Diabetes nutrition recommendations have had many iterations over time. Until the early 2000s ushered in carb counting, exchange lists were the primary tool for meal planning. But even then, grouping foods of equal nutritional value and “exchanging” choices essentially dismissed traditional, cultural-specific preferences.  

A long-awaited guide with ethnic and regional food practices, customs, and holidays became available in the 1990s by the Diabetes Dietetic Practice Group of the Academy of Nutrition and Dietetics — including guidance on traditional Mexican foods and their nutritional exchanges. 

In 2019, Choose Your Foods: Food Lists for Diabetes was created for more cultural foods used by Hispanics from different countries. It included foods like tamarillo, guava, chorizo, cassava, plantain, and chayote. Then, Cultural Food Practices replaced the Ethnic and Regional Food Practices series and added more Hispanic regions, which improved educational accessibility for cultural eating.  

To better understand the cultural constructs between diabetes and food, T1D Exchange talked with two women who live with type 1 diabetes (T1D) about their personal experiences. 

 

T1D Exchange interviews: Anna Norton and Marina Chaparro  

Anna Norton, a Cuban American healthcare executive, was diagnosed with type 1 diabetes 33 years ago — 2 weeks prior to starting college. “I was put on the American Diabetes Association exchange diet,” explained Norton. “I did not have a meal plan for college, but I remember buying sugar-free jelly and peanut butter.” 

“I had never eaten a peanut butter and jelly sandwich because I lived in a Cuban household,” said Norton. “But I ate it because it was on the exchange list.”  

Marina Chaparro, a Mexican American pediatric registered dietitian, certified diabetes care and education specialist, and owner of Nutrichicos, was born in El Paso and diagnosed with type 1 diabetes 24 years ago, about a year before starting college.  

Her diabetes care team prescribed a carbohydrate counting diet of 45-60 grams per meal and 15 grams for snacks. “They recommended corn tortillas. But in Chihuahua, the traditional staple is flour tortillas,” said Chaparro. “My family and I had to re-learn how to eat.”  

 

Were Cuban cultural foods on your exchange list?  

While Norton was diagnosed in a hospital with a large Cuban population, the exchange list she received did not reference any Cuban foods, nor did she receive any specific counseling. Moreover, Cuban food is very different from Mexican food. 

“I had a rice cooker in my dormitory, and I made chicken with Cuban spices,” explained Norton. “I didn’t have beans or plantains.”

 

How did you dose insulin for foods not on the exchange list?  

“I would use a sliding scale,” said Norton. “I ate guava pastries, meat empanadas, and Cuban ham croquettes from my family’s bakery. I would give insulin afterward, and I was constantly chasing the highs,” said Norton.   

 

What were your biggest dietary challenges? 

“I remember a lot of sugar-free foods,” said Chaparro. “There was an over infatuation with sugar, so I was given sugar-free cake and cookies. To this day, I can’t eat Jello and angel food cake because they remind me of that era — I couldn’t have the real deal.” 

“One of the biggest misconceptions is: ‘Mexican food is unhealthy and must be changed,’” explained Chaparro.   

 

 What dietary shifts or advice have you experienced over the years?  

“After reading an article in Diabetes Forecast, I asked my doctor to change my insulin from 70/30 to Humalog,” explained Norton.  

“I didn’t know anything about carbohydrate counting. In 2000, a doctor started me on a pump and connected me with a Cuban American who also had a pump,” said Norton. This doctor told me I could eat whatever I wanted, and I could sleep late — all I had to do was read the nutrition facts label.” 

“I could finally eat Cuban foods and anticipate the highs instead of chasing them,” said Norton.   

For Chaparro, finding nutrition information on the internet was groundbreaking. “I’ve seen a greater acceptance of food diversity. Having a continuous glucose monitor (CGM), an insulin pump, and information from the web has improved the quality of life for many people with diabetes,” said Chaparro. 

 

How are you managing your diabetes today? 

“My palate is very extensive,” said Norton. “I eat Colombian foods, Cuban foods, and Pakistani foods.  I can anticipate how carbohydrates, alcohol, fat, and sickness affect me. I wear a CGM and an insulin pump on a loop system, and it works very well for me,” said Norton.   

Chaparro has also found more flexibility in her current diabetes management system. She shared her core philosophy as a pediatric registered dietitian: “I want to teach families to enjoy their food while being balanced and mindful.” 

“My goal is to help children enjoy a slice of pizza without their glucose going into the 300s,” said Chaparro. “Pizza requires advanced carbohydrate counting because of its high fat content and delayed absorption.” 

 

The Bottom Line  

People living with diabetes can use various apps and nutrition databases to access nutritional information such as carbohydrates, proteins, fats, and other nutrients about cultural foods, helping them fit these foods into their eating plans.  

Cultural foods like beans, avocado, mango, chia seeds can be nutrient-dense, while flan can be eaten for pleasure or celebration. To manage diabetes, it is important to choose foods you enjoy, that are nutrient-rich in appropriate portions, and are complemented by occasional indulgent foods.