If you eat according to the Eatwell plate, is an Hba1C of 48 achievable?

[tim2000s]

I blogged recently about DAFNE encouraging "normal" eating and that in doing so, it may affect the ease with which people achieve the new NICE target of 48 mmol/mol for Hba1C, without having a fairly roller coaster time.

Given that to most people, normal is what the are before being diagnosed, I wondered how people get on with normal eating and the ups and downs? When I eat more carbs I roller coaster a lot more. What about you?

 

[azure]

It depends how many carbs you're talking about. I eat a moderate amount of carbs - 150 to 200g - and if all's well I don't rollercoaster too much. I do test lots though and correct if necessary. My last HbA1C was 32.

I personally think that there's an 'upper limit' of carbs for most people over which it's difficult to get control. Or rather, too much effort!

 

[donnellysdogs]

I roller coaster on anything within eatwell plate due to slow colonic transit. And as for 3 meals a day? I just cannot do that.

The carbs they suggested even pre diagnosis of SCT is prob why I needed a pump. Now just one meal with pure natural foods and no roller coasters unless its my own stupidity or adverse reactions to meds or eating our.

Mine wasn't just a roller coaster.. Felt like a full on helter skelter drop zoom drop sometimes with the hypos....

 

[nmr1991]

i eat anything I want, from celery to mars bars, and think I have an average of 7-8% hba1c

 

[tim2000s]

Thanks @nmr1991. That's very much inline with what I wrote about.

 

[Gaz-M]

I eat most food, not so many sweets or chocolate these days but I did before, I never have a lunch and do not low carb but over the past month my daily carb intake is 111, so maybe a lowish intake but I eat alot at tea-time and breakfast

 

[zjed]

For me, the more carbs I have, the bigger the roller coaster. I find it a lot easier to hit lower targets when I reduce my carb intake.
Here's another guys high/low carb experiment. I generally agree with his findings and think you could get to 48 on a higher carb diet, but it would be a lot harder work getting there.

 

[tim2000s]

Thanks @zjed. That was the piece that got me writing the blog. I think the new NICE target is good, but as he says, it's hard to achieve on a normal carb diet. If you are eating all the processed stuff that many do it is even harder.

 

[pinewood]

I have not changed my eating habits since being diagnosed, other than perhaps being more consistent with my lunch on Monday to Friday at work and having salad, as I have a routine which I know works perfectly (2 units 20 mins before and I sit at 4.5-5.5mmol until dinner despite being inactive at my desk).

Average carbs day per day is 100-200g, but occasionally much more at weekends. I assume I am still honeymooning (daily 10 units of lantus and total novorapid no more than 12 units per day even with significant carb intake).

I'm overseas at the moment and have been very much overindulging at breakfast each day - this morning, for example, I had 2 large pastries, a bowl of granola, an omelette and fruit and yoghurt (!). 4 units 20 mins before kept me steady at between 5-7 mmol but (thanks to Libre) I've learnt that I get a spike after about 2 hours, so a 1.5 unit top-up 2 hours after eating keeps me steady with no spiking. I do cardio exercise (run 3-5km) and weights before breakfast, which no doubt helps. For dinner I can eat a high carb meal and dessert and, again, never rise above 8ish if I dose in advance and remain a little active afterwards (this makes a HUGE difference for me - I can guarantee a spike if I am inactive).

I'm not expecting it to be this easy forever but at the moment but for now I find that I can tolerate high carbs easily so long as I dose appropriately. Libre has been invaluable for this. I'm not criticising low carb but I think it should be treated with a little caution for those who won't stick with it - I've read a lot about people going on to LCHF and then pretty much losing their ability to tolerate carbs and then, when they have "splurge" days or go on holiday etc, they suffer badly as they can't deal with it. Would be interesting to see some research on this.

 

[staffsmatt]

I think the problem with putting every diabetic on a restricted diet is that people wouldn't stick to it (look how hard people find it to lose weight) if you educate them on how to cope on a normal diet then at least you give them a fighting chance.

 

[phoenix]

I've been thinking about this one so reply complete with pictures as it's easier to explain!
Short answer yes, but not if it's badly interpreted.
I think the eatwell plate is a poor representation because it's supposed to cover the distribution of elements over time not in one meal . You aren't supposed to eat much fatty/sugary foods ie cakes and biscuits but if you take the plate as a meal plate it implies that you can eat them at every meal rather than occasionally. I also hate the way the modern version uses a lot of processed foods
However, UK guidelines are not that different from French and I know you can definitely achieve a good HbA1c with those,
In UK the guidelines are: not more than 35% fat, 50% carbs. (plus 5 fruit and veg a day etc) and the only difference is that the French have a slightly higher fat bracket 35-40%
Heres what I try to follow most days(not every day, I don't stick to it when I eat out for example. Pleasure is also important ) and I only have two portions of dairy because I take milk in coffee which adds up to another portion.
I do find eating a consistent pattern of meals prevents roller coasting.


0n a daily basis though it really works out very similarly to the eatwell plate.



French schools have to follow the nutritional guidelines so here a diagram of a typical school meal pattern (picture from this US blog (google menu scholaire or equlibre find hundreds of menus following this pattern)

I had a go at putting this menu into this calculator for calories/balanced meals. I did it as if it were for me and I gave myself a 1500 calorie a day need (sometimes I eat more, sometimes less)
I had to fiddle a little with quantities but this is what I came up with to get a 9/10 for balance; couldn't get 10!

I probably wouldn't eat peas with the meal and would have a lot more salad and a tomato instead .It would reduce the glucides (carbs) by a bit .I would probably replace the cheese with a plain yoghurt When I did it I still got 9/10 .
I eat mainly carbs at breakfast porridge made with milk and berries (38g) and probably eat more protein and carbs in the evening.
(I suspect an average day would balance out at a little high in protein and probably nearer 45 than 50% carbs)
What I think I'm trying to say is that following the guidelines should not result in the sterotype we sometimes read of huge amounts of pasta, potatoes, rice etc.

Edit absolutely agree with the last post about the necessity of exercise; diet is not the only factor that effects blood glucose levels.

 

[Pinkorchid]

Yes I think it is achieviable for many people as some are able to handle far more carbs than others. There is no one diet to suit all so we have to design our diets to suit us personally
The Eat Well plate it is just an example of a plate of healthy food all of which would suit anyone who is not diabetic but no one said we have to eat everything on that plate we have to modify it to suit ourselves just as we do if we follow the LCHF some eat quite high carbs some very low

 

[dannyw]

Yes I think it is achieviable for many people as some are able to handle far more carbs than others. There is no one diet to suit all so we have to design our diets to suit us personally
The Eat Well plate it is just an example of a plate of healthy food all of which would suit anyone who is not diabetic but no one said we have to eat everything on that plate we have to modify it to suit ourselves just as we do if we follow the LCHF some eat quite high carbs some very low

I totally agree, we need to all adapt but that is not what OP was asking. The question was if you stick to the eatwell plate, not modify it.
I also believe a few could achieve good results but ultimately, the more carbs you eat, the more there is for margins of error.

 

[tim2000s]

What I think I'm trying to say is that following the guidelines should not result in the sterotype we sometimes read of huge amounts of pasta, potatoes, rice etc.

I think this is where DAFNE needs renaming. Simply by using the term "Normal Eating", many people see this as a license to continue to eat what they like, without really understanding the impact.

I think the other factor is understanding the profile of what is eaten. As described by @pinewood, having the Libre means that he knows how various combinations affect his bg profile. The only other way to do this is to test. A lot. But that's a different point and relates to my belief that CGM is critical in best understanding what your BGs really do.

What I've found is that if I keep carb intake below around 30g per meal specifically, fat and protein together are way more predictable than when I have more than 30g of carbs per meal. There seems to be a multiplier factor, which I've seen research on, which makes managing bolusing much more difficult.