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Fresh focus is a podcast delivering bites of nutrition information to veterans and their family between visits. Whether you are busy with a family, retired, or more isolated, you can stay connected for you. Dietitians from the Marion VA Health Care System will deliver evidenced based, consistent information to take on today's hot topics while promoting positive health outcomes.
The Department of Veterans Affairs does not endorse or officially sanction any entities that may be discussed in this podcast, nor any media, products or services they may provide.
Hello everyone, and welcome to the Fresh Focus Podcast, a Podcast where we give you bite sized food and nutrition tips to chew on in between office visits. I’m Natalie, one of your Marion VA healthcare Dietitian Nutritionists. I am also a Certified Diabetes Care and Education Specialist with over 20 years’ experience.
You may remember that in episodes 1-6, the Marion VA dietitians covered the healthy plate and in episodes 13-18 focused on using diabetes meal planning. In that series, we covered the basic building blocks of our plates: Carbohydrates, which are the foods that increase our blood glucose levels (these are found in fruits, dairy, and starches) and those that do not increase our glucose levels: proteins, fats, and non-starchy vegetables.
In this episode, we will be talking about how to plan healthy snacks with diabetes. Many years ago, the hospital diets for diabetes had snacks set at 2:00 pm and 8:00 pm. The reason for this is that the older insulins (NPH and Regular) often peaked at these times and these set snacks helped prevent hypoglycemia (or low blood glucose levels which are defined as glucose less than 70 ). In today’s world, there are many advances to diabetes medication and insulin regimes and snacks are more individualized than they were before.
Before we can plan your snacks, we need to take a step back and look at your personal diabetes regime along with your eating and hunger patterns. It is important to understand how your diabetes medications work to help you plan when you may need (or want) a snack. If you have questions, ask your pharmacist or local diabetes educator to explain how your medications work. In general, diabetes medications fall into two categories: Basal medications and Bolus Medications. The basal medications are generally “slow and steady” and cover the blood glucose that your body naturally produces. Some examples of basal medications are glargine insulin, metformin, DPP4 inhibitors (the gliptins), the incretin mimetics (daily or weekly injection) and the SGLT2 inhibitors (like empagliflozin). These generally to not cause hypoglycemia unless a patient is on too high of a dose for them. The bolus medications are the ones that work quickly and are meant to cover a meal spike. These medications are more likely to cause hypoglycemia. Some examples of bolus medications are rapid acting insulins (like aspart or lispro) and sulfonylureas like glipizide or glyburide. Taking these medications without eating can cause hypoglycemia.
Now that we have an understanding of the basic diabetes medications, we can get back to planning your snacks. In most patients, keeping your carbohydrates in the 15 to 30 gram range is recommended for a snack. However, it is a good idea to start by keeping a one to two week food and glucose log to help assess your glucose patterns. Often times, you will notice a pattern happening. Maybe it is that your glucose levels are dropping too low when you exercise or maybe they are dropping too low when you sleep. In these circumstances, a well-planned snack may help to prevent a low glucose reading. A good rule of thumb is to eat 15 grams of carbohydrate for every 30 minutes of physical activity. Some examples of 15 grams of carbohydrate would be a small apple/orange, a cup of milk, a small container of yogurt, ½ sandwich or 6 crackers and peanut butter. Another good rule of thumb is that if your blood glucose level is below 130 at bedtime, a 15 gram carbohydrate snack may prevent you from dropping too low overnight. If you have tried these methods and are still experiencing hypoglycemia, you should talk to your provider about adjusting your diabetes medications.
In some persons with diabetes they may run higher at certain times of the day. Many persons with type 2 diabetes will experience higher glucose levels in the morning hours. This is called the dawn phenomenon. It usually occurs between 2 am and 8 am. Researchers believe the overnight release of counter regulatory hormones increases insulin resistance, causing blood glucose levels to rise. If you find yourself in this situation, eating less carbohydrates in the morning hours may help to get your glucose levels on track. If your glucose levels are running high, eating a snack with 15 grams of carbohydrate or less is recommended.
Keep in mind that protein foods are very low in carbohydrate and will have little effect on glucose levels. The protein group includes foods like turkey, chicken, beef, and pork, fish, nuts and nut butters, cheese and cottage cheese. Protein takes longer to digest and will keep you feeling fuller.
Fats such as nuts/nut butters, olive oil, and cheeses also are low in carbohydrates and will have little effect on glucose levels.
Non- starchy vegetables have less than 5 grams of total carbohydrate and will have little effect on glucose levels. Some classic snack examples include carrots, celery, cauliflower, and cucumbers. Try combining a protein or fat with your veggies for a satisfying low carbohydrate snacks! Personally I love cream cheese on cucumbers and home made salad dressing with raw vegetables.
Another tip is to combine protein and a carbohydrate food. Eating these together can help you to feel fuller and keep blood glucose levels stable. Some of my favorite combinations that are about 15 grams of carbohydrate include: a sliced apple and peanut butter, 13 Whole grain tortilla chips with a sprinkle of cheese and salsa (yes you can microwave them!), ½ Turkey sandwich with avocado and tomato, sugar free yogurt topped with 1 Tbsp of granola, roasted pecans and 2 Tbsp dried cranberries, or a boiled egg and a piece of toast.
We hope that today’s episode has given you some fresh ideas for healthy snacking. Thanks so much for joining us for this episode. Be sure to subscribe, leave a review, and share these episodes with anyone you might think would benefit from healthy snack ideas. Remember to reach out to your local VA Dietitian and CDCES to assist you in reaching your health goals.