Newly diagnosed diabetics face many challenges, but perhaps one of the most difficult is adopting a diabetes diet, so that levels of blood glucose, or blood sugar, remain under control. But that doesn't necessarily mean completely giving up favorite foods, experts say. Instead, moderation is key—and employing carbohydrate counting when planning meals is highly recommended. (Four tips on how to count carbs appear on the next page.)
"Carbohydrate counting appears to be the best [dietary] tool for managing glucose levels," says Sue McLaughlin, president of health care and education at the American Diabetes Association. Food has three energy-producing components: protein, fat, and carbohydrate. Carbohydrate is the nutrient that the body most easily turns into blood sugar. Not paying attention to carb content in meals is likely to result in blood glucose that is "extremely variable and unpredictable," McLaughlin says. That means a person with diabetes should limit consumption of carb-heavy foods like bread, rice, starchy vegetables, grains, and fruit—but not avoid them altogether because some of these foods contain vitamins, says Ann Albright, director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention.
The more carbs a person eats, the higher his or her blood glucose level goes—and the higher the blood glucose, the more insulin the body needs to process the sugar. Research shows that counting carbohydrates helps keep glucose levels in check. A study published in February in Diabetes Care , for example, found that counting carbs and monitoring blood sugar were associated with lower A1C levels (a measure of average blood glucose level during the previous three months) in kids with type 1 diabetes. While there are no numbers to show how many diabetes patients use carb counting, experts say it's likely that the tool is underutilized because of a lack of education for diabetics about how to properly manage their diets.
Carbohydrate monitoring for diabetics is not a new approach: A 1988 study reported that the most important dietary goal for people with type I diabetes is establishing a regular meal pattern with consistent caloric and carbohydrate intake. But the importance of closely watching blood glucose levels did not garner widespread attention until the Diabetes Control and Complications Trial, conducted from 1983 to 1993. Keeping blood glucose levels as close to normal as possible, the government-funded trial showed, slows the onset and progression of damage to the kidneys, eyes, and nerves in diabetics.
In fact, any sustained lowering of blood glucose offered a benefit, according to that study, even if the person hadn't properly controlled blood sugar in the past. That's when it became clear that diabetics and their doctors needed to do more to achieve long-term control of blood sugar levels, says Martha M. Funnell, a research investigator at the University of Michigan and director for administration in the school's Center for the Study of Complications in Diabetes.
The challenge, according to Funnell, is that "in order to really learn carbohydrate counting well, you need to work with a dietitian, and those services have [traditionally] been poorly paid for" by insurers. Even when consultation with a dietitian would be a covered insurance benefit, patients don't always get referred to dietitians by their doctors. And sometimes they do get referred but never go to the appointment. "It's really critical for patients to really understand [that] a dietitian can help you figure out how to plan a meal in a way that fits with your diabetes," Funnell says.
In addition to any prescribed medication, a diabetic's treatment plan should entail taking a look at which foods are a part of his or her diet, Albright says. A good goal for diabetics is to have 45 to 60 grams of carbohydrate at each meal; the ideal amount may vary depending on the person, so it's important to discuss with your healthcare provider the level of carbohydrate that is right for you. Managing cholesterol and blood pressure is also essential.
Carb counting has become popular not only among diabetics. So-called low-carb diets, such as the Atkins, Zone, and Protein Power diets, have been touted for weight loss. Promoters of these diets contend that if carbs increase blood sugar and insulin levels and lead to weight gain, then limiting carbs should lower blood sugar and insulin levels, in turn leading to weight loss. Indeed, some people do shed pounds while on low-carb diets, but it probably isn't related to insulin or blood sugar levels, according to experts at the Mayo Clinic.
And just as there are many options for weight loss, counting carbs isn't the only method used to help diabetics manage their conditions. The plate method, for example, involves planning a meal by drawing an imaginary line down your plate to separate food groups; another option is a low-glycemic diet, which entails mainly eating foods like nuts, pasta, beans, peas, and lentils. It's all about finding the method that works best for that particular person, experts say. "The effort is worth it," Albright says. "This is a disease that requires effort to live successfully with."
Here are four tips for counting carbs:
1. Talk with your doctor or dietitian about how much insulin "covers" a particular amount of carbs. A good rule of thumb is one unit of insulin per 15 grams of carbohydrate, but that varies by person. Once you've done this, you're ready to get started. For each meal, add all carbs in the food you plan to eat. Then take enough insulin to process that amount of carbohydrate.
2. Know which foods contain carbs. But remember: A diabetic diet doesn't have to totally exclude certain foods, but "there are big differences in [which foods] we would encourage on a daily basis and those we'd advise to eat sparingly," McLaughlin says. In general, avoid regularly eating products that don't contain many nutrients, such as sugar-sweetened drinks or foods that contain a lot of refined sugar in small portions; fudge is an example.
3. Read food labels. Measure and weigh your food, and be aware of portion sizes. Distribute carb intake through several feedings throughout the day to prevent elevated post-meal blood sugar readings.
4. Choose foods that are rich in nutrients, high in fiber, low in fat, and high in naturally occurring vitamins and minerals.
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