By Michelle May, MD and Megrette Fletcher, M.Ed., RD., CDCES authors of Eat What You Love, Love What You Eat with Diabetes
If you have diabetes you may have heard that you need to eat on a rigid schedule. That may have been true 10, 20 or 30 years ago when medication options were limited. The great news is there are a lot of new diabetes medications and most don’t require you to eat at set times or eat when you’re not even hungry!
This significant advance in diabetes care is helpful if you are trying to be more mindful and use hunger as your guide for eating. Your hunger and fullness levels usually reflect the rise and fall of your blood glucose so you can use the Hunger and Fullness Scale (page 53 of Eat What You Love, Love What You Eat with Diabetes) to begin to fine-tune your eating patterns for optimal energy and glucose control. Starting in the middle, let’s work our way down the scale.
Level 5 or higher. If you’re at level 5 or above and want to eat or keep eating, you know that something other than hunger triggered this urge. This is an opportunity to learn more about yourself and how you respond to your environment and emotions.
Level 4. When your hunger level is at 4, you’re slightly hungry and starting to think about eating. You can begin to plan for it by making sure time and food will be available when you’re ready to eat. There will be times when you’ll want to eat even though you’re only slightly hungry, for example, at a mealtime or when you won’t have another opportunity to eat later. Just keep in mind that if you’re only a little hungry, you need only a little food.
Level 3 or 2. The ideal time to begin eating is when you reach level 3 or 2. At this point you’re significantly hungry, so food will be pleasurable and satisfying. Eating at this point also prevents a low blood glucose reaction if you’re on medications that put you at risk for hypoglycemia, as we’ll explore next. It’s important to plan meals ahead of time and to be prepared to respond to hunger even when it’s not a conventional mealtime. Keep nutritious foods on hand-in your office, purse, briefcase, car, gym bag, carry-on-to eat when you’re hungry.
Level 1. If you put off eating or don’t notice that you’re hungry until you’re famished or hypoglycemic, you may not think as clearly or make mindful decisions about what to eat. When you’re at level 1, you’re more likely to eat anything you can get your hands on and to eat too quickly to notice when you’ve had enough. That’s why you can easily go from starving to stuffed. If you are at risk for hypoglycemia, it’s especially important to monitor your hunger symptoms, blood glucose levels, or both so you can respond rapidly and appropriately.
Level 0. If you are at risk for hypoglycemia (low blood sugar) because of the medications you take, a “0” means that your blood sugar is too low (less than 70 mg/dL). Immediately stop what you are doing and treat the low blood glucose level with 15 grams of carbohydrates. Examples:
4 oz of juice
3-4 glucose tablets
6 saltine crackers
8 oz of skim milk
Avoid choosing foods that are high in fat (like a chocolate bar or potato chips) because the fat will actually slow down the absorption of the carbohydrates.
Wait 15 minutes and retest your blood sugar. If your blood sugar is still less than 70 mg/dL take another 15 grams of carbohydrates wait 15 minutes and retest, until your blood sugar is over 70 mg/dL. Once it is above 70 mg/dL, decide whether you are going to eat a meal within 1 hour. If you’re not, have a larger fat and protein containing snack such as ½ sandwich, yogurt with nuts, or peanut butter and crackers.
To learn more about how using your hunger to help with portion size, read chapter 5 of Eat What You Love, Love What You Eat with Diabetes, by Michelle May, MD with Megrette Fletcher M.Ed., RD, CDCES