Posted by on Thursday, 13 May 2010

Diabetes Blog Week (Day 4) : To carb or not to carb

I came across the Bitter-Sweet Diabetes Blog the other day, written by Karen in Conneticut, US. When we began writing this family blog of living with diabetes we did a bit of looking around and while there were a bunch of active bloggers in the states, and some in Europe, those in the UK were a little harder to find. It would seem that Karen is part of a fairly wide-reaching network of diabetic bloggers both in the US and further afield (the Diabetic Online Community or DOC). Last week, Karen had a moment of inspiration and decided to set up Diabetes Blog Week (May 10-16) to inspire anyone writing about their experience of diabetes with a week's worth of topics. Today is Day 4, and the topic is 'To Carb or Not to Carb'.

Sometimes you look back on your life and think, well that was lucky. And that's just how I feel about my diagnosis. I know that's a slightly odd thing to say, but of all the long-term conditions one could get I think diabetes is a pretty good option. Yes you have to change aspects of your life. Yes sometimes it's incredibly frustrating and gets in the way. Occasionally it's quite scary both for you and those around you. On the whole though it is fairly easy to get along with (or even pretty much ignore for very short periods).

Another reason why I feel lucky is that when I was diagnosed I was introduced to the concept of 'exchanges' so I've been estimating carbs and adjusting doses almost from the beginning. The idea that people have been advised by medical professionals to eat great platefuls of carbs without any measurement of the load and just bung in a standard dose is quite frightening. I can't imagine what my control would have been like if I'd been given that as an approach. The first DSN I saw, way back in 1991, asked me about my general diet and from our conversation suggested a base level of carbohydrate to aim for which would make the whole dose thing easier to begin with. When introduced to basal-bolus, one of the main benefits, it seemed to me, was the ability to change the dose to match your meal. There was no longer any reason to stick to x grams of carbohydrate. My fortuitous timing then gave me this outlook:

  • Eat normally
  • Eat healthily
  • Wholefoods will be easier on the bg
  • Watch the fat intake but let's not be silly about it (I'm lucky never to have had a problem with my weight)
  • Drink in moderation (and be very careful when you don't)
  • Have an occasional treat/pudding/blowout - you're not a monk

Only quite recently I have come into contact with several people (both T1s and T2s) who manage their diabetes with a very low carb diet, some with spectacularly good effects. I don't go very low carb myself, tending towards 150g/day, sometimes much higher. In fact the more I read of the experiences of T2s the luckier I feel with T1. At least if I've got a big celebration blowout I can split a whopping insulin dose into several phased deliveries so that it gets gradually absorbed as my digestive system chugs through it all.

The secret to a happy, healthy diabetic diet I think is best summed up by this: Eat to your meter. Testing just before meals is not enough for me. I also need to check what happens in the hours afterwards. That way I can identify which foods cause spikes (or crashes) in my blood sugars, and then I can either avoid that food, or work around the problem with altered doses, splits and timings. Once the patterns have been spotted I've more chance of knowing what to do. Everyone is different. What works for me may not work for you. If you eat low carb and it works, brilliant. If you eat carbs and you can manage it, great!

The bottom line is keeping your control tight. That way we'll all keep well.


  1. Hey Mike.
    I've never talked to anyone else with diabetes before and my diabetes is actually slightly different to most peoples (well, everyone is slightly different of course!) in that I am neither T1 or T2, I have Cystic Fibrosis Related Diabetes, in short it has elements of both types but i use insulin to control it, though I have more freedom with diet as i need a hi-cal diet and i have to change doses very often as sometimes my body can produce its own insulin for short periods of time.
    hmm Ive gone off track. Anyway, what I wanted to ask is do you know what your numbers do straight after meals? Like as in if you tested 1 hour after, rather than 2-3 hours after? Because out of curiosity about spikes etc I did some tests like that and the levels were soaring...on talking to my diabetes team I just got the response of "As long as it has gone down after 2 to 3 hours post-meal it doesnt matter how high they go in the first hour or so"... Wondered about your experiences if any with that kind of thing?

  2. Hi Lauren
    Thanks for your comment. Popped by your blog out of interest the other week - how's the foot?
    Crikey I think I have it tough! Can't imagine trying to control a diabetes where your pancreas opts in and out whenever it feels like it! Reassuring to hear that your med team are relaxed about your post-meal rises in bg (blood glucose) levels. Hard to know what range you are experiencing, but the targets for T1s are 4-6mmol/l before meals and no more than 9 mmol/l up to 2 hours afterwards. T2s have a slightly harder time I think with a target of 8 after meals.
    It would be a very good day for me indeed to meet those targets all the time. Depending on how well I've judged the carb and fat content of a meal (fat slows down carb absorption) I could be well into the teens at 1- 2 hours, or possibly hypo!
    Difficult to know what else to say without knowing what insulin(s) you are on. I recently found the very helpful and friendly Diabetes Support Forum with a bunch of very experienced people with all sorts of varieties of diabetes. Might be worth your while having a browse, or maybe posting a question or two. The link is above on the right.

  3. Well said!!! When I was diagnosed in 1979, it was an even more strict exchange system diet. I could only eat certain exchanges in certain amount at certain times of the day - whether I was hungry or not!!! I feel very thankful for the better insulin and the pump I have today - but I do still try to keep an eye on my carbs. Sure, I will splurge once in a while. But like you said, I keep a close eye on what carbs to what to my blood sugar and try to make good choices overall! :)

  4. Thanks Karen. Thanks too for organising the whole Diabetes Blog Week thing, it made fascinating reading.