Thanksgiving dinner can be a challenging time for people with diabetes because of the many food choices.

They can’t just sit down at the table and dig right into the turkey and sweet potatoes. Instead, they must choose just the right combination of food to keep their blood sugar in check. Many times, their planning begins long before anyone sits down at the dinner table.

More than 30 million Americans have diabetes — maybe you or someone you love. People with diabetes must make sure their meals are balanced so they don’t overeat carbohydrates. Carbs turn into glucose, a type of sugar they cannot process well.

Carving Out Carbs

If people with diabetes have too many carbs, it can cause their blood sugar to increase. This can lead to a range of problems, including dizziness, nausea, extreme thirst and even a diabetic coma. If blood sugars remain elevated, long-term health problems can occur.

“At a holiday dinner, with all the choices of carbohydrate-rich foods, it can be difficult to maintain a modest amount of carbs,” says Judy Kolish, a registered dietitian and certified diabetes educator. “You have mashed potatoes, sweet potatoes, dressing, rolls, cranberries — a lot of these have carbs; and then, desserts like pie are very carbohydrate-laden. Since you cannot have it all, you have to figure out what’s most important and make decisions based on that.”

Of course, nobody wants to be that guest — the one who causes his or her host extra stress by asking for all kinds of accommodations. On the other hand, no Thanksgiving host wants to see a guest with an empty plate.

Kolish says the best planning begins long before the holiday. Reach out to the host and simply ask what’s on the menu. If it’s someone who knows you well enough to invite you for Thanksgiving dinner, he or she won’t mind if you ask a few questions ahead of time.

If the menu has many choices that are carb heavy, mention that you have diabetes (if you’re comfortable sharing that information). Let your host know that you will be bringing some of your own food.

Bring Your Own

There are lots of great diabetes-friendly recipes that those without diabetes will also enjoy. Use this as an opportunity to showcase a new recipe or try something different. Be creative and make something that isn’t just a low-carb version of what’s already on the table, Kolish says.

“First identify what the menu is and which foods you will eat,” she says. “Then build something that fills in the gaps that other people also will enjoy. Or figure out what you would love to have that’s not available to you and bring that.”

If the dinner is set up buffet-style, where guests move through the line filling their plate, Kolish says you should survey all the options before you pile on the food.

“A lot of times, we start out with no idea what’s on the buffet and just fill up our plates,” she says. “We can’t make good decisions without knowing what’s there. Take a peek and look at what you really want to eat. If you don’t like cranberries, for example, then don’t choose them. If you want to use your carbs for dressing, then do that.”

Fortunately, there are plenty of diabetes-friendly recipes that taste as good as the full-sugar version. But Kolish cautions against buying sugar-free pies at the grocery store or, if you do, check the carbs first. The pie filling is sugar free, but there are still carbs in the crust.

“When you think about cake or pie, the basis of it is flour, which is still a carb,” Kolish says. “Removing sugar takes out some, but you’re still getting a carb-laden dessert. People think if they eat sugar-free they are safe, but it can have just as many carbs. So be really careful in terms of the overall meal.”

Some diabetes-friendly desserts include sugar-free gelatin with fruit cocktail and non-dairy whipped topping, or making a mousse (made with stevia) instead of pie.

Focus on Being Together

The most important thing, Kolish says, is to focus on the joy of being together.

“To me, owning it is the important thing,” Kolish says. “More people have needs as far as alternative food options because of various health concerns. If you can’t speak to that, if you can’t have a really good dialogue about it, people will feel like they can’t go to these events like holidays. That’s not what anyone wants.”

With a little planning and communication, people with diabetes can enjoy a delicious Thanksgiving dinner with friends and family.

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Learn more about dealing with diabetes.

For more information and healthy ideas for managing diabetes, visit the diabetes section of LifeTimes.