Diabetes and Diet: A Recipe for Optimal Control

Just about everything we eat causes blood sugar to rise, and managing type 1 diabetes well depends on effectively balancing food, exercise, and insulin. In the past, hard and fast rules about diet made it a battleground in families, but with today’s array of new tools, new insulins, and new strategies, children and adults have gained greater flexibility in deciding what to eat and when to eat it. It all starts with counting carbs.

Once a person with type 1 diabetes (or their caregivers) accepts daily insulin shots or a pump as a fact of life, food becomes the major focus and often the cause of considerable stress for the entire family. It’s not uncommon to see families where food becomes the ‘bad guy.’ “I’ve seen so many families where food has turned, let’s say, a child’s typical request for a snack into a virtual battleground,” says Cyndy Schroeder, a dietician, diabetes educator, and JDRF volunteer. “It doesn’t have to be that way.”

Individualized meal planning is an integral part of every diabetes care plan, the key to which is balancing diet, exercise, and insulin intake to achieve as normal blood sugar levels as possible. Adults, parents and children new to diabetes still have to learn about eating out, portion control, label reading, and more. But the old rules have changed; and new tools, new insulins, and new strategies are providing both young and adult patients with a newfound freedom.

Many years ago, before the introduction of fast-acting insulin, a person with diabetes had to follow a stricter regimen. The treatment plan in diabetes required the patient to modify his lifestyle around a narrowly fixed insulin therapy. Now, research has resulted in our knowing a lot more about how to handle type 1 diabetes. New methods of assessing the effects of foods and newer insulins let us adjust insulin dosing around the dietary lifestyle we want to lead. “The method we use now–based on counting carbohydrates in the food we eat–not only offers more flexibility, but it forms the basis of intensive blood sugar management,” says Ed Banion, a dietician at Animas Corporation.

What is a Carbohydrate?

Carbohydrates (“carbs,” for short) are one of the primary sources of energy found in food. They include simple carbs (foods rich in sugar) and complex carbs (foods rich in starch, such as rice, pasta, bread, and cereal).

How Carb Counting Works

There are different carb-counting techniques, but typically, an insulin-to-carbohydrate ratio is determined to calculate the amount of “covering” insulin. For example, if someone needs to take one unit of rapid-acting insulin to cover every 15 grams of carbs eaten, then she would need to take 3 units of insulin to cover 45 grams. The ratio is determined by taking into account an individual’s needs and responses to particular carbs. A carb-counting meal plan is never a “do it yourself” project but rather best undertaken in collaboration with a diabetes educator, dietician, or other members of your diabetes care team.

Carb Counting

The carbohydrate counting approach is based on the premise that carbohydrates, which are found in most foods except for meat and fat, are the main source of blood glucose and have the greatest effect on blood sugar. Carbs enter the bloodstream as glucose within 15 minutes to 2 hours. A fairly accurate determination of the carb content of a meal or a snack is therefore a critical factor in achieving desirable blood glucose levels.

Key to this approach is the requirement to count the carb content of meals and snacks and then use fast-acting insulin to match or cover the blood glucose-raising effect of carbs. Using this approach to eating, you can work with your diabetes care team to develop an insulin regimen that conforms to your meal routine and food choices. You can track results with regular blood sugar monitoring and make adjustments to keep blood sugar under optimal control. Pump users have even greater flexibility and control, since all the basic data is pre-programmed, allowing pumps to deliver small amounts of insulin regularly, including a “bolus” of insulin when needed to cover food that is eaten.

Getting Started

Adapting to this form of meal planning and insulin therapy takes work, particularly at the beginning. You must learn how to calculate insulin-carbohydrate ratios, how blood glucose levels react to different foods, and how to read food labels to determine carb content. You must also get used to frequently monitoring blood sugar levels throughout the day. When you become more experienced, you may find that certain foods will give you a bigger spike in blood sugar levels than you expected, while others will have less of an effect. It’s a good idea to record your food intake–including the type, amount, and timing–in a log book, so you and your diabetes care team can analyze patterns and improve your diet and blood sugar control. Once you’re on track, you’ll find that the freedom and flexibility that comes with this method is unmistakable and liberating. “Today, most kids and teens with diabetes and their parents know their carb ratios and know the carb counts of just about every food,” says Moira McCarthy Stanford, mother of a teen with diabetes. “Quite a difference from the days when I had to tell my daughter, ‘No cake for you!’”

What Stays the Same

But learning the ropes about carbs is not the same as eating healthily. “Just because you’re covering your carb intake doesn’t mean you can throw away the basic tenets of good nutrition and eat whatever you want,” says dietician Cyndy Schroeder. “You can’t expect to eat desserts all day and stay healthy.” The basic nutritional mantra for people with type 1 remains the same for those who do not have the disease: good nutrition, variety, balance, and moderation.

Note: Your doctor may have started your newly diagnosed child on a strict fixed-dose regimen, with no insulin pump, and in that case may also recommend more consistency in carb intake than the method outlined in this article. In this case, you may want to talk with your doctor about whether adopting a more flexible regimen in the future makes sense.

For further information on nutrition and carb counting: Ask your diabetes educator or other health care team member for recommendations. A number of Internet sites provide extensive information, such as the Joslin Diabetes Center at http://www.joslin.org/info/managing_diabetes.html.