June 29, 2007

What's the Best Diabetes Diet?

Easy question! The best diabetes diet is the diet that keeps your blood sugars within the normal range after every meal.

What foods you eat to achieve this goal will vary greatly since your own personal blood sugar response to food varies depending on a lot of factors. For almost all Type 2s it is the carbohydrate in their foods--both sugar and starches--that raises blood sugar. What varies is how high and how fast those blood sugars rise in response to carbohydrate in the meal.

Factors Affecting Your Tolerance for Carbohydrate

  • Your Weight. Many people don't realize this, but the amount that a gram of carbohydrate will raise your blood sugar depends on your size. If you are 300 lbs, you'll get 1/2 of the rise in blood sugar from that gram of carbohydrate as would a person who weighs 150 lbs. This is one reason why the "one size fits all" recommendations for how much carbohydrate you should eat are deeply flawed.

  • What Physiological Problem Causes Your Diabetes. There are many different physiological problems that cause Type 2 diabetes and different causes can give you a very different response to the carbohydrates in your meals.

    That is why you have to test the different foods you eat to find out whether they fit on your own, personal, diabetes diet. What works for one person may fail miserably for others.

    Most notoriously, the supposed "low glycemic" foods and "healthy whole grains" recommended so heartily by people who don't have diabetes can raise your blood sugar very dramatically if you don't have a strong phase 2 insulin response.

    If this term isn't one you are familiar with, you can learn about the phases of insulin response HERE.

    If you do still have a strong second phase insulin response, which some Type 2s do, you will be able to eat these slower carbs. If not, they'll cause blood sugar spikes every bit as damaging as those from supposedly "faster" carbs.

  • Your Meds. People have very different responses to every diabetes medication, again because the underlying cause for their abnormal blood sugars can vary so widely.

    For me, without any meds, eating 60 grams of carbohydrate would reliably put my blood sugar at 250 mg/dl or more at one hour after eating. With Metformin alone, that would drop to maybe 200 mg/dl, with metformin and 3 units of insulin, it would drop to about 140, maybe less, but I'll end up in the 80s at 2 to 3 hours later making it a bad idea for me to use any more insulin--or eat any more carbohydrate. With Januvia my blood sugar would rise to 129 mg/dl and then start dropping, though because of my concerns about the side effects, discussed elsewhere I avoid Januvia for now.

    Thus you can see that my "diabetes diet" is going to be different depending on what meds I'm taking. Yours will be, too.

It is because people vary so much in what their own bodies can tolerate that you see the vicious online "diet wars" where people who can eat a lot of carbohydrate accuse those who can't of being fanatics, and those who can't accuse those who can of living in a dream world. Throw in dietitians and doctors who have never tested their own blood sugar in response to food intake and know only what they've read about nutrition in studies, often conducted among people who do not have diabetes and you can see why diet becomes an area fraught with myth and controversy.

That's why the only way you can find out what your own diabetes diet should be is by using your meter and testing the foods you eat--starting out with the understanding, that there is going to be a limit on how much starch or sugar every person with Type 2 diabetes can handle. If you could eat all the sugar and starch you wanted and get normal blood sugar readings, you wouldn't be diabetic, would you?

Straight Talk about Safe Blood Sugar Targets

There's a huge difference between truly safe, normal, blood sugar levels and the blood sugar levels too many doctors and diabetes educators tell you are "okay for a diabetic." This is because the ADA has, for years, told people with diabetes that they should settle for dangerously high blood sugars so as to avoid hypos.

Since Type 2s controlling their diabetes with diet alone are incapable of experiencing dangerous hypos, this is flawed advice. Type 2s taking all oral drugs except for Sulonylureas like Amaryl and Glipizide are also incapable of experiencing dangerous hypos.

When you are not taking insulin or a sulfonylurea drug, feeling a bit shaky as your blood sugar gets to a normal level--anything 70 mg/dl (3.8 mg/dl) or higher--is not an actual, damaging hypo, just a sign that your body isn't used to normal blood sugars. That kind of "hypo" feeling will go away as your get used to normal blood sugars.

This means that there is NO reason for you to avoid shooting for truly normal numbers if you are a type 2 not sulfonylurea drugs. If you are on these drugs, you may have to talk to your doctor about reducing the dose as you bring your carb intake down to the level that gives you normal blood sugars.

Even Type 2s using insulin can shoot for these normal numbers, too, if they are taught how to adjust their doses correctly. A study presented at this past week's ADA conference found that patients instructed properly can adjust insulin levels better than their doctors. Read about it HERE.

I shoot for normal numbers with mealtime insulin and and I know plenty of others who do, too. Type 2s on insulin usually do not have the same problems with dramatic swings in blood sugar that Type 1s have, but many doctors do not realize this. (We'll discuss how to make sure your doctor is teaching you the most modern techniques of insulin dosing for type 2s in a future posting.)

What Blood Sugar Levels Should You Aim For?

I'd suggest aiming for blood sugar levels low enough not to damage your organs!

You can learn what science has found out about normal blood sugars HERE. You can read some of the better research that connects blood sugar levels with organ damage HERE

I'd suggest you start out by shooting for the following blood sugars after meals:
  • One hour after eating: Under 140 mg/dl (7.8 mmol/L)
  • Two hours after eating: Under 120 mg/dl (6.7 mmol/L)

Lower is better, but these are a great level to start with.

Don't obsess about whether you should count from when you start eating or afterwards. There's a natural variation in when the peak will occur but fifteen minutes in either direction won't make a significant difference in your health.

With some foods, like pasta or pizza that take a very long time to digest (or if your stomach for some reason doesn't empty at a normal rate) you might want to look at your blood sugars a few hours after these suggested times as the blood sugar peaks may be postponed.

There are going to be plenty of times when you don't hit these targets. Don't panic, just by attempting to hit them, you are making huge improvements in your health. And if you can hit them more than you miss you'll see a dramatic improvement in not only your A1c but in any early diabetic complications you might have picked up, most notably neuropathy.

NOTE: I've written a longer piece explaining some of the tips and tricks that can help you make a diabetes diet work over the longterm on this page:A Diabetes Diet is Different from a Weight Loss Diet


Anonymous said...

let’s think for a while about our body. What is our body’s composition? The most part of it is water, around 70%. Taking this into account, you can simply think on what you need to consume everyday. Your body needs mostly water.