Monday, November 5, 2012

Day 5: A Conundrum



Every person who is diagnosed with type 2 diabetes is encouraged to modify their diet in order to help control their diabetes.  Some of those people are sent to a dietician or certified diabetes educator (CDE) while others are left to find the information on their own.  Today, I’d like to focus on carbohydrates since that is the one thing that affects our blood glucose the most.  

When I was first diagnosed over 7 years ago, the American Diabetes Association website recommended that people with diabetes consume approximately 45 grams of carbohydrates at each meal.  Since then they have changed their focus more towards individualizing a meal plan and working with your doctor/dietician to find a target that works for you.  I like that shift but the recommendation for amount of carbs has basically remained the same.  Here is a quote from the ADA website:  “If you haven’t set up an individualized meal plan yet, we suggest including about 45-60 grams of carbohydrate per meal to start. If you follow that recommendation, you would be eating a total of 135-180 grams of carbohydrates throughout the day. However, some people may need more and some people may need less, so set up a plan that works for you soon!”

While at the TCOYD conference this month I sat in on a presentation done by a CDE about what we can eat when we have type 2 diabetes.  They started out with breakfast and immediately showcased different cereals and breads that we can eat at breakfast, as long as they are whole grain and have lots of fiber.  I also stopped by a booth by the Lily Company which had CDEs available to help you with whatever questions you might have.  Again, the focus was on eating a variety of foods but focusing on whole grains as a healthy option for our carbohydrate needs.  (They did also mention eating healthy vegetables.)

Now I did start out, many years ago, eating approximately 150 grams of carbs per day.  At that time I was able to control my diabetes with diet and exercise alone.  Eventually I had to begin taking Metformin and that dosage has increased over time.  During that time I have also had to lower the amount of carbohydrates I eat at any given meal in order to maintain a decent blood glucose level.  I have had to adjust my carb intake, just like the ADA website quote suggests: “some people may need less”.  This is all well and good since I have paid attention and made adjustments as needed.  In fact, I rarely eat any carbs at breakfast unless you count the veggies in my omelet or quiche.  The idea that I can still eat cereal, even oatmeal, is ludicrous.  I simply can’t. 

I have a serious concern about how diet is portrayed in the medical/dietary community.  There is too much emphasis put on the idea that we people with diabetes can eat anything in moderation.  In fact, I also touted that in my early blog posts, but I have always paid attention to what my meter tells me and adjusted accordingly.  My concern is that there are too many people “out there” who don’t pay attention to their meters or don’t bother to adjust and are simply going by what they read online or are told by a CDE.  Never have I heard a medical person say that carbs should be cut back drastically if your blood glucose rises too high.  When I’ve mentioned eating a low carb diet I’ve been told that whole grains are good for us and we should be eating them.  Really?  Even if a modest bowl of unsweetened oatmeal shoots my glucose up over 200?  Even if a sandwich made with whole wheat bread spikes my glucose past something reasonable?  I should still eat it?  I don’t think so.

I dearly wanted to ask the CDE at TCOYD what she would recommend for someone like me who can’t tolerate such high carb counts.  I wanted to hear what her advice would be but I never got the chance.  I wonder, would she say “take more meds”?  Would she recommend insulin?  I’ll never know, I guess, but I suspect that might be one answer.  If there are any CDEs reading this post, I’d love to hear your advice.  My preference would be to lower carbs before increasing meds.

So here’s the conundrum: carbohydrates cause our blood glucose to rise and yet we are constantly bombarded with the idea that we should eat more.  Whole grains are our friends! (Despite the fact that they can be evil).  We must eat a “balanced diet”, regardless of whether or not some of the components totally muck up our glucose control.  No freakin wonder people are confused!!  What about the idea of getting our carbs from leafy, non-starchy vegetables?  Why is it always thrown out there that we should eat grains and potatoes?  I don’t get it.  It’s plain to me that we can’t just eat anything in moderation.  It’s time to put on our big girl panties and realize that we have to give up certain foods.  Deal with it.

I recently had a conversation with two men who were eating lunch at the senior center.  Both of them have type 2 and both of them are on insulin (long acting).  One was eating a huge plate of meatloaf, a big baked potato (all smothered in gravy), a roll and some canned veggies. The other one was sipping on a glass of juice.  Both were telling me how hard it is to control their diabetes.  Ya think?

I think I understand why associations like the American Diabetes Association continue to recommend such high carb counts; I believe that their focus is still on people with type 1 or people who use insulin.  I think the recommendations are higher because there is a concern for hypoglycemia.  Hello!!!  People with type 2 who don’t use insulin (or any other type of med that can cause hypos) are not in danger of going low! We are in danger of spiking too high and then not having any quick way to lower it.  I don’t think our society has made a sufficient shift toward people with type 2. I think that the science is changing so fast that the recommendations can’t keep up. There isn’t one way to treat type 2.  There isn’t one way to eat.  There isn’t a specific carbohydrate amount that we should be eating and yet we are still being told to “eat this much”.  We’re still being told to eat whole grains even when we show that we can’t and continue to have decent glucose control.  ARGHHH!!!!

Deep breath.  So what do we do?  I’m certainly not advising anyone to drastically lower their carb intake.  Hey, I don’t know you or what meds you’re taking or how insulin resistant you are.  Therefore, it would be silly for me to give you any advice (beside the fact that I’m not a doctor).  I will, however, advise you out the wazoo to take charge of your diabetes.  If your meter doesn’t like a certain food, then STOP EATING IT!  Don’t continue to eat cereal or bread if it spikes your glucose, no matter what your CDE says.  Discuss it with them and try to come up with a plan that isn’t just “increase your meds”.  Wake up and take charge!  Don’t be a sheep!  Your health is too important for you to not take an active role.  You may not have a medical degree or nutrition training, but you certainly are in the front lines in your fight to control your diabetes.  Don’t hesitate to speak up.  Don’t hesitate to experiment.  It’s your health.

This ends Kate’s soapbox stand.

1 comment:

  1. Thank you for giving a voice to the complaints that I have after coming home from seeing my DE (I live in Canada). Those are the exact words of the dietician "as long as you keep within 45 grams per meal it's ok". That is one of the questions I had was what type of cereal I should be eating. I try to keep it to a high fibre cereal with low sugar. I have to eat cereal because I'm also on low protein diet (60 grams). So much of my information I found online thru trial and error. Every meal plan for diabetics is high protein--which doesn't work for me.

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