Ask the Expert: Christine McKinney, RD, CDE
Living with diabetes can sometimes be overwhelming. This section focuses on practical information about diabetes. Experts in various fields related to diabetes will give advice about day-to-day living. These topics will change regularly, so check back often to meet our new experts!
Questions & Answers with Christine McKinney, Registered Dietitian
1. What strategies should people with diabetes follow when eating out?
People with diabetes can following the same strategies when eating out that other people follow to eat healthy. When possible, it is good to know the menu in advance. Many restaurants publish their menu and nutrition facts online. By looking this up, you can make a healthy choice even before you go. When you are there, ask questions about how the food is prepared and if sauces, gravies or dressings can be served on the side.
At restaurants, portion control is important. Consider some of these ideas to keep portions smaller:
- Have soup and salad as a meal
- Share your meal with others
- Use a smaller plate for buffets or salad bars
- Divide your meal and place a portion in a to-go container before eating
- Stop eating when you are satisfied and ask for the food to be removed from the table
If the menu is too overwhelming, a safe bet is lean protein and vegetables. For example, most restaurants have grilled fish, broccoli and salad. Many restaurants accommodate special requests so speak up for your health.
2. Is there a "diabetes diet"? What can I eat?
Many years ago the term “diabetic diet” was popular. Now a diet for diabetes is simply healthy eating. Food for people with diabetes doesn’t need to be something special or sugar-free. Healthy eating is including all food groups daily in controlled portions. A great way to do this is to look at your plate. Think of filling ½ of your plate with vegetables and maybe a small portion of fruit, ¼ with protein and ¼ with starch. Check out MyPlate for more information on portion sizes and recipes.
People with diabetes should have an awareness of carbohydrates. Learning amounts of carbohydrates in food and serving sizes is important. When eating carbohydrates, try to include protein and/or a healthy fat to blunt the glycemic effect of the carbs. For example, instead of eating a plain banana eat a banana and almond butter. Fiber is a form of carbohydrate that our body doesn’t digest. Fiber slows down the rise in glucose and has the added benefit of the feeling of fullness without as many calories. To increase fiber intake, eat more vegetables, seeds, nuts, whole grains, legumes and fruit. All of these foods are part of healthy eating which means they are should be in your “diabetes diet”.
3. Are artificial sweeteners recommended for people with diabetes?
Non-nutritive artificial sweeteners do not have to be used when you have diabetes, but keep in mind that using sugar can cause quick increases in blood glucose. It is true that artificial sweeteners have no calories and shouldn’t increase glucose. They are already in many foods that are labeled as “diet” or “sugar-free”. Artificial sweeteners still taste sweet. So by drinking or eating artificial sweeteners your taste buds still get that sweet taste. That may sound good to you, but it makes other naturally sweet foods taste not as sweet. If you choose to use artificial sweeteners, do so in moderation. Drink more water than diet drinks and eat real whole foods.
4. Can a person with diabetes still eat sweet foods or desserts?
The short answer is yes, but in moderation, keeping in mind that when you do eat these foods they can raise blood glucose very quickly. Sugar has damaging effects not just on glycemic control but also blood vessels and organs. For everyone, with or without diabetes, sugar intake should be reduced. The more sweets we eat, the more we tend to crave them. When we eat less sugar, foods that are naturally sweet like fruits and vegetables taste sweeter. Remember that desserts and sweets are not everyday foods. These are sometimes foods to be enjoyed in small portions.
5. What is the best strategy to lose weight with diabetes?
There are so many strategies for weight loss. A good starting place is a food log. This can be done on paper or using an app on your phone. A good food log includes not just the food itself but the amount consumed and how is was prepared. Having to write down all that you eat and drink creates awareness. Awareness of the foods you eat, portions, timing of meals and snacks and possibly even feelings related to food.
One of the best strategies for overall health and weight loss is to eat real whole foods. Real foods are foods that came from the ground or an animal. Vegetables, fruits, grains, meat and milk should make up our diet. Simply increasing vegetable intake and decreasing processed starches can help with weight loss. This should also help with glycemic control by reducing carbohydrate intake. Think about what you ate today and where it came from.
6. What leads to high blood glucose levels?
We often blame food first for high blood glucose levels, but there could be some other culprits. When you have a high blood glucose value, it’s important to think about why it’s elevated and document the reason. This is essential for you to understand and also to share this with your diabetes health care provider. Many foods and drinks do increase glucose. Carbohydrates break down into glucose so it’s good to know which foods and drinks contain carbohydrates. Besides food, consider some of these situations next time:
- Lack of sleep
- Less activity than usual
- Forgetting to take diabetes medications
- Hormone changes
Excess body weight can predispose to insulin resistance and increased blood glucose. Treating high blood glucose includes staying hydrated, checking glucose more often to make sure it is trending down and knowing when to contact your doctor.
7. Are there supplements that can help my diabetes control?
Supplements can be used by people who have diabetes but it is important to understand that there are not enough scientific studies for supplements to be routinely recommended. The government doesn’t regulate supplements in the way that it regulates medications. Some supplements may not have been well tested and could interact with other medications that you take. It is important to talk with your healthcare provider before you start taking supplements.
Some supplements that have been associated with improved glycemic control include:
- Bitter melon
- Gymnema sylvestre
For more information on supplements check out the National Institutes of Health Medline Plus or the National Institutes of Health Office of Dietary Supplements.
8. What does alcohol do to my glucose levels?
Adults with diabetes can drink alcohol in moderation when diabetes is controlled and you have talked with your healthcare provider. Moderation is one drink per day for women and two drinks per day for men. One drink is 12 ounces of beer (around 5% alcohol), 5 ounces of wine or 1.5 ounces hard liquor (40% alcohol or 80 proof). Alcohol should be avoided when taking certain medications, and if you have high triglycerides, nerve damage or are pregnant.
Alcohol can actually increase or decrease glucose depending on the type and how much is consumed. When alcohol is consumed in moderation and without added carbohydrates from other sweetened drinks, glucose can decrease. This happens because the liver isn’t able to release glucose while it is processing alcohol. Symptoms of hypoglycemia can be similar to drinking too much so tell those around you that you have diabetes and wear medical ID. Glucose can increase from alcohol when there are added carbohydrates from drinks (always think about the carbs in “mixers”), drinking more than moderation or eating more food.
Remember that alcohol is added sugar and calories. Talk with your health care provider about alcohol and see if it is safe for you.
9. Are eggs good or bad for people with diabetes?
For years we thought that cholesterol in eggs made the cholesterol in blood rise. Research has shown that dietary cholesterol doesn’t equal serum cholesterol. The 2015 Dietary Guidelines for Americans supports this and doesn’t have any recommended cholesterol limits. To help control cholesterol, the focus has shifted to limiting saturated fat. However, research for people with diabetes does still support fewer eggs. Recommendations are for one egg or less per day for people with diabetes.
10. Is coffee good to drink for people with diabetes?
People tolerate caffeine differently. For some, it can increase blood pressure and make them feel jittery. However, coffee does contain phytonutrients and has been associated with decreased risk of diabetes, heart failure, Parkinson’s disease and liver disease. Caffeine in moderation of around 400 mg of caffeine (2-3 cups of coffee) per day is not associated with any health risks (unless told otherwise by your healthcare provider). To get the most phytonutrients from your cup of Joe, look for a dark roast and avoid paper filters. Try percolator, French press, boiled or cold brew coffee.
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Questions from our readers
I was reading an article on your website’s Patient Guide to Diabetes about resistant starches (https://hopkinsdiabetesinfo.org/what-is-resistant-starch/). It notes that cooking oats reduces the amount of resistant starches but an alternative is to make overnight oats to preserve the resistant starch content. I tend to like hot breakfasts and was wondering if I heat up my overnight oats, is that the same as cooking it and will that reduce the resistant starch content?
Dear Interested Reader:
Thanks for your question about resistant starch in oats. Overnight oats are a great idea to include some resistant starch. It’s true that cooking will reduce some of the resistant starch. One option is to quickly heat overnight oats instead of a longer cooking time. A shorter cooking time will help to retain some resistant starch. Oats have many other health benefits as they are a whole grain that contains fiber and protein which can help with controlling blood glucose. Enjoy your overnight oats as a healthy breakfast option cold or reheated.
Is there a formula or method to calculate carbs to sugar? If a product says 20 grams of carbs per serving, how much in sugar would that be, and vice versa? How to convert sugar to carbs? So if a product says it has 20 grams of carbs and 4 grams of sugar, what would the total sugar and or carbs be?
Dear Interested Reader:
Thanks for your great question. There isn’t a standard calculation for carbs to sugar because the amount of sugar in carbs varies. If you are reading the Nutrition Facts panel on the foods label, the total carbohydrate number includes dietary fiber, total sugars, and added sugars. Total sugars include sugars naturally found in foods (like fruit and dairy products) and sugar added to foods. So, if a product has 20 grams of carb and 4 grams of total sugars, the carbs remain the same because the sugar was already included in the 20 grams. Most people with diabetes count total carbohydrates and don’t add or subtract sugars because they are already included in the total carbohydrate number. If you want to read more on this, check out ADA’s Making Sense of Food Labels.
I read one of your articles on resistant starches with a great deal of interest. As a 71 year-old Type II diabetic. I have avoided medications and maintained a reasonably good A1c (usually in the 6’s) over the past 15 years with diet and exercise. In recent years it has become much more difficult to keep my glucose levels at a healthy level. My question – by refrigerating pasta overnight before warming and eating with a marinara or aglio e olio sauce, can I expect a beneficial outcome regarding my glucose levels? This is extremely important to me. I am of Italian heritage and miss my pasta!
Dear Interested Reader,
Thanks so much for your question and sharing about your diabetes management. There is research to support that cooking, cooling, and reheating pasta can reduce the rise in glucose by making it a resistant starch. As a reminder, the fat and protein content of your meal may reduce glycemic response by slowing digestion. For example, the marinara sauce is likely lower in fat than the aglio e olio sauce. People have different glycemic response to foods, so try this as an experiment for yourself. You should still be able to enjoy some pasta in your diet.
Can people with diabetes eat honey?
Dear Interested Reader,
Thank you for your question. Yes, people with diabetes can include some honey in their diets. Honey is a type of sugar, so it raises blood sugar levels. Honey is sweeter and slightly higher in calories and carbohydrates compared to white table sugar.
- 1 tablespoon of honey = 60 calories and 17g carb (from 17g sugar)
- 1 tablespoon of sugar = 48 calories and 12g carbohydrates (from 12g sugar)
Honey does have a few benefits compared to sugar. Honey is more natural and less processed than sugar. It contains small amounts of vitamins, minerals, and antioxidants. Honey has a lower glycemic index than sugar. Because honey is slightly sweeter, you may be able to use less for the same sweet taste. If you want to include honey in your diet, use it in small amounts for sweet taste.
I have a question for you, after reading the article on resistant starch. Is there a reference you can point to on why oats kept in the fridge overnight are preferable. Are you saying raw soaked oats are better than cooked, or does the extra cooling a fridge provides, help in any way. I soak my oats at room temperature, in order that natural fermentation can help break down the oats overnight. If I refrigerate they won’t ferment but I’m curious if there is a particular advantage of the fridge.
Dear Interested Reader,
Thank you for your question. When oats are cooked they lose some of their resistant starch. Raw soaked oats would be a better choice than cooked oats if you are looking to increase resistant starch. There is not an advantage to refrigeration if soaking oats overnight. The idea of overnight oats in the refrigerator was an example of how to eat raw oats. There may be a small increase in resistance starch by eating cooked oats that have been refrigerated, but that is more commonly true with rice, pasta, and potatoes. Soaking oats is a good choice instead of cooking oats for more resistance starch. Oats have some great health benefits so enjoy your oatmeal in a variety of ways.
Can rice powder be used as a resistant starch? It is just ground rice and has not been heated.
Dear Interested Reader,
Thank you for your question. Rice powder is a resistant starch. I found one study that compared retrograded rice (heated and cooled) to common rice powder. The study concluded that retrograded rice had higher resistant starch levels compared to rice powder. I think rice powder could be a partial substitute for flour to include resistant starch. If you enjoy rice, try it cooled for the added resistant starch benefits.
I’m writing to ask a question I’ve wondered about. When I buy plain, raw nuts, I’ve noticed that the bag claims the nuts have saturated fat! I’ve always thought of saturated fat coming from animal products (i.e. meat, butter, cheese, eggs, etc.) Do plain nuts really have (a small amount of) saturated fat? I’m confused! Please explain. Thanks!
Dear Interested Reader,
Thank you for your question. You are correct-nuts do contain a small amount of saturated fat. Other plants also contain saturated fat including avocado, seeds, cocoa butter, olives, and oils. Saturated fat is usually thought of as a single nutrient, but there are different types of saturated fatty acids. Some types of saturated fats have a neutral effect on cholesterol. Food usually contains a mix of fatty acids, so it’s hard to compare the health effects of one type to another. However, the combination of fats in nuts has many health benefits. I encourage my clients to include nuts in their diet. Nuts are a nutrient-dense whole food that are beneficial for heart health, blood pressure, weight management, and improving glycemic control. In addition to healthy fats, nuts contain protein, fiber, and vitamin and minerals such as magnesium, folate, and potassium. Nuts also contain phytochemicals that act as antioxidants and work to reduce inflammation. So, continue to enjoy nuts as a healthy part of your diet.
I would like to know more about the Dash diet. Could you send me an example of how a dash diet looks like for a week? (Menu).
Dear Interested Reader,
Thanks for your question. The DASH Eating Plan is a healthy balanced eating plan to help control blood pressure. The eating plan emphasizes whole grains, fruits, vegetables, and low-fat dairy while limiting sodium, saturated fat, and sugar. NIH is a great website to learn more about the DASH Eating Plan. A sample weekly meal plan is also available.
Meet Christine McKinney, our registered dietitian and expert of the month!
Christine McKinney is a Registered Dietitian with a Master’s Degree in clinical nutrition from the University of Wisconsin-Stout. Christine has been providing nutrition counseling at Johns Hopkins Bayview Medical Center for almost 15 years. She is a specialist in weight loss, diabetes and prenatal nutrition. Christine is a Certified Diabetes Educator. She has given many presentations and has been quoted in local and national publications on various nutrition topics. When not at work, Christine enjoys hiking in the woods with her kids, trying new recipes, cycle class and taking care of her chickens.