Food Safety for People with Diabetes

Source: USDA
The United States Department of Agriculture’s (USDA) Food Safety and Inspection Service (FSIS) is tasked with ensuring the nation’s commercial supply of meat, poultry and egg products is safe, wholesome and correctly labeled and packaged.

Foodborne Illness in the United States

When certain disease-causing bacteria, viruses or parasites contaminate food, they can cause foodborne illness. Another word for such a bacteria, virus, or parasite is “pathogen.” Foodborne illness, often called food poisoning, is an illness that comes from food you eat.
The food supply in the United States is among the safest in the world – but it can still be a source of infection for all persons.
According to the Centers for Disease Control and Prevention, 48 million persons get sick, 128,000 are hospitalized, and 3,000 die from foodborne infection and illness in the United States each year. Many of these people are children, older adults, or have weakened immune systems and may not be able to fight infection normally.
Since foodborne illness can be serious – or even fatal – it is important for you to know and practice safe food-handling behaviors to help reduce your risk of getting sick from contaminated food.

Food Safety: It’s Especially Important for You

As a person with diabetes, you are not alone – there are many people in the United States with this chronic disease. Diabetes can affect various organs and systems of your body, causing them not to function properly, and making you more susceptible to infection. For example:

Your immune system, when functioning properly, readily fights off harmful bacteria and other pathogens that cause infection. With diabetes, your immune system may not readily recognize harmful bacteria or other pathogens. This delay in the body’s natural response to foreign invasion places a person with diabetes at increased risk for infection.

Your gastrointestinal tract, when functioning properly, allows the foods and beverages you consume to be normally digested. Diabetes may damage the cells that create stomach acid and the nerves that help your stomach and intestinal tract move the food throughout the intestinal tract. Because of this damage, your stomach may hold on to the food and beverages you consume for a longer period, allowing harmful bacteria and other pathogens to grow.

Additionally, your kidneys, which work to cleanse the body, may not be functioning properly and may hold on to harmful bacteria, toxins, and other pathogens.

A consequence of having diabetes is that it may leave you more susceptible to developing infections – like those that can be brought on by disease-causing bacteria and other pathogens that cause foodborne illness. Should you contract a foodborne illness, you are more likely to have a lengthier illness, undergo hospitalization, or even die.

To avoid contracting a foodborne illness, you must be vigilant when handling, preparing and consuming foods.

Make safe handling a lifelong commitment to minimize your risk of foodborne illness. Be aware that as you age, your immunity to infection naturally is weakened.

Major Pathogens That Cause Foodborne Illness

(Click to enlarge image)

Eating at Home: Making Wise Food Choices

Some foods are more risky for you than others. In general, the foods that are most likely to contain harmful bacteria or viruses fall in two categories:

Uncooked fresh fruits and vegetables

Some animal products, such as unpasteurized (raw) milk; soft cheeses made with raw milk; and raw or undercooked eggs, raw meat, raw poultry, raw fish, raw shellfish and their juices; luncheon meats and deli-type salads (without added preservatives) prepared on site in a deli-type establishment.

Interestingly, the risk these foods may actually pose depends on the origin or source of the food and how the food is processed, stored, and prepared. Follow these guidelines (see chart below) for safe selection and preparation of your favorite foods.

If You Have Questions ….… about Wise Food Choices:
Be sure to consult with your doctor or healthcare provider. He or she can answer any specific questions or help you in your choices.

…about Particular Foods:
If you are not sure about the safety of a food in your refrigerator, don’t take the risk.

When in doubt, throw it out!

Wise choices in your food selections are important.

All consumers need to follow the Four Basic Steps to Food Safety: Clean, Separate, Cook and Chill.

Common Foods: Select the Lower Risk Options

Taking Care: Handling and Preparing Food Safely

Foodborne pathogens are sneaky. Food that appears completely fine can contain pathogens --disease-causing bacteria, viruses, or parasites – that can make you sick. You should never taste a food to determine if it is safe to eat.

As a person with diabetes, it is especially important that you – or those preparing your food – are always careful with food handling and preparation. The easiest way to do this is to Check Your Steps – clean, separate, cook, and chill – from the Food Safe Families Campaign.

Four Basic Steps to Food Safety

  • Clean: Wash hands and surfaces often

Bacteria can spread throughout the kitchen and get onto cutting boards, utensils, counter tops, and food.

To ensure that your hands and surfaces are clean, be sure to:
Wash hands in warm soapy water for at least 20 seconds before and after handling food and using the bathroom, changing diapers, or handling pets.

Wash cutting boards, dishes, utensils, and counter tops with hot soapy water between the preparation of raw meat, poultry, and seafood products and preparation of any other food that will not be cooked. As an added precaution, sanitize cutting boards and counter tops by rinsing them in a solution made of one tablespoon of unscented liquid chlorine bleach per gallon of water, or, as an alternative, you may run the plastic board through the wash cycle in your automatic dishwasher.

Use paper towels to clean up kitchen surfaces. If using cloth towels, you should wash them often in the hot cycle of the washing machine.

Wash produce. Rinse fruits and vegetables, and rub firm-skin fruits and vegetables under running tap water, including those with skins and rinds that are not eaten. With canned goods: remember to clean lids before opening.

  • Separate: Don’t cross-contaminate

Cross-contamination occurs when bacteria are spread from one food product to another. This is especially common when handling raw meat, poultry, seafood, and eggs. The key is to keep these foods – and their juices – away from ready-to-eat foods.

To prevent cross-contamination, remember to:

Separate raw meat, poultry, seafood, and eggs from other foods in your grocery shopping cart, grocery bags, and in your refrigerator.
Never place cooked food on a plate that previously held raw meat, poultry, seafood, or eggs without first washing the plate with hot soapy water.
Don’t reuse marinades used on raw foods unless you bring them to a boil first.
Consider using one cutting board only for raw foods and another only for ready-to-eat foods, such as bread, fresh fruits and vegetables, and cooked meat.

  • Cook: Cook to safe temperatures

Foods are safely cooked when they are heated to the USDA-FDA recommended safe minimum internal temperatures, as shown on the “Is it Done Yet” chart.

To ensure that your foods are cooked safely, always:

Use a food thermometer to measure the internal temperature of cooked foods. Check the internal temperature in several places to make sure that the meat, poultry, seafood, or egg product is cooked to safe minimum internal temperatures.

Cook ground beef to at least 160 ºF and ground poultry to a safe minimum internal temperature of 165 ºF. Color of food is not a reliable indicator of safety or doneness.

Reheat fully cooked hams packaged at a USDA-inspected plant to 140 ºF. For fully cooked ham that has been repackaged in any other location or for leftover fully cooked ham, heat to 165 ºF.

Cook seafood to 145 F. Cook shrimp, lobster, and crab until they turn red and the flesh is pearly opaque. Cook clams, mussels, and oysters until the shells open. If the shells do not open, do not eat the seafood inside.

Cook eggs until the yolks and whites are firm. Use only recipes in which the eggs are cooked or heated to 160 ºF.

Cook all raw beef, lamb, pork, and veal steaks, roasts, and chops to 145 ºF with a 3-minute rest time after removal from the heat source.

Bring sauces, soups, and gravy to a boil when reheating. Heat other leftovers to 165 ºF.

Reheat hot dogs, luncheon meats, bologna, and other deli meats until steaming hot or 165 ºF.

When cooking in a microwave oven, cover food, stir, and rotate for even cooking. If there is no turntable, rotate the dish by hand once or twice during cooking.
Always allow standing time, which completes the cooking, before checking the internal temperature with a food thermometer.

Is It Done Yet?
Use a food thermometer to be most accurate. You can’t always tell by looking.
USDA-FDA Recommended Safe Minimum Internal Temperatures

Beef, Pork, Veal, Lamb, Steaks, Roasts & Chops
145 ºF with 3-minute rest time
145 ºF
Beef, Pork, Veal, Lamb Ground
160 ºF
Egg Dishes
160 ºF
Turkey, Chicken & Duck Whole, Pieces & Ground
165 ºF

  • Chill: Refrigerate promptly

Cold temperatures slow the growth of harmful bacteria. Keeping a constant refrigerator temperature of 40 °F or below is one of the most effective ways to reduce risk of foodborne illness. Use an appliance thermometer to be sure the refrigerator temperature is consistently 40 °F or below and the freezer temperature is 0 °F or below.

To chill foods properly:

Refrigerate or freeze meat, poultry, eggs, seafood, and other perishables within 2 hours of cooking or purchasing. Refrigerate within 1 hour if the temperature outside is above 90 °F.

Never thaw food at room temperature, such as on the counter top. It is safe to thaw food in the refrigerator, in cold water, or in the microwave. If you thaw food in cold water or in the microwave, you should cook it immediately.

Divide large amounts of food into shallow containers for quicker cooling in the refrigerator.

USDA-FDA Cold Storage Chart

These time limit guidelines will help keep refrigerated food safe to eat. Because freezing keeps food safe indefinitely, recommended storage times for frozen foods are for quality only.

In the Know: Becoming a Better Shopper

Follow these safe food-handling practices while you shop.

  • Carefully read food labels while in the store to make sure food is not past its “sell by” date.
  • Put raw packaged meat, poultry, or seafood into a plastic bag before placing it in the shopping cart so that its juices will not drip on – and contaminate – other foods. If the meat counter does not offer plastic bags, pick some up from the produce section before you select your meat, poultry, and seafood.
  • Buy only pasteurized milk, cheese, and other dairy products from the refrigerated section. When buying fruit juice from the refrigerated section of the store, be sure that the juice label says it is pasteurized.
  • Purchase eggs in the shell from the refrigerated section of the store. (Note: store the eggs in their original carton in the main part of your refrigerator once you are home.) For recipes that call for eggs that are raw or undercooked when the dish is served – homemade Caesar salad dressing and homemade ice cream are two examples – use either shell eggs that have been treated to destroy Salmonella by pasteurization or pasteurized egg products. When consuming raw eggs, using pasteurized eggs is the safer choice.
  • Never buy food that is displayed in unsafe or unclean conditions.
  • When purchasing canned goods, make sure that they are free of dents, cracks, or bulging lids. (Once you are home, remember to clean each lid before opening the can.)
  • Purchase produce that is not bruised or damaged.

Check Your Steps:
Check “Sell-By” date.
Put raw meat, poultry, or seafood in plastic bags
Buy only pasteurized milk, soft cheeses made with pasteurized milk, and pasteurized or juices that have been otherwise treated to control harmful bacteria.
When buying eggs, purchase refrigerated shell eggs. If your recipe calls for raw eggs, purchase pasteurized, refrigerated liquid eggs.
Don’t buy food displayed in unsafe or unclean conditions
Food Product Dating

Types of Open Dates:

Open dating is found primarily on perishable foods such as meat, poultry, eggs, and dairy products.
A“Sell-By” date tells the store how long to display the product for sale. You should buy the product before the date expires.
A “Best if Used By (or Before)” date is recommended for best flavor or quality. It is not a purchase or safety date.
A “Use-By” date is the last date recommended for the use of the product while at peak quality. The date has been determined by the manufacturer of the product.
“Closed or coded dates” are packing numbers for use by the manufacturer. “Closed” or “coded” dating might appear on shelf-stable products such as cans and boxes of food.

Transporting Your Groceries
Follow these tips for safe transporting of your groceries:

Pick up perishable foods last, and plan to go directly home from the grocery store.
Always refrigerate perishable foods within 2 hours of cooking or purchasing.
Refrigerate within 1 hour if the temperature outside is above 90 °F.
In hot weather, take a cooler with ice or another cold source to transport foods safely.

Being Smart When Eating Out

Eating out can be lots of fun – so make it an enjoyable experience by following some simple guidelines to avoid foodborne illness. Remember to observe your food when it is served, and don’t ever hesitate to ask questions before you order. Waiters and waitresses can be quite helpful if you ask how a food is prepared. Also, let them know you don’t want any food item containing raw meat, poultry, seafood, sprouts, or eggs.

Ask whether the food contains uncooked ingredients such as eggs, sprouts, meat, poultry, or seafood. If so, choose something else.

Ask how these foods have been cooked. If the server does not know the answer, ask to speak to the chef to be sure your food has been cooked to a safe minimum internal temperature.

If you plan to get a “doggy bag” or save leftovers to eat at a later time, refrigerate perishable foods as soon as possible – and always within 2 hours after purchase or delivery. If the leftover is in air temperatures above 90 °F, refrigerate within 1 hour.

If in doubt, make another selection!

Smart Menu Choices

Tips for Transporting Food

Keep cold food cold, at 40 °F or below. To be safest, place cold food in cooler with ice or frozen gel packs. Use plenty of ice or frozen gel packs. Cold food should be at 40 °F or below the entire time you are transporting it.
Hot food should be kept at 140 °F or above. Wrap the food well and place in an insulated container.
Stay “Food Safe” When Traveling Internationally
Discuss your travel plans with your physician before traveling to other countries. Your physician may have specific recommendations for the places you are visiting, and may suggest extra precautions or medications to take on your travels.

Foodborne Illness: Know the Symptoms

Despite your best efforts, you may find yourself in a situation where you suspect you have a foodborne illness. Foodborne illness often presents itself with flu-like symptoms.
These symptoms include:


People with diabetes who experience vomiting and diarrhea can develop unstable glucose levels and may need to seek medical attention. If you suspect that you could have a foodborne illness, there are four key steps that you should take. Follow the guidelines in the Foodborne Illness Action Plan (below), which begins with contacting your physician or healthcare provider right away.
When in doubt – contact your physician or healthcare provider!

Foodborne Illness Action Plan

If you suspect you have a foodborne illness, follow these general guidelines:

  • Consult your physician or healthcare provider, or seek medical treatment as appropriate.

As a person with diabetes, you are at increased risk for severe infection.

Contact your physician immediately if you develop symptoms or think you may be at risk.
If you develop signs of infection as discussed with your physician, seek out medical advice and/or treatment immediately.

  • Preserve the food.

If a portion of the suspect food is available, wrap it securely, label it to say “DANGER,” and freeze it.
The remaining food may be used in diagnosing your illness and in preventing others from becoming ill.

  • Save all the packaging materials, such as cans or cartons.

Write down the food type, the date and time consumed, and when the onset of symptoms occurred. Write down as many foods and beverages you can recall consuming in the past week (or longer), since the onset time for various foodborne illnesses differ. Save any identical unopened products.

If the suspect food is a USDA-inspected meat, poultry, or egg product, call the USDA Meat and Poultry Hotline, 1-888-MPHotline (188-674-6854). For all other foods, call the FDA office of Emergency Operations at 1-866-300-4374 or 301-796-8240.

  • Call your local health department …

… if you believe you became ill from food you ate in a restaurant or other food establishment.
The health department staff will be able to assist you in determining whether any further investigation is warranted.