In September 2015, The Johnson & Johnson Diabetes Institute, in partnership with The Diabetes Influencers Network (DiabetesInfluencers.com, @DiabetesINFL), hosted a Twitter chat for healthcare professionals about nutrition and diabetes. The chat was facilitated by Mary Ann Hodorowicz, RD, MBA, CDE, CEC, @mahodorowicz? and Amy P. Campbell, RD, MS, CDE, @amypcampbell.

Here are some common questions asked by people with diabetes, followed by answers from our hosts and participants.

Do I have to give up sugar or sugary foods and drinks completely?

It’s? not? realistic? to? think? that? people? will? give? up? sugar? completely, so help them manage their? intake. “Use? in? moderation? and? be? accountable? for? what you eat”? is? much? more? acceptable.? Educate to count portion size, calories and carbs.

Sugary? food? can? be ?substituted? for? other? carbs, but it is? low in nutrients and? fiber? and? high in? kcal.? Diet soda is best to prevent high blood glucose.? Some sugary foods can be surprisingly low in carbs.? Educate your patients to read labels!

Patients? need? to? find? what? amount? of? sugar? they? can? tolerate? and? what? foods? with? sugar? they can have.? They can have sugary foods for a treat or special occasion.? But? don’t? forget? to? count? them? as? carb? choices!

Food and drink? considerations? are? a? part? of? an overall? Lifestyle? Change? and? should? be? considered ?on? a? case? by? case? basis. Frequent? blood glucose? checks? can? help? a? person? know? how? to? best? fit? treats? into? eating? plan.

Can I use artificial sweeteners?

Yes, but wisely.? They are usually found in non-nutrient dense foods.? “Diet” foods? can? be? a? trap, so its important? to? remind? patients that? sugar-free? foods? aren’t ?always? carb? or? calorie-free.? Carb? and? calorie? free? sweeteners? are ok, but? foods? containing? them, ??like sugar? free? cookies, usually? have? carbs? that? must? be? counted.

Beware also that artificial? sweeteners? can? induce? glucose? intolerance:? the? body? doesn’t? know? it’s? an? artificial? sweetener? until? it’s? too? late,? so insulin? may? still? be? stimulated.? Consider natural no- or low-cal sweeteners if your patient has this reaction.

Can I eat foods made with sugar alcohols?

Some people mistake sugar alcohol for true alcohol.

Sugar? alcohols? don’t? contain? sugar? or? alcohol:? they? are? a? carb,? and not? necessarily? low? cal.? Mannitol,? maltitol,? lactitol,? xylitol,? sorbitol,? hydrogenated? starch? hydrolysate,? and? isomalt? are all sugar? alcohols.

Sugar? alcohols? have? some? serious? side? effects – patients? must? use? in? moderation.? Read labels!!

Foods? with? sugar? alcohol? (carb),? are? OK? but? often? have? other? carbs? that? must? be? counted.? Sugar? alcohols? are? NOT? low? in? calories, and sugar-free? may? not? mean? carb? free.

Not all sugar alcohols are created equal.? Sugar? alcohols? can? have? a? laxative? effect,? causing? gas,? bloating,? and? diarrhea.? Erythritol has the fewest GI effects as it does not ferment in the colon.

If? counting? carbs? on? insulin-carb? ratio, if a? food ?has? 5? or? more? gm? SA,? subtract? 1/2? of? from the total? carb count. Sugar alcohols have 2 calories per gram.

Should I eat more high fiber foods?

High? fiber? foods? are? sensible? all? around,? not? just? for? diabetes.? A? high? fiber? diet? can? reduce? the risk? of? diabetes mellitus and? help? control? blood? sugar and promote good? colon? health.

High? fiber? foods? help? moderate? the? rise? in? blood glucose, control? blood? cholesterol? and? can? help? slow? glucose? absorption.? Its bulk helps people feel full.? A good goal is 20-35 grams daily

Viscous fiber is best. Viscous fiber gels in fluid and can best reduce blood glucose and blood cholesterol!? Fibers? that? do? not? “gel”? are not? as? effective? in? blood glucose? and? blood? cholesterol? reduction.? The Academy? of? Nutrition? and? Dietetics? diabetes? evidence-based? guideline recommends? 7? to? 13? gms? viscous fiber? per? day.

Can I drink alcohol?

If diabetes is under control, an occasional drink is probably ok. As with so many foods, moderation is best. The AHA’s recommendation is 1 drink/day for women, 2 for men.

Alcohol can cause a low blood glucose episode. With? alcohol,? the liver? will? kick? in? to? detox? and? then? cannot? release? stored? glucose? quick? enough.? Low? blood glucose? can? occur? quickly? with? ETOH? and? activate? insulin? in? the system? So check? blood glucose? more? often? when? drinking? alcohol.

People taking? insulin? or? certain? types? of? diabetes? pills? should always? eat? a? carb? food? when? drinking? alcohol? to? prevent? lows.

Look out for alcohol mixers, however, like soda and juice. Consider diet versions or seltzer water instead.

What kind of fats can a person with diabetes eat?? How much is ok?

Good? fats? are? important? for? heart? health? and? help? to? slow? the digestion? of? carbs.? Avocado,? extra virgin olive oil,? nuts,? canola? and? peanut? oils,? fatty? fish? like? salmon,? seeds? and? avocado are recommended. Also avoid the obvious trans fats.

If? carbs? raise? blood? sugar,? should? I? avoid? all? carbs?

NO,? NO,? NO!? Avoid all carbs only if you want sub-optimal brain function.? The brain needs glucose.? The human body needs carbohydrate to function properly.? Carbs are the bodies preferred fuel source. But plant-based, whole-food carb are the healthiest choices.

A daily meal plan should include healthy carbs.? Low quality, empty calorie carbs are the downfall of healthy eating. The best? carbs? are? from? plants – veggies,? fruit,? whole? grains,? nuts,? seeds and? beans – and ?low-fat? milk? and? yogurt.

Educate patients to eat? less? saturated? and? trans? fats, and ?more? mono? and? polyunsaturated? fats? plus? omega-3s. If weight loss is desired, use less fat in cooking and at the table.

Do I need to lose a lot of excess weight?

Excess weight affects much more than just diabetes. To lose excess weight, recommend a balanced,? calorie? controlled meal plan under the guidance of a medical professional.

Slow, steady weight loss is best to avoid complications. Make? small,? gradual? changes? to? food? and? physical? activity? –? it helps? weight? come? off? and? stay? off!

Losing? as? little? as? 5%? of? excess? weight? can? greatly? help? control? blood glucose,? blood pressure,? blood? lipids? and? increase? energy.

Gastric bypass is a last resort, but can have amazing improvements. It almost instantly returns blood glucose to normal levels.? For? some? people,? gastric? bypass? surgery? can? lead? to? diabetes? remission.? But it’s not for everyone! Many people still need long term counseling to maintain weight loss

Do I have to eat 3 meals a day, every day?

There? is? not? a? single? “perfect”? meal? pattern,? but? 3? meals? a? day? is? great.? 3? meals? and? 2? healthy? snacks? is good,? too!

Basically, every body is different, and your patients need a meal plan that fits their lifestyle.? Some people eat 6 (smaller) meals per day.? Smaller? meals? eaten? more? often? will? likely? promote? satiety? and? help? keep? blood? sugars? steady, especially? if? they? contain ?protein.

Have? patients? do? a? food/activity? log? to? track the? number of? calories? they consume over? a day? and? see? where? adjustments or additional? foods? are? needed.

Should? I? take? my? diabetes? medications? if? I? skip? a? meal?

It depends on the medications and the meal.

Some? diabetes? medications? trigger? the pancreas? to? release? insulin? all? day, so? foods? need? to? be? eaten? to? prevent? low? blood glucose.? Know which medications cause low blood glucose.

Skipping? meals? is? the? quickest? way? to? feel? lousy? both? from? hunger? and? blood sugar? dips.? A? regular? “meal? skipper”? should? talk? with? their healthcare provider? – they might? need? a? different? type? of? diabetes? medication.

Skipping? meals? also? sets? people? up? to? overeat? at? the? next? occasion? (or? choose? less? healthy? foods).? The brain and central nervous system can only burn blood glucose to survive.? The rest of the body can burn fat and muscle.

Should I take vitamins/minerals or other supplements?

It depends? on? the? quality? of? the? diet? and? other? medical? conditions.? Some dietary supplements can affect blood glucose levels.? Specific questions should be addressed to a doctor or dietitian.

People? should? carry? full? list? of? every? over-the-counter? and? herbal? supplement? they? are? taking,? in? addition? to? their prescriptions.

No? matter? what,? remember,? “supplements”? are? not? “substitutes”? for? a? healthy? diet!

Do? I? have? to? cut? back? on? salt? and? salty? foods?

Reducing? intake? to? less? than? 2.4 g? sodium/day? should? have? clinically? important? effects? on? blood? pressure.

Most? sodium? comes? from? packaged and restaurant? foods,? not? the? salt? shaker.

Also look? out? for? salt? substitutes? which? often? contain? potassium.? Check with a healthcare provider before using.

The recommended daily allowance is 2300mg sodium, 1500mg for those over 50, or who have hypertension or related conditions.? These are difficult but doable numbers.

Salt raises blood pressure, which raises the risk of heart attack and stroke.? Read labels and use salt substitutes, like herbs, spices, garlic, etc.

Remember? that? meal? planning, medications? and? exercise? all? work? together? to? control? blood glucose? and? cardio-vascular disease? risk.