohydrate.
If you use carbohydrate counting as a meal-planning approach, you and your dietitian will decide on a "target" amount of carbohydrate that you should eat at each meal and snack. The amount of carbohydrate will be balanced with your physical activity and medication to keep your blood glucose level close to normal.
When your meal plan is based on carbohydrate counting, it is important that you eat the same amount of carbohydrate at the same time each day. You don't have to eat the same foods, just foods with the same amount of carbohydrate. You can use Nutrition Facts labels, exchange lists, nutrient value tables, or pocket counters to help determine how many grams of carbohydrate various foods contain. Also, the recipes in this cookbook provide the amount of carbohydrate per serving. This is extremely helpful if you are using carbohydrate counting as your meal-planning approach.
Other meal planning options
There are additional meal planning options other than the food choices lists or counting carbohydrate. An option popular in the past, though used less often now, is the food pyramid. This approach groups foods into a pyramid, with more healthful foods (such as whole-grains, fruits, and vegetables) forming the foundation and foods that need to be eaten in moderation (fats and sweets) at the top. This graphic tool visually reinforced what foods needed to be eaten most and which should be avoided (visit www.mypyramid.gov for more information on this method). Calorie counting and fat gram counting are also popular options, though they are more often used specifically for weight loss than diabetes meal planning. Discuss different meal planning options with your RD. Working together, the two of you should be able to develop a program that works for your lifestyle.
Serving Sizes
Whichever meal-planning tool you use, it's vital that you learn about serving sizes. You may be working very hard at eating the right foods at the right time, but if you eat too much or too little, your blood glucose level will be too high or too low.
How do you know if your serving is the right size? Start by measuring your food with measuring cups, measuring spoons, or a food scale. Don't trust your eyes to estimate a serving size until you've had some practice. For at least a week, measure and weigh everything you eat. You will know whether your meal plan is working by measuring your blood glucose level 1 to 2 hours after you eat. Judging by the results, you and your dietitian can make the necessary changes to your meal plan.
Even when you have been following your meal plan for a long time, it's a good idea to measure your servings occasionally to make sure your estimates are correct. You may be able to use mental pictures or visual cues to help you eat the right serving sizes. For example, you may know that 1 cup of milk fills your glass to a certain point or that a 3-ounce serving of meat is about the same size as a deck of cards.
Reading Food Labels
It is easy to buy healthful bread, plain rice and pasta, fruits, and vegetables. But with other foods it can be hard to know which are most healthful and which will fit best into your meal plan. The Nutrition Facts label found on food packages can help you decide which foods to buy and how they will fit into your meal plan.
The first thing you should check on the Nutrition Facts label is the serving size. Make sure that this is the amount you usually eat. If you eat twice as much, you will get double the calories and other nutrients shown on the Nutrition Facts label. If you use exchange lists, remember that the serving size on the food label may be different from that in the food choices lists. For example, the serving size for orange juice is 8 fluid ounces on a Nutrition Facts label and 4 fluid ounces (1/2 cup) in the food choices lists. So an 8-fluid-ounce juice box would be listed on the label as 1 serving, but you would need to count it as 2 fruit choices. The label also tells you the number of servings per container, which can help you serve the appropriate amount.
The next section tells you about the calories, fat, cholesterol, sodium, carbohydrate, and protein in 1 serving of the food. The total number of calories in a serving and the number of calories that come from fat are listed first. For fat, saturated fat, cholesterol, sodium, total carbohydrate, and dietary fiber the actual amount (grams or milligrams) and the Percent Daily Values are listed. If your meal plan is based on counting grams of carbohydrate, grams of fat, or calories, you will find this information very helpful.
The Percent Daily Values shows how much of your daily allowance for that nutrient 1 serving of the food provides, based on someone eating 2,000 calories per day. If you eat fewer than 2,000 calories per day, the food would provide a greater percentage of your daily allowance for each nutrient; if you eat more than 2,000 calories per day, the food would provide a smaller percentage of your daily allowance. Your dietitian can help you figure out your own daily values in grams and percentages for your calorie level. The Percent Daily Values helps you see how the food can fit into a healthful eating plan. If you eat a food that provides a large percentage of the Percent Daily Values for fat, try to balance it with foods that provide a lower percentage of the Percent Daily Values at the same meal or later in the day.
For vitamin A, vitamin C, calcium, and iron, the Nutrition Facts panel lists only the Percent Daily Values. These percentages can help you find foods that are good sources of each of these nutrients.
The Nutrition Facts label also has an ingredient list. The ingredient list details exactly what is present in a product. Ingredients are listed in order of weight, with the largest amount listed first and the smallest amount listed last. For example, if the first ingredient in a breakfast cereal is sugar and the second ingredient is the grain, the cereal is probably high in sugar.
Using the food label should be part of your strategy for healthful eating. Your dietitian can help you practice using food labels to make the best decisions about what to buy.
Bon AppÉtit!
You may feel that you have to think very hard about what you eat. But with time, you will find it easier to make healthful food choices. This cookbook is a tool you and your family can use to make it easier to prepare and eat foods that help you manage your diabetes, and your overall health. Set the table, relax, and enjoy your meal.
In Addition
To obtain a referral to an RD in your area, visit The American Dietetic Association's Web site at www.eatright.org.
For general information about diabetes, call the American Diabetes Association at 800-DIABETES (800-342-2383). A free packet of information about diabetes is available upon request. Also, if you are interested in ordering other American Diabetes Association books, or would like to receive a free catalog of books, call 800-232-6733. Visit the American Diabetes Association's Web store at store.diabetes.org.
Copyright © 1999, 2007 by The American Diabetes Association and The American Dietetic Association
From the Introduction
Food gives us energy and provides essential nutrients for good health, but eating food is also something we enjoy and look forward to. It's hard to imagine breaks at work, a trip to the movies, watching sports, and gathering together for holidays, birthdays, or picnics without our favorite foods!
When you (or a family member) is diagnosed with diabetes, you may have concerns and questions about your eating habits and whether or not you can eat your favorite foods.
Having diabetes does not mean giving them up entirely, but you may need to eat some foods less often or in smaller amounts and you may need to buy or make more healthful versions of some of the foods you enjoy.
Remember: the food that is good for you is the same food that is good for people without diabetes. You won't need to spend more time in the kitchen chopping, mixing, and preparing special meals. Your family and friends can enjoy the same healthful foods that you are eating and enjoying. Take a look through this book -- you're sure to find some family favorites.
The recipes in the cookbook are easy to prepare, and the ingredients are readily available in supermarkets or well-stocked grocery stores. Whether you love to cook or are just learning how, this book can help you manage your diabetes.
ABOUT THE RECIPES
The 400 recipes in this book are the best of the best from the Family Cookbook series, volumes I to IV, published by the American Diabetes Association and The American Dietetic Association. To create the most delicious and healthful dishes, the recipes chosen for this collection were revised, updated, and taste-tested to make sure they are consistent with the latest diabetes recommendations and make the best use of new food products available in the marketplace today.
The updates and changes to the recipes include the following:
* Recipes use new lower-fat ingredients whenever possible.
Most Americans eat too much fat, which can contribute to the development of diabetes, heart disease, cancer, and obesity. In this book, the ingredient chosen for a recipe is the lowest-fat product that could be used to create a dish with the best taste and texture. For example, each recipe that uses salad dressing, mayonnaise, or sour cream was tested with light, low-fat, and fat-free variations. If you want to eat foods with a minimal amount of fat, you can use fat-free products in recipes that call for the low-fat versions. The texture and taste of the dish may change but the recipe will still taste fine. Remember, however, that fat-free does not mean carbohydrate-free or calorie-free.
* Recipes use unsaturated fats whenever possible.
Monounsaturated fats (olive or canola oil) and polyunsaturated fats (sunflower and other vegetable oils) are better for your heart than saturated fats (butter or meat fats). Eating too much saturated fat, as well as cholesterol, can increase your risk of cardiovascular disease. To further lower the cholesterol in the recipes, use egg substitutes or egg whites instead of whole eggs.
* Most recipes use sugar instead of sugar substitutes.
Recent nutrition guidelines for diabetes management allow sugar as part of a healthful eating plan. Sugar has the same effect on blood glucose levels as other carbohydrates, such as rice or potatoes. But keep in mind that sugar doesn't contain the nutrients (vitamins, minerals, and fiber) that are in other carbohydrate-rich foods like rice and potatoes. That's the main reason to eat only small amounts of sugar. Foods containing sugar count as part of the total amount of carbohydrate in your eating plan. For blood glucose control, the amount of carbohydrate you eat is more important than the source of carbohydrate.
* In recipes with more than 400 mg of sodium, the amount of sodium is set in bold type and there is an arrow > pointing to the sodium line.
Eating too much sodium may contribute to high blood pressure in sodium-sensitive individuals. Table salt is the most common form of sodium in our diets. However, many foods contain sodium. Sometimes you can taste it, as in pickles and bacon. Other times you cannot. There is "hidden" sodium in many foods, such as cheese, salad dressing, tomato sauce, and canned foods. If you need to reduce the amount of sodium you eat, omit the salt from a recipe and/or use low-sodium versions of canned foods, such as vegetables, broths, and sauces. To boost the flavor of the dish, experiment with herbs or spices. Not everyone should use salt substitutes. Check with your doctor or dietitian before using them.
* Recipes provide a choice of fresh or dried herbs.
You may like the flavor of garden-fresh herbs that you buy at the supermarket or grow at home. Or you may like the convenience of dried herbs. Whichever you prefer, the amounts for both forms are listed in the recipes.
* Each recipe has a new nutrient analysis and the latest diabetes exchange information.
The recipe nutrient and exchange information is for one serving. Measure your serving size the first time you make a recipe. Portion size is an important factor in controlling your weight and blood glucose level. As time goes on, you'll develop an ability to estimate portion size visually without measuring and weighing.
NUTRIENT ANALYSIS
Each recipe includes a complete nutrient analysis with the same nutrient information you find on the Nutrition Facts label on food packages. When a recipe lists a choice of ingredients, the first choice was used for the nutrient analysis. The analysis does not include optional ingredients and garnishes.
EXCHANGE INFORMATION
Each recipe provides the most up-to-date exchange information for people who use an individualized meal plan based on exchanges. (The exchange lists are in the Appendix.) Exchange lists are foods listed together because they are alike. Each serving of a food has about the same amount of carbohydrate, protein, fat, and calories as the other foods on that list.
If you use the exchange information in the recipes, it will be helpful for you to know the following:
* Only whole or half exchanges are listed, not smaller fractions such as quarters.
* Foods from the carbohydrate group (starch, fruit, milk, and other carbohydrate exchanges) may be interchanged. Each exchange group contains about 15 grams of carbohydrate.
* If a recipe is a "free food," it has no more than 20 calories and no more than 5 grams of carbohydrate per serving.
* If you eat 1 or 2 exchange servings of vegetables at a meal, you do not need to count them as part of your meal plan. However, if you eat 3 or more servings of vegetables at a meal, you will need to count the exchanges.
* If beans, peas, or lentils are the main ingredient in a recipe, the exchange information may include starch and very lean meat to help plan vegetarian meals. If the recipe contains beans, peas, or lentils as one of the many ingredients, they are included as a starch only.
* If more than half of the fat in a recipe is one type of fat, the exchange listing provides the specific type of fat (monounsaturated fat, polyunsaturated fat, or saturated fat). This does not affect the amount of total fat or calories, but it can help you identify the predominant type of fat used in the recipe.
WHAT IS DIABETES?
Your body produces glucose from the foods you eat and uses this glucose as fuel. Glucose travels around your body in the bloodstream, but it has to get into your cells before you can use it. Insulin, a hormone made by the pancreas, is the key that opens the door and lets glucose into the cells. People who have diabetes either do not make enough insulin or cannot use the insulin that they make. Therefore, the glucose cannot get into their cells, so their blood glucose levels increase. Untreated diabetes causes great thirst, frequent urination, blurred vision, weakness, sudden weight loss, fatigue, and irritability.
If your diabetes is not discovered or is not managed properly, the high blood glucose levels damage body tissues and blood vessels over time. This is why people with diabetes are more likely to have heart and blood vessel disease, and kidney, eye, and nerve damage. If you keep your blood glucose levels close to normal, you can avoid many of these complications. Therefore, it is important for you to learn how food, activity, and medications affect your blood glucose level and what you can do to manage it.
Presently, about 16 million people in the United States have diabetes, but more than 5 million of them don't know it. About 625,000 people a year are diagnosed with diabetes. You are more likely to develop diabetes if you are overweight, inactive, 45 years of age or older, or have a relative with diabetes. Also, people of African-American, Hispanic-American, Native-American, Asian-American, and Pacific Island backgrounds are especially at risk. Women who have had a baby that weighed more than 9 pounds also have a higher risk of developing diabetes later in life.
People with type 1 diabetes do not produce any insulin, and need insulin injections. If you have type 1 diabetes, you need to coordinate your insulin with what you eat, when you eat, and your physical activity. Your insulin injections and meals are planned so that the insulin is available when you need to get glucose from your bloodstream into your cells. This helps you keep your blood glucose levels close to normal and prevent the damage that results from high blood glucose levels.
People with type 2 diabetes may make some insulin but cannot use it properly. Many people with type 2 diabetes can keep their blood glucose levels close to normal by eating healthful food choices and getting daily exercise. Some people with type 2 diabetes need to take pills to help their bodies use more of the insulin they make. Others take another kind of pill that slows carbohydrate absorption so that glucose does not surge into their blood after a meal. And some people with type 2 diabetes need insulin injections to keep their blood glucose levels near normal.
MANAGING DIABETES
So far there is no cure for diabetes. But you can manage your diabetes so you prevent long-term complications and feel well day-to-day. The management of diabetes involves three things:
* food
* exercise
* medication
Generally speaking, food raises your blood glucose level; exercise and medication lower it. You need to balance these three to keep your blood glucose level close to normal.
FOOD
You can make a difference in your blood glucose control through your food choices. You do not need special foods. In fact, the foods that are good for you are good for everyone. However, it's important to eat about the same amount of food at the same time each day. Regardless of the level of your blood glucose, avoid skipping meals or snacks, as this may lead to large swings in blood glucose levels.
Your dietitian will take into consideration your age, life-style, activity level, food preferences, and health goals to determine your calorie, carbohydrate, protein, and fat needs. Your dietitian can then translate your nutrient needs into a meal plan to get the right balance among your food, medication, and exercise. Also, your dietitian can help you prepare for times when you are sick or for emergencies when you can't eat healthful foods, or can't eat them at the right time. It's always a good idea to visit your dietitian any time your schedule changes or when you have a life change, such as going off to college, starting a new job, having a baby, or retiring, or whenever your meal plan isn't working for you.
Remember, the more information you provide about what you eat and what you are willing to change, the better your dietitian can tailor your meal plan, and the more likely you are to follow it.
EXERCISE
Your body uses insulin more efficiently when you exercise, whether or not you have diabetes. That's why people with type 2 diabetes can sometimes manage their blood glucose levels with just food and exercise. Also, if you take insulin or diabetes pills, you may need a lower dose if you start to exercise regularly. Exercise also makes your heart healthier. This is important because people with diabetes are more likely to get heart disease.
You don't have to jog or take an aerobics class every day. Start slowly and do whatever type of exercise you enjoy, such as walking, dancing, or swimming. You could start by walking for 5 minutes each day and work up to 30 minutes a day by making your walk 5 minutes longer each week. The important thing is to do something each day, for a total of 30 minutes of activity. Your body works best when you use it.
MEDICATION
Your diabetes care team, which includes your doctor and dietitian, will decide whether you need insulin and/or diabetes pills. If you need either one, they will teach you how and when to take them and how to balance the medication with your food and exercise.
Your diabetes care team will show you how to test your blood glucose level. They will also help you learn to adjust your food, exercise, and medication to keep your blood glucose level close to normal throughout the day.
MEAL PLANNING
An individualized meal plan is one of the most important tools for managing your diabetes. Your meal plan will serve as a guide to help you know what to eat, when to eat, and how much to eat at each meal or snack.
There are several meal-planning approaches your dietitian may recommend. The most common "tools" are based on: the Diabetes Food Guide Pyramid, exchange lists, and counting grams of carbohydrate. These help you eat similar amounts of carbohydrate, fat, protein, and/or calories at the same times each day. Your meal plan will also help you learn about foods and how their nutrient content affects your blood glucose and lipid levels. A registered dietitian can help decide which tool will work best for you.
THE DIABETES FOOD GUIDE PYRAMID
The Diabetes Food Guide Pyramid, which is based on the Dietary Guidelines for Americans as well as the Food Guide Pyramid, tells you about the food groups and how many servings to eat from each food group each day. Even if you don't remember the exact number of servings from each group, the size of the pyramid blocks used to represent each group reminds you how much to eat from that food group.
The bottom level shows the foods you should eat most of every day -- grains, beans, and starchy vegetables (6 or more servings). The next level up shows that you should choose plenty of vegetables (3 to 5 servings) and fruits (2 to 4 servings). Be sure to measure your fruit serving sizes. If you eat large servings of fruit, you may eat too much carbohydrate and your blood glucose level may increase too much. Eating foods from these three groups, which are at the base of the pyramid, is the foundation of a healthful meal plan.
Moving up the pyramid, milk and yogurt (2 to 3 servings) and meat and others (2 to 3 servings) are represented by smaller blocks. These foods are important for good health too, but in moderate amounts. Choose low-fat or fat-free milk and yogurt for calcium and other vitamins and minerals without too much fat. Choose lean meats, poultry without the skin, seafood, and dry beans and peas for iron and other vitamins and minerals without too much saturated fat and cholesterol.
The Diabetes Food Guide Pyramid
At the very top of the pyramid, fats, sweets, and alcohol are represented by a small triangle. This group includes oil, butter, margarine, salad dressing, mayonnaise, doughnuts, cookies, cakes, chips, and alcoholic beverages. Your dietitian can show you how to use the new low-fat or fat-free alternatives to many of these foods.
Don't try to follow all the guidelines at once. Make one change at a time, such as eating more vegetables or drinking fat-free milk. When this change becomes part of your eating habits, make another change. After a while your new, more healthful eating habits will improve your blood glucose control, cholesterol level, weight, and overall health. The good news is that The Diabetes Food Guide Pyramid illustrates a healthful eating plan for everyone, so your family and friends can follow it too.
EXCHANGE LISTS
The exchange lists meal-planning approach has been used since 1950 and has been updated several times. The most recent exchange lists have many more choices on the food lists to make your meal plan more flexible. The exchange lists divide foods into three main groups: Carbohydrate, Meat and Meat Substitutes, and Fat. Every food on a list contains about the same amount of carbohydrate, protein, and fat in the serving size listed. So you can substitute or "exchange" one food on a list for another food on the same list. (See page 480 for the exchange lists.)
The Carbohydrate Group has five lists: starch, fruit, milk, other carbohydrates, and vegetables. Foods from the starch list, fruit list, milk list, and other carbohydrates list all contain 60 to 90 calories and 12 to 15 grams of carbohydrate in one serving, whereas the vegetable list contains 25 calories and 5 grams of carbohydrate. Therefore, these foods can be exchanged for one another occasionally. For example, if you are at a restaurant and fruit is not available, you may choose an extra serving of bread instead. The other carbohydrates list includes desserts and snack foods. If you use a lot of these foods in your meal plan, you may not get all the nutrients you need. But you can enjoy an occasional serving of these foods to replace a starch, fruit, or milk in your meal plan and still keep your diabetes under good control.
The Meat and Meat Substitutes group has four lists of meats and other protein foods: very lean, lean, medium-fat, and high-fat meats. One serving of each of these foods contains 7 grams of protein and no carbohydrate. The fat content varies from 0 to 1 gram for very lean meat and meat substitutes to 8 grams for high-fat meat and meat substitutes.
Foods in the Fat group are divided into three types: monounsaturated, polyunsaturated, and saturated. Monounsaturated and polyunsaturated fats are more heart-healthy than saturated fats, but all three types contain 5 grams of fat, no carbohydrate, and 45 calories per serving.
The exchanges also include a list of Free Foods -- one serving of these foods does not provide enough calories or carbohydrate to be counted in your meal plan. However, as with all foods within an exchange list, it's important to check the serving size.
Some Nutrition Facts labels on food packages (see page 20), such as breakfast cereals and frozen entrees, provide exchange information as well as nutrient information.
You and your dietitian can design a meal plan that lists how many exchanges you should have from each list at each meal or snack. You can choose which foods on the lists to eat and check the appropriate serving size. For many people with diabetes, this is a preferred mealplanning approach. Like the Diabetes Food Guide Pyramid, a meal plan based on exchanges can help you to control your blood glucose, cholesterol level, and weight, and to eat a healthful diet. All the recipes in this cookbook provide exchange information.
CARBOHYDRATE COUNTING
Carbohydrate counting is a sophisticated meal-planning approach that can offer a lot of flexibility. This approach is based on the main influencer of blood glucose -- grams of carbohydrate in foods. Your dietitian will develop a meal plan that indicates the amount of carbohydrate to be eaten at meals and snacks. If you know how much carbohydrate you are eating, you have a good idea of what your blood glucose level will be.
Carbohydrates are found in starches and sugars. Foods that contain carbohydrate include:
* breads, crackers, and cereals
* pasta, rice, and grains
* vegetables
* milk and yogurt
* fruit and juice
* sugar, honey, syrup, and molasses
All sugars are carbohydrates. Sugars are added to foods such as baked goods and frozen desserts and are present naturally in foods such as milk and fruit. If you look at the Nutrition Facts labels on some unsweetened foods, such as unsweetened yogurt, you will see sugars listed because of the natural sugar (lactose) from the milk. The Nutrition Facts label gives one value for the total amount of natural and added sugar in a food. However, keep in mind that all carbohydrate turns into blood glucose sooner or later. The kinds or sources of carbohydrate are less important than the total amount of carbohydrate.
If you use carbohydrate counting as a meal-planning approach, you and your dietitian will decide on a "target" amount of carbohydrate that you should eat at each meal and snack. The amount of carbohydrate will be balanced with your physical activity and medication to keep your blood glucose level close to normal.
When your meal plan is based on carbohydrate counting, it is important that you eat the same amount of carbohydrate at the same time each day. You don't have to eat the same foods, just foods with the same amount of carbohydrate. You can use Nutrition Facts labels, exchange lists, nutrient value tables, or pocket counters to help determine how many grams of carbohydrate various foods contain. Also, the recipes in this cookbook provide the amount of carbohydrate per serving. This is extremely helpful if you are using carbohydrate counting as your meal-planning approach.
Copyright © 1999 by the American Diabetes Association and The American Dietetic Association
From Chapter 1: Breakfast and Brunch: Egg Dishes, Pancakes, Waffles, and French Toast
NORTHWEST BERRY PUFF
A delicious breakfast treat your whole family will enjoy! This fun pancake puffs way over the top of the pan and is garnished with heaps of berries and a dusting of powdered sugar. Beautiful to look at and scrumptious to eat.
1 pancake (6 servings)
2 large whole eggs
1 large egg white
1/2 cup fat-free milk
1/2 cup all-purpose flour
1 tablespoon granulated sugar
1/8 teaspoon salt
2 cups fresh raspberries, blackberries, boysenberries, blueberries, strawberries, or a combination
1 tablespoon powdered sugar
1. Heat the oven to 450°F. Prepare a 10-inch ovenproof skillet or glass pie pan with nonstick pan spray.
2. Beat the eggs and egg white in a medium bowl. Whisk in the milk. Slowly whisk in the flour, sugar, and salt. Pour into the prepared skillet and bake 15 minutes. Reduce the heat to 350°F and bake 10 minutes more, or until the batter is puffed and brown. Remove from the oven and slide the puff onto a serving plate.
3. Cover with fruit (if strawberries are used, slice large berries in bitesize pieces); sift powdered sugar over the pancake. Cut the puff into 6 equal wedges.
Nutrition Facts per Serving
Serving size: 1 slice
Amount per serving:
Calories 110
Calories from fat 18
Total fat 2 gm
Saturated fat 1 gm
Cholesterol 71 mg
Sodium 89 mg
Total carbohydrate 18 gm
Dietary fiber 2 gm
Sugars 7 gm
Protein 5 gm
Exchange List Approximations
Starch 1
Fruit 1/2
Copyright © 1999 by the American Diabetes Association and The American Dietetic Association
From Chapter 3: Appetizers, Dips, and Spreads
SPICY ARTICHOKE DIP
Canned artichokes are a useful pantry item, easy to add to an antipasto platter or to transform into marinated salad with chunked white mushrooms and a sharp vinaigrette. Here the artichokes are made into a tangy dip which can accompany crudites, crackers, or Italian Pita Crisps.
1 cup (8 servings)
One 14-ounce can artichoke hearts, drained
One 4-ounce can chopped green chiles, drained
2 tablespoons light mayonnaise
1 tablespoon fresh lemon juice
1 teaspoon olive oil
1/4 teaspoon hot pepper sauce
1. Combine all the ingredients in a food processor or blender. Blend until almost smooth.
2. Heat the mixture in a medium saucepan for 5 minutes over low heat, or until hot, or bake in a small casserole at 350°F for 15 minutes. Serve warm.
Nutrition Facts per Serving
Serving size: 2 tablespoons
Amount per serving:
Calories 30
Calories from fat 17
Total fat 2 gm
Saturated fat 0 gm
Cholesterol 2 mg
Sodium 178 mg
Total carbohydrate 3 gm
Dietary fiber 1 gm
Sugars 1 gm
Protein 1 gm
Exchange List Approximation
Vegetable 1
Copyright © 1999 by the American Diabetes Association and The American Dietetic Association
From Chapter 5: Salads and Salad Dressings
BLUE CHEESE DRESSING
Use this calcium-rich dressing over mixed greens or spinach leaves, or as a creamy contrast to chunked chicken and apple salad. A moderately priced blue cheese will provide excellent flavor.
1 1/4 cups (10 servings)
3/4 cup low-fat cottage cheese
1/3 cup low-fat (1 percent fat) buttermilk, or water
2 tablespoons fresh lemon juice
1 tablespoon chopped onion
2 ounces blue cheese, crumbled
1/4 teaspoon salt
1/8 teaspoon freshly ground pepper
1. Put the cottage cheese, buttermilk or water, lemon juice, and onion in a blender or food processor. Blend until smooth and creamy.
2. Add the blue cheese, salt, and pepper; blend a few seconds to combine the ingredients but leave some cheese chunks. Cover and chill. The dressing will keep about 5 days. Shake or stir before serving.
Nutrition Facts per Serving
Serving size: 2 tablespoons
Amount per serving:
Calories 36
Calories from fat 17
Total fat 2 gm
Saturated fat 1 gm
Cholesterol 5 mg
Sodium 215 mg
Total carbohydrate 1 gm
Dietary fiber 0 gm
Sugars 1 gm
Protein 4 gm
Exchange List Approximation
Fat, saturated 1/2
Copyright © 1999 by the American Diabetes Association and The American Dietetic Association
From Chapter 6: Meat
MEXICAN BAKE
Olé! Young and old alike love this casserole filled with meat, beans, and cheese. If you like, you can substitute baked or fat-free corn tortilla chips for the flour tortillas called for in the recipe. Just be sure to check labels and use an amount equal to 4 starch exchanges (or the equivalent of 60 grams of carbohydrate).
About 6 cups (6 Servings)
1/2 pound (90 percent lean) lean ground beef
1/2 cup chopped onion
1 clove garlic, minced
1 teaspoon chili powder, hot or mild
1/2 teaspoon cumin
1/8 teaspoon crushed red pepper flakes
One 8-ounce can unsalted tomato sauce
One 15-ounce can ranch-style pinto beans in tomato and chili sauce
1 cup low-fat cottage cheese
One 8-ounce container low-fat plain yogurt or fat-free sour cream
1/4 cup canned chopped green chiles
4 flour tortillas 7 to 8 inches in diameter
1 1/2 cups (about 6 ounces) shredded reduced-fat Mexican-style blended cheese
1. Preheat the oven to 400°F. Prepare a 2-quart casserole with nonstick pan spray.
2. Sauté the ground beef and onions in a large skillet until crumbly. Drain off any excess fat.
3. Add the garlic, chili powder, cumin, and pepper flakes and mix thoroughly with the meat. Add the tomato sauce and beans. Mix well.
4. In a separate bowl, mix the cottage cheese, yogurt, and chiles.
5. Bake the tortillas on a cookie sheet until crisp and beginning to brown, about 5 minutes. Break the tortillas into large pieces. Reduce the oven temperature to 350°F.
6. Put half the tortillas in the bottom of the prepared casserole. Spoon half the meat mixture evenly over the tortillas. Add half the yogurt mixture and sprinkle with half the cheese. Repeat the layers, ending with the cheese off top.
7. Bake, covered, in a 350°F oven for 30 to 35 minutes.
Nutrition Facts per Serving
Serving size: About 1 cup
Amount per serving:
Calories 352
Calories from fat 115
Total fat 13 gm
Saturated fat 6 gm
Cholesterol 53 mg
Sodium 1026 mg
Total carbohydrate 33 gm
Dietary fiber 4 gm
Sugars 9 gm
Protein 30 gm
Exchange List Approximations
Starch 2
Meat, lean 3
Fat 1/2
Copyright © 1999 by the American Diabetes Association and The American Dietetic Association
From Chapter 8: Fish and Shellfish
FLOUNDER WITH PARMESAN CRUST
Simple preparations such as this Parmesan crust are ideal for flounder, and keep fat at just 2 grams per serving. Try Asparagus with Dijon Sauce and saffron rice as sides.
6 servings
6 flounder or sole fillets (1 1/2 pounds total), thawed if frozen
1/3 cup plain low-fat yogurt
2 tablespoons grated Parmesan cheese
1 tablespoon Dijon mustard
1 tablespoon fresh lemon juice
1 1/2 teaspoons prepared horseradish, drained
1. Preheat the broiler and prepare the broiler pan with nonstick pan spray. Arrange the fish on the broiler pan.
2. In a small bowl, combine the yogurt, Parmesan, mustard, lemon juice, and horseradish. Spread the mixture over both sides of the fillets.
3. Broil about 8 inches from the heat, turning once, for about 6 minutes, or until the fish flakes easily with a fork.
Nutrition Facts per Serving
Serving size:
About 3 1/2 ounces fish
Amount per serving:
Calories 122
Calories from fat 19
Total fat 2 gm
Saturated fat 1 gm
Cholesterol 62 mg
Sodium 166 mg
Total carbohydrate 1 gm
Dietary fiber 0 gm
Sugars 1 gm
Protein 23 gm
Exchange List Approximation
Meat, very lean 3
Copyright © 1999 by the American Diabetes Association and The American Dietetic Association
From Chapter 9: Vegetables
INDIAN CORN PUDDING
Vegetable puddings are, like custards, traditionally bound with eggs and cream. We've lightened up this recipe, replacing the cream with fat-free milk and decreasing the amount of eggs used. If you prefer, you can bake this pudding in individual ramekins instead of a casserole dish. Spray the ramekins with cooking spray and pour in the mixture. Decrease the baking time to 45 minutes, or until set. To unmold, run a thin knife around the edge of each custard and invert directly onto dinner plates.
About 3 cups (4 servings)
2 large eggs, beaten, or 1/2 cup egg substitute
2 tablespoons finely chopped onion
2 tablespoons finely chopped green or red bell pepper
1/2 teaspoon salt
1/4 teaspoon ground mace
1/8 teaspoon ground white pepper
1 tablespoon margarine
1 1/2 cups fat-free milk
2 cups fresh corn kernels, cut from cobs, or one 15-ounce can whole kernel corn, drained
1. Preheat the oven to 325°E Prepare a 1 1/2-quart casserole with nonstick pan spray.
2. Combine the eggs, onion, bell pepper, salt, mace, and white pepper in a medium bowl.
3. Melt the margarine in a large nonstick saucepan; stir in the milk and heat for 5 minutes. Add the egg mixture and corn; stir to mix well.
4. Pour the mixture into the prepared casserole. Bake for 1 hour, or until set.
Nutrition Facts per Serving
Serving size: About 3/4 cup
Amount per serving:
Calories 181
Calories from fat 54
Total fat 6 gm
Saturated fat 2 gm
Cholesterol 108 mg
Sodium 689 mg
Total carbohydrate 26 gm
Dietary fiber 6 gm
Sugars 8 gm
Protein 9 gm
Exchange List Approximations
Starch 1 1/2
Milk, fat-free 1/2
Fat 1/2
Copyright © 1999 by the American Diabetes Association and The American Dietetic Association
From Chapter 12: Desserts
GRANNY SMITH APPLE TART
Refrigerated folded pie crusts make pies and tarts simple, and are more tender and flexible than frozen pie crusts. Dough hearts add a pretty decorative touch, but feel free to use any other shape cookie cutter, such as leaves, apples, or stars, for variety.
1 tart (8 servings)
1 refrigerated fill-and-bake pie crust (7 to 7 1/2 ounces)
3 large Granny Smith apples (about 1 1/2 pounds total), peeled, cored, and thinly sliced
2 teaspoons fresh lemon juice
1/4 cup packed brown sugar
1/4 cup sour half-and-half, or 1/4 cup nonfat sour cream
1 tablespoon quick-cooking tapioca
1 1/2 teaspoons ground cinnamon
2 teaspoons granulated sugar
1. Preheat the oven to 350°F
2. Put the pie crust into a 9-inch-diameter tart pan with a removable bottom; press the crust against the fluted edge and trim off any pastry that extends over the top. Roll the trimmed dough into a ball; flatten to 1/4 inch and cut 2 or 3 shapes with a cookie cutter. Prick the tart shell in several places with the tines of a fork.
3. Put the sliced apples in a large bowl; drizzle them with lemon juice and toss to mix.
4. In a small bowl, blend the brown sugar, sour half-and-half, tapioca, and cinnamon.
5. Fold the brown sugar mixture into the apples until all the fruit is coated. Spoon the apples into the tart shell; arrange the dough shapes on top of the apples. Sprinkle granulated sugar over the top.
6. Bake for 35 minutes, or until the apples are tender. Cut in 8 equal slices. Serve hot or at room temperature.
Nutrition Facts per Serving
Serving size: 1 slice
Amount per serving:
Calories 200
Calories from fat 70
Total fat 8 gm
Saturated fat 3 gm
Cholesterol 8 mg
Sodium 146 mg
Total carbohydrate 34 gm
Dietary fiber 2 gm
Sugars 20 gm
Protein 1 gm
Exchange List Approximations
Other carbohydrate 2
Fat 1
Copyright © 1999 by the American Diabetes Association and The American Dietetic Association
The best cookbooks help us create delicious meals that appeal to our senses of sight, smell, and taste. If you get the added bonus of meals that are also healthful and nutritious, you have found a treasure of a cookbook indeed. If you have special health or dietary concerns, the search for such a cookbook can be frustrating. The New Family Cookbook for People with Diabetes offers you both good food and good health.
The recipes were developed for people with diabetes by The American Dietetic Association and the American Diabetes Association in their Family Cookbooks, volumes I, II, III, and IV. We've chosen the best recipes from these volumes and updated them using the newest and healthiest ingredients available. In addition, The New Family Cookbook for People with Diabetes incorporates the most recent nutrition recommendations for people with diabetes. These recommendations are designed to improve the health of persons with diabetes.
The recipes in this book help you and your family take the right steps toward good eating and good health. To help you take the mystery out of healthful eating, nutrient information and exchange values are provided per serving for each recipe.
We have learned a great deal about food and the nutrition it provides. This book translates our learning into practical solutions you can use as you plan and prepare your meals each day.
Ann Albright, Ph.D., RD
President,
Health Care and Education
American Diabetes Association
Connie Diekman, M.Ed., RD, LD, FADA
President,
The American Dietetic Association
Copyright © 1999, 2007 by The American Diabetes Association and The American Dietetic Association