Diabetes Month Tip of the Workday

Question

How many times per day should a person with diabetes eat?

Answer

The answer to this question ultimately depends on what type of medication and insulin regimen the person is on (if any), what other medical problems they might have that can interfere with nutrient absorption, and to a certain extent, how old they are.  

If you are trying to control your blood glucose without any type of medication (pills or injectables), you might benefit from eating at least three times a day to keep your carbohydrate and your protein intake spread throughout the day.  Some people can get away with keeping in spread through two meals a day, others need to have something in the morning to keep them from overeating later.  Whatever helps you achieve your basic carbohydrate/protein intake, create a caloric deficit if you are trying to lose weight, and keep from being miserable because you are skipping meals.

If your provider has you on a medicine like metformin (aka Glucophage), you will probably have to take this medication with a meal that has protein in it to reduce your chance of side effects like nausea and diarrhea. To keep yourself from being miserable, it is better that you have 2-3 meals a day.

If you take a medication like Victoza orExenatide to help with blood glucose control and weight loss, you will have to be careful to avoid overeating at meals to keep from having nausea and vomiting as well.  Even if you are trying to lose weight you need to get enough nutrition, ergo, you will be better off eating three times per day.

Most of the people that I work with, because of their station in life, wind up taking some of our long standing medications like Glipizide (Diabeta) and insulin 70/30, or insulin NPH. These medications/insulin require a pretty rigid schedule to prevent hypoglycemia (low blood glucose).  Therefore, people who take these medications would benefit from eating three meals per day at roughly the same time each day so that they can get enough protein, avoid hypoglycemia, and avoid overeating.  If they take Glipizide or insulin 70/30, they probably need to eat a snack at night as well.  (And sometimes a small snack can be worked in for those with a schedule that keeps more than 4-5 hours between meals).

Over the years many people with Type 2 diabetes have been told to eat six smaller meals per day.  This statement is NOT based in evidence and usually leads to weight gain, since they will likely consume more calories and never have a chance to “tap into” their fat stores.  They will also likely have even worse blood sugar control.  If someone feels compelled to eat in between meals to avoid hypoglycemia they most likely need a reduction in insulin and/or medication as no one should have to “feed” their insulin.  Leave the six meal a day recommendations to those who need to gain weight (like little kids with Type 1), have certain digestive conditions (like IBS that is diarrhea-dominant), and/or just a generally poor appetite.

The need to have a regular eating schedule to prevent hypoglycemia and to get enough protein taps into another problem that many of the people that I work with face; that of food security.  I would like to give this attention in another blog post.  But, usually if someone is having a lot of low blood glucose levels at the end of the month it might be because they are running out of food by that time.  I sometimes see people’s glucose levels go a lot higher at the end of the month because they have only higher carbohydrate staples to consume.  Eating regularly and in balanced amounts is currently something that not everyone has access to, and needs to be taken into account when we try to be compassionate towards others.

Thanks again for reading, see you the day after United States Thanksgiving!