8 Things to Consider When Choosing a Blood Glucose Monitor

Test strips are sold separately from glucose monitors and can be pricey.

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Blood glucose monitors are devices—about the size of a cell phone or smaller—that are used to monitor your blood sugar at home.
Although they can be mistaken for the latest fancy digital device, these gadgets come with lancets, which are used to poke the finger, and test strips, which is where you place the drop of blood before inserting it into the monitor to get a blood-sugar reading.
They range in price from $20 to $70, but are often given away for free by various health-care providers. Companies can afford to give the monitors away for free because they make their money from the glucose strips, which can be pricey—$1 or more per strip. If you check your blood sugar as often as you should, you can easily spend more than $100 a month.
The vast majority of your cost will come from glucose strips. So when choosing your device, you should pay attention to the cost of the strips, even if the monitor is free.

Glucose Meters

"This may save your life"  Watch video

More about blood sugar monitoring

• How to Test Your Blood Sugar at Home
• Expert Advice About Home Blood Glucose Monitoring
• 7 Ways to Make Blood-Sugar Testing Less Painful

You may need to select a specific blood glucose monitor because that's what your insurance plan covers. Edith Sciamanna, 79, of Binghamton, N.Y. has the Accu-Chek Advantage for just that reason. "I'm quite satisfied with it," she says.
However, if you do have the luxury of choice, there are differences between models that can help you decide (in addition to the cost of the strips). Consider that some systems:

• Are multisite: This means you can prick yourself not only on the finger but also on the upper arm, forearm, thigh, calf, or fleshy part of the hand.
• Require smaller samples of blood: The lancet doesn't poke the skin as deeply.
• Give results in as little as five seconds: This feature is particularly handy if you think you're experiencing hypoglycemia. If blood sugar is dangerously low, you need to find out fast and consume glucose to counteract it.
• Have more memory: Some record as few as 10 previous tests; others can keep a record of the 500 previous tests.
• Are smaller and more portable than others: If you're not into big purses, your blood sugar monitor's size might matter. Good news—today's units are much smaller than in the past. Models like the FreeStyle Lite and the OneTouch UltraMini fit into a slim pocket.
• Come with software: Although most glucose monitors can store results in their memory, some devices will also sync with your computer. Downloading your data may make it easier to share your readings with your physician and track your blood sugars over many months. You'll also be able to back up your data in the event you lose your monitor. If you're computer-challenged or prefer to keep track of your readings manually, you can skip this feature.
• Are geared towards those with low vision: Larger readouts make it easier for people with vision problems to see the results.
• Are easier to use: Because you may not always be checking your blood sugar under ideal conditions, it's important to consider the design of the model and its strips. Some models feed their strips from an internal drum (Accu-Chek Compact Plus) or disc (Ascensia Breeze 2); others have to be inserted into a small slot, a challenge at 4 a.m. when your blood sugar is low and your hands are shaking.
• Here are examples of some glucose monitors. (Prices are variable, and some reflect kits that come with strips included, so search around for the best deal.)
• The OneTouch Basic Meter is not multisite, requires 10 microliters of blood, gives readings in 45 seconds, has a 75-test memory, and comes with software. Cost is $70; $110 for 100 strips.
• Accu-Chek Active requires one microliter of blood, gives a reading in five seconds, and can store up to 200 test results. Cost is about $20; $30 for 50 strips.
• Accu-Chek Aviva requires 0.6 microliters of blood, renders results in five seconds, and has a memory for 500 previous tests. Cost is $73; $98 for 100 strips.
• The Ascensia Breeze 2 meter is multisite, requires 2.5 to 3.5 microliters of blood, provides readings in five seconds, can store up to 420 tests, and comes with software. Cost is $33; $90 for 100 strips.
• The Freestyle Freedom Meter requires the least amount of blood (0.3 microliters), is small, gives results in five seconds, and stores 250 previous tests. Cost is about $28; $97 for 100 strips.
• Medtronic Guardian RT is a continuous monitoring system (a small sensor that is inserted under the skin and sends readings every five minutes to a monitor). Cost is $1,339 ($35 additional for the sensor). Other continuous monitors include the DexCom Seven System ($800 for the basic system and $240 for a package of four sensors) and the Abbott FreeStyle Navigator, which was approved by the FDA in March 2008. Most insurance plans do not cover continuous monitoring systems.
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How to Get More Fiber if You Have Diabetes

Even dressed up, 50 grams of daily fiber is a lot to pack away.

(ISTOCKPHOTO)

If you’ve got type 2 diabetes, the quality of food is as important as the quantity. And fiber is the best stuff around.
Fiber itself doesn’t raise blood sugar because it can't be digested, and that's good. But even better, it can blunt the impact that carbohydrates have on blood sugar. The reason? The intestines take a bit more time to digest fiber-rich foods, and that slows the release of glucose into your bloodstream.

You need to check labels and add more fiber
A 2000 study of 13 patients showed that patients with diabetes who consumed 50 grams of fiber each day lowered their glucose levels 10% and insulin levels 12% more than those who consumed 24 grams of fiber a day.
he problem is that 50 grams of fiber per day is a lot of fiber. Most Americans consume only 15 grams every day, according to the American Heart Association, and the American Diabetes Association recommends that people with diabetes eat 25 to 50 grams daily. While it’s tough to consume that much, it’s not impossible.
"Check nutrition labels to see how much fiber there is in the foods you eat," says LuAnn Berry, RD, a certified diabetes educator and diabetes specialist at the University of Pittsburgh Medical Center. "Then go back to the ones with the most grams of fiber per serving."

Good sources of fiber include:

• Whole grain products, such as whole wheat bread
• Dried beans, including kidney, black and garbanzos, lentils
• Oats, which are found in oatmeal
• Apples and pears with their skins on

Berry says you can eat the fiber-high foods alone or add them to recipes—for example, put beans in a salad. However, don’t forget to calculate how much carbohydrate you are adding. A half-cup of beans, for example, has the same carbohydrate count as a third-cup of pasta.
"Make some decisions that will guarantee increased fiber in your diet," says Berry, "such as always having a whole-grain item (small muffin, half a whole grain English muffin, 3/4 ounce whole grain cereal) as one carbohydrate choice, in addition to a piece of fruit and a serving of dairy, for breakfast."
Seveda Williams, 41, of Brooklyn, N.Y., diagnosed with type 2 diabetes four years ago, eats oatmeal and adds in fruit for an extra fiber dose. For a snack, she combines lemon juice, oatmeal, and sugar substitute, sprinkles the mixture on sliced apples (with the peel on for fiber), and bakes the apples in the oven as a substitute for apple pie.

Why Carbohydrates Are So Important in Diabetes

Counting carbs at meals and snack time is one method used to control blood sugar.

ISTOCKPHOTO/HEALTH

Carbohydrates are sugar-based molecules found in fruit, vegetables, whole grains, and dairy products. The make up about 45% to 65% of calories in a healthy diet (the exact percentage is hotly debated); the rest come from fat and protein.

You'll find carbohydrates in the healthiest foods you eat, and in the least healthy. Check the food label to find out exactly how much is in your favorite foods.

How you eat can affect blood sugar
Choosing the right kind of carbohydrates and spacing them out evenly throughout the day can keep blood sugar from rising too high, too fast (90% of the carbohydrate calories you digest end up as glucose, so they have a much bigger impact on blood sugar than fat or protein).
"The goal ... is to take in enough carbohydrates to nourish ourselves, but never so much that it causes high blood sugars," says Linda Sartor, a diabetes nutrition specialist at the Penn Rodebaugh Diabetes Center at the Hospital of the University of Pennsylvania in Philadelphia.
Up until about the mid-1990s experts believed that people with diabetes should never eat foods that contain so-called "simple" sugars—those found in cakes and candy—and instead eat "complex" carbohydrates, or those with longer chains of sugar molecules such as potatoes, fruit, vegetables, and grains.
We now know that all carbohydrates can cause a rise in blood sugar. Pasta and potatoes, for example, may cause a rapid rise in blood sugar, as can pastries (although other beneficial ingredients in food, such as fiber, cause blood sugar to rise more slowly).

Some carbs are better than others
The goal is now to maximize intake of the good stuff—vitamins, minerals, and fiber—and minimize carbohydrates that boost blood sugar too much, offer few nutritional benefits, or are packed with fat and calories.
A dietitian or diabetes educator will help you develop a meal plan to get a good balance of carbohydrates, protein, and fat, and an appropriate amount of calories. They'll teach you how to manage carbohydrate intake, usually by carbohydrate counting, but sometimes using the exchange diet, the plate method, the modified food guide, or other meal plans.
You'll need to fine-tune your meal plan by testing blood sugar before and after meals. Specific foods that cause blood sugar to rise too high can vary from person to person (for example, you may find you can only have small portions of orange juice or pasta due to a big rise in blood sugar).
Carbohydrates generally have their peak effect on blood sugar about an hour to two hours after they are eaten, and are gone within three hours.

How to Know When You'll Need Insulin

Injecting insulin above and to the side of the belly button can result in more consistent results.

(ISTOCKPHOTO)

There's no simple way to tell when a patient with type 2 would do best on insulin, says Richard Hellman, MD, former president of the American Association of Clinical Endocrinologists. But there are guidelines.

"In general if a patient has a hemoglobin A1C that is higher than the agreed upon goal and they are not on insulin, we recommend insulin therapy," Dr. Hellman says. The American Diabetes Association (ADA) recommends an A1C of 7% or below, and the American College of Endocrinology and the American Association of Clinical Endocrinologists recommend an A1C of 6.5% or below.

If you can't lower your A1C with diet, exercise, or other medications, you may need insulin to do the job.

Exceptions to the insulin rule
There are exceptions, of course. Someone who otherwise seems to be a good candidate for insulin may not be able to manage such a regimen if he or she has limited vision and dexterity and no family support.

Good News About Today's Improved Insulins

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More about using insulin

• The 4 Insulin Types and Their Potential Side Effects
• Needing Insulin Doesn't Mean You've Failed to Control Diabetes
• Why Insulin Use Isn't Always Permanent

If you do need insulin in the short- or long-term, your doctor may prescribe one of four different types. These vary by how quickly or slowly they reach the bloodstream (the onset), the amount of time they work at maximum strength (the peak time), and how long they continue to be effective (the duration).

The goal is to mimic the pancreas
The different types of insulin mimic the natural rhythm of a healthy pancreas, which produces a consistent low level of the hormone and occasional bursts of insulin to cope with postmeal boosts in blood sugar.

According to the American Diabetes Association (ADA), your need for insulin is based on several factors.

• How long you have had diabetes
• Your blood glucose level
• What other medicines you take
• Your overall health

As diabetes progresses, you may be more likely to need insulin
In type 2 diabetes the body is resistant to insulin. The beta cells in the pancreas churn out insulin as fast as they can to overcome this insulin resistance. This Herculean task can eventually exhaust the beta cells and diminish their ability to produce insulin, potentially resulting in them being unable to produce any insulin at all.
Although early treatment to reduce blood sugar can help save the beta cells, diabetes is a progressive disease. Sometimes, particularly if diabetes is diagnosed a decade or more after its onset, the beta cells are too far gone to salvage, and you may need to take insulin permanently.

Last Updated: April 24, 2008

Insulin resistance

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Insulin resistance refers to the inability of the body tissues to respond properly to insulin. Insulin lets sugar (glucose) enter body cells, where it is used for energy. Insulin also helps muscles, fat, and liver cells store sugar to be released when it is needed. If the body tissues do not respond properly to insulin, the blood sugar level rises.
Insulin resistance causes the pancreas to release too much insulin (hyperinsulinemia). It may also cause the liver to release too much sugar into the blood.
Several factors may increase insulin resistance, including:

• Family history. Insulin resistance may run in families.
• Being overweight. The more a person weighs, the more insulin his or her pancreas makes and the less the person's body cells respond to insulin. People who are overweight mostly in the upper body have greater insulin resistance and have the greatest risk of developing type 2 diabetes.
• Lack of exercise. People who get little or no exercise often have much greater insulin resistance than people who exercise on a regular basis.
• Age. Teens and older adults usually have greater insulin resistance. Teens have greater insulin resistance because of growth hormones.
• Pregnancy. In the last 3 to 4 months of pregnancy (third trimester), insulin resistance is increased. A woman who did not have diabetes before pregnancy can develop a type called gestational diabetes.
• Some medicines such glucocorticoids (for example, prednisone) can reduce the body's response to insulin.

Lifetime Risk for Diabetes Mellitus in the United States

1. K. M. Venkat Narayan, MD;
2. James P. Boyle, PhD;
3. Theodore J. Thompson, MS;
4. Stephen W. Sorensen, PhD;
5. David F. Williamson, PhD

[+] Author Affiliations

1. Author Affiliations: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, Atlanta, Ga.

Abstract

Context  Although diabetes mellitus is one of the most prevalent and costly chronic diseases in the United States, no estimates have been published of individuals' average lifetime risk of developing diabetes.

Objective  To estimate age-, sex-, and race/ethnicity-specific lifetime risk of diabetes in the cohort born in 2000 in the United States.

Design, Setting, and Participants  Data from the National Health Interview Survey (1984-2000) were used to estimate age-, sex-, and race/ethnicity-specific prevalence and incidence in 2000. US Census Bureau data and data from a previous study of diabetes as a cause of death were used to estimate age-, sex-, and race/ethnicity-specific mortality rates for diabetic and nondiabetic populations.

Main Outcome Measures  Residual (remaining) lifetime risk of diabetes (from birth to 80 years in 1-year intervals), duration with diabetes, and life-years and quality-adjusted life-years lost from diabetes.

Results  The estimated lifetime risk of developing diabetes for individuals born in 2000 is 32.8% for males and 38.5% for females. Females have higher residual lifetime risks at all ages. The highest estimated lifetime risk for diabetes is among Hispanics (males, 45.4% and females, 52.5%). Individuals diagnosed as having diabetes have large reductions in life expectancy. For example, we estimate that if an individual is diagnosed at age 40 years, men will lose 11.6 life-years and 18.6 quality-adjusted life-years and women will lose 14.3 life-years and 22.0 quality-adjusted life-years.

Conclusions  For individuals born in the United States in 2000, the lifetime probability of being diagnosed with diabetes mellitus is substantial. Primary prevention of diabetes and its complications are important public health priorities.

Top 5 Risk Factors for Type 2 Diabetes

There are some things that you cannot change that increase your chances of getting type 2 diabetes:
Risk factors that you cannot control include:²

• Family history. If you have a parent, brother, or sister who has type 2 diabetes, you have a greater chance of developing the disease.
• Age. The risk for getting prediabetes and type 2 diabetes increases with age. And the number of children being diagnosed with type 2 diabetes is increasing. Usually, children who get type 2 diabetes have a family history of the disease, are overweight, and are physically inactive.
• Race and ethnicity. African Americans, Hispanics, Native Americans, Asian Americans, and Pacific Islanders are at higher risk than whites for type 2 diabetes.
• History of gestational diabetes or having a baby weighing more than 9 lb (4 kg). Women who have had gestational diabetes or who have had a large baby are at higher risk for developing type 2 diabetes later in life.
• Low birth weight. People who weighed less than 5.5 lb (2.5 kg) at birth are more likely to develop type 2 diabetes later in life.

Other conditions that put you at risk for type 2 diabetes—and that are also linked to obesity and a lack of physical activity—include:

• Polycystic ovary syndrome (PCOS), a hormone imbalance that interferes with normal ovulation.
• Metabolic syndrome, a group of abnormal physical findings related to the body's metabolism.

If you are concerned about diabetes, you can take a test to determine your risk of getting the disease. If you are at risk, you can discuss with your doctor how to make healthy changes in your life. If you want, your doctor can refer you to health professionals who are trained to help you make your own easy-to-follow plan for eating and exercising. No matter how and when you start, it is important to remember that even small changes can lower your chances of developing diabetes.

6 Most Common Type 2 Diabetes Symptoms

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At first, your blood sugar level may rise so slowly that you may not know that anything is wrong. One-third of all people who have diabetes do not know that they have the disease.¹
If you do have symptoms of type 2 diabetes, they may include:

• Feeling thirsty.
• Having to urinate more than usual.
• Feeling more hungry than usual.
• Losing weight without trying to.
• Feeling very tired.
• Feeling cranky.

Other signs of type 2 diabetes may include:

• Infections and cuts and bruises that heal slowly.
• Blurred vision.
• Tingling or numbness in your hands or feet.
• Trouble with skin, gum, or bladder infections.
• Vaginal yeast infections.

Some people have already developed more serious health problems by the time they are diagnosed with type 2 diabetes. Over time, diabetes can lead to problems with the eyes, kidneys, heart, blood vessels, and nerves. Signs of these problems may include:

• Numbness, tingling, burning pain, or swelling in your feet or hands (diabetic neuropathy).
• Blurred or distorted vision or seeing flashes of light; seeing large, floating red or black spots; or seeing large areas that look like floating hair, cotton fibers, or spiderwebs (diabetic retinopathy).
• Chest pain or shortness of breath. This may be a sign of heart or blood vessel problems.

Why Getting Rid of Belly Fat May Lower Type 2 Diabetes Risk

Belly fat can hamper blood-sugar-regulating organs.

Istockphoto

Excess weight is probably the number one risk factor for type 2 diabetes. Yes, other factors, such as genes and aging do play a role in type 2 diabetes.
But an International Obesity Task Force estimated in 2002 that 60% of diabetes cases around the world were due to weight gain, and in Western nations it was closer to 90%.
If you are obese or overweight, you are 90 times as likely to develop type 2 diabetes as someone who is not, according to a review of medical literature published in 2003 by University of Kentucky and other researchers.

Why belly fat is so bad
And while any excess fat cranks up the risk of diabetes, fat in your midsection—which tends to swaddle organs that play a key role in regulating blood sugar—is a bigger contributor to risk.
"When those fat cells go in and around your belly, not down in your buttocks or your hips, but when it's around the belly … that fat in and of itself works to block the action of insulin, which is necessary to lower the blood sugar," says Gerald Bernstein, MD, director of the diabetes management program at the Gerald J. Friedman Diabetes Institute at Beth Israel Medical Center in New York City.

More about type 2 diabetes

• How Type 2 Diabetes Can Damage Your Body
• 6 Most Common Type 2 Diabetes Symptoms
• Top 5 Risk Factors for Type 2 Diabetes

Insulin normally triggers the liver to take up extra blood glucose and store the energy for future use. But when the liver is submerged in fat tissue, insulin "can't get the liver to respond," he says.
As a result, blood sugar can accumulate in the bloodstream, where it can damage organs all over your body. But even a relatively moderate amount of weight loss and exercise can protect you from diabetes.

5 Important Tests for Type 2 Diabetes

It takes more than just one abnormal blood test to diagnose diabetes.

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For centuries, diabetes testing mostly consisted of a physician dipping his pinkie into a urine sample and tasting it to pick up on abnormally high sugar. Thankfully, testing for type 2 diabetes is lot easier now—at least for doctors.
Urine tests can still pick up diabetes. However, sugar levels need to be quite high (and diabetes more advanced) to be detected on a urine test, so this is not the test of choice for type 2 diabetes.
Blood tests
Almost all diabetes tests are now conducted on blood samples, which are collected in a visit to your physician or obstetrician (if you're pregnant).

More about type 2 diabetes

• How Type 2 Diabetes Can Damage Your Body
• One Man's Weight Loss Was a Sign of Diabetes
• 6 Most Common Type 2 Diabetes Symptoms
• Top 5 Risk Factors for Type 2 Diabetes

If you have an abnormal result—meaning blood sugar is too high—on any of these tests, you'll need to have more testing.
Many things can affect blood sugar (such as certain medications, illness, or stress).
A diabetes diagnosis requires more than just one abnormal blood sugar result.

How Type 2 Diabetes Can Damage Your Body

Diabetes is the leading cause of kidney failure in the U.S.

(ISTOKEPHOTO)

Type 2 diabetes is the most common type of diabetes by far—making up more than 90% of the 24 million cases in the U.S.
Experts use words like "epidemic" and "worldwide crisis" when they talk about it: Millions of people have it and a staggering number are expected to get it (300 million worldwide by 2025, according to one study).
Diabetes doesn't get the attention of, say, cancer or scary viruses. One reason might be because type 2 diabetes is so incredibly common—about 20% of people over age 60 get it. A large chunk of the population just seems to have the genetic programming to develop the disease with age.
Type 2 diabetes is showing up in young people
However, diabetes is also on the rise because our modern lifestyle—lots of food and little exercise—speeds up the process.

High Blood Sugar

It's like a poison in the body  Watch video

More about diabetes

• 5 Important Tests for Type 2 Diabetes
• Why Belly Fat Increases Type 2 Diabetes Risk
• 6 Most Common Type 2 Diabetes Symptoms

So people who might have developed this "old-age disease" in their 60s and 70s are now developing the disease much earlier due to obesity and lack of exercise; sometimes in their teens or in childhood.
Anyone can get diabetes. But some people are at much higher risk, particularly those who are obese. (Are you overweight? Use this body mass index calculator to find out.)
One in three children born in the U.S. in 2000 will develop diabetes at some point in their life (including more than half of Hispanic females), according to a Centers for Disease Control and Prevention study published in 2003.
But not all is gloom and doom. If you have diabetes, you have a lot more control over the disease now than just about any other point in history. And if you have prediabetes, you have a good chance of preventing or delaying the disease by making lifestyle changes or taking medication.

How Type 2 Diabetes Can Damage Your Body

What happens in the body when you have type 2 diabetes
With type 2 diabetes, the muscles and liver that normally take up blood sugar and use it for energy begin to lose their sensitivity to the hormone insulin, a condition known as insulin resistance.
The pancreas, which contains the insulin-making beta cells, responds to the body's insulin resistance by churning out even more of the hormone. Even though insulin levels may increase to a degree, even the increased amount is not sufficient to prevent blood sugar from becoming too high. (In contrast, type 1 diabetes is a less-common autoimmune disease that destroys the insulin-producing cells, although some people don't fit neatly into either category.)
The excess blood sugar in diabetes can wreak havoc on blood vessels all over the body and cause complications. It can severely damage the eyes, kidneys, nerves, and other body parts; cause sexual problems; and double the risk of heart attack and stroke.
Eventually, insulin-producing cells can shut down and stop producing the hormone completely. Some people with type 2 diabetes need insulin, but most don't. (It's type 1 diabetes that requires insulin shots to survive; about one-third of people with type 2 use insulin.) You may need to inject insulin to help replace or supplement your own natural production of the hormone and to help your body overcome insulin resistance.
Good news about managing type 2 diabetes
The good news is that if you eat healthier carbohydrates and more fiber, blood sugar drops. And exercise can increase the insulin sensitivity of muscles, which will then absorb more blood sugar. If diet and exercise alone won't do it, there are drugs that boost the muscle's sensitivity to insulin and curb blood sugar.
In the past 10 years a slew of new drugs have come on the market that control blood sugar in new and innovative ways. Blood-sugar testing has made huge strides too—some monitors now require only tiny amounts of blood and give results in seconds.
So much of this illness is under the patient's control. But having that much control over a disease isn't a cakewalk. You may need to battle psychological demons to remain motivated over the long haul and learn how to live with diabetes and still feel alive.
"The good news is that with diabetes, 90% is up to the patient," says Yvonne Thigpen, the diabetes program coordinator at Mount Clemens Regional Medical Center in Michigan. "The bad news is that 90% of diabetes management is up to them."

8 tips for eating well

These practical tips can help you make healthier choices. The two keys to a healthy diet are eating the right amount of food for how active you are and eating a range of foods to make sure you're getting a balanced diet.
A healthy balanced diet contains a variety of types of food, including lots of fruit, vegetables and starchy foods such as wholemeal bread and wholegrain cereals; some protein-rich foods such as meat, fish, eggs and lentils; and some milk and dairy foods.

On this page

 1. Base your meals on starchy foods

2. Eat lots of fruit and veg

3. Eat more fish

4. Cut down on saturated fat and sugar

5. Try to eat less salt - no more than 6g a day

6. Get active and try to be a healthy weight

7. Drink plenty of water

8. Don't skip breakfast

1. Base your meals on starchy foods

Starchy foods such as bread, cereals, rice, pasta and potatoes are a really important part of a healthy diet. Try to choose wholegrain varieties of starchy foods whenever you can.
Starchy foods should make up about a third of the food we eat. They are a good source of energy and the main source of a range of nutrients in our diet. As well as starch, these foods contain fibre, calcium, iron and B vitamins.
Most of us should eat more starchy foods - try to include at least one starchy food with each of your main meals. So you could start the day with a wholegrain breakfast cereal, have a sandwich for lunch, and potatoes, pasta or rice with your evening meal.
Some people think starchy foods are fattening, but gram for gram they contain less than half the calories of fat. You just need to watch the fats you add when cooking and serving these foods, because this is what increases the calorie content.

Why choose wholegrain foods?

Wholegrain foods contain more fibre and other nutrients than white or refined starchy foods.
We also digest wholegrain foods more slowly so they can help make us feel full for longer.
Wholegrain foods include:

• Wholemeal and wholegrain bread, pitta and chapatti
• Wholewheat pasta and brown rice
• Wholegrain breakfast cereals

More on starchy foods

2. Eat lots of fruit and veg

Most people know we should be eating more fruit and veg. But most of us still aren't eating enough.
Try to eat at least 5 portions of a variety of fruit and veg every day. It might be easier than you think.
You could try adding up your portions during the day.
For example, you could have:

• a glass of juice and a sliced banana with your cereal at breakfast
• a side salad at lunch
• a pear as an afternoon snack
• a portion of peas or other vegetables with your evening meal

You can choose from fresh, frozen, tinned, dried or juiced, but remember potatoes count as a starchy food, not as portions of fruit and veg.

More on fruit and veg including a portion guide

3. Eat more fish

Most of us should be eating more fish - including a portion of oily fish each week. It's an excellent source of protein and contains many vitamins and minerals.
Aim for at least two portions of fish a week, including a portion of oily fish. You can choose from fresh, frozen or canned - but remember that canned and smoked fish can be high in salt.

What are oily fish?

Some fish are called oily fish because they are rich in certain types of fats, called omega 3 fatty acids, which can help keep our hearts healthy.

How much oily fish?

Although most of us should be eating more oily fish, women who might have a baby one day should have a maximum of 2 portions of oily fish a week (a portion is about 140g). And 4 is the recommended maximum number of portions for other adults.
Examples of oily fish
Salmon, mackerel, trout, herring, fresh tuna, sardines, pilchards, eel
Examples of white or non-oily fish
Haddock, plaice, coley, cod, tinned tuna, skate, hake
Shark, swordfish and marlin
Don't have more than one portion a week of these types of fish. This is because of the high levels of mercury in these fish.
Anyone who regularly eats a lot of fish should try to choose as wide a variety as possible. Eating a wider variety of fish and shellfish will also help reduce the environmental impact.
For more information on fish and for advice - including recommended limits - for children, women who are pregnant, breastfeeding or trying for a baby, see the link below.

More on fish

4. Cut down on saturated fat and sugar

Fats

To stay healthy we need some fat in our diets. What is important is the kind of fat we are eating. There are two main types of fat:

• saturated fat - having too much can increase the amount of cholesterol in the blood, which increases the chance of developing heart disease
• unsaturated fat - having unsaturated fat instead of saturated fat lowers blood cholesterol

Try to cut down on food that is high in saturated fat and have foods that are rich in unsaturated fat instead, such as vegetable oils (including sunflower, rapeseed and olive oil), oily fish, avocados, nuts and seeds.

Foods high in saturated fat

Try to eat these sorts of foods less often or in small amounts:

• meat pies, sausages, meat with visible white fat
• hard cheese
• butter and lard
• pastry
• cakes and biscuits
• cream, soured cream and crème fraîche
• coconut oil, coconut cream or palm oil

For a healthy choice, use just a small amount of vegetable oil or a reduced-fat spread instead of butter, lard or ghee. And when you are having meat, try to choose lean cuts and cut off any visible fat.

How do I know if a food is high in fat?

Look at the label to see how much fat a food contains. Generally the label will say how many grams (g) of fat there are in 100g of the food.
Some foods also give a figure for saturated fat, or 'saturates'.
Use the following as a guide to work out if a food is high or low in fat.
Total fat - what's high and what's low?
High is more than 20g fat per 100g
Low is 3g fat or less per 100g
If the amount of fat per 100g is in between these figures, then that is a medium level of fat.
Saturated fat - what's high and what's low?
High is more than 5g saturates per 100g
Low is 1.5g saturates or less per 100g
If the amount of saturates per 100g is in between these figures, then that is a medium level of saturated fat.
Remember that the amount you eat of a particular food affects how much fat you will get from it.
Try to choose more foods that are low in fat and cut down on foods that are high in fat.

Sugar

Most people in the UK are eating too much sugar. We should all be trying to eat fewer foods containing added sugar, such as sweets, cakes and biscuits, and drinking fewer sugary soft and fizzy drinks.
Having sugary foods and drinks too often can cause tooth decay, especially if you have them between meals. Many foods that contain added sugar can also be high in calories so cutting down could help you control your weight.

How do I know if a food is high in added sugar?

Take a look at the label. The ingredients list always starts with the biggest ingredient first.
But watch out for other words used to describe added sugars, such as sucrose, glucose, fructose, maltose, hydrolysed starch and invert sugar, corn syrup and honey. If you see one of these near the top of the list, you know the food is likely to be high in added sugars.
Another way to get an idea of how much sugar is in a food is to have a look for the 'Carbohydrates (of which sugars)' figure on the label. But this figure can't tell you how much is from added sugars, which is the type we should try to cut down on.
High is more than 15g sugars per 100g
Low is 5g sugars or less per 100g
If the amount of sugars per 100g is in between these figures, then that is a medium level of sugars.
Remember that the amount you eat of a particular food affects how much sugars you will get from it.
Sometimes you will only see a figure for total 'Carbohydrates', not for 'Carbohydrates (of which sugars)', which means the figure also includes the carbohydrate from starchy foods.

More on sugars

5. Try to eat less salt - no more than 6g a day

Lots of people think they don't eat much salt, especially if they don't add it to their food. But don't be so sure!
Every day in the UK, 85% men and 69% women eat too much salt. Adults - and children over 11 - should have no more than 6g salt a day. Younger children should have even less.
Three-quarters (75%) of the salt we eat is already in the food we buy, such as breakfast cereals, soups, sauces and ready meals. So you could easily be eating too much salt without realising it.
Eating too much salt can raise your blood pressure. And people with high blood pressure are three times more likely to develop heart disease or have a stroke than people with normal blood pressure.

How do I know if a food is high in salt?

Check the label to find out the figure for salt per 100g.
High is more than 1.5g salt per 100g (or 0.6g sodium)
Low is 0.3g salt or less per 100g (or 0.1g sodium)
If the amount of salt per 100g is in between these figures, then that is a medium level of salt.
Remember that the amount you eat of a particular food affects how much salt you will get from it.

More on salt

6. Get active and try to be a healthy weight

It's not a good idea to be either underweight or overweight. Being overweight can lead to health conditions such as heart disease, high blood pressure or diabetes. Being underweight could also affect your health.
Check if you are the right weight for your height using the link below.
If you're worried about your weight, ask your GP or a dietitian for advice. But if you think you just need to lose a little weight, the main things to remember are:

• only eat as much food as you need
• make healthy choices - it's a good idea to choose low-fat and low-sugar varieties, eat plenty of fruit and veg and wholegrains
• get more active

It's also important to eat a variety of types of food so you get all the nutrients your body needs.
Physical activity is a good way of using up extra calories, and helps control our weight. But this doesn't mean you need to join a gym.
Just try to get active every day and build up the amount you do. For example, you could try to fit in as much walking as you can into your daily routine. Try to walk at a good pace.
Whenever we eat more than our body needs, we put on weight. This is because we store any energy we don't use up - usually as fat. Even small amounts of extra energy each day can lead to weight gain.
But crash diets aren't good for your health and they don't work in the longer term. The way to reach a healthy weight - and stay there - is to change your lifestyle gradually. Aim to lose about 0.5 to 1kg (about 1 to 2lbs) a week, until you reach a healthy weight for your height.

More on healthy weight

Check your height for weight

7. Drink plenty of water

We should be drinking about 6 to 8 glasses (1.2 litres) of water, or other fluids, every day to stop us getting dehydrated.
When the weather is warm or when we get active, our bodies need more than this. But avoid drinking soft and fizzy drinks that are high in added sugar.

More on drinks

Alcohol

There is nothing wrong with the occasional drink. But drinking too much can cause problems. Alcohol is also high in calories, so cutting down could help you control your weight.
Women can drink up to 2 to 3 units of alcohol a day and men up to 3 to 4 units a day, without significant risk to their health.
A unit is half a pint of standard strength (3 to 5% ABV) beer, lager or cider, or a pub measure of spirit. A glass of wine is about 2 units and alcopops are about 1.5 units.
For good health, it's a good idea to spread your drinking throughout the week and avoid binge drinking. Drinking heavily over a long period of time can damage the liver.

More on alcohol

8. Don't skip breakfast

Breakfast can help give us the energy we need to face the day, as well as some of the vitamins and minerals we need for good health.
Some people skip breakfast because they think it will help them lose weight. But missing meals doesn't help us lose weight and it isn't good for us, because we can miss out on essential nutrients.
There is some evidence to suggest that eating breakfast can actually help people control their weight.
So why not go for a bowl of wholegrain cereal with some low-fat milk and sliced banana and a glass of fruit juice for a healthy start to the day?