Part One Hi and welcome! Learning that you have diabetes usually comes as a bit of a shock followed by confusion from often conflicting advice. But don’t panic, it can be managed. It does require a bit of a lifestyle change in terms of diet and discipline, but we can and will help you with that. We were all in the same boat once! Introduction, and Why Low-Carb? This page has been provided for those who are new to the forum or to the concept of low-carbing as a tool for managing diabetes. Although it is aimed principally at Type 2 diabetics, Type 1s and others can also benefit significantly. 'Managing diabetes' means different things to different people, but ultimately the aim for Type 2s should be to get your blood sugar numbers into the same area as non-diabetics. This means an HbA1c level of less than 42 mmol/mol (6.0% in the old measurement system). (48 mmol/mol or 6.5% and above is regarded as diabetic, 42-47 mmol/mol as prediabetic). For Type 1s, the aim should be the lowest practicable levels concomitant with good control and avoidance of hypos in accordance with their consultant's guidance and personal life choices. So, the main priority is to get blood sugars under control. This is essential to minimise the risk of developing unpleasant complications (including amputations, kidney failure and blindness) if the condition is left unattended and sustained high blood sugar levels are allowed to prevail. The chief symptom of diabetes is an elevated blood glucose level. Whilst some medications can help Type 2 diabetics to reduce blood glucose, another significant factor is a reduction of those foods in the diet which often raise the levels in the first place. This is not just obvious sugars in sweets, chocolate, cakes, biscuits, breakfast cereals and so on but most carbohydrates as well. Carbohydrates metabolise quickly to sugar in the system (some take a little longer than others) and so for diabetics they act basically as if they were sugar. It’s best to cut out starchy carbs as much as possible, including bread, potatoes, pasta and rice - 'wholemeal' or so-called 'healthy' carbs included. This may be contrary to medical profession guidance you have received to eat carbs with every meal – this is advice rejected by most well-controlled T2s on here. Low-carbing can therefore result in medications (including the amount of insulin required for T1s) being reduced. ALWAYS consult with healthcare professionals on this. In some cases (Type 2 diabetics only) medications can be avoided or eliminated altogether. (It is a mistake to imagine that drugs alone will enable you to manage Type 2 diabetes successfully, so don't become complacent if you are on medication – it is assumed that for most people minimisation or elimination of medication is in itself a major objective. Testing In order to learn what foods you can and cannot tolerate it is strongly recommended that you have a test meter (not usually prescribed for T2s). With this you can measure your blood glucose levels before and after meals and see what ‘spikes’ you. Again this may be contrary to professional advice you might receive which often regards testing as pointless. But how else are you supposed to learn? Many on here use the SD Codefree system (from Amazon etc. or direct from the supplier Home Health UK) because the strips are the most cost-effective. There is also a Type 2 Testing Program from DCUK which provides 400 test strips/lancets, a structured testing program and a Nexus meter. What does Low-Carb mean? A low carb diet is not necessarily low in all carbohydrate foods, simply those which disrupt blood glucose and insulin levels. Generally, the diet includes the healthy natural and unprocessed foods similar to those eaten in populations where diabetes and heart disease are rarely found. So you can eat/drink: Meat, fish, eggs, butter, cheese, plain Greek yoghurt and cream Vegetarian protein such as tofu and TVP Above-ground green vegetables, tomatoes, avocados, nuts as a good snack Berry fruits in moderation (blueberries, raspberries, blackberries, strawberries) Occasional small amounts of dark chocolate (85% cocoa or more) Tea, coffee (try with cream instead of milk) Plenty of water Red wine, dry white wine, champagne, spirits in sensible amounts And you should avoid: Sugar - soft drinks, sweets, juice, sports drinks, chocolate, cakes, buns, pastries, ice cream, breakfast cereals. Preferably avoid sweeteners as well. Starch - bread, pasta, rice, potatoes, chips, crisps, porridge, muesli, foods containing processed flour and so on. 'Wholegrain products' are just less bad. Moderate amounts of root vegetables (carrots, parsnips) may be OK (unless you’re eating extremely low carb). Margarine - industrially imitated butter with unnaturally high content of Omega-6 fat. Has no health benefits, tastes bad. Statistically linked to asthma, allergies and other inflammatory diseases. Fruit, especially tropical fruits which contain lots of sugar. Eat once in a while at most. Treat tropical fruit as a natural form of sweets. The impact of apples and pears varies from person to person. Beer - liquid bread. Full of rapidly absorbed carbs. Sweet white wine, cocktails with sugary mixers. In broad terms, carbohydrates have a large impact on blood glucose levels, protein much less, and fats have little if any effect. An effective low carb diet (or perhaps we should refer to it as a 'lifestyle') is one which allows a person to maintain, most of the time, a healthy blood glucose level. The amount of carbs it contains will vary between individuals, depending mainly on personal choice, pancreatic function and insulin resistance. A possible range might be: » Low carb (ketogenic) 0-50g carbohydrate per day » Typical low carb 50-90g » Liberal low carb 90-130g » Moderate carb 130-170g » High carb 170g and more For low carb foods aim for those that have less than 10g total carbohydrate (excluding fibre) per 100g, less than 5g if you can. Ignore the ‘of which sugar’ bit, that’s not as important. You will become an avid reader of food labels! (And the MyFitnessPal app can scan them). Also avoid low fat versions of food items – these often contain added sugar. Some prefer to keep eating some carbs, because they want to and/or they can tolerate more; and some are less able to eat higher levels of fat. Some diabetics (more often Type 1 than Type 2) can be coeliac, and have to follow a low carb, wheat/gluten free diet using prescribed food items via their GPs. What about LCHF? LCHF (Low carb high fat) is a variant of low-carbing which many diabetics successfully adopt. When you reduce carbohydrates, you also reduce the calories that come with them. To make up these calories you can replace them with a higher proportion of fats, such as those found in fatty meat, butter, cheese and cream. LCHF is advocated by a Swedish dietician, Dr Andreas Eenfeldt, who runs a website under the name 'Dietdoctor' – Google this for more details. There is now also the Low Carb Program. What might happen when you start to Low-carb? The following does not happen to all who start a low carb eating regime, but some may experience one or more of these stages. Days 1 to 3 - carb withdrawal and hunger. Eat lots of fibre and lots of fat. Fat and fibre together produce a high degree of satiety. Add flax seeds, as they are high in both fibre and healthy omega-3 fatty acids. Salads with protein (tuna, chicken, etc.) and lots of olive oil dressing is another good bet. Don’t go hungry! This isn't like other diets where you can expect to go for long periods being hungry. Eat every 3 hours if you want to, snack on low carb foods (such as cheese or nuts) as you want until the hunger goes. Days 3 to 5 - the wall. People often lose a lot of salt with the fluid in the first few days, and you have cut out the supply from junk food, so add some salt and/or a cup of hot water with a stock cube several times per day. Days 5 -14 - reward time. By the end of the first week you should start to reap the rewards of low-carb eating. This is the stage where many people begin to experience increased energy, better mental concentration, better sleep patterns, less compulsive eating, and few or no carb cravings. Some experience it as a “fog lifting” that they didn't even know was there.