[blonde kiddo]

Hi everyone,

As a Brit reading and using this forum I am very intrigued by a theme I seem to be noticing on here regarding the treatment of diabetes in the US. The impression I get over what is advocated in the US is that a diabetic diet should be a low carb diet? But this doesn't seem to be so for diabetics in Britain. On the contrary it seems the emphasis in the UK (for type 1's at least) is on being able to adjust carb intake, to the patient's liking, in programmes such as DAFNE. I wondered if the low carb ideal in the US (if it really does exist) is merely down to Dr. Bernstein or whether there's any research out there suggesting low carb diet can improve long term diabetic control?

Comments from both sides of the Atlantic appreciated!

Sarah

[Cyborg]

Personal experience shows that eating carbs have the largest impact on bg. It's only common sense to realize eating foods that affect the bg less requires less insulin and less associated issues (large bg swings, etc.)

[JediSkipdogg]

The only theory for low carb is for type 2s. I'm not sure how treatment over there is for a type 2 compared to the US, but most start on diet and exercise. The diet consists of lowering carb intake as much as possible so that the body doesn't have to produce as much insulin. If diet doesn't work, then medicines are added which either inhibit the production of glucose by the liver or the ingestion of carbs in the intestional tract.

Now, there is a theory for type 1s in the US that lower carb is better. Carbs are what cause the BG to rise. And with ONLY insulin, carbs will make your BG peak before it returns to normal/a safe level. Therefore, the old theory is to eat as few carbs as possible....until now.

You may wonder, well, why aren't all people (non diabetics) that way then if they eat carbs. So shouldn't they be on a low carb diet to so they may live longer and not have harmful high BG rises. Well, not until recently was there a drug to take care of that. When a diabetic stops producing insulin, they are stop producing Amylin. Amylin is a product of the body that helps to reduce the peaks from food intake. It works along with insulin so the food doesn't have as much of an effect on the body. Sometime in early 2006 (I think) they created Symlin, which is the synthetic form of Amylin. Now, a diabetic should be able to truely eat what they want without the high peaks from food. Therefore they can maintain a BG pattern as close to a non-diabetic. Of course though, like all drugs, it doesn't work for everyone the same way. So some people may not have that option and some don't want to inject another shot, as Symlin has to be a seperate shot injected with each meal.


I hope that helps some.

[shabbie6247]

Originally Posted by blonde kiddo

Hi everyone,

As a Brit reading and using this forum I am very intrigued by a theme I seem to be noticing on here regarding the treatment of diabetes in the US. The impression I get over what is advocated in the US is that a diabetic diet should be a low carb diet? But this doesn't seem to be so for diabetics in Britain. On the contrary it seems the emphasis in the UK (for type 1's at least) is on being able to adjust carb intake, to the patient's liking, in programmes such as DAFNE. I wondered if the low carb ideal in the US (if it really does exist) is merely down to Dr. Bernstein or whether there's any research out there suggesting low carb diet can improve long term diabetic control?

Comments from both sides of the Atlantic appreciated!

Sarah

hi sarah,
good thread

its my belief and experience that the uk diabetics arent as well educated as our US friends.
i have noticed that uk diabetics are expected to magically reduce blood sugars and keep an A1c hovering around 7%, but unless you are lucky enough to get onto a DAPHNE course, you wont get any further help. the dietitian only tells you to eat a third of your diet in carbs, and unless you know to ask about carb counting you wont get any help there either.
~ now dont get me wrong my healthcare team are pretty good, and let me get on with my own management. the D nurse told me that i am an exception at the hopsital clinic with an A1c of 6.2 ~ apparently this is unheard of here!

re: your carb counting question, i find my Bgs are much more stable if i confine my carb intake to under 50 grams per meal. (sorry to dedicated low carbers!) so while im not a true low carber i will always select lower carb for my meals. evening meals give me the most trouble BG's-wise so i choose not to eat what i call 'hard-carbs' ie bread, pasta, rice, potatoes. i fill up instead on veggies and proteins. seems to do the trick for me anyways

someone pointed out the other day that the uk information is more about glycemic index and glycemic loading (how much a given food raises your BG and how long it lasts)

[REDLAN]

I'm unconvinced of the low carb argument for type 1's.

I believe we had a very unscientific poll on here a while back about carb intake and A1c results - I believe the poster was hoping to show that type 1 low-carbers had better A1c's than high carbers, thereby proving Cyborg's contention.

However there were a significant number of posters with high carb diets (250 grams plus) who had achieved lower A1c's than the low carbers who posted.

I think that what matters for good control is accurately matching your insulin requirements for your food intake. And some people find this easier with a low carb diet.

me personally, I seem to do well on a high carb diet (my typical daily intake is around 250 grams). I need to eat at least 30grams at a sitting to actually have some carbs to inject against (my I:C ratios are fairly low).

As a side note - very low carb diets may be risky if you engage in strenuous exercise. Failure to replenish depleted glycogen afterwards has been responsible for several deaths. If your liver's supply of glycogen is depleted then a night time hypo can be very risky, as your liver is unable to respond to the hypo and raise your blood sugar.

I regularly engage in strenuous activity - and I eat a lot of carbs when I do so - my daily intake can rise as high as 400g on my cycle days.

[xMenace]

The natural tendency is to lower BGs by lowering carbs. If that means cutting them out altogether, so be it. In reality I think low carbers are unecessarily missing out on important dietary components as well as the enjoyment of foods.

I readily admit that we as a society eat too many carbs and too many of the wrong types of carbs. A recent show on CNN suggested that over 60% of the average US resident's carb sources were derived from corn. The health implications of this are just plain scary. We do all need to eat a variety of healthy carbs in much lower quantities, but we do need to eat them. They provide the energy we need to function. I don't for a minute believe extreme low carbers are healthy, happy, or productive.

As for type 1's, we cannot eat everything despite what some claim. Lowering carbs and eating more complex ones is just as important for us. Personally I can't handle any more than 40g at breakfast, and I can only do that with pre-bolusing. When I eat a large meal or fast acting carbs, I know keeping my BGs in check will eb a challenge. Every additional carb increases the variances in my numbers. Eating like the typical non-diabetic is also at least risking cardiovascular and obesity complications plus the usual diabetic ones.

I've come up with thre predominant reasons for (extreme) low carbing by type 2's: fear, guilt, and lack of education.

Most type 2's I've observed maintain an inherent fear of both complications and injections and a guilt associated with increasing medications. The fear I can understand, it is a very powerful force. It can be overwhelming. It can and does drive people into radical dietary choices. We see evidence here on DF all the time.

Don't ever think us type 1's don't fear the future. Most of us have regular thoughts about our futures, and it does affect us and our decisions too. The needles I have little sympathy for. Suck it up princesses! When you start getting 3" needles poked into your eye sockets, I'll start to listen.

The guilt I can understand from experience. I always felt guilty my BGs were off. I still do. It's a powerful force. IMO avoiding this guilt is a big reason for low carbing. Type 2's often feel guilty about having to take more meds or go on insulin. Type 2's will almost all progress. There's no stopping it. It doesn't depend on your decisions. There is no need to feel guilty. There is nothing wrong with increasing your meds or going on insulin. The disease is advancing and you'll need to go there anyway. Why torture yourself?

I'm not a type 2, so I can only speculate on what training they get. My observation, and I've talked and chatted with many and I've hung around the DE centre many times, is that training can be different from town to town and country to country. I do know that their training is no where near sufficient. People in my local support group have almost no clue what this disease is about. All they know is they should test a few times a day and watch their diets. Jesus H. Christ some of these have been D for several years and don't even see a doctor! Us long termers that have read dozens of books, have been to training classes every decade or so, ask our doctors questions until we get thrown out of their offices, and who live on the net seeking answers MIGHT be educated enough. I still fall down once in awhile, and it's not ****ing pretty when I do. Basically there are too many diabetics and not enough DE's, and the information we get does not stay with us. I think we need regular, ongoing support. DF anyone?

I don't ever want to riducule peoples choices, that's not what this is about. We all make difficult choices daily, and they are life and death decisions. I have no problem with anyone deciding to low carb as long as they understand what they are doing and why. Information is power people. Seek it and make informed choices.

[kgm0612]

My personal opinion is.......follow a diet that works for YOU and YOU alone. For me, it's low carbing and matching my insulin to it. My younger brother prefers a higher carb diet and is happy if his blood sugar is a bit higher than the norm two hours after eating.

Karen

[cheryl]

Beautifully stated X-menace. That is how I feel, I do believe that the normal population is killing themselves with these high high carb diets..There are bad carbs...

I think some low carbers went from eating whatever to restricting even good carbs(LIKE FRUIT)......I cannot still for the life of me see how you take that out of a diet...I can see some types of fruit, but not all...

I have got to say when I did low carb it for a bit, you kind of can understand your body, what a lot or what I can suggest is to low carb it, get yourself in good control, then bring back healthy carbs, and see which one's you can and cannot tolerate.....

I was on low carb and I still ate my one fruit strawberries, because let me tell you there are barely any carbs in those suckers to sneeze at....then I started to add all the healthy carbs back.......a lot of fruit, ate potato's again, I even found healthy french fries, low carb tortilla wraps, low carb yoguart....Low carb soy milk.....and I find what bad foods, don't have a ton of bad **** in them.....so if I want to indulge, atleast I am not putting harmful harmful stuff in my body...

I consider myself lucky as to have this knowledge, The most important aspect is finding what works for you and that you are truly happy with what you do....If you are and your healthy then go for whatever makes you feel that way...

I guess I have my Nani(grandmother)in me I think she'd fall over dead with a heartattack if she heard people didn't eat fruit, I got her genes LOL>.....

Cheryl

[Alice]

I agree that the US has become a country of "supersize" portions...of all foods, not just carbs. On the otherhand, I don't feel that someone who eats moderate carbs (I eat a healthy 2-3 servings a meal, sometimes more, sometimes less) is necessarily a "high-carber"...this is what bothers me about the carb debate. I think there is a middle ground.

I don't believe in the "more insulin" makes you more fat...as the author was pitching on Good Morning America this morning. But I know a few on this list do believe this. I think your body naturally produces what it needs to process carbs. I think Type I's take only the insulin they need to process carbs (obviously, it's very difficult to walk around with too much insulin in your body!)...Therefore, I just don't buy the excessive insulin production as a problem for weight loss. But that's my opinion, I'm happy others can disagree with me.

I also think that manufactured insulin is very different than natural insulin. Therefore, the sensitivity is different as well.

In summary, I think as long as you are treating your carb intake with the proper amount (and timing) of insulin, carbs should not be an major issue. For Type II', there seems to be a big resistance to medication, therefore, many hope (and some succeed?) to minimize carb intake.

I just don't care for the "low carb is best" mentality. There is a middle ground. There is also a need for more exercise to get the calories burned...and improve overall tissue health.

[notme]

I think this really is a question seperated by the type of diabetes you are treating. I do believe that type two's have to follow a stricter carb intake and match it with meds and exercise. I think it is also an issue of "know your carbs". Some carbs, (many times it is carbs added with fats or simple sugar) can drive your blood glucose out of range and it is hard to recover. That is a much tougher issue for type two's since they cannot do an insulin correction.

People with type one diabetes have to know their carbs, but have an easier time treating more complex carbs. Once you figure out your food (like pizza or Chinese food) you can make those adjustments with insulin.

Simple answers like a percentage of daily intake or carb counting doesn't work for anyone. Sadly, it is a lot more complex depending on the food, your insulin sensitivity or resistance and activity level.

I think the people on the boards realize the complexity of this question and that is why we get such a variety of answers.

I am one of the people that do believe, the more insulin you take, the more weight gain is possible. I live it. I also believe in moderate carb intake.

[rzrbks]

Point 1. Many people in the US have a sick and unnatural fear of Education and Expertise so they go hunting for anything that Does Not include Experts and is NEW, different and makes them feel special.

Point 2.

That is why the Institute of Medicine (IOM), part of the National Academy of Sciences, recently issued a recommendation that children and adults get a minimum of 130 grams of carbohydrate a day to maintain maximum brain function.

>>>perhaps # 2 explains #1<<<

Point 3. The only research I've been able to find on Low Carb + Diabetes is either Type 2 and weight loss related or is such a small sampe as to be worthless or nearly so--10 people, 18 people, 27 people-- coupled with the fact that their trial period is so short the results are again, very questionable.

Point 4. Medicine is an Art, what works for BillyJimBob, doesn't necessarily work for JimBillyBob without tinkering designed for their individual systems

Conclusion You and your Dr./Health Care Provider have to work out what best for YOU and don't listen to the latest Doofus to buy a computer with a good word processing program and the need to make a Gazillion bucks.

[BlueSky]

Originally Posted by blonde kiddo

.... it seems the emphasis in the UK (for type 1's at least) is on being able to adjust carb intake, to the patient's liking, in programmes such as DAFNE. ...

DAFNE is essentially a type 1 control methodology, based on the intensive therapy paradigm. As such, it does not address the needs of 95% of the people out there who are trying to control their blood glucose - all the T2s. The DAFNE "like what youeat ... eat what you like" motto also pre-supposes that all T1 diabetics respond to insulin in a similarly consistent fashion. While this may be true for most of them, it is certainly not the case for all of them. A lot of us (like me and cyborg) have some degree of insulin resistance. It changes the way we respond to insulin and reducing carbo intake is a much more important tool for achieving satisfactory control.

There is a growing awareness that perhaps eating what we like, or what is easily available, may not be such a good idea. Even for T1s. People like Bernstein and Eades probably have had a lot to do with this. And their ideas are becoming more acceptable as the realisation that there is nothing wrong with getting most of our energy from fat, gains momentum.

The UK establishment may be some way from accepting this position. But so is the American medical establishment. The difference, I guess, is that dissenters in the US are more vocal and have attracted a more enthusiastic following. The popularity of low-carb eating is being driven by rapidly increasing numbers of frustrated T2 sufferers who are looking for more effective treatment options. The number of people in this situation has been boosted by more stringent diagnostic benchmarks and the enormous amount of publicity T2 diabetes has been getting.

[rzrbks]

I guess, is that dissenters in the US are more vocal and have attracted a more enthusiastic following. The popularity of low-carb eating is being driven by rapidly increasing numbers of frustrated T2 sufferers who are looking for more effective treatment options.

I know what I want and I want it NOW-------btw, it'd better fun, easy and painless.

[NoelD]

Low carbing made a big impact on my A1C and over all BG's, regardless of what anyone says.

[Merry]

For my type 2, I have to take meds, go walk a couple of times a day, and distribute my carb intake into three or four meals and a couple of snacks. Anything else and the blood glucose level goes up, and I get on a see-saw of up and down, feeling out of sorts. I do not know about everybody else.

I went to a class a few years ago the they advised diabetics to get on a schedule, take meds, walk, and write down what they eat and how much they walk/swim/bike for a while until they learn to deal with their own condition. Sometimes meds will change. I think it is a personal thing. Fast food is something that has to be watched. But that is changing, and there are a variety of foods to get at fast food places now, and it is becoming easier to remain fed and sane.