About a month ago, Marjorie Thier received some daunting news.
"I was told I have diabetes," said the 72-year-old Safety Harbor woman. "It's so scary because of what all it can do to your eyes, your feet and kidneys."
Diabetes is a chronic condition where the body doesn't produce or correctly use insulin, a hormone needed to convert sugar, or glucose, into energy. Over time, unchecked blood sugar can lead to blindness, heart disease or kidney damage.
But by eating right and exercising regularly, Thier may be able to avoid diabetes-related problems.
She has dusted off her Richard Simmons exercise tapes and is walking the dog. She also enrolled in a class at Mease Countryside Hospital to learn how to make proper food choices.
Nancy Maza, a registered dietitian and certified diabetes educator who teaches the class at the hospital, said the most common misconception people have about diabetes is that carbohydrates need to be avoided. Not true.
"It's all about eating consistent amounts of carbohydrates at each meal," Maza explained to a recent class, adding that fat also needs to be moderated. "It's a correct balance of carbohydrates, proteins and fats that will help achieve a healthy weight and keep blood sugar stable."
Carbohydrates have the biggest effect on blood sugar so they must be monitored, she said.
Maza refers to each serving as a "choice." One choice is equal to 15 grams of carbohydrates. The number of choices for each meal varies according to age, weight, gender and activity.
On this day, Thier learned she could have three carb choices at mealtime, or a total of 45 grams of carbohydrates.
Her choices can come from breads, crackers, cereals, pastas, fruits, milk, yogurt, chips, granola bars, soup and vegetables. But how much of each one can she spend on a carbohydrate budget?
The devil is in the details.
For instance, one carb choice can mean a quarter cup of Grape Nuts or three-quarters cup of cornflakes. Or perhaps one 4-inch banana or 2 tablespoons of raisins.
Nutritional information can be found on food labels, in books, online and from doctors and dietitians.
The American Diabetes Association recently created an interactive online tool called MyFoodAdvisor, which helps demystify food choices, at tracker. diabetes.org/myfoodadvisor.html.
Users can plug in the name of a food and get a breakdown of calories, carbohydrates, saturated fat, sodium and fiber.
Consumers can also find healthy recipes for a fresh herb omelet or flounder with Parmesan crust, then save their favorites to the online recipe box. Or take an old family recipe, such as grandma's pumpkin pie, input ingredients and have it analyzed for nutritional makeup.
The right menu
"Folks, you are done skipping meals," Maza told the class.
For people with diabetes, long stretches of time without food can cause problems. The goal is to keep blood sugar levels constant and that's aided by proper diet and, in many cases, medication.
She also advised the class to concentrate on low-fat foods "because too much fat can hold the glucose in the blood longer." The longer that sugar is in the bloodstream, the more damage it can cause to organs and eyes.
With that, the students moved to a lunch buffet of fruit, low-fat Swiss cheese, turkey, chicken salad, whole wheat bread, Italian wedding soup, lettuce and tomato, and sugar-free drinks.
It was a chance to practice their newfound knowledge.
"The lettuce and tomato are free choices because they are nonstarchy vegetables unless you have very large amounts," Maza said.
Free foods are those foods and drinks that contain less than 5 grams of carbohydrates per serving, such as one piece of sugar-free hard candy, a tablespoon of soy sauce or a glass of diet soda.
Some "free" foods must be counted and limited as well.
Diane Bordner, 62, of Palm Harbor received her diabetes diagnosis 20 years ago, but did little about it.
"It seemed like too much trouble to plan," she said.
Now she regrets it.
In July, she was diagnosed with heart disease and underwent double bypass surgery.
"I wish I had paid attention 20 years ago," she said. "Now I'm learning how to get my nutrition in a consistent way that will benefit my health."
Terri Bryce Reeves can be reached at firstname.lastname@example.org.
Cheddar and Zucchini Frittata
1 cup refrigerated or frozen egg substitute or 4 eggs
1/2 cup finely shredded reduced-fat cheddar cheese
2 tablespoons snipped fresh flat-leaf parsley
1/4 teaspoon ground black pepper
1/8 teaspoon salt
2 teaspoons olive oil
12 ounces zucchini, halved lengthwise and sliced
4 green onions, sliced
Position a rack in the upper third of the oven and preheat oven to 450 degrees. In a medium bowl, whisk together eggs, cheese, half of the parsley, pepper and salt. Set aside.
In a 9- to 10-inch ovenproof skillet, heat olive oil over medium-high heat. Add zucchini and green onions; cook for 5 to 8 minutes or just until tender, stirring frequently.
Carefully pour the egg mixture over the vegetables. Reduce heat to medium. As mixture sets, run a spatula around the edge of the skillet, lifting egg mixture so uncooked portion flows underneath. Continue cooking and lifting edges about 5 minutes or until egg mixture is almost set (surface will be moist). Reduce heat as necessary to prevent overbrowning.
Place the skillet in the oven. Bake about 5 minutes or until the frittata is firm and the top is golden. Sprinkle with remaining tablespoon of parsley. Cut into wedges. Serve warm.
Nutritional information per serving: 115 calories, 5g fat (2g saturated), 321mg sodium, 6g carbohydrates, 1g fiber, 11g protein.
Source: Diabetic Living magazine
Farmhouse Beef Casserole
Olive oil cooking spray
1 small, about 4 ounces Russet or all-purpose potato
1 cup shredded low-fat mozzarella cheese
1 pound extra-lean ground sirloin
1 medium yellow onion, chopped
2 cloves garlic, minced
14 1/2-ounce can no-salt-added diced tomatoes with juice
1 tablespoon chili powder, or to taste
2 cups shredded green cabbage
Freshly ground pepper to taste
1 to 3 tablespoons purchased taco sauce
6 slices pickled jalapeno (optional)
Preheat oven to 375 degrees. Lightly coat a 2-quart casserole with cooking spray.
Peel and grate the potato into a bowl. Stir in 1/4 cup of the cheese. Spread evenly over the bottom of the prepared casserole dish. Bake for 15 to 20 minutes, until potato is browned and crispy.
Meanwhile, brown ground sirloin, onion and garlic in a large nonstick skillet, breaking up the beef with a wooden spoon as it browns. Discard any excess fat. Stir in tomatoes with their juice, chili powder and the cabbage. Season with pepper to taste. Saute, stirring, for a minute or two. If mixture seems too dry, add 1 tablespoon of the bottled taco sauce, adding up to 2 tablespoons more, if needed, if mixture seems too dry.
When potatoes are done, spoon beef mixture on top of potatoes. Top with remaining cheese and jalapeno slices (if using). Bake for 25 to 30 minutes, until casserole is hot and bubbly. Serve at once.
Nutritional information per serving: 235 calories, 24g protein, 11g fat (5g saturated), 12g carbohydrates, 2g fiber, 357mg sodium.
Shrimp Enchiladas With Mole
1/4 cup mole sauce (see note)
2 tablespoons olive oil
1/2 ounce Mexican chocolate
18 medium shrimp, peeled, tail removed
1 teaspoon kosher salt
1/2 teaspoon garlic powder
1/2 teaspoon sweet paprika
6 jalapeno peppers, small
1 white onion, large peeled and sliced 1/4 inch thick
6 corn tortillas
1/2 cup mozzarella cheese, shredded
1 head romaine lettuce, sliced
1 tomato, sliced 1/4-inch thick
1 cup queso fresco, Mexican, crumbled
1/8 teaspoon chili powder (to garnish)
1 lime, quartered
In an aluminum baking tray on a preheated grill, mix mole and olive oil together. Add the chocolate and cook until it melts, stirring frequently to keep the chocolate from scorching. Set aside and keep warm.
Toss shrimp with salt, garlic powder and paprika and grill until pink, 2 to 3 minutes per side. Remove shrimp and chop into pieces. Grill jalapenos and onion slices until nicely marked and slightly softened.
Grill tortillas, turning, until they are warm and pliable. Dip each tortilla in the mole sauce to cover completely. Place some shrimp in each tortilla, roll up loosely, and set seam down in mole. Sprinkle the top with mozzarella cheese and grill, covered, until cheese melts.
Put 2 or 3 enchiladas on a serving plate, and top with sliced lettuce, grilled onions, tomatoes and queso fresco. Sprinkle chili powder over the top, and serve with lime wedges and grilled jalapenos.
Note: Look for mole jars in the Mexican food aisle of your grocery store.
Nutritional information per serving: 407 calories, 19g fat (5g saturated), 45g carbohydrate, 11g fiber, 19g protein.
4 sheets phyllo pastry dough
2 teaspoons unsalted butter, melted
1 tablespoon confectioners' sugar, divided use
6 tablespoons low-fat yogurt
1 tablespoon lemon curd
12 ounces small strawberries, hulled and cut in half
Preheat the oven to 400 degrees. Set a sheet of phyllo dough on a nonstick baking tray. Brush with melted butter and sprinkle with 1/2 of the confectioners' sugar.
Bake the pastry for 10 minutes until golden. Let it go cold.
Mix the yogurt with the lemon curd and spread over the pastry. Top with the strawberries and sprinkle with the remaining confectioners' sugar. Serve at once.
Nutritional information per serving: 89 calories, 2g fat (1g saturated), 16g carbohydrates, trace sodium.
Source: The Diabetes Weight Loss Diet by Antony Worrall Thompson (Kyle Books, 2008)
>>by the numbers
23.6-million people in the United States have diabetes.
7.8 Percent of the U.S. population with diabetes (17.9-million people diagnosed and 5.7-million people undiagnosed).
57-million people have prediabetes.
$174-billion a year is spent on diabetes treatment.
Source: American Diabetes Association and Centers for Disease Control and Prevention
The Morton Plant Mease Diabetes Education Center offers classes in a variety of locations. For information, call (727) 734-6888. This program is recognized by the American Diabetes Association and qualifies for Medicare and other insurance reimbursement for some people.