Holiday Time and Diabetes | eleven common sense rules



Nora Saul, M.S, R.D., L.D.N., C.D.E.
Nora Saul is a Certified Diabetes Educator and Manager of Nutritional Education at the Joslin Diabetes Center

Dietitians aren’t the most revered people around this time of year. The general perception is that we take the jolly out of holiday gatherings.

I love good food and I love to eat. And I completely believe in the 80/20 rule. You know the one I am talking about: spend 80% of your time on the 20% of things that count.

When applied to food that means spend 80% of your food budget consuming healthful foods that increase your likelihood of avoiding chronic diseases and keeping your A1C in good control.

That leaves plenty of wiggle room.

So this year I am not going to tell you how you can eat a low fat Thanksgiving dinner on 45 or 60 grams of carbohydrate. I am not going to provide a list of recipes for “mashed potatoes” made with cauliflower, or tell you should eat the pumpkin pie instead of apple pie because it has fewer carbs. If you want to learn how to do that, pick up just about any diabetes or fitness magazine.

Instead, I am going to remind you that healthy eating is about having a game plan for the long haul and feeling comfortable indulging on an occasional basis without fear of bringing your A1C up 2 percentage points or feeling guilty because you ate 115 grams of carbohydrate at the holiday dinner.

I don’t think one or two high calorie meals make much difference in the scheme of things.

In the six weeks between Thanksgiving and New Years, decide on the meals that you want to fully enjoy without becoming a poster child for the “sin” of gluttony. The rest? Well, they become everyday meals — you use your meal plan just as you would at home.

Remember Thanksgiving and New Years dinners add up to only two meals and for those of you who celebrate Christmas – a total of three meals. If you remember 80/20 you will be just fine.


So here are ten more basic, common sense rules for the holidays (actually for any food

  1. Never let yourself “starve” Use the hunger scale to figure out how hungry you are and if you are starting to move into the 3 and below rankings, have a small snack.
  2. Enjoy the conversation and the company — Eat slowly enough to give your brain time to register that you are filling up and aren’t hungry anymore.
  3. Know the count — if you carb count, get to know the carb counts of typical holiday foods, not so you can limit yourself but so that you can give the appropriate amount of insulin.
  4. Choose your celebration splurges — which ones have sumptuous food you don’t want to pass up and which ones do you want the company to be the main attraction.
  5. Concentrate on the vegetables and proteins first to help reduce your appetite.
  6. Eat what you want not what other people want you to eat.
  7. Practice the art of the polite decline — you can still show Aunt Masie that you love her, even if you don’t want to eat her fruitcake.
  8. Leave the table before you are full.
  9. You don’t need to try everything today — that’s what leftovers are for.
  10. When you move away from the table, keep moving. After-dinner is a great time to put on your new hat and gloves and take in the vistas in your aunt’s neighborhood (the football game will still be there when you get back).

Those are my common sense rules for dealing with holiday eating.  What are yours?

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  1. Thank you! Thank you! Thank you! As a T1 I always focus on the “treats” that I don’t get during the course of the year. I love mashed potatoes, but I can have those anytime. I LOVE the homemade gravy and I do not have that during the rest of the year, ditto for the homemade cornbread stuffing. So I have the stuffing w/ turkey and top it w/ some gravy. And definitely having some of the maple cranberry sauce. I measure everything — not a big deal b/c we do our meal buffet style and it is slow-moving! Happy Thanksgiving!!

  2. Thank you! This is an important message for all people not just those with diabetes. I especially appreciate the acknowledgment that people with diabetes are human and it is not a sign of weakness to desire or indulge in a scrumptious meal. I have been living with diabetes for almost 20 years and I don’t need a special plate or contract to help me know how to healthfully enjoy a delicious meal.

  3. Finally! A web dietician with a heart! So much of the diabetes newsletters I get are filled with negativity– warnings, commands, nagging. Diabetes takes enough joy out of life without having endless warnings of the threat of complications and naggings to avoid everything but fruit and vegetables. Everyone is different in diabetes, of course, and what is acceptable food or beverage to one is bad news to another, and each one has to plot his own course, but frankly, the endless warnings and naggings are very tiresome. Thanks for being understanding and sensible at these times of years! Happy Thanksgiving!

  4. Please understand that I have always been a non-conformist which means that I don’t want anybody to think that I am contradicting Ms. Nora Saul, CDE. She is of course right.

    When I was diagnosed as a type 2 diabetic in July 1991 based on a fasting sugar reading of 468 mg/dl and was required to take several anti-diabetes pills, I refused to do so. So I was then required to take a stress test to find out if my heart was still healthy enough to take some more stress and strain. Luckily, I passed the stress test.

    What did I, a 55-year-old man then, do next? I ran our stairs for a total of 2 hours/day in as many sessions as 8, and ate only heart-healthy, natural, and fresh (raw or cooked) foods, mostly carbohydrates.

    I attended a seminar held in our city’s hospital where I learned about the KQP (King, Queen, Pauper) way of eating (only water between meals). To me, this means that I have to eat as much as want at breakfast, eat less when I get hungry, and eat the least the next time I get hungry.

    Long story short, for more than 20 years now, all my after-meal sugar levels have been unacceptably high, all my past A1c”s were from 5.2% to 6.3% (the one I had in Jun 2011 was 5.6%), have never had any hypoglycemic episode, have not had any diabetes complications, have been exercising an average of 90 minutes/day, have been as healthy as any 76-ear old man wants to be, and have been feeling strong and energetic like I am half my age.

    In short, I have been living like I have no diabetes.



  5. Being a mum of aT1 teenager can be even more tricky. Sometimes it’s difficult to draw the line. Both of us are responsible and although the first two years I was quite strict, things are starting to change this third year and we have made some exceptions and everything is going right! Thank you Nora (and also my peditrician) for helping me to be more flexible!
    Among others things, my son will enjoy a piece of a special sweet called “Roscón de Reyes” (usually a sugar-frosted fruit-filled bread, although ours is nearly sugar free, but he doesn’t even notice that!) in the family breakfast we will have on 6 January to celebrate The Three wise men.

  6. Thank you for this web site. After 60 plus years with type l diabetes we can still learn.I am grateful for Joslin Clinic and how they helped me when I went there in 1972. This thanksgiving and every day I am thankful.

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