Question
How much carbohydrate can a person
with diabetes eat and still keep the blood glucose under control? And still
make an attempt to have good quality of life?
Answer
The answer depends on the person’s age,
body size, activity level, weight loss goals (if any), what the blood sugar
meter says, and how tightly they want their blood glucose controlled by diet. In other words, the carbohydrate intake needs
to be individualized based on those goals, often with the help of a Registered
Dietitian and Certified Diabetes Educator.
There are also books and online
resources that you can use to help personalize your carbohydrate intake based
on what your blood glucose monitoring device says and what your health goals
are. Said online and published resources
are not a substitute for seeing an endocrinologist and/or a Certified Diabetes
Educator, however, I know that sometimes seeing an educator is cost prohibitive
and/or discussing food with a stranger can seem awkward as well. One of the books that I like to recommend as
a way to get started with picking out a blood glucose monitor and setting
carbohydrate goal is “Blood Sugar 101: What They Don’t Tell You About Diabetes”
(Link). Despite the rather ominous sounding title, this
book outlines a simple plan for understanding what carbohydrates are, target
blood glucose goals, and adjusting your carbohydrate intake to include foods
you like in the right portions for you. For a more extensive read on diabetes, testing
equipment, diet, and a testing plan there is Dr. Bernstein’s Diabetes Solution.
Naturally, when I start to talk about
“carbohydrate counting” and “testing” I frequently get a panicked look as many
of the people I work with have not had the chance to make testing or math their
friend just yet. Or they might be willing to test their blood sugars, but their
insurance will only pay for a certain amount of test strips and they don’t feel
like they can afford the out of pocket costs for additional strips. As a result of this, some people will ask for
a “ball park” answer. Said answer, and
this is a HUGE ballpark now, people with Type 2 diabetes will usually need to
keep their carbohydrate intake about 20-40% of calories. For the population that I work with, (older,
less active) that usually means 100-130 grams per day, or about 30-45 grams at
each meal and 15-20 grams per snack (most people eat two or three times that
amount). Again—emphasis on the huge
ballpark number. I have some folks that
only eat about 15 grams at meal and some can do the 45, but the portion control
is paramount to helping people with diabetes eat a variety of foods while still
meeting their blood glucose goals.
For people with Type 1 diabetes, they
will usually get better control if their blood sugars if they are able to count
carbohydrates and inject meal time insulin based on how much carb they are
eating and add a correction factor based on their blood sugar. (That was a very simple answer to a process that
requires a lot more reading about Type 1 diabetes in general; as well as
different kinds of insulin and how they work—hard to add in to this particular blog
post. Adjusting your insulin based on carbohydrate intake also involves a lot
more testing—up to 4 or more times per day, which sounds daunting but becomes
easier with time and practice. Many
people also find that making every meal into a mathematical equation is hard at
first, and then becomes easier to do with time.
Think about how much carbohydrate you
eat every day, and next week we’ll talk about some basic ways to help people
reduce it. (These tips are corresponding to my work week. Happy Veterans Day tomorrow!)
Want to keep reading about how to
individualize carbohydrate counting?
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