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25 Responses

  1. Gretchen
    Gretchen May 29, 2009 at 6:59 am | | Reply

    1. I think someone who does not have diabetes is unable to grasp the fact that that “healthy whole grains” raise blood glucose levels and they’re not particularly healthy for people who have diabetes. The same goes for fruits.

    2. A 37% carb diet is not a low-carb diet. On a 2000-calorie diet, that would be 185 g of carbs per day. Bernstein recommends 30. Others recommend 50 or even up to 100. When you don’t eat many carbs, the fats you eat are burned for energy rather than being stored.

    3. It’s quite possible to eat a LC diet without splurging on saturated fat.

    4. If you tell people to “eat more fruits and vegetables,” I bet most of them will eat a lot of sugar-dense sweet fruits and starchy vegetables like potatoes. If you think they can be taught to distinguish, then they can also be taught to distinguish sat fat from other fats.

    5. “. . . with appropriate insulin doses as needed.” First, not everyone is taking insulin. Second, some people now thing it’s swings in BG that cause complications, and it’s almost impossible to use insulin to keep BG level when you eat a high-carb diet. You can “cover” it in the sense that the BG will eventually go down, but in the meantime, you’re swinging from high to low. CGMs have demonstrated this. Someone without diabetes who has never tried to cover foods with insulin really can’t understand the problem.

    6. “Although dietary carbohydrate increases postprandial glucose levels, avoiding carbohydrate entirely will not return blood glucose levels to the normal range.” That’s simply not true. Some people with early type 2 can have normal BGs if they don’t eat a lot of carbs. And even for those with more advanced type 2 or type 1, the fact that eating LC won’t return BGs to normal doesn’t mean that smaller increases after eating aren’t beneficial. This is the type of double-talk people use to convince others that the high-carb diet is best.

    7. “glucose is the primary fuel used by the brain and central nervous system.” This is old information. They now know that with some adaptation, the brain can use 50 tp 75% ketones. Furthermore, the body can make glucose out of protein, a process known as gluconeogenesis. I’d assume a nutritionist should be aware of this. Children have been maintained on ketogenic diets for a long time and their brains don’t shrivel up.

    8. “foods that contain carbohydrate are important sources of many nutrients, including water-soluble vitamins and minerals as well as fiber.” This is true, and the most nutrient-dense ones are the low-carb vegetables like broccoli, cauliflower, leafy greens, berries. The vegetables that people give up are stuffed with starch, which doesn’t have a lot of redeeming value, or they’re fruits that have been bred to be very high in fructose, which causes high triglycerides and is an important risk for heart disease.

  2. RB
    RB May 29, 2009 at 8:16 am | | Reply

    Excellent counterpoints Gretchen.

    I can’t beleive that we still get the same ADA nonsense thrown out constantly. I suppose that’s what one would expect from an ADA person though.

  3. Todd
    Todd May 29, 2009 at 9:40 am | | Reply

    Gretchen

    I’m a type 1 diabetic using an insulin pump
    1. I eat whole grains and fruit in moderation and they don’t cause big spikes for me. Why do you say they they are not healthy?
    2. Please explain your math. You say 37% of 2000-calorie diet is 185 grams of carbs, which assumes 1 gram of carbs = 4 calories. Where do you get this?

    It’s seems like a balanced, healthy diet is going to be naturally relatively low in carbs and fat, and fixating on percentages and precise numbers is silly, because as we all know, each person is different and each person has to eat what works best for them.

    6. Please point to the research that backs up your assertion. Do you maintain that if I eat NO CARBS, then I will not need to take any boluses to keep my blood sugar normal?

    Saying things like “This is the type of double-talk people use to convince others that the high-carb diet is best” makes it sound like there is a grand conspiracy to get people to eat excessive carbs. Do you think Hope is maybe being paid by the “Carb Cabal” to promote an unhealthy lifestyle? No, she is saying eat a balanced diet and don’t fixate on “low carbs over everything else”.

    FWIW, my endo is much more concerned with my fat intake (and cholesterol numbers) than my carbs. I think the study in question backs up the idea maybe we are a little too obsessed with carbs over all else.

  4. Lauren K
    Lauren K May 29, 2009 at 12:05 pm | | Reply

    I never listen to CDEs as a general rule. I think each person has to find what works with their lifestyle, taking into consideration what they enjoy eating and how much of a glucose spike they can expect from certain foods. Don’t listen to others’ advice if it doesn’t work for you! I have no idea what my “insulin to carb” ratio and “correction factor” are. I bolus based on experience — like how much for an apple? — AND, more importantly, my activity level that day. We type 1′s, who live with the disease, are the real experts when it comes to what works. It’s absurd, and irresponsible, to try to standardize us.

  5. Lauren K
    Lauren K May 29, 2009 at 12:10 pm | | Reply

    And I could not disagree more with the statement that rapid-acting insulin isn’t as rapid as we thought. That is the OPPOSITE of my experience. Humalog is far TOO rapid for me and wears off too quickly for the sort of slow carbs that I eat. Apidra was very bad for me — way too fast and too brief a duration of action.

    If I were to bolus Humalog 20 minutes before eating I would be in the midst of a horrible low blood sugar 20 minutes into my meal. I am extremely insulin sensitive and that it setting me up for disaster. Another reason I’ll follow my own instincts and experience rather than others’ advice, which can prove to be very harmful.

  6. Heather
    Heather May 29, 2009 at 12:18 pm | | Reply

    Gretchen,

    “First, not everyone is taking insulin.”

    Did you miss the part “How Many Carbs for Type 1 Diabetics?” This isn’t about Type 2 and doesn’t claim to be applicable to those with Type 2.

    Type 1s DO take insulin.

    “it’s almost impossible to use insulin to keep BG level when you eat a high-carb diet. You can “cover” it in the sense that the BG will eventually go down, but in the meantime, you’re swinging from high to low.”

    While that happens occasionally, if it’s happening frequently, then you need to reevaluate your ratios and/or figure out which foods affect you that way. See the comments from the earlier post linked all the way at the top to see how the same food affects different people in VERY different ways.

  7. LindaB
    LindaB May 29, 2009 at 1:59 pm | | Reply

    I don’t anything about Gretchen’s diabetes, but, I can tell you that I have found that by setting my pump w/ a basal rate of .7 overnight and .8 starting at 8 am with a carb ratio of 1 unit for 10g of carbfor breakfastand then a ratio of 1 unit for 8 gr of carb for lunch and dinner w/ a 105 total carb intake per day, thats 30g at each meal and 15 for a nighttime snack, I have found that my sugars have leveled out to about a consistene 120-130, most of the time. I also have experimented w/ bolusing for longer periods of time, due to gastroparesis.
    It took alot of trial and error to reach this formula. But It works for ME. I keep in mind all the research thats out there, but in the end you have to look at what thingslike food exercise, a complication (maybe) affect you. Diabetes, either type is not a cookie cutter disease. My diabetes is not yours and vice versa. Learn how YOUR diabetes works. Use research and the tools an out there as a guideline for your individual care, not as a this is the only way to do things. Just a thought.

  8. Anne Findlay
    Anne Findlay May 29, 2009 at 5:26 pm | | Reply

    Thank you for your clarifications of this study. It was an interesting study to me, and you answered a lot of questions that I had had. I think the definition of “low carb” has changed quite a bit over the years. Perhaps we are just trying to get back to “normal carb” levels after years of being advised to cut way back on fat (and consequently, eat much higher amounts of carbs).

    For me, using a CGM in combination with Symlin has significantly reduced my post-meal BG rises. I pretty regularly would shoot into the high 200s/low 300s after breakfast. Now (and, granted, it is not perfect), I can keep my post meal BG’s ~<180 and sometimes really close to where I started. It has taken me many false starts to get used to Symlin, but with consistency, I have grown to appreciate its effects.

    I, for one, greatly appreciate the efforts of those (with or without diabetes!) in the scientific/medical communities, who work to improve the lives of people with diabetes.

    Cheers,
    Anne

  9. Carole Smith
    Carole Smith May 29, 2009 at 8:37 pm | | Reply

    I have been using Insulin for almost 30 years, and I have found that the diet that works best for me is a high complex carb diet – I eat 150- 180 carbs per day. I usually avoid products made with while flour. If I take my insulin about 10-15 min before I eat, I can easily keep my high at 150 or less. I eat fruits, but combine them with more complex carbs (ex” oat bran hot cereal with blueberries & bananas for breakfast (20 carbs for cereal plus 20 for the fruit) – is a favorite breakfast of mine that produces a nice low curve. (I even eat ‘pizza’ using whole wheat pita flat bread for the crust & no sugar added Hunts Spaghetti sauce for the sauce & cover it with vegies, cheese & a little meat. – again I have a fairly low bs curve for this) – I currently am using a MM pump with their CGMS – so I can easily track this.

    So I agree with those who said that it is up to each diabetic to figure out the diet that works for them & that they are comfortable with. I can see how a low carb diet might be better for Type 2 diabetics, especially if it can keep them off of medication. For Type 1, it seems that we have more leeway in determining a diet and medication method that works for us and that we are comfortable with. BTW – after 32 years as a diabetic (type 1.5 – initially diagnosed with type 2 at age 29) – I have no complications except for some very mild loss of feeling in my feet – so either I am very lucky or I have been doing something right.

  10. Hans
    Hans May 30, 2009 at 12:39 am | | Reply

    Hope Warshaw is right, there is no automatic correlation of less carbs and lower bg numbers in order to get a low A1c result. But there is no reason for the opposite either. A diabetic who wants to produce a healthy bg curve must actively explore and match his individual insulin curve with his individual carb curve. Sure that is much easier with lower amounts of carbs and insulin.
    And she’s also right in that it can be necessary to inject more or less time before eating so that insulin and glucose do arrive in the blood stream at roughly the same time. That is why I inject my Apidra at 6 for my breakfast around 6.30 to 6.40. For the rest of the day it is ok for me to inject just before eating.

    But the idea that we should eat starches for their vitamins and minerals is just poor misconception as those goodies tend to disapear in the processing. Most of our minerals and vitamins we get from fibres (if not from pills) – with an astonishingly modest demand for insulin.
    Similarly misleading is the notion that our organism should constantly be in need of glucose from outside and that we would deprive it of its necessary fuel by limiting our glucose intake. 100 mg/dl means that there is 1g of glucose running with every 1 litre of blood in our pipelines. A small number with diabetics and the median amount per day is even less than that in perfectly healthy people. So nobody with a reading of 100 mg/dl and more must eat glucose for the fueling of his brain. For that he mustn’t even inject insulin as the brain cells do not need any insulin to facilitate their glucose intake.

    By the way, there are quite a number of folks around this world who would never have been able to live and survive before the advent of supermarkets if the carbs to fat and protein ratio was as stringent as is argued in the guest post above. So where had their brains been getting their glucose from for centuries? Simply from gluconeogenesis, the process by which the liver produces glucose from protein. And where had the rest of their cells been getting their fuel from? Simply from fat. From the fat they used to eat with the protein. – Even with most people living mostly on starches and sugars these days most of the calories are not instantly burnt as fuel but stored as fat in their fat cells. Ok, some of the calories also go into the glycogen store of the liver but that is rather limited as 2 g of glycogen bind 10g of water whereas their 8 calories fit easily into 1g of fat storing 9. Interesting to imagine what a lean adult person would look like if he had to carry the energy stored in his 7 to 8 kilos of fat in the form of glycogen together with the necessary water. Fat does actually look like the best possible way of biologically saving energy for later use.

    It has been my personal experience for more than 5 years with an A1c from 4,8 to 5,3 (mainly max 140-120-100 mg/dl 1-2-3 h after input) that the amount of Apidra/Humalog I have to inject corresponds mainly to my input of starches and sugars. And that my body weight starts rising with roughly more than 80 units of insulin (34 from Lantus) per day, which leaves me with my individual median insulin-carb ratio with about 100g of carbs per day. On the other hand I know of lean diabetics eating 400-500g of carbs a day. So the only one for all solution can obviously be that there is none ;-)

  11. Doug
    Doug May 30, 2009 at 11:48 am | | Reply

    Type 1 diabetics seem to have very individual responses to carbs, and even within a person (using myself as an example), tolerance to carbs change over a lifetime.

    Recently, my diet has changed to much more protein, very little carbs, vegetables primarily from above-ground sources (limiting root vegetables), and limited fruit intake. My basal rates have decreased 0.3 units/hour of Novolog. BG is still fluctuating as I adapt to how my body responds to the different meals, but highs have decreased to the high 100′s/low 200′s.

    I think that I read somewhere on Diabetes Mine that diabetes “is a disease of carbohydrate intolerance”, and that is the direction that I’m taking my care because it works in my case.

  12. Gretchen
    Gretchen May 30, 2009 at 12:01 pm | | Reply

    I don’t want to dominate this discussion, but some people asked me questions, so I’ve answered.

    1. Calculations. 37% of 2000 calories = 740 calories from carbs. 740/4 = 185.

    2. I agree with those who say the most important thing is what works for you. If you can eat whole grains without a big rise in BG, then keep eating whole grains. But there’s nothing in whole grains that you can’t get from other foods. You can get the fiber without the carbs from brans.

    3. The idea of a “balanced” diet sets me off because balance depends on how you divide food into groups. Someone from the Arctic might consider balane to mean one-third seal, one-third whale blubber, and one-third caribou. Dieticians keep telling us we should eat a balanced diet and not cut out whole food groups . . . except for fat, of course, or meat, if you’re a vegan.

    4. I never suggested that anyone go on a no-carb diet. People on *low* carb diets eat LC fruits (mostly berries) and vegetables. When you have type 1, if you stopped eating any carbs, you would then turn the protein you ate into sugar (and if you didn’t eat enough protein, you’d start burning your own muscles). So you’d still need some insulin.

    105 g a day is what I’d call a “lowish-carb diet.” The ADA recommendation for 60% carbs would be 300 g a day for a 2000-calorie diet.

    5. I don’t have time to come up with references for everything I said. If you need those, just don’t believe me.

    6. I don’t think Ms Warshaw is part of a “carb cabal.” I do think she has a closed mind on the topic. She had a debate with Bernstein on some program, I think DLife, and she smiled patronizingly while he presented evidence for his point of view and then went on about balanced diets, with no evidence to support her arguments. The ADA is heavily invested in the “the more carbs you eat the better” approach, and it’s difficult for people to admit they’re wrong. They’re slowly changing.

    7. We’re all different in how we react to insulin. I once bolused Novolog and didn’t eat anything for I think 45 minutes and my BG hardly moved. It was the amount that made me go slightly low after eating.

    8. I realize this is a type 1 site, mostly, and of course type 1s all take insulin. But the ADA applies Ms Warshaw’s advice to type 2s as well.

    9. Those who are fortunate enough to have CGMs or who are prescribed a lot of strips and know how to use the data can even out their peaks by modifying various factors. But I think there is a large type 1 population that doesn’t have these tools, or doesn’t have the smarts to use them properly. Telling those people to eat a low-fat high-carb could be contributing to complications.

    Many type 1s who got CGMs were aghast to see how high they were spiking between meals. They might always have been close to their target BGs when they measured premeal, but they went really high before that.

    I realize that fats can also cause problems, and again this might be individual, with some tolerating more fat than others. If you eat both fat and high carbs, then the fat will keep your BGs high for hours, the well-known pizza effect. When you eat fat but don’t eat many carbs, the BG will never go high, and in most people, fasting triglycerides will come down greatly.

  13. just my 2c
    just my 2c May 30, 2009 at 10:18 pm | | Reply

    This is not abt the discussion but just some gentle feedback for Hope Warshaw, whose article I enjoyed reading.

    “As a dietitian and diabetes educator for more years than I like to count, (however, not a person with diabetes), I wanted to provide more context for you to evaluate the research featured in “How Many Carbs for Type 1 Diabetics“?”

    My gentle suggestion, in terms of not upsetting Type 1′s (like me) who live with this (expletive) illness 24/7, would be a slight adjustment, as follows:

    I am not a person with diabetes. But I am a long-time dietitian and diabetes educator who cares deeply about people with diabetes. So I wanted to provide more context for you to evaluate the research featured in “How Many Carbs for Type 1 Diabetics“?

    “for more years than I like to count”

    usually one says this about something unpleasant, no? (Like: “I’ve been trying to lose weight for more years than I like to count.” “I’ve been at this same job for more years than I like to count”) You presumably wouldn’t say this abt something you enjoy, right? (“I’ve been a mother for more years than I like to count”). So it was off-putting here, fwiw.

  14. dan 2
    dan 2 May 31, 2009 at 6:36 pm | | Reply

    This comment is being writen from the view of 43 years as an insulin dependent diabetic. My first point is that insulin has one function and that is to lower blood glucose. Our objective is to maintian a blood glucose level between 80-110 which can result in an A1c between 4-6.

    My comments are based upon my numbers. The amount of insulin necessary is small. Some people could be in a range that is a very small amount and ranges that are a challenge for a 3/10 cc syringe and the choice of insulin. So, one suggestive approach is an increase in carb consumption to balance an insulin quantity that can be measured and delivered to offset the carbs.

    These are my personal readings. A cracker and/or cookie of 10 grams of carbs requires a bolus of 0.35 units of U100 insulin. If my blood glucose is 105 before the cookie it will rise to 135 after the cookie if I do not give myself a bolus! An error of 40 grams in the computation of a meal of carbs can mean an additional bolus of 1.40 units of insulin to drop a blood glucose from 205 to 105. These are small numbers that do result in a serious challenge to maintain a normal blood glucose range. This is the reason that I wear an insulin pump. We need a better way to deliver and balance the insulin needs to match our blood glucose levels in a “normal” optimal range.

    D2

  15. Diabetes Diets | DiabetesBloodSugar.info

    [...] Carbohydrate: How Much (or Not) to Munch? (diabetesmine.com) [...]

  16. Shirley Dingley
    Shirley Dingley June 7, 2009 at 3:34 pm | | Reply

    I try to eat whole grains, limit the amount of fats in my diet; however, it seems to me that when you cut down to much you get hungry. I also have cut all sugar subitutes out of my diet; as well as, caffine. When I have something with sugar subitutes, about one to two hours later, my body is telling me “you promised me food well where is it” and I start mindless eating. Does anyone else have this proble? Thanks.

  17. Acai Berries
    Acai Berries August 14, 2009 at 10:49 am | | Reply

    ne suggestive approach is an increase in carb consumption to balance an insulin quantity that can be measured and delivered to offset the carbs.

  18. Resveratrol
    Resveratrol August 14, 2009 at 11:39 am | | Reply

    I do not give myself a bolus! An error of 40 grams in the computation of a meal of carbs can mean an additional bolus of 1.40 units of insulin to drop a blood glucose from 205 to 105.

  19. Benefits of A Low Carb Diabetes Diet | Common Diseases | Your Personal Health Care Blog

    [...] Carbohydrate: How Much (or Not) to Munch? (diabetesmine.com) [...]

  20. Barry
    Barry September 8, 2009 at 2:20 pm | | Reply

    When you start trying to count your calories and carbs all the time, you forget about the big picture. Work out / exercise and eat healthy foods. That’s the secret to losing weight!

  21. lance
    lance November 9, 2009 at 4:42 am | | Reply

    My recent post about Carb Intake for Type 1 Diabetics was pretty critical of new research and of the ADA?s recommendations. Today, please enjoy a counterpoint view: A Guest Post by Hope Warshaw, nutrition expert and CDE As a dietitian and diabetes educator for more years than I like to count.

  22. Great Coupons
    Great Coupons January 28, 2010 at 1:00 am | | Reply

    Great website!

  23. Eliken
    Eliken September 21, 2010 at 5:08 pm | | Reply

    Great post! A healthy diet balances the life of people with diabetes and improves quality of life.

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  24. Denise
    Denise January 3, 2011 at 11:16 am | | Reply

    If my A1c is 9.5 how many carbs should have a day.

  25. Chook Pens
    Chook Pens March 11, 2012 at 9:25 am | | Reply

    Great post! A healthy diet balances the life of people with diabetes.Chook Pens

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