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Do you aim for low GI when carb counting?

T

the_anticarb

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Just wondering, for those of us counting carbs on a basal/bolus regime using a fast acting insulin - do you try and follow low GI principles as well as carb counting, or take more the attitude that a carb is a carb and just insulin match to total carbs? I have been told conflicting things, dietician at my last hospital (who was very good) said just to match the carbs and it was ok to have things like white bread and occasional sugary treats so long as I did this. New dietician is in favour of a low GI approach, and gave me a GI sheet to follow but I have to say a lot of the things on the low GI part of the sheet I've found to spike my sugars eg low sugar muesli, wholemeal bread, fruits. So I'm not sure that for me personally there is much mileage in low GI'ing as well as carb counting, it doesn't seem to make a massive difference as the novorapid works pretty quick in any case and in theory should act as quickly as a high GI food (the first dietician told me this!)

Just wondering if others use low GI, and if so why - is it solely to improve BGs or for other health related reasons also? I'm aware that there are lots of other health benefits to choosing whole grains/ wholemeal/ natural foodstuffs but I'm predominantly interested in whether it makes any difference to blood sugar control for people.

Ta
 
As I understand it, low GI carbs take longer to get into your system, ie turn into blood sugar. The blood sugar rise is therefore more gradual, it coincides with your insulin starting to work, and you avoid huge spikes of high blood sugar just after a meal. That's why they are talked of as 'beneficial', because the idea of managing blood sugar is to get it as even as possible, not leaping up and crashing down.

BUT! it all depends when you take your insulin and how fast your insulin acts. So for example, I'm on humalog which is relatively speedy. If I inject, say, 15 mins before a meal and have something REALLY low GI like wholewheat pasta, I will actually go hypo before the pasta's had time to turn into blood sugar. So I end up treating the hypo, sugars go up, and then the pasta kicks in too, and my sugars go sky-high. Not beneficial at all! Equally, if you are eating before taking exercise, it's worth considering that a low-GI meal may have an effect on that. Great if you are running a marathon, less great if you are about to do exercise that is very high-impact where you need sugar right away.

And don't forget that the other foods you are eating affect the rate of absorption too. Personally I find eating fatty things with carbs slows down the blood sugar rise, effectively making the carb part lower GI (although of course you don't want to end up overdoing it on the fat). I find it makes a difference depending on the time of day too. Eg I couldn't eat (high GI) white bread for breakfast because my bloods would be up and down all day, but for some reason my body's more forgiving about it if I eat white bread later on in the day. That is a purely personal thing based on my own blood sugar readings and experiments. You will have to find out how it works for your body.

So knowing if something is low GI is just an extra piece of info really, to add to your armoury. You can make it work for you to get better control, but it's a pretty inexact science...like everything to do with diabetes, to be honest.

Hope that helps?
 
Agree with everything snodger said...

Also, I find that if I eat high GI things, my BG can be really high after a meal (even a couple of hours later)

e.g.
12 - 6.4
12 noon - lunch 80g carb, with 8 units novorapid
4pm - 14.2
6pm - 10
9pm - 6.6 (before dinner)

So I injected the right amount of insulin, as I was within the guidlines for my next meal.
However, I had dangerously high blood suger for 9 hours between meals.
If this happens every meal time (i.e. if you always eat high GI foods) - you'll find you hba1c creap up even through technically you are "well controlled"

When i mentioned this to the dietician she just said, don't test between meals... I never found sticking my head in the sand and ignoring a problem a particularly good solution!
 
I understand the principles, just find personally it doesn't seem to make that much difference, so eg porridge and low sugar muesli on the low gi list, along with wholemeal bread, but seem to spike me as much as, eg white bread or potatoes. In fact given the choice between a breakfast of porridge and milk and the equivalent carbs in white bread, cheese and ham the white bread meal would prob spike me less as the fat in the cheese would slow it down.

The other solution of course is to pre-inject the novorapid 10-15 mins before the meal (or if not all of it a proportion) so that it hits before the spike, prob with this is not only if u get it wrong you go hypo but you are then committed to eating exactly those carbs if you change your mind,

Just interesting that I've had two different hospitals espouse completely different approaches, one the 'eat what you like and inject for it' approach (which is quite radical for a dietician to say, really!) and the othe the low GI approach but I suppose they may feel they have to push the low GI approach due to the other health benefits. I mean, a diabetic eating what they want?
Fun and games..........
 
As far as I know, low GI foods are only 'good' for you because of the bg spike thing. If that isn't the case for you, if your body doesn't really show a slower spike - and everyone's different - then don't worry about choosing low GI stuff.

jameshallam - what did you say when your dietitian said not to check between meals? that's...um... jaw-dropping!
 
Snodger said:
As far as I know, low GI foods are only 'good' for you because of the bg spike thing. If that isn't the case for you, if your body doesn't really show a slower spike - and everyone's different - then don't worry about choosing low GI stuff.

jameshallam - what did you say when your dietitian said not to check between meals? that's...um... jaw-dropping!
Click to expand...

I thought there were other health benefits too as low GI foods are typically the unprocessed foods (hence they break down slower) which contain more vitamins minerals and good stuff because these are not stripped out in the over processing of the food? eg wholemeal bread contains the whole wheat germ which has lots of health benefits as opposed to white bread where this has been removed?
 
I use the GI index as a probably reaction but not to govern what I may or may not eat, it just a consideration when I'm sorting out my dose, which and how I'm going to bolus for it..

I noticed some of the suggestions...

Knowing the profile of your insulin, and how long it effects your BG's for, on adverage with humolog and Novorapid it takes about 10-15 minutes to kick in, peaks around the 2 hour mark at this point you've used about 80% of the dose, but it tends to last another 2-3 hours with a slight dropping off you BG's..

Knowing what exactly happens with yourself, is very important part of gaining control, as you can then pitch your injection to catch a spike and/or even spilt injections to suit the slow adsortion of low GI foods, such as pasta or high fat content food etc..
 
the_anticarb said:
I thought there were other health benefits too as low GI foods are typically the unprocessed foods (hence they break down slower) which contain more vitamins minerals and good stuff because these are not stripped out in the over processing of the food? eg wholemeal bread contains the whole wheat germ which has lots of health benefits as opposed to white bread where this has been removed?
Click to expand...
good point, there will be more vitamins in wholemeal bread compared to white. I was thinking of specifically diabetes-related 'good' things!
 
Snodger said:
jameshallam - what did you say when your dietitian said not to check between meals? that's...um... jaw-dropping!
Click to expand...

I said, "even if I don't check the problem will still be there!"
she said, "don't worry about it"

At which point I lost a lot for respect for her. This was pretty early on in my 'life with diabetes'.

I later had a similar conversation with her colleague on a DAFNE course. They told me that I was testing too much (I used to like to check 2-3 hours after a meal to check if I had given myself the correct dose).
 
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