Stumble It!
How Many Carbs for Type 1 Diabetics?
If you have type 1 diabetes, you should be eating extremely low carb, right? This keeps your insulin requirements to a minimum and assures the best possible blood sugar control, according to intuition and the personal experience of many PWDs. But guess what? New research does not agree.
Yesterday, diabetes nutrition expert Hope Warshaw sent me an email flagging a new study published in the American Journal of Clinical Nutrition which concludes that — get this — “Among intensively treated patients with type 1 diabetes, diets higher in fat and saturated fat and lower in carbohydrate are associated with worse glycemic control, independent of exercise and BMI.”
The researchers, including Dr. David Nathan of DCCT fame, followed 532 subjects for five years in this study, the first to closely examine “the association of diet composition with subsequent HbA1c concentrations” in Type 1s who use insulin in various quantities throughout the day.
The substitution of fat for carbohydrate was associated with higher A1c levels, about a full percentage point, if I’m reading the study correctly. Both Warshaw and the study authors seem to indicate that this data lends credence to the ADA recommendations that between 45% and 60% of a diabetic’s diet should be carbohydrates. WtF?*
* Excuse my language again, but can it really be that we’re all totally misled in our knowledge (belief?) that low-carb=better BG control. I think not.
I printed out the study and took a copy with me to my endo appointment yesterday. She looked the document over and chuckled. Research is so nebulous, we agreed. “You can find all sorts of associations supporting contradictory hypotheses,” she said. Ain’t it the truth! But here’s the really smart thing she said:
“The way that carbohydrates effect people with diabetes is just so individual… Some people can eat English muffins or cereal for breakfast, take a certain amount of insulin, and they’re fine. While somebody else might eat exactly the same muffin or cereal — exactly the same amount of carbs — and dose for it, and they’ll still go sky-high. You just have to learn which type of carbohydrates your body can best handle.”
My experience exactly! My one type 1 friend at the gym once told me “I can’t do cereal.” But she eats sandwiches and pie…? I, on the other hand, can eat a small bowl of cereal and sometimes even go low afterwards. Yet a few simple corn crackers send me reeling. Every-body’s different. Which sure doesn’t make BG control any easier. I generally aim to eat less than 45g per meal.
What about you? Got any special “catapult foods” that send you into the stratosphere?
Explore posts in the same categories: D-News Examined, Food
Cheetos just kill me, probably in more ways than one. I get a small rise in BG just after, but it’s the spike about 2-3 hours later that always gets to me. But I just can’t give up the crunchy (fake) cheesy goodness…
Posted by: Joey | May 14th, 2009 at 6:39 ampasta – - for a high that just won’t quit!
Posted by: Kate | May 14th, 2009 at 6:41 amYeah…Oatmeal. Regular, slow-to-cook oatmeal. My endocrinologist insists it doesn’t raise blood-sugar, but constant 300 readings afterwards makes me think she’s mistaken. No extra sugar (sweet and low instead) and milk, that’s all it takes.
Posted by: Jim D | May 14th, 2009 at 6:41 amSince I started using Symlin, this has become less of an issue for me. I have to take an extended bolus to eat a meal with 70g carbs. I try to aim for low-GI carbs but the effects are dramatic (of the Symlin) for me. I tried it 2-3 times and quit before I found a way to use it that worked for me.
My original meal plan in 1988 from my endo was for lunch, for example: 2 bread exchanges, 2 fruit exchanges, 2 meat and maybe 1 fat (or something equivalent in carbs)…. It worked fine for me for years…
Certain carbs do still send me high, especially dry cereal. Oatmeal (with symlin) is fine though. I have to take a 1.5-hour, 25%/75% extended bolus so I don’t go low.
Posted by: Anne | May 14th, 2009 at 6:48 ammilk is super fast-absorbing for me. Jim D I wonder if it’s the milk, rather than the oats? Could be both.
Posted by: Anne | May 14th, 2009 at 6:49 amWell, this is pathetic…but…if I eat under 25 carbs in a meal I do great. More than that and I’m screwed.
Posted by: William Lee Dubois | May 14th, 2009 at 7:00 amHow interesting, I tolerate oatmeal extremely well and eat it every morning. However, pasta and rice I can’t do well at all. Dreamfield’s pasta with only 5 grams of carb/serving let me eat pasta after a 20 year absence.
Posted by: riva | May 14th, 2009 at 7:01 amGrape juice is like rocket fuel for my BG. Great for when I’m low, but sometimes I feel like all I have to do is smell it and I jump to 300+. Also, non-food related, cutting my basal rate for exercise is always dicey. Cut a tenth too much and I’m guaranteed to be high two hours later.
Posted by: David Downs | May 14th, 2009 at 7:38 amCheesecake, mayonnaise, shortbread cookies (even if its just one small cookie) my sugar goes high 4 HOURS after i eat it..all the fat likes to kill me
Posted by: Yousif | May 14th, 2009 at 7:55 amWow! I’m pretty surprised about the results of that study! I’ve always felt so guilty for not being able to keep a lid on my carb intake.
I think what your doc said was right on point – we’re all SO different!
Posted by: Scott K. Johnson | May 14th, 2009 at 8:30 amMilk is also a huge spiker for me. I know people think of that as “slower carbs”, but it’s like juice for my body.
Bagels are a mess for me, but a glazed donut is no problem.
Posted by: jill. | May 14th, 2009 at 8:48 amBaked white potatos. No other potato products (fries, chips, mashed) cooked in any way messes me up like a baked white potato.
Posted by: Brian | May 14th, 2009 at 8:52 amI am very much in favor of diabetes being renamed “Trial and Error”.
-Lloyd
Posted by: Lloyd | May 14th, 2009 at 8:56 amthinking about this more, who really substitutes the carbs with fat? I would imagine that the balance would include more fat but also more protein. I know, for myself, that after a really high-fat meal, my blood sugars are horrible for something like 12 hours, for a given amount of carbs. Also I think the types of carbs do make a difference (low GI vs high GI) and one person’s low GI seems to be another’s high…
Posted by: Anne | May 14th, 2009 at 9:01 amIt’s so interesting to read through the comments and hear what does and doesn’t spike each of us. I have no issues with pasta. And with my pumps dual-wave feature, I can even do pizza without a spike.
But oatmeal and wrap sandwiches spike me so high that I don’t eat them anymore. It’s grits and whole wheat sandwiches for me instead.
Posted by: Karen | May 14th, 2009 at 9:04 amI can’t eat rice. Any rice sends me ludacris speed into a light year or two…
Posted by: Gina | May 14th, 2009 at 9:23 amWhile I love bread products, more than an exchange or two worth of yeast bread at the time will send me high and keep me there. The other thing I’m finding is that there is a bit of a sodium correlation: the more sodium I consume at the sitting (whether or not it’s counteracted by potassium), the more grains are likely to rise me higher and longer than otherwise.
Posted by: tmana | May 14th, 2009 at 9:45 amPasta. And the whoel wheat, high fiber ones are worse. They delay a nasty high sometimes until the next morning. Love the comment by Lloyd above about renaming diabetes “Trial and Error,” so true!
Posted by: Alexis Pollak | May 14th, 2009 at 9:49 amChinese food is deadly for me. Spikes me for hours. Even in very small quantities, even a protein like General Tso’s chicken kills me. Goes to show just how much starch and sugar they put in those dishes.
Posted by: Rafael | May 14th, 2009 at 1:16 pmI think its important to take into consideration the quality of the carbs in an eating plan in addition to the quantity. I find that the low glycemic index carbs that I use, sweet potatoes, brown rice, pumpernickel bread and whole wheat pasta plus the correct timing of my meal bolus seem to help with control of my post prandial spikes in blood sugar. There are many other variables that we need to deal with as well.
Posted by: Florian | May 14th, 2009 at 2:04 pmI will second Lloyd’s motion to rename diabetes to “Trial and Error” with one amendment “Lots of Trials and Lots of Errors”
I have to double my insulin for cereal with milk (which I love & cannot live without) and I have to set my target to 80, not 120. This is the only food I have to double the IC ratio (I suspect an allergy to one of the milk proteins). For junky carbs in desserts, I have to add about 30% more insulin.
Posted by: Don | May 14th, 2009 at 4:17 pmThe more I think about it, Lloyd’s comment is really a gem. From now on I will say I suffer from “trial and error” instead of diabetes. Kinda covers all bases including my various character flaws!
Posted by: Don | May 14th, 2009 at 4:25 pmBananas drive my blood sugar…well, bananas. As soon as I eat one, I can feel my skin starting to get that creepy crawly “high” feeling.
Also, for some reason, I can do milk and cereal separately, but when I combine the two, it seems to make my sugars skyrocket. I can not explain why.
Posted by: Harry | May 14th, 2009 at 5:11 pmOMG I’m with Lloyd, too. How about “Trial and Error Manual Blood Sugar Control”?
Posted by: AmyT | May 14th, 2009 at 6:01 pmThanks, Anne, I hear ya! But having had type-1 for 45+ years, I’ve never seen a direct correlation between my drinking milk and a noticeable rise in blood-sugars, not that you’re wrong, you’ve probably hit it on the nose, but I’ve just never seen the correlation.
Posted by: Jim D | May 14th, 2009 at 8:57 pmIt might be like Harry experiences, the sum is greater than the parts, so like you said, it’s probably both.
I refuse to eat oatmeal without milk, bloodsugars be dammed!
Now for Cheetos and bananas, to the moon with those too, but what the heck, a man’s gotta eat what a man’s gotta eat.
This whole post of comments would be a great education tool for nutritionists, CDE’s, endo’s, heck – family & friends. What a testament to the lives we lead! As for me, it depends on the day! But I do find that I can do cereal w/milk as a bedtime snack and be fine, whereas for breakfast, forget it. (My new discovery = Pacific Foods unsweetened almond milk – low carb, and the fat isn’t too high either)
Posted by: T1 in Boston | May 14th, 2009 at 9:53 pmMy husband can’t look at a potato, a grain of rice, or a piece of pasta. His sugar skyrockets. But, a glass of wine, a strawberry daiquiri, or dark chocolate does nothing. Go figure!
Posted by: Ladybug Crossing | May 15th, 2009 at 3:29 amSince I discovered Carba Nada pasta (I buy on Amazon), pasta no longer seems to be a problem for me. Symlin doesn’t seem to help my constant highs at all.
But crackers, bread, potatoes, and bananas make my BG go through the roof!
Posted by: Erika Roe | May 15th, 2009 at 6:26 amThis post (and comments) is probably the best one I have read in the past year (not saying the others are bad, this is just REAL educational and enlightening for me). I would love to see more of this kind of discussion in the future here. Also, what kind of highs you people are seeing.
My son was diagnosed last year (11 years old) and all of these comments are helpful.
Posted by: terry | May 15th, 2009 at 10:52 amHi all; I am Dave Gallagher, living in Massachusetts.
I am relatively healthy Type 1 diabetic, for 46 years. (I’m 55).
This is a very good topic for my first post!
I love pasta. But for me it is and has been like the “Devil With a Blue Dress On” or the mythical utterly seductive and beautiful Medusa. But after another mythical “pig” God, Poseidon violated her in Athena’s temple) her revenge was turned any man into stone who ignored the mirror’s warnings, and looked directly at her face….This is a pretty well-known Greko-Roman myth — but exists in many other places.
The world of pasta and diabetes is one of these places:
Pasta is almost impossible to resist – but turns my insulin to carb ratio into stone!!!
But, interesting post Erika. I have not yet tried Carba Nada pasta; but in the recent past have tried Greenfield pasta with no success despite the company’s claims.
I’ve established a fairly accurate insulin to carb ratio (bolus), as well as a correction (or basal) ratio; it works consistantly with almost all other foods — and 9x out of 10-times. When it doesn’t, usually I have made an estimating mistake, or have been a “wee bit” too liberal.
But (at least for me) pasta continues to challenge my percieved knowlege and “almost laugh at me!!
I have been re-taught measuring pasta portions by my present wonderful and excellent Nutrionist at Boston Medical Center. But alas — still no success. I am beginning to wonder if this seductive food simply defies us all; doing what it wants to do”? Logic would say “No” — but experience says a loud “YES.
“Maybe there are some unique amino acids in pastas that deal with the CHO absorption timing and manner? We do know everybody’s body and metabolic functions *are* different. It this is so, then it’s reasonable to believe that we all digest, absorb (or expel) nutrients differently. But it’s also reasonable to learn and deal with most of these what I call “challenge foods.” But pasta must be different. Personally I think it is the diabetic’s “Achilles Heel” This wonderful food seems to almost be human. It does “what it wants to do.” If it doesn’t like the rules — it changes them…..
I know mine is not an isolated problem. I’d really appreciate a response from others in this wonderful blog who may have”figured this out.” Frankly I’m tired of my own failing here. But, I’m a stubborn (but not stupid) 3rd generation Irish-American. “We” don’t give up easily….But this one stumps me…..
I just discovered this blog, and want to thank all of you who have made it a proactive and helpful group. I look forward to participating, learning, and passing along what I know and have learned in my 46-years living with diabetes. I am “tenured” with diabetes – but can and mus always share and learn.
Thanks all!
/Dave Gallagher
davgall@comcast.net
P.S. Typed but not proofread….(in other words please forgive typos, mispellings and repetitive statements.
Posted by: Dave Gallagher | May 15th, 2009 at 12:18 pmI’m 56 and have had diabetes for 13 years. I am Type 1. Bagels are the devil for me, so I limit myself to 1/2 bagel when I choose to indulge and always include cream cheese. Breakfast carbs are my nemesis–especially oatmeal (I also eat “real” and not instant). After wearing a CGM for several months, my endo and I decided to try bolusing for breakfasts 20-30 minutes before eating. Works for me. I also try to keep my carb limit to 45g at a meal, but I’m only human.
Posted by: Sara B | May 15th, 2009 at 4:32 pm“After wearing a CGM for several months, my endo and I decided to try bolusing for breakfasts 20-30 minutes before eating. Works for me.”
makes me wonder how many of these catapult foods would be manageable with CGM. i look forward to the day when anyone who wants CGM can have it!
Posted by: Don | May 15th, 2009 at 10:47 pmPasta is no problem for me (as long as I don’t have more than 1.5 servings), but rice? Forget it! I can’t have more than a teaspoon, which doesn’t seem worth it. I don’t really miss rice, but I do miss mochi and dim sum. Cereal and granola are a recipe for spike city. No problem with potatoes, but corn is out. Ooh, here’s one I do miss: Snyder’s pretzel pieces. I love them, but they spike me like nothing else (and yes, I pre-bolus, my I:C ratio is correct, etc.)
Posted by: Lili | May 15th, 2009 at 11:15 pmGiven the fact that I have Type 1, and for the last year and a half joined the ranks of being gluten intolerant, my selection of carbs had to change dramatically. Talk about trial and error.
Posted by: Mark R | May 15th, 2009 at 11:34 pmPorridge with milk is fine for me, Special K with milk sends me through the roof.
Posted by: Alison | May 16th, 2009 at 1:58 amI can do pasta and rice without a problem but pizza and curry need a stroke of diabetes genius to make sure I’m still in range several hours later.
Fresh orange juice is like rocket fuel, but apple juice is tolerable with a couple of units.
It’s definitely trial and error and what works for you. I work on the principle that fewer carbs is better, but I balance that with the fact that I can’t live without pasta and I will be found indulging in a curry every now and then.
One year ago I needed to have a colonoscopy. I was SO concerned, in that the diet for one day preceding the procedure consisted of juices and jello and ice pops. I was certain I’d have the worst BG’s anywhere! After it was all said and done, I realized that my BG’s had been better than ever! I commented about this to my endo. She said “Of course your BG’s were fine on that diet. It’s when we throw fat and protein into the mix that BG’s are less predictable!”
Posted by: June S. | May 17th, 2009 at 10:01 amCanada & Australia have been working under this assumption for years now and are finding really good results.
Posted by: Heidi Renee | May 18th, 2009 at 2:53 amRice makes my BG WAAAAAAAAAAAAY HIGGGH, althoughh i love it. and pecan tarts:(
Posted by: Doa'a | May 19th, 2009 at 5:58 pmOH and i can’t havee FRENCH FRIEEES:(
Posted by: Doa'a | May 19th, 2009 at 5:59 pmCoffee and splenda makes my sugar go crazy, any one else get this effect??
Posted by: meg | June 30th, 2009 at 7:13 pmvery informative blog, It gives me some inspiration.
Posted by: Ladybug | September 17th, 2009 at 1:06 pmI was controlling under type II. I am steroid induced diabetic. thanks to all the dr’s who gave me steroids for lung infections because god forbid I should become antibitic resistant. Oh and their thinking now has cost me one long lobe-mororns! afte rthe lung surgery BG out of control now I take insulin. I am in the angry phase still. I find food one of the last pleasure I can have and now that is gone. The only time my BG wa sin range since starting insuloin was once I had a sald and that was all I ate all day. I see the endo in 2 weeks we will talk. I grew up stick thin eating and drinking what i wanted. I truley hate being a diabetic.
Posted by: Brandie | October 6th, 2009 at 2:06 amI meant one lung lobe removed. repeated infections and pnemonia destroye dthe lung. One thing, I discovered. I longed to go to a MX restaurant and have a margarita but it would spike my BS like crazy. I asked the restaurant think you will ever get SF maragritas they laughed in my face. But at KROGER wher ethey sell their drink stuff, their margarita mix is SF and taste like the real thing. If you don’t want to do the alcohol it is great without the alcohol. It has a somwhat diff consistance but I tell you it is good sometimes you have to pour it out other times scoop it out. It was fabulous and no sugar!
Posted by: Brandie | October 6th, 2009 at 2:11 amI have to double my insulin for cereal with milk (which I love & cannot live without) I have to set my target to 80, not 120. This is the only food I have to double the IC ratio (I suspect an allergy to one of the milk proteins). For junky carbs in desserts, I have to add about 30% more insulin
Posted by: infants | November 8th, 2009 at 10:02 pm