1. Controlling Diabetes During the Holidays Janine Freeman, RD,LD,CDE
UGA Extension Nutrition Specialist

2. ‘Tis The Season For Temptation
Out-of-control blood sugars
Extra pounds
With the holiday season upon us, there will be
more boxes of chocolate,
sweet potato pies,
and tempting cakes than you can count.
And for the momentary pleasures they can give you, they can wreak havoc on blood sugar control.
It can be a challenge to keep your diabetes well-controlled and keep off the unwanted pounds.

3. Holidays Are A Time To: Share with family and loved ones
Become spiritually connected
Shop, decorate the house, wrap gifts
Bake and cook
Eat, eat, eat...
(USE MOUSE)
The holiday season should be a very special time set aside to share with family and loved ones.
A time when many people become more spiritually connected
Families and friends partake of the season’s festivities.
Unfortunately, holiday customs seem to primarily revolve around eating:
-You meet friends for a holiday lunch.
-You attend parties with loads of tempting foods and drinks.
- You bake holiday treats.
-Family get-togethers involve more food than anyone can possibly eat.

4. Focus On Holiday Activities That Don’t Involve Food
Decorating for the holidays
Attending holiday musicals or plays
Christmas caroling
Shopping
Gift-giving
Try to focus on holiday activities that don’t involve food. WHAT CAN YOU DO?
Have family or guests help decorate for the holiday;
organize groups to attend holiday musicals or plays,
have a caroling party.
Go shopping(KEEP WITHIN BUDGET)with your family or friends even if you’re finished purchasing your gifts to get some extra activity and to enjoy the holiday spirit.
Think of ways you and your family can participate in gift-giving, especially to those in need. (Retirement Centers, sponsor a family to give gifts through churches or other organizations)

5. Make Time for Physical Activity
Relieves your stress
Improves your mood
Lowers your blood glucose levels
Helps with weight control
Make time for physical activity despite your busy schedule. It can
relieve your stress that’s so common during the holidays,
improve your mood, making you more likely to keep up with your self- care responsibilities
lowers your blood glucose levels,
and help with weight control.

6. Fit Physical Activity Into Your Busy Schedule
Split your activity into 2 or 3 intervals of minutes each
Make physical activity a family event
Walk around the neighborhood after dinner
Go mall-walking
Park farther from your destination
Think you don’t have a 30-minute block of time to walk? Try splitting it up into 2 or 3 segments of minutes each. Maybe once in the morning, after lunch, and after dinner. It’s easier to fit into your schedule.
Gather your family together and make physical activity a family event. Children learn by example. Make physical activity part of the family routine. You can catch up on what’s going on with your family during the walk.
In inclement weather, go mall-walking. Many malls have walking clubs.
When shopping, park as far away from the store as you can to get in extra steps.

7. Stay Active While Travelling
Wear walking shoes
Get to airport early and walk concourses
Take very little carry-on luggage and walk during layovers
Look for hotels with exercise facilities
Air travel can interfere with exercise routines. Be creative as to how you can incorporate some physical activity. It’s also very important to get up and move around during long flights.

8. Lighten Up Your Favorite Holiday Foods
Make changes in recipes to:
lower the carbohydrate
less effect on blood glucose
lower the fat or change the type of fat
healthier for your heart
fewer calories
You can still eat traditional holiday foods like everyone else. However, you can make some changes to either reduce the carbohydrate in high-carbohydrate foods and/or lower the fat in traditionally high-fat foods.

9. Holiday Baking Desserts can be made with: sugar low-calorie sweeteners
Many desserts can be made with either sugar or low-calorie sweeteners. Some, however, work best with sugar.
If you use sugar, you’ll get additional carbohydrate - the amount will depend on how much sugar the recipe calls for.

10. Use of Sugar in Diabetes Meal Plan
Raises blood glucose levels in similar way to starches
Can be used in moderation
Years ago experts assumed that foods with sugar made the blood sugar increase more quickly and to a greater extent than starchy foods.
Research now has shown that foods with sugar raise the blood glucose very much like starchy foods. Therefore, the total amount of carbohydrate is more important than whether you’re eating sugar or starch.
Small amounts of foods with sugar can be used in your mealplan.

11. Use of Sugar in the Meal Plan
Substitute sweets for other carbohydrate in the same meal
Check effect on your blood glucose after meals
But you must substitute them for other carbohydrate-containing foods. If you simply add them to your usual meal plan, your blood glucose will increase.
Always check your blood glucose a couple of hours after a meal when trying new foods.

12. Role of Sugar in Baking
Sugar provides volume, texture, moistness, and browning
Low-calorie sweeteners only provide sweet taste
We can’t simply substitute low-calorie sweeteners for sugar in baked foods like you can with beverages.
We often think of adding sugar simply for the sweet taste, but sugar goes through certain chemical changes during baking that some foods require to result in an acceptable product.
Sugar provides structure, volume and texture to recipes. It also add browning, helps retain moisture and provides tenderness to baked goods. It also has a preservative quality, so foods may not last as long without sugar.

13. Sugar in Baking Sugar is needed in yeast breads to raise
The quality of many cakes and cookies suffer with reduced sugar or no sugar
For example, yeast will not grow well if sugar is totally removed from bread recipes.
Generally the quality of baked goods like cakes and some cookies suffer when sugar is reduced or replaced by a sugar-substitute.

14. Low-calorie Sweeteners in Baking
Sucralose (Splenda)
Aspartame (Equal, NutraSweet)
Acesulfame-K (Sweet-One)
Saccharin (Sweet ‘n Low, Sugar-Twin)
Neotame (recently approved by FDA)
Currently 4 low-calorie sweeteners are available for use in the US and 1 additional one, Neotame, has recently been approved by the FDA, but is not yet available in a table-top sweetener.

15. Sucralose (Splenda) 600 times sweeter than sugar
Stable at high cooking temperatures
Recipes available on web site
How many of you have used Sucralose, Splenda?
It is a relatively new sweetener available in the US, made from a sugar molecule and is extremely sweet. Therefore, you get very little of the sweetener in a serving. It is not digested and absorbed, therefore it doesn’t raise the blood sugar or provide any calories.
A nice property about Splenda is that it is very stable in cooking. It comes in granular form to use in cooking and baking which measures like sugar. The packet form is for sweetening beverages or cereal.
Recipes are available online.

16. Consider Heat Stability of Sweeteners for Cooking or Baking
Unstable at high temperatures
Aspartame (loses sweetness)
Saccharin (becomes bitter)
Stable in cooking and baking
Sucralose
Acesulfame-K
When choosing a low-calorie sweetener to use in cooking or baking, consider the heat stability.
Aspartame is not stable at high temperatures and will lose its sweetness if cooked at a high temperature or for very long. It gradually loses sweetness over time.
Saccharin, although preferred by many people who grew up with it, tends to take on a bitter taste with heat.
Sucralose (Splenda) and Acesulfame-K (Sweet-One) do not lose their sweetness when cooked.

17. Increase Stability of Aspartame
(Equal, NutraSweet, store brands)
Add to food after cooking
Combine with more stable sweetener
Add acidic ingredient
With aspartame, it’s best to add it to the food or beverage after cooking like in a pudding or sauce. It can be used in some baked products like cheesecake or pumpkin pie that don’t have a large amount of sugar and are not subjected to extremely high temperatures. Using some sugar or combining with another more stable sweetener may be advisable.

18. Low-calorie Sweeteners
In general, use when sugar is primarily for sweet taste
Fruit fillings (pies, cobblers)
Custards
Puddings
Beverages
Frozen desserts
Sauces and marinades
Low-calorie sweeteners work best when sugar is needed primarily for taste as in fruit pies, custard pies like pumpkin, beverages, marinades, frozen desserts.
You may need to add some extra thickening to fruit fillings, puddings because sugar lends a viscous quality.

19. Low-calorie Sweeteners
Do not work well as the sole sweetener
in these foods:
Meringues
Angel food cake
Pecan pies
Pound cake
Foods that require a lot of sugar do not work as well when sugar is totally replaced with a low-calorie sweetener.
Meringues and angel food cake will have less volume and stability without sugar.
Pecan pies contain a lot of corn syrup - replacing the corn syrup with a low calorie sweetener is not recommended.

20. Tips for Using Low Calorie Sweeteners in Baking
Cookies, muffins, quickbreads:
Honey or molasses will add some flavor and moistness
Add baking soda
Check for doneness early
Special recipes are often required to get an acceptable product when reducing the sugar in cookies, muffins and quickbreads.
You can add 1 Tbs molasses to each cup of sugar you’re replacing to achieve browning
Extra soda can help with raising.
Foods made without sugar tend to bake more quickly.

21. Tips for Using Low Calorie Sweeteners in Baking
Cakes:
Use molasses or cocoa for browning
Add 1/2 cup nonfat dry milk and 1/2 tsp baking soda for every cup of sugar replaced
Combine sugar with low calorie sweetener
Cakes without sugar tend to be flat, rubbery, dry and light-colored without much browning if the sugar is replaced with a sweetener.
Specific guidelines are listed on Splenda’s web page for adding nonfat dry milk for more bulk, soda to help it raise, and molasses for more color.

22. Tips for Using Low Calorie Sweeteners in Baking
Fruit fillings, sauces, puddings, custards
Add thickening
Reduce cooking time
In fruit fillings and sauces, add some thickening as sugar has a viscous quality that sweeteners don’t have and reduce cooking time.

23. Choose A Sweetener for Pumpkin Pie
What is the purpose of sugar in pumpkin pie?
Primarily sweet taste
Which sweeteners could be used?
Equal, Splenda, Sweet-One, or others
Although the preference for various sweeteners is very individual, some will be better choices with certain foods.

24. Choose a Sweetener for Red Velvet Cake
What is the purpose of sugar in a red velvet cake?
Volume, texture, tenderness, moistness
Would you use a sweetener? If so, which one?
Sugar would work best
Cakes work best with sugar. However, you can try using part low-calorie sweetener with instructions on Splenda web site adding additional nonfat dry milk and baking soda.:

25. Choose a Sweetener for Christmas Cookies
What is the purpose of sugar in cookies?
Texture, tenderness, browning, moistness, taste, volume
What sweetener would you use?
Sugar alone or sugar with Splenda, Equal, Sweet-One
Combine sugar with Splenda?

26. Sugar vs Low-calorie Sweetener
Pumpkin pie with sugar
38 grams carb
Pumpkin pie with low-calorie sweetener
20 grams carb
Using a low-calorie sweetener will reduce your carbohydrate and calories, depending on how much sugar you’re replacing. Making pumpkin pie with a low calorie sweetener saves 18 grams of carbohydrate (1 carb choice or 1 exchange) and saves 73 calories.

27. Sugar vs Low-calorie Sweetener
12 ounces Iced Tea with Sugar
33 grams carb
12 ounces Iced Tea with Low Calorie Sweetener
0 grams carb
We often don’t think about sweetened beverages. Compare regular sweetened tea with tea sweetened with a low-calorie sweetener.
33 grams of carbohydrate can have a significant impact on your blood sugar.

28. Reduce Fat in Recipes Non-baked foods:
Substitute fat with non-fat or low-fat ingredients
Reduce the fat
You can also reduce the fat in some recipes.
You can substitute the entire amount of fat with non-fat or low-fat ingredients in foods that are not baked. Generally, the fat is primarily for flavor in these foods.
Examples include banana cream pie, chocolate pudding, strawberry pie, salads like chicken salad.

29. Reduce Fat in Recipes In baking:
Some fat needed for flavor, moisture, and tenderness
Fat has a greater role in baked foods. It gives your baked foods flavor, moisture, and a tender texture.
If you reduce the fat in your recipe, you should replace it with other ingredients that work in a similar way.
Depending on the recipe, you may have a better product if you leave a small amount of the fat in the recipe.

30. Reduce Fat in Recipes In baking:
Use low-fat yogurt or sour cream in place of regular sour cream in cookies and muffins
Replace fat with 1/2 amount of fruit puree or applesauce
1/2 cup prune or banana
puree in place of 1 cup
margarine
Using nonfat or low-fat yogurt, nonfat or low-fat sour cream, and fruit purees (like banana or prune), applesauce, or cottage cheese can provide a lot of the same characteristics as fat in muffins, cakes, cookies, and quick breads.

31. Traditional vs Healthy Pumpkin Pie
Let’s look at how we can adjust a recipe for pumpkin pie to reduce the calories, fat, and carbohydrate. By replacing the sugar with Splenda and using evaporated skim milk instead of whole milk:
We can reduce the calories by 100
Cut the carbohydrate in half
Reduce the fat by 1/3

32. Holiday Meals

33. Holiday Meal Tips Identify carbohydrate foods:
(carbohydrates raise the blood glucose the most)
Starches
bread and rolls, stuffing, potatoes,
sweet potatoes, corn, peas, butter beans
Sugars
fruit, candy, desserts, milk, sodas,
sweet tea, eggnog
One of the first things you should do at a holiday meal is to identify the foods that contain carbohydrate. They will have the most effect on your blood glucose.

34. Holiday Meal Tips Eat usual daily amount of carbohydrate
Space out carbohydrate based on timing of holiday meal
Adjust insulin based on carbohydrate if you’ve been trained
Check blood glucose regularly
The most important factor in keeping your blood glucose in check is to keep within your usual daily carbohydrate range. The more carbohydrate you eat at a meal, the higher your blood glucose will rise after the meal. So, for most people with diabetes, it’s best to space it fairly evenly throughout the day.
If you take the short-acting insulin at each meal, you can adjust your insulin based on how much carbohydrate you plan to eat.
Check your blood glucose 2 hours after meals to see what your usual range is. (A general guideline is less than , but you and your doctor may choose to go even lower).

35. Holiday Meal Tips Fill up on low-calorie salads and vegetables
Avoid second helpings
Use high-fat condiments sparingly
Small portion of dessert can be eaten in place of other carbohydrate foods
To minimize the extra calories and high blood sugars, don’t forget to include vegs and lettuce salads (other types of salads can be high in fat and carbohydrate)
Go light on the gravy, sauces and butter.
A small amount of dessert can be eating in place of other CHO foods.

36. Estimating Portion Sizes
1 cup pasta = woman’s clenched fist
½ cup vegs = ½ tennis ball
1 fruit serving = 1 tennis ball
3 ounces meat = deck of cards
1 teaspoon = thumb-tip
1 tablespoon = 2 thumbs pressed together

37. Make Smart Food Choices
63 grams carb
1 piece pecan pie
(1/8 of pie)
58 grams carb
1/2 cup mashed potatoes
1/2 cup stuffing
1 roll
1/2 cup green beans
3 ounces turkey
2 Tbs. gravy
Tossed salad with Italian dressing
Just to keep it in perspective:
A piece of pecan pie has a whopping 63 grams of carbohydrate equal to the amount of carbohydrate in an entire dinner of potatoes, stuffing, roll turkey and veg and salad.
In other words, a piece of pecan pie will raise your blood sugar about the same amount as the turkey meal.

38. Holiday Meal 3 ounces turkey 1/2 cup stuffing (20 grams carb)
2 Tbs. gravy
1/2 cup green beans (5 grams carb)
Tossed salad with Italian dressing
1 slice pumpkin pie (38 g carb - sugar)
(20 g carb with sweetener)
To stay within the 60 grams of carbohydrate, you could have a nice meal with a piece of pumpkin pie. Use a low-calorie sweetener and you only get 45 grams of carbohydrate
Total carb: 63 grams (45 grams)

39. Traditional Holiday Dinner
Waldorf Salad
Roast Turkey/gravy
Green Bean Casserole
Mashed Potatoes/Gravy
Sausage Stuffing/gravy
Cranberry Sauce
Dinner rolls with butter
Pecan Pie
Alternative
Low-fat mayonnaise
Without gravy
Plain beans or ff soup
Eliminate gravy
Avoid sausage
SF cranberry relish
Eliminate butter
Pumpkin Pie
Can you give suggestions to lighten this meal to make it more diabetes-friendly?
Pecan pie: 503 calories, 63 CHO, 27 g fat
Pumpkin orsweet potato pie: 285 calories, 40 g CHO, 12 g fat

40. Attending Holiday Parties
Plan ahead what you will eat
Offer to bring a healthy dish
Eat something light at home to curb your appetite
Parties are difficult for many people. It’s best to decide ahead of time what and how much you’ll eat.
Offer to bring a healthy dish - that way you’ll ensure that there’s at least something healthy for you to eat.
Don’t go to the party famished - you’ll eat too much. Instead, if you’re very hungry before the party, eat something light at home to curb your appetite.

41. Attending Holiday Parties
Skip second helpings
Avoid lingering near buffet table
Mingle with guests - you’ll eat less
Avoid the temptation to have second helpings - extra carbohydrate and extra calories. Try to stay within your usual portion sizes.
Don’t hang around the buffet table - it’s too tempting. Instead, mingle with guests. You’ll eat less if you’re talking.

42. Limit Alcoholic Beverages
Reduces willpower
Adds extra pounds
Can cause hypoglycemia if taking insulin
Always eat something when drinking
Alcohol reduced willpower, so many people tend to eat more when they drink.
Alcohol contains extra calories and often it is mixed with high-calorie mixers (Eggnog)
People taking insulin can experience low blood sugar after drinking alcoholic beverages, so it’s best to eat something when drinking.
American Diabetes Association recommends:
Women: limit to no more than 1 drink in a day
Men: Limit to no more than 2 drinks in one day
Some people should not drink at all - those with high triglycerides, neuropathy, and those taking medications that interact with alcohol (look on medication bottles)

43. Holiday Entertaining Reduce stress by planning ahead
Ask people to bring a dish
Don’t try to be a Martha Stewart
Get enough sleep
Entertaining can be very stressful. Planning ahead will help tremendously.
Don’t try to do everything yourself. Ask others to bring a dish. Get your family involved in preparing for the party.
Get plenty of sleep. You’ll be able to deal with the stress more effectively.

44. Reduce Your Stress Plan ahead Make a shopping list
Take a vacation day to do your shopping or holiday baking
Schedule physical activity
Ways to deal with the holiday stress:
Make lists of things you have to do for the holidays:
people you need to buy gifts for, the type of gifts, holiday baking or cooking you need to do.
If you feel like you don’t have enough time, take a vacation day to do your shopping or holiday baking
Schedule physical activity in every day. You’ll be amazed how much better you deal with the stress.

45. Enjoy Your Holidays Don’t set your expectations too high
Enjoy your holiday festivities
Remember that no one is perfect - don’t set your expectations too high. Your overall diabetes control won’t suffer with a little indiscretion. Enjoy the special times and a few special meals, but remember to get right back on track the next day.
Keep checking your blood glucose regularly so you know how you’re doing.
Remember the whole purpose behind the holidays and try to experience the enjoyment..

46. Happy Holidays!

47. Practical Non-food Gifts to Give or Receive
Pedometer
Exercise video
Walking shoes
Exercise clothes
Fitness class
Gift certificate to spa
Healthy cookbook
Some good non-food gift ideas for people with diabetes or anyone include:
pedometer to measure steps and motivate people to move more
exercise videos
walking shoes, cushioned socks
appropriate clothes for exercising
gift certificates to a spa or health club
healthy cookbook - Example of a holiday cookbook:
The American Diabetes Association’s Mr Food’s Everyday’s a Holiday Diabetic Cookbook ( (2002)