Ask D’Mine: “Diabetes-Friendly” Popcorn, BG Targets for Type 1′s

Welcome back to our Saturday event, the diabetes advice column Ask D’Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

This week we’re talking food — yay! And also digging into the meaning of glucose targets for people living on insulin — less yay, but certainly important to understand.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

Clara from Indiana, type 2, writes: I heard that popcorn is a good “diabetes-friendly” snack, but I was surprised to see how many carbs it has. I like to have popcorn for lunch, which means I’d sometimes eat about 4 cups. That’s minimum 25 carbs! Why do I think that’s just too much?

Wil@Ask D’Mine answers: First off, let’s be clear that I don’t find the terms “diabetes-friendly” and “snack” to be compatible. Second off, let’s be clear that popcorn, diabetes-friendly snack or not, is most definitely not a diabetes-friendly meal! Meals need to have things like protein… and vitamins… and stuff.

But as to how much of anything is too much, consider that to maintain weight, a healthy meal for a woman would be in the 40-50 carb range, while men get to pig out in the 50-60 carb range. If you need to lose weight, a slightly lower carb count per meal is a good idea. Of course, carbs are only part of the story. We gotta talk about calories too. Carbs are a useful tool for understanding how much impact on your blood sugar a given food will have, and can be used as a rough guide for weight. But calories are a far more useful way to understand if what we are eating will keep our weight stable, make it go up, or make it go down. In general, the more carbs the more calories, but not always. Take popcorn for example.

A single serving of popcorn is anywhere between 4 and 5 ½ cups. Those little mini microwave bags are generally in the five-cup range, and yep, you nailed it: they run about 25 carbs. And they traditionally weigh in at 200 calories.

But they don’t have to.

The latest and greatest thing in popcorn is the 100-calorie “mini” bag of microwave popcorn. When I first heard about these calorie-skimpy bags, I just assumed the cheap-ass people at Orville Redenbacher’s slashed the serving size to two cups to achieve the calorie drop, but I was wrong. Both the 200-calorie and the 100-calorie bags are the same serving size, around five cups. WTF?

What has changed is the oil.

A good old-fashioned 200-calorie bag of microwave popcorn has 15 grams of fat. The new 100-calorie bags only have 2 grams of fat. By reducing the oil / fat content, they slashed the calories. The carbs stayed the same.

Less fat makes them healthier, right?

Not necessarily.

It depends on what you mean/want/need when it comes to the label “healthier.”

For you, my type 2 cousin, it may be better to have less fat. But for me and my T1 kin, the higher fat popcorn may be better. No shit. Here’s why: fat slows down the absorption of carbs. For those of us dependent on insulin, we often have a hard time matching the speed of carb absorption in our intestines with the speed of our insulin’s action. Higher fat meals give us an edge, by slowing down the carb absorption and matching it more closely with the action curve of our modern “fast–acting” insulins.

So if I ate the 100-calorie bag, I’ll actually have a steeper, faster excursion into high blood sugar territory than if I ate the 200-calorie bag. That’s because they both have the same 25 carbs, but with less fat, the lower calorie bag will pump those carbs into my blood stream much more quickly. If I take more insulin to try to compensate, I’ll probably go low a few hours downstream.

Of course most T2s don’t have this problem. Y‘all have some insulin gettin’ mainlined from your pancreases still. You’d have to experiment with a box of each kind of popcorn, a stop watch, and a glucometer, but I’d bet there would be precocious little difference between what the two kinds of popcorn would do to your blood sugar.

Oh the other hand, the majority of T2s struggle with weight, so fewer calories would be better, and because virtually all T2s have a greater risk of heart trouble, cutting the fat content makes the 100-calorie bag a win-win for you.

But back to your original question, i.e. eating a bag of popcorn for a meal and worrying if it’s just too much. Let me end with this thought  setting nutritional value and fat aside for the moment, a 200-calorie meal is waaaaaay on the light side, containing only 10% of your daily calorie allowance to maintain your weight. If you are trying to lose weight, you need to take in fewer calories of course, but if you only ate three meals of popcorn per day (don’t you dare!) you’d be getting 600 calories a day—fewer calories than the folks in Soviet labor camps got. And I think we can all agree that The Soviet Labor Camp Diet is not going to be the next best-selling fad diet any time soon!

Something to think about.

Jean from Minnesota, type 1 for one year, writes: I was curious as to what BG numbers most type 1s aim for? For example, morning fasting numbers — do most try to keep the BG number under 90? 80? in the 70s? I’m not a control freak, but I think it would motivate me to have a realistic target number, even though I know I won’t (can’t) meet it all the time.

Wil@Ask D’Mine answers: To be honest, there is quite a bit of disagreement about our target numbers, both in the medical community and in the patient communities.

In fact, the two largest diabetes doctors’ groups can’t even agree on where are numbers should be:

The American Association of Clinical Endocrinologists (AACE) Guidelines call for:

A Fasting blood sugar of less than 110 mg/dL

And a two hour post-meal peak below 140 mg/dL.

While…

The American Diabetes Association (ADA) Guidelines call for:

A Fasting blood sugar of between 70-130

And a two hour post-meal peak below 180.

So that’s…. ummmmm… quite a difference of opinion.

And these numbers have become something of a moving target themselves over the last few years, with a trend towards personalizing them, at least for various therapies and age groups. Many docs are choosing higher targets for pediatric populations, whose blood sugars do the funky chicken dance with less warning, and for older folks, since the results of the Accord Trial suggest to many that shooting for lower blood sugars may be fatal to older folks. For what it’s worth, I also support higher target for older patients as frankly, the older you get, the more likely you are to be done in by heart attacks, strokes, falling down stairs, or getting pecked to death by ducks (hey, it could happen) rather than being done in by your diabetes. Simply put, at some point your risks of garden-variety mortality get so high, it really isn’t worth the effort to keep your blood sugars low. Something else will surely do you in before the blood sugar gets the chance.

Many PWDs seek “normal” non-diabetic blood sugars, the rationale being that as close to normal as possible is healthier. But this would mean sub-100 blood sugars. And while it can be done with super-low-carb eating and lots of insulin, I personally don’t believe it’s safe.

Trying to stuff diabetes back into the box it came in is nearly impossible given today’s technology and medicines. And trying too hard to achieve “normal” blood sugars hugely increases the risks of hypoglycemia. Hypos are dangerous; they can kill you very quickly if you go too low, and recent evidence also suggests lows may also damage the heart. To top it off, frequent lows also result in hypoglycemia unawareness, and if you develop that you are at even greater risk of the whole go-really-low-and-die-quickly thing.

Sorry, I didn’t intend to scare the pants off you…

In my option, the AACE guidelines are unrealistically inflexible. One thing they don’t take into consideration is personal variation. Depending on your therapy, medications, diet, exercise patterns, and lifestyle, your morning numbers could vary quite a bit. That being the case, I like ranges. If your average has to be a little higher to ensure your lowest numbers aren’t too low, well that’s money in the bank. So chalk one up for the ADA. But at the same time, I feel 70 mg/dL is dangerously thin ice for most T1s. Or anyone else using insulin. You are very close to a hypo at that point.

I like to shoot for a morning target of 115/mg/dL most of the time. I get nervous if I get much below 90, and I get pissed off if I get much above 120. As for after-meal numbers, unless I’ve been forced to eat tofu and water cress, I’m not sure I’ve ever seen a 140 after eating. I do think, however, that keeping under 180mg/dL eighty percent of the time is realistic and achievable.

Remember too, that speed of change is nearly as important as degree of change. Slowly changing blood sugars are much easier on your diabetic body than rapidly changing blood sugars.

But no matter what numbers you and your doc settle on, remember these are just targets. Even high-tech predator drones miss their targets and blow up Afghan ice cream trucks now and again. A target is just something to shoot for, to strive for. They’re not carved in stone. They’re not the unmalleable laws of physics.

So no guilt allowed when you miss a target! At least not when you miss a blood sugar target.

If you just blew up an Afghan ice cream truck, then I think some guilt is called for.

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.