Nearly 30 million people of all ages have been diagnosed with diabetes. Individuals managing this condition face daily challenges in maintaining optimal blood sugar levels. However, the holiday season, marked by abundant feasts and treats, presents a unique set of hurdles for diabetics striving to balance festive enjoyment and health-conscious decisions. In this article, we delve into practical strategies tailored to assist individuals with diabetes in navigating the holiday festivities while effectively managing their blood sugar. 

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Understanding the Impact of Holiday Foods on Blood Sugar 

Traditional holiday foods, often rich in carbohydrates and sugars, can significantly impact blood sugar levels, posing challenges for individuals with diabetes or those striving to maintain stable glucose levels. Staple dishes like mashed potatoes, stuffing, and desserts are typically high in simple carbohydrates and refined sugars and low in fiber, leading to rapid spikes in blood sugar after consumption. Combining large portions and frequent snacking during festive gatherings also contributes to prolonged periods of elevated blood sugar. For individuals with diabetes, careful monitoring of food choices, portion sizes, and carbohydrate intake becomes crucial during the holiday season. Implementing strategies, such as opting for whole grains, incorporating fiber-rich foods, and practicing moderation, can help mitigate the impact of traditional holiday fare on blood sugar levels.

Preparing for Holiday Feasts

One of the hardest parts about living with diabetes is balancing and timing meals and snacks while trying to live a "normal" life. While planning meals helps make blood sugar-smart decisions, it can be more challenging during the holiday season, often characterized by potlucks, gatherings, and eating out. The American Diabetes Association (ADA) has created the Diabetes Plate Method to simplify making balanced meals without counting, calculating, or weighing. This method uses a 9-inch plate to visualize the correct portions of food groups that should make up a meal. To create meals using the Diabetes Plate Method, fill half the plate with nonstarchy vegetables, a quarter with lean protein, and one-quarter with carbohydrates (e.g., whole grains, starchy vegetables, fruit).

Careful and frequent blood sugar monitoring can provide meaningful feedback regarding how diet influences blood sugar control. Unstable, fluctuating blood sugars indicate the need for medication adjustments and lifestyle modifications. Consulting with your healthcare team (i.e., endocrinologist, nutritionist, dietician) before or during the holidays to discuss dosing adjustments to hypoglycemic medications and meal planning can help ensure blood sugar levels stay within their goal range.

Smart Food Choices and Substitutions

The carbohydrates we eat impact blood sugar, so balance is key. There are three main types of carbohydrates: starches, sugar, and fiber. The goal is to choose nutrient-dense carbohydrates rich in fiber, vitamins, and minerals and low in added sugars. Most carbohydrates you consume should be whole, unprocessed, non-starchy vegetables, like dark leafy greens, cruciferous vegetables, zucchini, cucumbers, and green beans. Whole grains, fresh fruits, beans, and starchy vegetables should be eaten in fewer quantities. Highly processed carbohydrates with added sugars, like sugary drinks, white bread and rice, and treats, should be limited to a minimum or avoided altogether. Balancing complex carbohydrates with healthy sources of lean protein and unsaturated fats helps slow digestion and absorption into the bloodstream, preventing rapid spikes and dips in blood sugar after eating. (3, 20) 

The concepts of glycemic index (GI) and glycemic load (GL) play significant roles in controlling blood sugar. The GI is a numerical scale that ranks carbohydrate-containing foods based on how quickly they raise blood sugar levels after consumption. Foods with a high GI cause a rapid spike in blood sugar, while those with a low GI result in a slower, more gradual increase. GL considers both the quality and quantity of carbohydrates in a food serving. It provides a more comprehensive picture by considering the amount of carbohydrates consumed, offering a more accurate representation of a food's impact on blood sugar. Evidence shows that low-GI and GL diets are positively associated with reduced risk and better management of type 2 diabetes.

Reading nutrition labels is a critical aspect of effective blood sugar management. Nutrition labels provide invaluable information about the composition of foods, helping diabetics make informed choices tailored to their specific dietary needs. By examining details such as total carbohydrate content, fiber, added sugars, and serving sizes, individuals can accurately assess the impact of a particular food on blood sugar. This knowledge lets them make healthier food choices, control portion sizes, calculate insulin doses more accurately, and maintain stable glucose levels. 

The following are examples of healthy holiday food choices and substitutions for people with diabetes:

• Lean proteins: poultry, fish, tofu, and legumes
• Complex, low-GI carbohydrates: sweet potatoes, legumes, oats, barley, quinoa, brown rice
• Unsaturated fats: avocados, nuts, seeds, olive oil, fatty fish
• Low-GI fruits (eaten in moderation): berries, cherries, apples, citrus
• Sugar substitutes: stevia, erythritol, or monk fruit
• Note that the order in which you eat your food can affect blood sugar levels. To prevent rapid blood sugar spikes during and after eating, it is recommended to eat macronutrients in the following order: protein, vegetables, fats, and carbohydrates. 

Portion Control and Mindful Eating

Controlling portion sizes helps regulate carbohydrate intake, a key factor influencing blood glucose levels. Portion size directly affects carbohydrates' effect on blood sugar levels; larger portions of high-GI foods will cause a higher spike in blood sugar than a smaller portion. It's easy to eat overeat, especially during holiday feasts or when eating out. Studies show that people tend to eat more when served food, partly because portion sizes have grown over the last 20 years. By consuming smaller, well-balanced portions, individuals can avoid overloading the body with excessive glucose, thereby preventing abrupt spikes in blood sugar. (6) 

The Diabetes Plate Method (discussed above) is one trick that can help keep portion sizes under control. The following "hand method" is another easy guide to visualize and estimate appropriate portion sizes: 

1. 3 ounces of meat, fish, or poultry: palm of hand (no fingers)
2. 1 ounce of meat or cheese: thumb (tip to base)
3. 1 cup or 1 medium fruit: fist
4. 1-2 ounces of nuts or pretzels: cupped hand
5. 1 tablespoon: thumb tip (tip to 1st joint)
6. 1 teaspoon: fingertip (tip to 1st joint

Mindful eating involves being fully present and attentive while consuming food, focusing on sensory experiences, and recognizing hunger and satiety cues to promote a healthier relationship with eating. Mindful eating practices include honoring the food before eating, engaging all senses during meals, savoring small bites, chewing thoroughly, eating slowly, and avoiding skipped meals. Mindful eating promotes awareness of the nutritional content of meals and hunger/satiety cues to prevent overeating, contributing to a successful approach for healthy blood sugar management and supporting overall cardiometabolic health.

Staying Active and Managing Stress

Exercise improves blood sugar control in type 2 diabetes, reduces cardiovascular risk factors, and supports healthy weight management. Exercise also benefits patients with type 1 diabetes by improving cardiovascular fitness, muscle strength, and insulin sensitivity. Aerobic, resistance, and high-intensity interval training have unique impacts on insulin sensitivity, making them all necessary forms of exercise to incorporate into a management regimen for diabetes. The ADA recommends getting at least 150 minutes of moderate-intensity physical activity weekly. Any physical activity is better than none. Longer periods of sedentary time are associated with increased mortality and morbidity and poorer glycemic control. Conversely, interrupting sitting with standing or light-intensity walking improves glycemic control in people with impaired glucose regulation. If you don't already have an established exercise routine, prioritize post-prandial walking during the holidays. Walking for 20 minutes after meals is more effective at lowering the glycemic impact of meals in individuals with type 2 diabetes than pre-meal exercise. (4) 

The holiday season can also be stress-provoking. Stress triggers the release of stress hormones like cortisol and adrenaline, leading to increased glucose production and reduced insulin effectiveness. For individuals with diabetes, this physiological response can result in elevated blood sugar levels and poorer glycemic control. Recognizing the potential negative impact of stress on diabetes management, it becomes crucial to prioritize stress management and self-care for blood sugar control during the holidays. Engaging in activities that promote relaxation, such as deep breathing exercises, meditation, gentle physical activity, and adequate sleep, can help alleviate stress. Additionally, setting realistic expectations for holiday commitments and delegating tasks can relieve pressures associated with the holidays. (15) 

Alcohol Consumption and Diabetes

Drinking alcohol increases the risk of hypoglycemic events, especially for diabetic patients taking hypoglycemic medications, such as sulfonylureas or insulin. This is because the liver is responsible for maintaining blood sugar and metabolizing alcohol; however, it cannot multitask, so it will prioritize alcohol metabolism when needed. Symptoms of intoxication mimic those of low blood sugar: slurred speech, confusion, and difficulty walking. The inability to quickly recognize and manage symptoms of hypoglycemia increases the risk of severe hypoglycemia and symptoms. Additionally, alcohol increases the risk of diabetes complications, including eye problems, heart disease, and stroke. (1, 16) 

There are no universal alcohol guidelines for diabetics. However, if you choose to drink, the following tips can make it easier to manage diabetes and alcohol intake safely: 

• Always drink in moderation. Moderate drinking is defined as one drink a day for women and up to two drinks per day for men. A standard drink is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80-proof spirits.
• Do not drink on an empty stomach. Eat a meal or snack when you drink to ensure blood sugar stays within its target range. 
• Monitor blood sugar levels regularly, even after you stop drinking, because alcohol can impair blood sugar for several hours. If blood sugar levels fall below 70 mg/dL, follow the "15-15 rule": have 15 grams of carbohydrates and recheck blood sugar levels after 15 minutes. Repeat until blood sugar is above 70 mg/dL. 
• Opt for light beers or dry wines – these have less alcohol and fewer calories than other options. If you like mixed drinks, use water or seltzer as your mixer over juice or soda, which are high in sugar. Avoid alcoholic beverages high in sugar, such as dessert wines, wine coolers, and sugary mixed cocktails (e.g., piña coladas). (11) 

Functional Medicine Lab Testing for Diabetics During the Holidays

Functional medicine lab testing offers a comprehensive understanding of an individual's blood sugar control and metabolic health. Specifically during the holiday season, when dietary/lifestyle habits and stress levels may fluctuate, specific tests become particularly useful for people with diabetes. 

Continuous glucose monitoring (CGM) systems offer real-time data on blood sugar fluctuations throughout the day, aiding in the identification of patterns and trends. This is a valuable alternative to fingerpricks for measuring fasting and post-prandial blood glucose levels.

A comprehensive diabetes panel assesses various markers of cardiometabolic health to assess glycemic control, insulin resistance, and adverse health complications resulting from hyperglycemia. A comprehensive metabolic panel (CMP) measures blood glucose and kidney and liver function. Hemoglobin A1c (HbA1c) is a long-term indicator of average blood sugar levels over the last three months; this is a standard biomarker used to diagnose and monitor diabetes. Fasting insulin is a single-marker measurement of insulin levels in a fasting state; elevated insulin levels indicate insulin resistance. All three of these labs are available through Access Medical Laboratories.  

Monitoring and Adjusting Blood Sugar Levels

Monitoring blood sugar during the holidays provides real-time insights into how variations in diet, stress, and other lifestyle changes impact blood sugar levels. Continuous awareness of these fluctuations empowers individuals to make timely adjustments to their food intake, medication, or insulin regimen. For instance, if blood sugar readings are consistently high, individuals can adjust their carbohydrate intake by choosing lower GI foods and eating smaller portions. On the other hand, if readings trend too low, adjustments in oral medications or alcohol consumption may be necessary to prevent hypoglycemia. Regular monitoring allows for a dynamic and personalized approach to diabetes management during the holidays, promoting optimal blood sugar control and minimizing the risk of diabetes-associated complications.

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Managing Blood Sugar During Holiday Meals: Final Thoughts

Enjoying holidays with diabetes requires a thoughtful approach to managing blood sugar levels during festivities. Key strategies include practicing portion control, choosing nutrient-dense and low-glycemic foods, mindfulness, and postprandial exercise. Monitoring blood sugar levels regularly allows for personalized adjustments to food intake, exercise, and medications. It is possible to strike a balance between enjoyment and responsibility throughout the holiday season by staying mindful of individual health needs.