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In Chapter 3, we’ll talk more about the data you need to record, how to record it, and how to use your results.
What’s So Important about Controlling Blood Glucose Levels?
When you get and keep your blood glucose levels in your target ranges, you feel better. You also can help prevent and/or delay the complications of diabetes, such as heart, eye, and kidney problems. Think of blood glucose control like walking on a balance beam—you don’t want to fall off on either side. There are dangers associated with both high blood glucose and low blood glucose (if you are on certain diabetes medications), so you want to stay right in the middle. Hypoglycemia is another word for low blood glucose. Hyperglycemia is another word for high blood glucose.
Table 1-2 gives you the target blood glucose levels that the American Diabetes Association (ADA) recommends. Ask your health care provider what your target levels should be; yours may be different from the ones in the table for a variety of reasons. For example, a pregnant woman may have lower target levels and an older person at risk for hypoglycemia may have higher target levels.
Basic Facts about Carbohydrate
When you eat any type of carbohydrate, the body breaks it down into glucose (sugar) and releases the glucose into your bloodstream. With the help of the hormone insulin, the cells of your body then use that glucose as fuel for all the different types of work they have to do.
There are three categories of carbohydrate: starches, sugars, and fiber. Starches and sugars are the main contributors of carbohydrate to our foods. Fiber is also carbohydrate, but its impact on blood glucose can be different than that of other types of carb. There are many types of fiber. (For more information on fiber, see Fiber and Blood Glucose, later in this chapter.)
You may have heard the terms “simple carbohydrates” and “complex carbohydrates” before. These categories were used for many years to try to explain how various types of carbohydrate affected blood glucose in different ways. These terms are no longer used because recent research suggests that that our old understanding wasn’t accurate. We now know that once carbohydrate is broken down, the body doesn’t know whether the resulting glucose came from the carbohydrate in mashed potatoes or a piece of apple pie. All carbohydrate becomes glucose—the body’s preferred and primary source of energy.
If Carbohydrate Raises Blood Glucose, Should I Follow a Low-Carb Eating Plan?
Once you realize that carbohydrate is the nutrient in foods that raises blood glucose the most, you might jump to the conclusion that people with diabetes should steer clear of foods that contain carbohydrate. But that’s incorrect. For starters, any eating plan that drastically restricts a particular food or food group is not realistic in the long term. Restricting carbohydrate would limit foods like fruits, vegetables, and whole grains, which are essential for good nutrition. And your body still needs carbohydrate for energy.
In general, the ADA recommends an eating plan in which about 45–65% of your total daily calories come from carbohydrate. The exact grams of carbohydrate you eat will vary depending on your total calorie goal and a number of other factors.
There’s been a lot of talk in recent years about using low-carb meal plans to lose weight. Most of these plans restrict carbohydrate intake to the point where less than 40% of your total daily calories come from carbohydrate. The results from research on these low-carb weight-loss plans have been mixed, and the long-term effectiveness of low-carb eating plans hasn’t been shown. At this point, many diabetes experts conclude that there’s insufficient evidence to recommend low-carb diets, especially to people with type 2 diabetes. Beyond the question of long-term effectiveness, there are safety concerns about following such a plan over the long term, such as concerns about the progression of heart and kidney problems.
It is most important to consider the total calories that you eat every day if you are considering weight loss, so it can be counterproductive to focus on only whether the calories come from carbohydrate or protein or fat. Therefore, it is best to choose healthy carbohydrate sources, like fruits, vegetables, whole grains, and nonfat and low-fat dairy foods. You do want to limit the not-so-healthy carbohydrate sources, like foods that contain added sugars and sweets, because they contribute concentrated amounts of calories and fats and add little in the way of essential vitamins and minerals.
The best advice? Find a sensible and realistic healthy eating plan for you that is based on sound science. The eating plan should help you lose weight (if you need to) and, even more importantly, keep weight off the rest of your life.
What about Sugars?
First, let’s get a few facts straight. Note the plural on “sugars” in the header. The sources of sugars we eat number far more than just the white granular stuff. There are sugars that occur naturally in foods, such as the fructose in fruit and the lactose in milk. Other sugars—such as granulated sugar, brown sugar, and high-fructose corn syrup—are added to foods when they are baked, cooked, prepared, or processed. The most important thing to remember about sugars is that they are carbohydrate and will raise your blood glucose.
If I have diabetes, can I eat sugary foods and sweets?
The short answer is yes. People with diabetes can eat sweets, as long as you account for them in your eating plan and adjust your medications to respond to the extra carbohydrate. Carb counting can help you do this, and you’ll learn how in this book. (This may be a surprise—for many years people with diabetes were told to avoid sugar. But now we know that the total amount of carbohydrate in a food or meal is the most important factor.)
This doesn’t mean that you should regularly eat candy, cake, and cookies. Realize that even a small serving of these types of foods contain a lot of carbohydrate. Cake and cookies also contain a lot of calories and fat. So you’ll want to limit them to special occasions and indulge in small portions, in addition to counting the carbs in your overall carb counting records.
Tips for Eating Fewer Sweets
• Choose a few favorite desserts and decide how often to eat them.
• Satisfy your sweet tooth with a bite or two of your favorite sweet rather than eating the whole thing.
• If you have a difficult time eating smaller portions or how often you eat sweets, it is best not to bring large portions of sweets into your home. You might only order dessert at restaurants or just purchase a small quantity at a time.
• Split a dessert with a dining companion in a restaurant. Ask for several forks or spoons to share the treat.
• Take advantage of smaller portions—kiddie, small, or regular—at ice cream shops or in the supermarket.
Easy Ways to Eat Less Sugar
• Instead of regular soda, go for diet soda, seltzer water, or, even better, water.
• When you order or buy iced tea, make sure it is unsweetened or sweetened with a low-calorie sweetener.
• When you buy fruit drinks or flavored seltzers, read the Nutrition Facts label. Make sure the calories, carbohydrate, and sugars are near zero. In general, it’s better to drink water and eat fresh fruit.
• Trade canned fruit packed in heavy syrup for fruit packed in its own juice or light syrup.
• Use low-calorie sweeteners instead of sugar.
• Use low- or no-sugar jelly or jam instead of regular.
Fiber and Blood Glucose
As explained earlier, fiber is a type of carbohydrate. There are hundres of different types of fibers in our foods. Depending on which type you eat,