By Marci Sloane, Ms, Rd, Ld/n, Cde

An estimated 24 million Americans have diabetes and 1/3 of them don't even know it! Diabetes can lead to many complications -- since it is a disease of the vessels: heart disease, kidney disease, blindness, nerve damage and amputation are some of the problems that can result from uncontrolled diabetes. The good news is that diabetes can be managed by you. With proper education, you have the power to avoid or reduce the severity of these complications.

You can make a life-changing difference by following these guidelines:

1. Limit carbohydrates (starch, fruit, milk, sweets) at each meal or snack.


2. Consume approximately 30-60 grams of total carbohydrate per meal (depending on your calories for the day and how your glucose is running).

3. Consume approximately 15-30 grams of total carbohydrate per snack combined with a lean protein and/or unsaturated fat such as a yogurt with nuts or a fruit with low-fat cheese.

4. Evenly distribute carbohydrates throughout the day to avoid fluctuations in blood sugar and to achieve a level blood sugar.

5. Consume slow-digesting foods or food combinations to assist you in achieving a more level blood glucose. Consume the following foods in combination:
   a. High fiber carbohydrates (30-50 grams a day) like brown rice, whole grain breads or cereals, grains such as kasha, barley or millet.
   b. Lean protein such as fish, shellfish, poultry, lean meat and low-fat cheese.
   c. Unsaturated fat such as nuts, nut butters, avocado, oils.

6. Test your blood sugar before meals and 2 hours from the start of the meal to determine if your body can handle the amount of carbohydrates you've eaten. If not, decrease the amount of carbohydrates or you may need a medication adjustment. For example: Test at 8:00 am before beginning breakfast and then again at 10:00 am.

7. Look for the following results when testing blood sugar:a. Before meals blood sugar should be 90-130 mg/dL (American Diabetes Association - ADA guidelines*) or 80-110 (American Association of Clinical Endocrinologists -- AACE guidelines**)
   b. After 2 hours blood sugar should be under 180 mg/dL * or under 140 mg/dL**.
   c. Blood sugar can expect to rise about 30-50 points from a meal.
   
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