Diabetes Forum UK

We know that carbs are the major problem for diabetics because thats what raises your blood glucose (BG), although the situation is slightly different for those who use insulin and those who do not.
For those who use insulin, the less carbs you eat, the more accurate you can be with your insulin dosage and be more controlled.
For people who do not use insulin the purpose of carb control is to stop the BG rising too far in the first place.
Because insulin users are balancing the number of units of insulin to inject against the number of carbs, the raw number of carbs is particularly relevant.  For T2s not on insulin this is very different.
T2s who are not on insulin are still producing insulin themselves, although the body is usually late in producing enough and releasing it into the bloodstream.  So the body will usually deal with the BG rise caused by the carbs eventually, but your BG will have gone far too high before your pancreas catches up and thats when the damage is caused.
So by managing carbs, we can control the BG rise.  But its not just about the raw number of carbs.  Different foods contain different types of carbs and these get converted to glucose at different speeds.  A baked potato will cause your blood glucose to rise extremely fast wheras some pulses and beans in particular will be far slower.  These slower carbs give the body longer to react, so it can keep up with the glucose better.
One way to get an idea of how fast and how far your blood glucose is likely to rise is the Glycemic Index (GI) and Glycemic Load (GL).  However these are only really a rough guess rather than hard facts.
So what seems to work best is the approach outlined in Jennifer's Advice - which is to test the effects of blood glucose on meals.  We tend to eat similar meals on a regular basis - for example I had weetabix or toast for breakfast for years before I was diagnosed.  So if you know the effects of meals on your blood glucose, you can find meals which do not raise your BG too far and continue to have those regularly.  If a meal raises your BG too high, then you can either avoid having that meal again or tweak the ingredients so that it has less of an effect.
This approach is commonly referred to as "managed carbs" as opposed to "low carb".  It doesn't necessarily mean a limit on the number of carbs - its just more based on managing what you eat in order to control your BG.
The low carb message on the other hand can be misinterpreted quite easily.  It started out as an approach for insulin users because it makes insulin dosing far more accurate.  With T2s not on insulin, the message can be too simplified and people tend to just concentrate on pure numbers of carbs.  Its quite possible to have more carbs of the right type and have lower BG rises.
So the number of carbs is not that important.  The effect that it has on your BG is.

Comments (2)

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written by Nicky Moxey, June 06, 2010

*nods* Yeah, I know it as "low-spike" eating. How relevant the GL is seems to vary widely from person to person - and you have to be sure to check the glycemic LOAD, not the GI, Index. For instance, carrots have a high GI, but a low GL, I can eat just about any quantity I like of them, cooked or raw - but I have a friend who can hardly eat any at all, they spike him out of all proportion. Parsnips do the same for me, as do oats.

The bottom line is, you gotta test to establish what a particular food or exercise pattern does to you.

Nicky.

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written by Trinkwasser 2, June 18, 2010

Yes I agree that "low carb" is used as a pejorative whereas "managed carb" sounds less like a soundbyte (although the carbs usually get managed downwards anyway).

In the past I've suggested to those (few) Type 1s who insist on dictating diet to Type 2s that they should try to go through the day using only their basal with no bolus insulin, then see what they can get away with eating. If they also want to experience reactive hypos they could give themselves the occasional bolus bearing no time or quantity relationship to their meals.

THEN they might understand the Type 2 problems a bit better.

Test Test Test also taught me a lot about how insulin resistance varies through the day and in different circumstances, something else medical professional seldom bother to mention. I used to max out at about 15g carbs at breakfast and 30g carbs in the evening. Now my ratio is more like 10g at breakfast and 50 - 80g in the evening, so long as I don't do it too often.

Mostly I keep to around 60g/day suitably distributed and mostly from vegetables and a few oatcakes, that doesn't spike my BG, or looking at my lipids and BP my insulin, and gives me more energy while I stay around the edge of ketosis.

Someone with a different balance between IR and insulin production might have a different limit and daily pattern.

I have specific problems with wheat and most fruits except berries. If I'd followed my doctor's instruction not to test how would I know?

The dietician's Typical Diabetic Breakfast of a banana in a bowl of oatmeal with low fat milk, toast with low fat margarine and a glass of orange juice is just about the worst thing I could possibly eat at that time of day, that's probably what they don't want me to find out.

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