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All diabetic patients, especially those who take insulin, should keep a diary of medication, blood glucose levels, and food intake. By combining all on a single sheet as in this model, a person can quickly see the effects of food and insulin and glucose levels.

What can I do myself?
Balance and moderation should prevail in planning and following a diabetic diet. It is vital that people with Type 1 diabetes learn how to match food intake with their insulin dosages, and how to measure their own levels of blood glucose. Meals and snacks should be eaten at regular intervals and timed according to the patient's insulin dosage and exercise regimen. To do this, a daily food diary (see sample) should be kept that lists all food and drinks as well as insulin injections, problems, and blood glucose levels.

Food portions vary considerably, especially if many meals are eaten in restaurants. At first, a person may need to measure portions until he or she learns how to judge amounts simply by looking at them.

As noted earlier, weight control is vital in managing Type 2 diabetes. It is believed that many cases of adult diabetes could be prevented if individuals maintained a desirable body weight and kept physically fit throughout life.

When should I see my doctor?
Anyone who has diabetes should see his or her doctor regularly, with extra visits during any illness, however minor. In addition, the diet should be planned in consultation with a registered dietitian or diabetes educator with training in dietary control of the disease. This health professional should work closely with the primary doctor, and also take into consideration the patient's food preferences and eating habits.

What will the doctor do?
First, the doctor reviews the patient's overall health and prescribes any medications that may be needed to control the diabetes. He or she should also review the patient's food diary and diet and exercise plan, and probably arrange a referral to a registered dietitian or diabetes educator to work out an individual eating program.

Long-term approach

A diabetic diet is a meal plan based on the patient's individual nutritional needs. It will probably employ the following food groupings or exchange lists, which are used by the American Diabetes Association and the American Dietetic Association:

• Starch/bread list, including breads, crackers, cereals, grains, pasta, dried beans, and starchy vegetables such as potatoes.
• Meat list, divided into high-, medium-, and low-fat choices.
• Vegetable list, including fresh, canned, or frozen vegetables of all kinds.
• Fruit list, including juices and fresh, frozen, canned, and dried fruits.
• Milk list, including a variety of milk, yogurt, and other dairy products.
• Fat list, including butter, margarine, and oils, as well as high-fat foods such as mayonnaise, nuts, and cheeses.

Every item on the exchange lists is noted by portion size. Each item in any category on an exchange list is roughly equal in nutritional value (including calories) to any other item in that category on the list — so one food choice can be "exchanged" for any other on that list. Using the exchanges, a person can "mix and match" within the same category, which makes it easy to select from a wide variety of foods.

For example, a typical day's eating program based on exchanges might include:

• 7 starch/bread exchanges. (For example, a bowl of cereal, 2 slices of bread, a serving of pasta, a small muffin, and 2 other choices, such as a snack of crackers.)
• 3 low-fat meat exchanges. (Each exchange equals an ounce of meat, poultry, or fish.)
• 1 milk exchange. (Each exchange equals 8 ounces of milk or yogurt.)
• 2 or 3 fat exchanges. (Each exchange equals 1 tea­spoon of margarine, butter, oil, or mayonnaise, or 1 tablespoon of salad dressing.)

• 7 vegetable exchanges. (Each exchange equals 1 cup raw or V2 cup of cooked vegetables.)
• 2 fruit exchanges. (Each exchange equals V2 cup of fresh fruit or juice.) Some combination foods

draw from more than one exchange list. For example, a regular slice of thin-crust pizza equals 2 starch exchanges, 1 meat exchange, and 1 fat exchange.

The American Diabetes Association also provides lists of so-called "free foods" — items containing less than 20 calories per serving — which can be eaten freely as desired. These include low-sodium bouillon, sugar-free carbonated drinks, coffee, tea, condiments, and salad greens.