Probably the biggest confusion people not familiar with diabetes have, regardless of Type 1 or Type 2, is about the difference between sugar and carbohydrates. Everyone automatically equates carbs with sugar. We used to think the same way and were thoroughly uninformed prior to V’s diagnosis. The reality is that carbs come from many different sources. Let’s break it down. There are three types of carbohydrates: starches, sugar and fiber. This means that there are carbohydrates in many different foods: grains, fruit, nuts and seeds, milk, and starchy vegetables, just to name a few. Even non-starchy vegetables have carbohydrates, but usually not enough to be concerned about. It is also possible for a food to have a substantial amount of carbohydrates and not a single gram of sugar. In fact, there is a quinoa blend we purchased at Costco recently, which contains 30g. of carbs to a 1/4 cup of dry mix and zero g. of sugar.
So the photo above that spells out the word carbs with various bread and pasta products is totally misleading. They could spell carbs with kale and it would still be accurate.
When we eat carbohydrates they are converted to glucose, which fuels our body with energy. Therefore, consuming any foods containing carbohydrates raises blood glucose. As a rule of thumb, anything more than 5g. of carbohydrates needs to be covered by insulin. This is where carb counting comes in. We need to know exactly or as exactly as possible how many carbohydrates V will eat in order to accurately calculate the right insulin dosage. We read labels very closely because the carb content varies greatly from product to product. Processed foods are especially tricky and can be “carby” even when low in sugar.
OK, so sugar is not the only thing to look out for, carbs come from many sources, even veggies have carbs, count the carbs and give insulin. Got it.
But wait, there is more! Not all carbs are created equal. Let’s start with simple carbs. Simple carbs are your good old sugar, aka fast acting sugar – cane sugar, honey, juice, etc. They are a quick source of energy, digested very rapidly, and can send your BG soaring in no time or put you on a roller-coaster of highs and lows. So sugars are the enemy? Not so fast. They are essential for treating lows, when you need that quick boost in BG immediately. V always has to keep a supply of fast-acting sugars on hand. We favor glucose tabs, jiuces and energy gells for durability, ease of use and effctiveness.
So, carbs are everywhere, simple carbs are good for treating lows, but otherwise not great for BG. Check lables, count the carbs and give insulin. Got it.
But wait, there is more! Let’s look at complex carbs that are, well, complex…
Starches are complex carbs. Also, fiber is a complex carbohydrate. And you thought it was only good for keeping regular! Fiber is the type of carbohydrate the body cannot digest, so generally it does not affect BG and does not need to be covered by insulin. That’s the reason non-starchy veggies are “free”: even though they are carbs, they contain so much fiber that unless you eat a metric ton of them, they will not raise BG. Starchy veggies have more carbs that have to be accounted for, so don’t load up on that loaded baked potato before calculating its carbs. Also, as a rule of thumb, if a food has 5 or more grams of fiber per serving, we need to subtract that from the total carbs.
By the way, a glycemic index will give you a good ballpark idea of how quickly different carbohydrates are digested and converted to glucose.
OK, so we have to look out for carbs everywhere, stick to simple carbs for treating lows, aim for complex carbs for slower release of energy, check on fiber amount and subtract it form total carbs, eat veggies with abandon but be mindful of starches. Got it.
But wait, there is more! Let’s talk about foods high in both carbs and protein. What’s protein got to do with it? Protein slows down the absorption of carbohydrates. It does so in a rather elegant way, too. Instead of delivering all of the energy at once it provides a slow release instead. Less crash and burn, more sustained energy, less chance of blood sugar spiking up. Yogurt, for example, may be a better snack than crackers when we want BG to maintain, because of the higher protein content. However, it’s not as good a choice for treating a low because it does not kick in right away.
Alright, carbs are practically in everything so pay attention, aim for complex carbs, account for fiber and subtract it from total carbs as needed, veggies are free except when they are the starchy kind, add protein to help keep BG leveled, but stick to simple carbs for treating lows. Got it!
But wait, there is more! Let’s add fat to the mix, specifically the greasy “bad” kind of fat. Think cake, ice cream and pizza, not eggs and avocados. Fat also delays the absorption of carbohydrates. But wait, isn’t is a good thing? Protein delays the absorption too and it makes for more leveled BG levels. Alas, no. Put simply, fat postpones the inevitable spike in BG until a few hours later. If V has pizza, she will be OK for a couple of hours, and then BAM her BG is sky high. We try to offset the effects of fat by programming the pump to deliver only a portion of her insulin right before meal, saving a good chunk of it to be delivered over the next 3 hrs as we anticipate a post-meal spike in BG at a later time than normal.
OK, let’s see here. Carbs are everywhere but sugar is not the enemy. Simple carbs are essential for treating lows but stay away from them unless you want to send BG to outer space. Complex carbs help BG to stay more leveled. Fiber matters, don’t forget to subtract it from total carbs. Eat your veggies. Don’t forget that fruits have carbs too! Protein will slow down absorption of carbs and provide for slower release of energy, so make sure your meals have some protein. Fat also delays the absorption of carbs but then the BG spike will ultimately catch up with a vengneance, so adjust insulin delivery accordingly and be mindful of how much fat your are consuming. Especially when it’s fat combined with simple carbs, like cake. Got it! Or not. Because wait… Is fat the enemy, or maybe cake, or pizza? But fat does not even have carbs or sugar, so what gives? Do we continue to fraternize with the enemy and find ways to adapt? And what do complex carbs really ponder about?
I don’t know how about you but my head hurts by now. If you got through this post and are not thoroughly confused, I will give you a cookie, but only if you are able to correctly explain to me the complexity of how it will affect BG based on its unique carbohydrate, fiber, protein and fat content.