food balancing act - suggestions please!

[academicdiabetic]

Hi,

So.. if I eat carbs my BGs shoot up and/or I have to inject more insulin (which has adverse effects).... so i shouldn't eat carbs... if I eat fat it has adverse outcomes for weight, heart etc. so I shouldn't eat fat... if I eat too much protein it will have an adverse effect on kidney function... so i shouldn't eat too much protein... fibre doesn't provide much in the way of nutrition..... so... any suggestions as to how you all balance this on a daily basis (I'm vegetarian, so please no meat, fish or seafood suggestions please!) ? Thanks!

 

[Squire Fulwood]

I normally ban myself from writing on here if I have had something to drink but what the hey.

No-one ever said you can't eat carbs. They would be difficult to avoid since they are in many foods including veg. The NHS says they are an essential dietary requirement. Refined ones and eaten in large quantities with no other foodstuffs will cause your blood sugar to rise to an unacceptable level. Eat your carbs, eat them with other foods but never eat refined carbs in large quantities.

No-one ever said you are not supposed to eat fats but you have trans fats, polyunsaturated fats and saturated fats. I think trans fats are now understood to be a bad thing. Polyunsaturated fats are also in doubt. A Mr. Dwight Ludnell (Dr. Dwight Ludnell but struck off) said that after performing heart surgery for 25 years we should tend to aim more for the grass fed butter kind of fat. He was struck off for saying the wrong thing but not necessarily being wrong. He thinks things like margarine should be given a wide berth.

http://www.sott.net/article/242516-Hear ... rt-Disease

You have already made your statement about protein since you are a vegetarian which presumably means you will see less protein than I will. Are you one of those vegetarians that can eat eggs and fish etc?

Thinks: if you are a vegetarian why are you worried about fats?

I hope no-one ever says that wine is bad for me.

EDIT: His name is Lundell not Ludnell. Must take more water with it.

 

[academicdiabetic]

Hi Squire,

Thanks for your reply. In response to your queries, I don't eat refined carbs, or at least not if it is obvious that that's what a foodstuff is, I do eat carbs with other things rather than on their own, I avoid trans and polyunsaturated fats for the most part, I do eat free range eggs occasionally, but not fish or anything else that happens to have a nervous system! I am on a bolus ratio of 1 unit to 10g carbs, but, by way of example, 9.8g carbs (in 20g of humous) eaten with 100g plain cottage cheese and 56g of cheddar cheese (hence concern re fat despite being an 8 stone veggie!) took my blood glucose up by 7 mmol/litre to 20 mmol/l .... which prompted quest for how on earth one can eat healthily and keep insulin dose as low as possible..... maybe I should take up red wine, at least it keeps the liver occupied!

 

[Squire Fulwood]

I don't eat refined carbs, or at least not if it is obvious that that's what a foodstuff is,

You raise an important point that I have been going on about for some time now. Some foodstuffs give surprisingly high blood sugar readings and at first I did not understand as much as I now do. Having looked at some prepared chicken products I found that they are made from mechanically recovered chicken (if you are lucky) and mixed with rusk and made into a sort of cake. This explains how they are consistent in size and shape and how they get the filling into kievs.

A question about doner kebabs on this forum recently revealed the fact that lambs don't come in that shape naturally and the whole thing is a meat/rusk mix.

The low fat foods often have sugar added to them to give them some taste so there are a lot of products out there which are just flour and sugar. My 18 months using my meter has partly been spent in identifying these foods. I use a gravy product which is made of starch and caramel (flour and sugar). It's never seen a cow.

I find the safest way is to buy identifiable foods and prepare them myself.

I am not sure how the above translates into the vegetarian world but I have found that if they can make something of just flour and sugar they will do so.

 

[mo1905]

If cottage cheese and cheddar cheese raised your glucose levels by so much, is this because you are not taking enough insulin ? Also, why is taking insulin promote adverse effects ? Thanks

 

[phoenix]

You need to take the amount of insulin needed to keep your glucose levels controlled. If you are eating a healthy diet, why should that be detrimental? That's what a normal pancreas would do.
In your example though you are eating a low carb meal ( 9.8g carbs (in 20g of humous) eaten with 100g plain cottage cheese and 56g of cheddar cheese)

Many people find that they need to take insulin for no carb/low carb meals beyond the amount that the carbohydrates would suggest.

Personally carb counting alone works for most of my meals because for normal every day main meals I tend to eat the same sort of balance of carb/protein/fat so my ratio probably takes that into account.
But vary from this and carb counting alone doesn't always work well.

The only way I have found out how to dose for alternative types of meals is by experience ie trial and guesswork coupled initially with lots of record keeping. Some people are more scientific and do try to use what they call total available glucose for dosing

Now I know that If I have a cheddar cheese omelette for lunch then I have to give an insulin dose for this despite the fact there are no carbs. I actually need to take the same amount of insulin as for a large salad, slice of nutty bread and a piece of brie .

If I have a veggie meal that contains lentils/chickpeas as the protein source then I find that I need a lower amount of insulin than the carb count alone would suggest. Chana dahl is very very low on the glycemic index.
(incidentally In India they have had success using very high carb, very high fibre diets based on a traditional Indian vegan diet. One French doctor I read also suggested that people with D would be better having a high legume diet, the reason that he didn't tell his patients to do it was because they wouldn't follow his advice)

There are several previous threads on here that discuss dosing for protein/fats see for example
viewtopic.php?f=15&t=37310&p=348974&hilit=total+available+glucose#p348974


Interestingly recent research seems to confirm that carb counting alone won't produce optimum results, especially if meals are high fat and or protein.

A person with a normal insulin response produces insulin in response to foods other than carbohydrates. If you look at this list here you'll see that researchers found that cheese for example produces an insulin response higher than that for All bran and not that much less than for lentils. The researchers drew up an index which ranked the amount of insulin the body produced for a number of foods.
http://en.wikipedia.org/wiki/Insulin_index

A couple of years some researchers conducted a small trial using the insulin index to dose for meals. They used a high carb meal (75 g carb and only 20% of the meal from protein and fat) as a control meal. The trial meal was a meal lower in carbs (45g) higher in protein and fat but calculated to have the same insulin demand (according to the index) as the high carb control meal.
They ate the control meal once, using a carb counting ratio that had been worked out by testing in the previous days. They ate the trial meal twice. Once they dosed using carb counting, the other time they dosed using the insulin index as a basis for the dose.
When they ate the second meal and dosed according to the amount of carbs blood glucose was higher for longer than when they dosed according to the insulin demand.
Ie the lower carb, higher protein fat meal needed more insulin than just counting the carbs suggested. When a person ate a higher carb meal counting the carbs alone seemed sufficient. (though the researchers didn't actually look at taking into account the protein/fat in this meal.. The amounts were probably low enough not to make a great deal of difference)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177729/

Very recently a piece of research looked at how much insulin was required to control high fat meals . The researchers used a closed loop system (which monitored levels continuously and automatically gave insulin when necessary using a pump)
The subjects ate meals with the same amount of carbs and protein but which had different amounts of fat. To keep levels controlled with the higher fat meal required an average of 42% more insulin.... but individuals varied a lot as to how much more insulin they required.
http://www.joslin.org/dietary-fat-can-a ... betes.html

 

[damienmyers69]

Hi all,
I would like to say from the get go, I am one of those diabetics that for 18+ years followed every diet I was told to do, and most of them actually made me so much worse.

Was only on june 27th 2011 when I was at the hospital having the results of my diabetic eye screening, and got told, do as your doing and your going blind, with lazer treatment for definite.
Or get your diabetes under control, and you got a 5% to 10% chance the damage behind your eyes will repair itself.

Since I beat death once with less than that chance I thought ok, if all the right things have failed me, time to forget everything I was told, and learn this from scratch.

I find it not the actual carbs themselves that do the damage, it is the carbs that sugar, be they from natural sugar, man made sugar, sugar alcohols, polyols, to us if your body is wired that way, 1g of sugared carb is no different than eating a teaspoon of sugar.

So, try keep carbs that sugar to a bare minimum, which for a veggie is almost impossible.

Normal carbs that don't sugar, yes they will still raise your BG, but slowly, which makes it easier for your tabs/insulin to work on over a 5 to 6 hour period.

Also, a multi vit one a day tab is essential.

By following this very very basic rule with my foods, I can enjoy a good kebab, cheese, the occasional few slices of low sugared bread, potatoes, rice, pasta, maybe a touch of veg now and then, and barely have to use my insulin most times, just my metformin.

You need structured eating times, like I do 12pm - 1pm lunch, 5pm to 6pm dinner, then I know with my tabs it gives me 5 to 6 hours for the food to be digested and the sugars to be removed from my body and if it a touch high before bed, i take a 5 to 10 unit shot of insulin knowing i be awake in 6 hours time, or set alarms to make sure i wake just incase.

And just to prove it worked, my HBa1C went from 11.9 to 7.2 in one month doing my own regime, i've maintained my weight, my cholesterol is now normal, BP now normal, and the damage behind my eyes is now reversed.

And I have maintained it for 20+ months now.

I still have my little treats, like a few squares of diabetic chocolate, the odd kebab now and then, cheese on toast, a meal out with sauces.

Am not saying dont listen to advice from the medical profession, please do as it is very important, it gives you a good foundation to then say ok, now to tweak it to my own body.

And trust me when I say this, I dont do change well, i'm stubborn, but when my back up against the wall, I find a way to win, so if I can do it anyone can, just have to want to badly enough.

So hope that helps out, aways happy to help with advice if anyone wishes it

 

[ewelina]

50-60% protein and about 10%fat convert into glucose. I think thats why you had such a high reading after eating cheese. I take extra insulin for most of protein (apart from fish and sea food)

 

[academicdiabetic]

Dear All,

Thank you very much for your informative and helpful replies. Much 'food for thought'.... Phoenix - I am impressed at the level of research you have done, that's really interesting as it provides an evidence base to work from and very kind of you to spend the time detailing it here, I'll look up the studies you mention.

I agree with Squire that it looks as if buying fresh, identifiable foods and preparing them yourself is the best option all else being equal and similarly with Damien that you probably have to work things out for yourself, as the 'official' advice is probably too simplistic - Ewelina's comments are intersting in that context as teh nurse had focussed purely on carbs and not mentioned that protein might also have to be controlled.

In terms of comments re insulin, personally I have to be careful how much I take, as I seem to be a bit too reactive to it, if I take more than 6 units of novorapid (regardless of what I eat) my BG shoots rapidly downwards and often ends up with a hypo. More broadly, people tend to assume that it is the 'diabetes' as such which directly causes problems such as the microvascular complications, actually there is no concrete evidence of that, but it is known that rapid swings in BG are something the cells cannot cope with and the mechanism linking this to microvasscular complications is clear, furthermore insulin is a toxin and excess amounts (which can actually be quite small in comparison to requirements) are associated with proliferation of tumour cells, finally hypos are actually more damaging than going 'hyper' - hence my broader comments on the dangers of insulin.

You have all heartened me to go back to the drawing board and take another run at this, checking in an empirical way how my particular body tends to react to differnet foodstuffs looks like the way to go from what you are all saying. Thank you so much for taking the time to respond so helpfully.