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?
Hi Everyone!! I just found this blog, and it is truly a blessing! I’m 27 years old, and was diagnosed at 18 months old. I’m reading everyone’s comments about carbs/low gi/hi gi foods, and I wanted to share a couple things that have truly made the difference for me. First off, raising my long-acting insulin a tad improved my readings DRAMATICALLY. I can not believe it. I see where some of you have had higher readings, and thought this may be something to talk to your endo about. Also, I was under-compensating for the carbs I used to eat. If my sugar was 63, for example, I’d have dinner, and wouldn’t “bolus” enough to compensate because my pre-meal reading was so good. Now, I still count my carbs, and compensate the correct amount. Lastly, it’s great to hear everyone’s take on the low carb/moderate carb issue. I’ve found that if I stay around 45 carbs per meal, I feel great and have awesome readings. Some Type 1′s swear by low carb, but this actually sends my sugar high. I attribute that to the ketosis going on in my body, and the delayed onset from the fatty foods. Anywhos, I just wrote a novel, but wanted to share my experiences!
I think the focus should be also on using this to our advantage: Bernstein’s law of small numbers. It’s a fact that the less insulin we give (due to fewer carbs and other factors like insulin sensitivity) the more likely we are to avoid extreme highs and lows. I can’t stress enough how that’s not a matter of opinion but reality. THAT is why so many people with type 1 diabetes are lowering their carbs and choosing whole foods with a lower glycemic load.
And while there isn’t a study about that yet, no study is ever going to make me change how I’m eating, which is about 60 grams of carbs a day. I only do it because so far all my blood and other tests are saying “keep doing what you’re doing!”
I have discovered, thanks to my weight lifter friend, that snacks of lean protein and veggies between meals keep me right between 80 and 120. I don’t eat my snacks and I climb to 200 before my next meal. Weird right?
So I am eating lots of nut butters, brown rice and goat mil protein powder with unsweetened almond or coconut milk (I have lots of food allergies so no cow products). I am steady freddy for the rest of the day. Can’t wait for my next HgA1c!!
Our Type 1 is now a teen, almost fully grown. Still eats basically the same amount of carbs per day, a little lower than when she was younger sometimes. Anywhere from 100 to 180 grams a day usually. Based on her appetite, small breakfast, about 25 grams, lunch 40 grams, after school snack 40 and about 60 for dinner usually. We try to give her the type of carba her body can handle. It varies time of day also. She can eat certain carbs in the day that she can’t eat mornings or dinner time. Low carb is not healthy for children and we have experience knowing that it is not necessary to go low carb for good blood sugar control. But everyone is different. I also think those who develop LADA may have a different form of Type 1, having some similarities with Type 2; it is a slower onset and nutritionists may prescribe less carbs. Very simply put: eat a balanced meal or snack with protein carb and a little fat, then observe with cgms or postprandial blood sugar testing. You will eventually have a menu of foods you can safely eat.
My granddaughter is spending the summer with me and she is a Type 1 diabetic. She’s 8 years old. If you could recomend a good cook book for me it would be a great help.
Thank you, Renee
Renee, my daughter was diagnosed last fall, at 18 years of age, with Type 1. I’ve found that a diabetic cookbook isn’t actually necessary, but what does help is when recipes/cookbooks have the food values attached (ie; carb count, fiber count, calorie count etc). And here is an EXCELLENT book that a scientist/ M.D. we know from Harvard, had sent us. I HIGHLY recommend it. The title is, “The Book of Better”. It pertains mostly to Type 1 diabetics but does touch on Type 2′s as well. Another thing that has TREMENDOUSLY helped my daughter is her insulin pump. She was very resistant to getting one and now is thrilled having it! It’s helping her blood sugars stay in a safe range much better than multiple injections each day. Good luck to you and your granddaughter Renee.
I have always eaten a lot of carbs 50 – 70 g of slow acting carbohydrate 3 times a day, of course this varies depending on how much i exercise and how I’m feeling. I have found the intake of complex carbohydrate with proteins and fats has kept my HgA1c’s in an excellent range (average of 5 over three years) I inject 17u of fast acting 3x a day and one of 28u long acting. If I exercise i reduce the fast acting by 30% before I go to the gym and afterwards for up to 24 hours. I am curious to know wether proteins should or could be counted in a diet? Do any diabetics notice a difference in blood sugar if they eat protein with their meal? I had a gym guy swear black and blue that it did and I have never noticed proteins have any effect on my blood sugar levels. It would be great if i could eat less carbs and count the protein as a replacement but i don’t know if i can do that?
I forgot to mention, I cannot eat any kind of fruit in the mornings. They make my blood sugar rocket, it’s really important to start the day on complex carbs. I never ever have hypos at night due to the Levemir working so well in my body. I don’t understand how it functions but I am always between 4.5 and 8(mmol/L) in the morning.
I find the best food of all for good blood glucose levels is brown rice it releases it’s energy so gradually and evenly. White rice is also amazing.
And when cooking a meal don’t shy away from using some fats they slow absorption of carbohydrate into the body and the slower the release the better your levels will be.