My Personal Action Plan to Healthy Eating
Diabetes ActiveCare
Lifestyle changes are not always easy to make, especially when it comes to the foods we eat. Setting healthy food
choice goals can help you get on track and stay on track to achieve them. Eating healthier might include any of
the following:
• Timing: Use a meal schedule that better matches your diabetes treatment plan
• Amounts: Choose smaller portions of foods high in carbohydrate, fat or both
• Selections: Add food choices that improve your health, such as fruits and vegetables
Importance
1. The first step is deciding how important it is to you to make healthier food choices. The more important
you think it is, the more likely you are to commit to your changes. If it is currently not very important,
examine your feelings. Think about what healthier food choices could mean to you now and in the
future. Check all that apply:
_____ I could better control my blood sugar.
_____ I could feel better.
_____ I would have more energy.
_____ I could learn to enjoy the foods I love, in reasonable portions.
What are the benefits you expect from making healthier choices? _______________________________
_______________________________________________________________________________________
Confidence
2. Next, how confident are you that you can improve your food choices? The more confident you are, the
better your chances are that you will stay with your plan. Circle one number:
1
2
3
Not confident
4
5
6
7
Somewhat confident
8
9
10
Fully confident
What could boost your confidence in your ability to start and continue making healthier food choices? Check those that apply, and add your own:
_____ Knowing I don’t have to do it alone. Friends and family will help me.
_____ Setting realistic expectations for myself, so I can succeed.
_____ Reading nutrition fact labels to learn more about food.
_____ Other ____________________________________________________________________________
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My Personal Action Plan to Healthy Eating
Page 2
Action Steps
3. The final step is establishing your action plan. Choose from the action steps below, and/or add your
own. Always consult with your doctor before making any changes in your diet, exercise, or blood sugar
treatment practices:
_____ I will follow a routine schedule for meals and snacks.
_____ I will strive for five total servings of fruits and vegetables daily.
_____ I will limit the number of times I have _________________________in a week to _________times.
(Fill in the blanks with a food choice you feel you need to limit — for example sweets — and the
reasonable limit for the number of times you’ll have them per week.)
_____ I will plan my plate.
_____ I will ask my doctor to refer me to a dietitian or diabetes educator to develop my personal
healthy eating plan to help me manage my diabetes.
I will start making these choices (when?) ____________________________________________________
The benefits I expect from my actions _______________________________________________________
_______________________________________________________________________________________
I will most likely succeed with my plan if _____________________________________________________
_______________________________________________________________________________________
Keeping track of your progress in making healthier food choices can help you see how well you are doing. Try
keeping a record of your food choices for one week, including the times of your meals and snacks. Then look it
over to see whether you have done what you set out to do.
If you are right on plan, congratulations. Keep up the good work! If you have missed your plan a bit,
look back at the goals you set. Are they realistic? Did you ask for and have the support you needed? Remind
yourself of the benefits you expect from your plan. Ask for help from friends and family, as
well as your healthcare team. Then, try again, and do the best you can. Remember, even small steps
can lead to big rewards!
Medicare Part B patients: Call us and mention reference
code EDO6500 to order your diabetes testing supplies.
1-877-231-5199 | www.optumrx.com/diabetes
The information in this educational tool does not substitute for the medical advice, diagnosis or treatment of your physician. Always seek the help of your physician
or qualified health provider for any questions you may have regarding a medical condition.
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