A meeting with a registered dietitian is an absolute must for anyone with diabetes. A good RD will explain the mysteries of exchanges and carbohydrate counting to you and will work with you to create a meal plan that works with your lifestyle. Parents cooking for a child with type 1 diabetes will have a whole different set of concerns and dietary issues than, for example, an adult with type 2 who wants to learn how to eat for better control when he's out on the road. If you don't have an RD already, talk to your doctor about a referral, or visit the American Dietetic Association's online referral database.

As part of your diabetes care team, your dietitian should be in close contact with your care provider. Make sure she's on top of any adjustments to your insulin or medication, which go hand in hand with what you're eating. The dietitian's office is another of those places where it helps to bring a spouse or companion for another set of ears, particularly your first time there.

Whether you're using carbohydrate counting or dietary exchanges, your RD will try to spread out your carbohydrate intake more or less evenly throughout the day to promote blood glucose balance. Again, your dietitian will work with you to come up with an appropriate amount of exchanges or carb grams, fat intake, and protein. He may also suggest other dietary guidelines based on your health history (e.g., low sodium if you have hypertension).

The ADA recommends that people with diabetes eat no less than 130 grams of carbs daily, and the American Association of Clinical Endocrinologists (AACE) suggests that total dietary carbohydrates represent 45 to 65 percent of daily calories. However, many people with diabetes find that a lower intake of carbohydrates offers them better control of their blood glucose levels. If you'd like to try a lower-carb meal plan, talk with your RD and your doctor about an approach that's right for you.

Building a Better Food Pyramid

In 2005, the U.S. Department of Agriculture (USDA) retired the old food pyramid and replaced it with an interactive and individualized tool that bases dietary recommendations on weight, height, gender, age, and activity level. The new nutrition tool, called MyPyramid, uses the 2005 Dietary Guidelines for Americans to generate your plan.

The guidelines recommend that between 45 and 65 percent of daily calories come from carbohydrates; and that only half of grain servings come from whole-grain, versus refined, sources. While this may be appropriate for some people with diabetes, for others it could pose a significant challenge.

The Healthy Eating Food Pyramid created by the Harvard School of Public Health is perhaps the best model for healthy eating with diabetes. Based on the abundance of research that demonstrates the negative impact of refined starches on blood sugar control, this pyramid uses carbohydrate quality as a blueprint, pushing starchy, high-glycemic index carbs up to the top of the pyramid (to use “sparingly”). It also adds heart-healthy oils to the whole grains at the bottom. Here are its recommendations:

• Unprocessed whole grains and healthy oils (e.g., canola, olive, safflower): 6 to 11 servings

• Nonstarchy vegetables: in abundance

• Fruits: 2 to 3 servings

• Nuts and legumes: 1 to 3 servings

• Dairy or calcium supplement: 1 to 2 servings

• Fish, poultry, and eggs: 0 to 2 servings

• Refined grains, high-carb starches, butter, red meat, and sweets: sparingly

Dear Diary …

Even if you follow your meal plan to the letter, you're still going to find that certain foods will give you a bigger spike in glucose levels than expected. You may also find that other foods you expected to pump up your readings barely bump the meter. That's the individual nature of diabetes. For this reason, a food diary is an invaluable tool in figuring out just how different foods affect your blood glucose levels.

Record the type, amount, and timing of foods eaten, along with what effect they had on your blood glucose levels (a reading before eating and a reading two hours postprandial). Many people choose to record the information in their blood glucose logbook. At first it may feel a little obsessive-compulsive to chronicle every bite, but you'll find it's worth it when the time comes to figure out a mysterious high or an unexpected low. It's also a great cure for mindless eating — you won't be polishing off what the kids left on their dinner plate or munching samples in the supermarket if you've trained yourself to write it down.