Skip to main content
  • More from ADA
    • Diabetes
    • Diabetes Care
    • Clinical Diabetes
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, abridged
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Spectrum

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Browse
    • Issue Archive
    • Saved Searches
    • COVID-19 Article Collection
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
  • More from ADA
    • Diabetes
    • Diabetes Care
    • Clinical Diabetes
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, abridged
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Spectrum
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Browse
    • Issue Archive
    • Saved Searches
    • COVID-19 Article Collection
    • ADA Standards of Medical Care
    • ADA Standards of Medical Care, Abridged
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
Departments

Controlling Calories—The Simple Approach

  1. M. Dianne Brown, MS, RD/LD, CDE,
  2. Heather D. Lackey, MS, RD/LD,
  3. T. Kathleen Miller, RN, RD/LD, CDE and
  4. Diane Priest, RD/LD
    Diabetes Spectrum 2001 Apr; 14(2): 110-112. https://doi.org/10.2337/diaspect.14.2.110
    PreviousNext
    • Article
    • Figures & Tables
    • Info & Metrics
    • PDF
    Loading

    One, Two

        Count my food.

    Three, Four

        Exercise more.

    Five, Six

        Small meals I fix.

    Seven, Eight

        Now how’s my weight?

    Nine, Ten

        Start again.

    (Apologies to Mother Goose)

    Counting—everyone in today’s health-conscious society is doing it, from calories to fat, from carbohydrates to fiber, from servings to portion sizes. When trying to match insulin with a food’s expected effect on blood glucose, counting plays an important role in the overall theme of portion control.

    Controlling portions is important whether one is trying to establish consistency in the foods consumed or trying to match insulin doses with a food’s expected blood glucose influence. Portion control is also a key element in weight management, and awareness of portion sizes can be the difference between gaining, maintaining, or losing weight.

    There is also evidence suggesting that moderate intentional weight loss, through the correct use of portion control, reduces mortality in type 2 diabetes.1 This increased life span results from improved insulin sensitivity and glycemic control.2 This finding clearly supports the notion that medical nutrition therapy is a powerful tool in overall diabetes management.

    Nutrition and exercise are the cornerstones of successful diabetes therapy. The American Diabetes Association3 recommends that the composition of meal plans for people with diabetes be based on an individualized nutritional assessment taking into account the individual’s desired outcomes. Consequently, meal plans can now be designed to fit the person, instead of the person trying to fit a predetermined meal plan.

    Still, most patients still identify food as the single largest challenge in balancing all the elements of diabetes therapy. Additionally, misinformation, long-standing habits, and cultural preferences toward food selection and physical activity may hinder patients’ achievement of their health goals.4

    Because people with diabetes face many challenges, offering a plan that can simplify food selection can be extremely helpful. There are various approaches to weight management and healthier eating, ranging in scope from the elementary to the complex. This article discusses two methods that have been verified as successful by our patients at the Diabetes Center of Oklahoma.

    IDAHO PLATE METHOD

    The Idaho Plate Method was adapted from a Swedish meal planning method by a group of Idaho dietitians who sought to meet the nutritional guidelines of the American Diabetes Association, the American Dietetic Association, and the United States Department of Agriculture’s Food Guide Pyramid.5

    The Idaho Plate Method works by visualizing how much space each of the major food groups should occupy on one’s plate. At breakfast, one-fourth of the plate should have a protein or meat, half of the plate should have a starch, and one-fourth of the plate would be empty. The meal should be completed with a milk, yogurt, or fruit.

    At lunch and dinner, the plate should show a similar pattern: one-fourth of the plate should have a starch, one-fourth should have a protein or a meat source, and half should be filled with low-calorie vegetables (not “starchy” vegetables, such as potatoes, corn, or peas). On the side of the plate there should be either 1 cup of milk or yogurt or a half-cup of pudding or ice cream, as well as one small piece of fruit (Figure 1).

    Using low-calorie seasoning to flavor food, the Plate Method provides approximately 1,200–1,500 calories. This approach is not only easy to use, but also works well when eating outside the home, such as in a restaurant or at a family gathering.

    The Plate Method works particularly well for patients who eat three meals a day, are at a low literacy level, have cognitive difficulties, are elderly, have type 2 diabetes and need to lose weight, or are hospitalized and need “survival” information. It also adapts easily for patients who snack by allowing individuals to move side items to snack time. It does not require math skills or a high reading level.

    For patients who are abstract thinkers, combination foods, such as casseroles or pizzas, can still be planned by visualizing how the various ingredients in the recipe can be broken down into specific food groups for the plate. For tuna noodle casserole with a salad, for example, half of the plate would have salad, celery, mushrooms, onions, and green peppers (vegetables); one-fourth of the plate would have tuna (protein); and one-fourth would have noodles (starch). When you add the side food groups (milk products and fruit), this is a well-balanced meal.

    Although the Plate Method works well for many people, it may be challenging for people who are not accustomed to having low-calorie vegetables as half of their midday and evening meals and for those who enjoy only a limited variety of vegetables. Also, members of ethnic groups for whom rice or another starch is a staple may find the one-fourth–plate limit for starch foods inappropriate.

    CHOICES METHOD

    The CHOICES method, formerly known as the POINTS method, involves calorie unit counting. The new name helps to avoid confusion between this meal planning and lifestyle approach and that used by Weight Watchers and helps to distinguish it as a broader lifestyle plan. CHOICES is an acronym for Choosing, Honesty, Organization, Innovation, Commitment, and Excellence, which are all considered watchwords for positive change.6 This approach was developed by Lanell Olson and M. Dianne Brown, diabetes nutrition specialists at the Diabetes Center of Oklahoma.

    Educators at our center find CHOICES to be successful because it encompasses many lifestyle elements. We emphasize that all decisions involving CHOICES are important for a healthy lifestyle and that patients can learn to build healthy eating practices by redefining foods into “choices” rather than characterizing foods as being either “good” or “bad.”2 In addition, the idea of choices is expanded to include attitudes, physical activities, and time management.

    The elements of the CHOICES approach are:

    •  Choosing. Educators emphasize that clients’ lifestyle choices, such as physical activity, food management, and time allocation, directly affect their future health and vitality.

    •  Honesty. Clients learn that honesty with oneself about actual food consumption and exercise, as well as emotional honesty, facilitates progress.

    •  Organization. This method promotes planning through the technique of “banking” calories. Patients learn to make choices by tracking and budgeting calories.

    •  Innovation. Here, we adapt each client’s lifestyle plan for a good “fit.” This involves using creativity to modify recipes or adapt exercise and eating plans to accommodate the unexpected.

    •  Commitment. Clients learn that lifestyle goals are achieved through steadfastness, which keeps the momentum going.

    •  Excellence. This is a satisfying by-product of a clear commitment to positive choices.

    Calorie Choices

    The CHOICES approach to healthier living and calorie control is user-friendly. Many people find it difficult to count hundreds of calories per meal. But with CHOICES, one calorie choice equals 75 calories, thus providing a simplified shortcut to traditional calorie counting.

    Newly diagnosed patients with type 2 diabetes, those who are unable or unwilling to make more complex food changes, or anyone desiring or needing to lose weight may be good candidates for this simple method. Here’s how it works:

    Julie needs 1,500 calories/day for weight loss. Using the CHOICES method, 1,500 calories is converted into 20 calorie choices per day (75 calories per calorie choice × 20 = 1,500).

    For optimal nutrition, Julie will be guided to consume a variety of foods based on the Diabetes Food Guide Pyramid. To assist with her blood glucose control, she will be advised to distribute her 20 calorie choices consistently throughout each day.

    For example, Julie’s breakfast could consist of four to five calorie choices. Lunch could include five more, and an afternoon snack could be one to two more. Her dinner could include five to six calorie choices, and her bedtime snack could consist of two to three calorie choices, for a total of 20 calorie choices (1,500 calories) per day.

    Carbohydrate Choices

    For clients who are at a healthy weight, a different type of counting may be helpful. Carbohydrate counting is an emerging meal-planning method that typically has an immediate effect on blood glucose.7 Becoming more aware of the carbohydrate content of foods can help patients unravel the mystery of how various foods affect their blood glucose level.

    Carbohydrate counting can be especially useful for people whose diabetes is controlled with oral agents that increase insulin production or with insulin injections. As with calorie counting, the CHOICES method simplifies the carbohydrate counting process; one carbohydrate choice equals 15 g carbohydrate.

    Moderate and consistent carbohydrate intake works well for people on a conventional insulin regimen, such as 70/30 or 75/25 NPH and regular insulin. Here’s how it works:

    Sarah needs ∼1,500 calories/day, with half of her calories coming from carbohydrate. Her dietitian translates her carbohydrate requirement into ∼180–190 g carbohydrate or 12–13 carbohydrate choices per day (180 g carbohydrate ÷ 15 g per carbohydrate choice = 12 carbohydrate choices).

    For example, Sarah’s breakfast might include three carbohydrate choices. Her lunch could provide three to four more, and her dinner could include four more carbohydrate choices. Her bedtime snack could include one carbohydrate choice.

    It is important to note that in order for Sarah to stay within her 1,500-calorie plan, she will need to pay attention to her fat and protein consumption, as well.

    For patients who are candidates for both weight loss and carbohydrate counting, dual use of calorie and carbohydrate choices can work well.

    Fine-Tuning Insulin-to-Carbohydrate Ratios

    A further refinement of the CHOICES carbohydrate counting approach is used for more intensive insulin regimens, in which an insulin-to-carbohydrate ratio is established. Using the CHOICES approach, the educators at our center developed a chart to match various insulin-to-carbohydrate ratios with the correct number of carbohydrate choices (Table 1). This has reduced errors in insulin dosing calculations. Here’s how it works:

    Jim has a 1:20 insulin-to-carbohydrate ratio (1 U lispro or regular insulin for every 20 g carbohydrate consumed). Using the chart shown in Table 1, he can determine the number of carbohydrate choices he will eat and the corresponding insulin dose he should administer before his meal. If, for example, he plans to eat a food that contains 24 g carbohydrate, he would find the 21- to 25-g range in the first column of the chart. Moving across that row, he would see in column 2 that that amount of carbohydrate equals 1.5 carbohydrate choices. In column 3, he would see that his premeal insulin dose should be 1 U, assuming that his premeal blood glucose is within target range.

    If Jim’s premeal blood glucose is not within target range, a blood glucose modifier or sensitivity factor may be used. This is a scale to help him determine the mg/dl drop in blood glucose when 1 U of rapid- or fast-acting insulin is given. For example, if Jim’s sensitivity factor is 50 mg and his target blood glucose range is 70–130 mg/dl, then for every 50 mg above 130 mg/dl, 1 U of insulin should be given.

    Thus, the CHOICES method allows people with diabetes to fine-tune their insulin requirements while using a simple, understandable, and sensible meal-planning approach.

    SUMMARY

    Clients at the Diabetes Center of Oklahoma have experienced success using both the Idaho Plate Method and the CHOICES method of meal planning. Both plans can be tailored to fit patients’ individual goals and preferences. Both are flexible—the Plate Method through its use of side food groups and the CHOICES method through calorie budgeting and behavior modifications. Both provide a framework that incorporates portion control with other tools to achieve weight loss and improve blood glucose control.

    Figure 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1.

    From Pyramid to Plate. The Idaho Plate Method recommendations for lunch and dinner.

    View this table:
    • View inline
    • View popup
    Table 1.

    Insulin-to-Carbohydrate Ratios and Carbohydrate Choices

    Footnotes

    • M. Dianne Brown, MS, RD/LD, CDE, Heather D. Lackey, MS, RD/LD, T. Kathleen Miller, RN, RD/LD, CDE, and Diane Priest, RD/LD are diabetes nutrition specialists at the Diabetes Center of Oklahoma in Oklahoma City.

    • American Diabetes Association

    References

    1. ↵
      Williamson DF, Thompson TJ, Thun M, Flanders D, Pamuk E, Byers T: International weight loss and mortality among overweight individuals with diabetes. Diabetes Care 23:1499–1504, 2000
      OpenUrlAbstract
    2. ↵
      Holler HJ, Pastors JG: Diabetes Medical Nutrition Therapy. Stover J, Ed. Chicago, American Dietetic Association, 1997, p. 193–198
    3. ↵
      American Diabetes Association: Nutritional recommendations and principles for individuals with diabetes mellitus (Postition Statement). Diabetes Care 24 (Suppl. 1):S44–S47, 2001
      OpenUrl
    4. ↵
      Bernstein G: Type 2 diabetes in children and adolescents. Pract Diabetol 11:37–41, 2000
      OpenUrl
    5. ↵
      Rizor HM, Richards S: All our patients need to know about intensified diabetes management they learned in fourth grade. Diabetes Educ 26:392–404, 2000
      OpenUrlFREE Full Text
    6. ↵
      Brown MD, Olson LT: Choices. Oklahoma City, Okla., Diabetes Center of Oklahoma, 1999
    7. ↵
      Brackenridge BP: Carbohydrate gram counting. Pract Diabetol 11:22–28, 1992
    PreviousNext
    Back to top

    In this Issue

    April 2001, 14(2)
    • Table of Contents
    • Index by Author
    Sign up to receive current issue alerts
    View Selected Citations (0)
    Print
    Download PDF
    Article Alerts
    Sign In to Email Alerts with your Email Address
    Email Article

    Thank you for your interest in spreading the word about Diabetes Spectrum.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Controlling Calories—The Simple Approach
    (Your Name) has forwarded a page to you from Diabetes Spectrum
    (Your Name) thought you would like to see this page from the Diabetes Spectrum web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Citation Tools
    Controlling Calories—The Simple Approach
    M. Dianne Brown, Heather D. Lackey, T. Kathleen Miller, Diane Priest
    Diabetes Spectrum Apr 2001, 14 (2) 110-112; DOI: 10.2337/diaspect.14.2.110

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Add to Selected Citations
    Share

    Controlling Calories—The Simple Approach
    M. Dianne Brown, Heather D. Lackey, T. Kathleen Miller, Diane Priest
    Diabetes Spectrum Apr 2001, 14 (2) 110-112; DOI: 10.2337/diaspect.14.2.110
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    • Tweet Widget
    • Facebook Like
    • Google Plus One

    Jump to section

    • Article
      • IDAHO PLATE METHOD
      • CHOICES METHOD
      • SUMMARY
      • Footnotes
      • References
    • Figures & Tables
    • Info & Metrics
    • PDF

    Related Articles

    Cited By...

    More in this TOC Section

    Departments

    • Smart Connected Insulin Pens, Caps, and Attachments: A Review of the Future of Diabetes Technology
    • Brief Literature Review: The Potential of Diabetes Technology to Improve Sleep in Youth With Type 1 Diabetes and Their Parents: An Unanticipated Benefit of Hybrid Closed-Loop Insulin Delivery Systems
    • Mental Health and Behavioral Screening in Pediatric Type 1 Diabetes
    Show more Departments

    Nutrition FYI

    • Chrononutrition Applied to Diabetes Management: A Paradigm Shift Long Delayed
    • The Gluten-Free Diet: Fad or Necessity?
    • Nutrition Considerations for Microbiota Health in Diabetes
    Show more Nutrition FYI

    Similar Articles

    Navigate

    • Current Issue
    • Papers in Press
    • Archives
    • Submit
    • Subscribe
    • Email Alerts
    • RSS Feeds

    More Information

    • About the Journal
    • Instructions for Authors
    • Journal Policies
    • Reprints and Permissions
    • Advertising
    • Privacy Policy: ADA Journals
    • Copyright Notice/Public Access Policy
    • Contact Us

    Other ADA Resources

    • Diabetes
    • Diabetes Care
    • Clinical Diabetes
    • Scientific Sessions Abstracts
    • Standards of Medical Care in Diabetes
    • BMJ Open - Diabetes Research & Care
    • Professional Books
    • Diabetes Forecast

     

    • DiabetesJournals.org
    • Diabetes Core Update
    • ADA's DiabetesPro
    • ADA Member Directory
    • Diabetes.org

    © 2021 by the American Diabetes Association. Diabetes Spectrum Print ISSN: 1040-9165, Online ISSN: 1944-7353.