Type 1 Diabetes Diets/Foods

Submitted by Thiruvelan on Wed, 06/23/2010
Type 1 Diabetes Diets/Foods

Diabetic foods are an umbrella term for foods used by the diabetics’ that help normalize/stabilize the blood glucose level, prevent hyper/hypoglycemia, and prevent diabetes complications.

Diabetes trying to eat healthfully? First, keep in mind, what works for someone else may not necessarily work for you—and vice versa.

Macronutrients are nutrients needed in large quantities; they are carbohydrates, fats, and proteins. 

Carbohydrate digested into glucose, protein digested into amino acids, and fat digested into fatty acids and absorbed for further utilization. Carbohydrates, proteins, and fats provide four, four, and nine calories of energy per gram, respectively.

Glucose from carbohydrate is the primary fuel for most of your cells. Amino acids from protein used to build, maintain, and repair body tissues, as well as to synthesize necessary enzymes and hormones. Fats are energy-dense macronutrient, provides essential fatty acids (EFA), and carry fat-soluble nutrients.

Why diabetes should avoid refined carbs?

When you eat white flour bread (pure starch), it quickly breaks down into glucose, dumped into the bloodstream, and raises your blood sugar level.

Do you know how much blood glucose your blood contains? For a healthy individual, about five grams (equal to a teaspoon of glucose) mixed with five liters of blood. 

Do you know, after carb ingestion, how much spikes in blood glucose level? After eating a bowl of pasta, rice, slices of bread, or potatoes, then hundreds of grams of glucose flood your bloodstream. That is, your blood spiked from 5 grams to about hundreds of grams. Proportionally your insulin level skyrockets to normalize your blood sugar. More starch, you eat higher the insulin level. High level of insulin in the blood is unhealthy and an invitation towards inflammation.

A Brief History of Diabetes Food!

Dietary treatment of diabetes was used in Egypt since 3,500 BC and was used in India more than 2000 years ago. In the 18th century, John Rollo’s calorie restriction diet could reduce glycosuria in diabetes.

Before insulin discovery, Frederick Madison Allen recommended a low-calorie diet to prevent ketoacidosis from killing diabetes patients; this help lives longer. However, they become undernourished and die of starvation.

In 1922, Frederick Banting discovered insulin that provides flexibility to diabetes patients in choosing the food they eat.

How is your body designed to handle ingested foods?

After digestion, carbohydrate are breakdown into glucose and release into the bloodstream. Blood contains about 5g of glucose (provides 80 kcal of energy) for immediate energy needs.

Excess remaining glucose will get stored as glycogen in the liver (about 100g that can provide 400 kcal of energy). And the muscles (about 400 to 500g can provide 1,500 kcal of energy) for future short-term energy needs. Liver storage is useful between meals and muscle storage used for muscle movements.

Once glycogen storage is over, absorbed glucose and fat are converted into fatty acids and stored as body fat for long-term energy needs.

Free fatty acids & triglycerides in the blood provide 80 kcal of energy. Muscle triglycerides storage can provide 2.500 kcal of energy. Adipose tissue (body fat) offers more than 80,000 kcal of energy.

The Carb Controversy!!!

The ADA recommends 45 to 65 percent of total energy should be from carbohydrates. 

The most agreed-upon recommendation for a diabetes patient is food that is low in sugar and refined carbohydrates.

Following DAFNE will put you on; Hyperglycemia soon after eating versus Hypoglycemia after a few hours.


Dose Adjustment for Normal Eating (DAFNE), are encouraged by health professionals. However, this approach relies heavily on carbohydrate counting and insulin dose adjustments. The review participants chose to severely restrict carbohydrate as they found large amounts of carbohydrate coupled with large insulin doses led to unpredictable blood glucose results. Ref: Diabetes Research and Clinical Practice 2011 Jan; 91(1):87-93.

Dr. Richard K. Bernstein recommends low carbohydrate diet; 6 grams of carb for breakfast and 12 grams each for lunch and dinner.

Dr. Richard K. Bernstein, a famous endocrinologist, is promoting a low carbohydrate diet. He recommends eating about 6 grams of carbohydrates for breakfast and 12 grams each for lunch and dinner. Those carbs will provide only 120 calories of a general diet of 2,000 calories or more. 

Confusing, is not it? Which advice to follow!

You may choose the middle between ADA & Dr. Bernstein; eat about 50 grams of carbs each day, sometimes a few more. You can lower the postprandial blood glucose by short distance gentle (not brisk) walk.

How low is low carb diet?

What are very low carb, low carb, moderate carb, and high carb diet? A diet with a carb that provides about total calories of:

  • Up to 10% (or 20 to 50 grams of carbs) is very low carb or ketogenic diet;
  • Over 10% to 26% (or 130 grams of carbs) is low carb diet;
  • Over 26% to 45% (or 145 grams of carbs) is moderate carb diet;
  • Over 45% (or 145 grams of carbs) is high carb diet. 

Reference: Nutrition & Metabolism 2008; 5: 9.

Big complaints about the low carb high-fat diet.

The medical professionals, explicitly dietitian express low carb high fat (LCHF) diet is challenging to get nutrients, problems with blood lipids, and not sustainable. 

However, you can get nutrients for green & some veggies. LCHF diet improves blood lipids. Many people have happily improved their health on an LCHF diet, so sustainable with wellness.

Inflammation & low carb diet: The Swedish study found a low-carb diet can help reduce inflammation. It has associated with all diseases such as allergy, heart disease, and cancer. Reference: Annals of Medicine, 2014 May; 46(3):182-7.

Allowed food label carb error insists for low carb diet

A non-obese type 1 diabetes with 150 pounds (68 kg.) body weight whose pancreas makes no insulin. Ingesting just 1 gram of carbohydrate can raise his/her blood sugar by about 5 mg/dl (0.3 mmol/L). You need to calculate precisely the amount of insulin you require to inject to maintain the blood sugar level as before meals.

Food producers are allowed a total carb error of +/- 20% in their nutritional label. Consider if you are taking 100 g of carb for a meal, then

The carb count error = (100 g X 20)/100 = 20 g. 

You take insulin for only 100 g carb, however actually there maybe 20 g in excess or shortage.

Blood sugar error for 20 g of carb = 20 g (carb error) X 5 mg/dl (blood sugar raise per 1 g carb)

                = 20 X 5 = 100 mg/dl (5.6 mmol/L)    

If the blood sugar level before the meal was 90 mg/dl and you have taken insulin for 100 g carb, however, the actual carb maybe 120 g or 80 g. This 20 g excess or shortage of carb may raise your blood sugar by 100 mg/dl or 5.6 mmol/L. 

Now your blood sugar level may be = 90 – 100 mg/dl (to) 90 + 100 mg/dl

                    = 0 mg/dl (to) 190 mg/dl
That is your blood sugar may be from 0 mg/dl to 190 mg/dl.

Want to keep your BS swing between 10 to 20 mg/dl. How to achieve it? Carbs are the main problematic macronutrient, you are well aware of! 

So it is simple, reduce the problematic nutrient (carb) to lower the error (blood sugar). Sounds so clear, simple and encouraging, is not it? Instead of eating pasta, bread, or rice as a carbohydrate portion, you can choose a salad. What is the difference? 

If you are taking 2 cups of pasta means 54 g of carb. 20% error causes about 11 grams of carb uncertainty. 11g multiplied by 5 mg/dl (blood sugar raise per 1 gram carb), which is equal to 55 mg/dl (3.1 mmol/L) rise or fall in blood sugar. 

If you are taking 2 cups of salad instead, this means 12 g of carb. 20% error causes 2.4 grams of carb uncertainty. 2.4g multiplied by 5 mg/dl (blood sugar raise per 1 gram carb), which is equal to 12 mg/dl (0.7 mmol/L) rise or fall in blood sugar. 

Uncertainty in insulin absorption insist for low carb diet

Additionally, all the insulin you inject cannot reach your bloodstream. Research shows there is uncertainty in the absorption of insulin even if the body is sensitive to the insulin. The more insulin you require to inject, then there will be a higher level of uncertainty.

The University of Minnesota researchers demonstrated that there is variation in insulin absorption based on the injected site. If you inject 20 units of insulin in your arms, you'll get on average 39% variation in the amount that reaches the bloodstream from one day to the other day. They also found abdominal injections had a 29 % variation. This insulin uncertainty is too high to manage if the insulin requirement is high.

For example, you require 20 units of insulin. 29% variability in insulin absorption will cause six units of uncertainty. A typical adult needs 1 unit of insulin to lower 40 mg/dl of blood sugar. Six units of insulin multiply by 40 mg/dl causes uncertainty of 240 mg/dl of blood sugar.

Just due to varying amounts of insulin absorption causes huge blood sugar swing and is entirely unpredictable.

What is the solution to this unpredictability in the insulin absorption? Reduce the insulin requirement, so its emphasize your need to reduce the carb intake. 

Amazing is not it! Just cutting down the carb helps in two entirely different ways to stabilize your blood sugar.

Diabetes is a disorder related to carbohydrate metabolism. Thus REDUCING carbohydrate is the obvious first line of treatment. 

Reference: Nutrition. 2015; 31(1):1-13.

The best approach to improve diabetes management is a low-carbohydrate diet. With fewer carbohydrates, blood sugar rises and falls more gently after eating, making for an easier target to hit accurately with insulin. Also, people on a low-carbohydrate diet require less total insulin, potentially providing metabolic benefits for weight control and heart disease prevention.

Is it possible for type1 diabetes to achieve normal blood sugar? 

Type 1 diabetes can achieve a non-diabetes number (normal blood sugar)! Eat a low carb diet consists of meat (protein), veggies (vitamin & minerals), and healthy fats (essential fatty acids). 

Note: if you are on a low-carb diet and occasionally eating a high-carb meal will run you into trouble of high blood glucose level that is difficult to control.

Benefits of low carb food?

Many patients with T1D on a very low carb diet maintains NORMAL HbA1c even values in the range of 4%. They reportedly have low rates of complications like diabetic ketoacidosis and low blood sugar. It has improved in insulin ratio, cardiovascular risk, and triglyceride to HDL-cholesterol ratio. Also, no evidence of effects on growth among children due to nutritional deficiency.

Low carb diet help achieve a healthy weight.

Studies show that people on low-carb diets lose more weight, faster. Reference: The New England Journal of Medicine 2003; 348:2074-2081.

Low carb diet help lower A1C

A large observational study of 1020 European outpatients with type 1 diabetes reported that a lower intake of total carbohydrate was associated with lower levels of HbA1c. Ref: Diabetic Medicine 2000 May; 17(5):351-9.

Low carb diet attenuates blood glucose fluctuations

By reducing dietary carbohydrate, the error rate in determining the required exogenous insulin amount reduced, and blood glucose fluctuations attenuate. Reference: Nutrition. 2015 Jan; 31(1):1-13.

Low carb diet lessens or eliminates hyperglycemia and hypoglycemia.

Consequently, less frequent and severe hyperglycemic episodes. As well as a reduction in overall insulin requirements should result. Demonstration of these benefits with carbohydrate restriction in type 1 diabetes patients has recently reported. Reference: Diabetology & Metabolic Syndrome 2012 May 31; 4(1):23. & Asia Pacific Journal of Clinical Nutrition 2016; 25(1):78-84.

Low carb diet can significantly reduce total daily insulin requirement.

Five studies reported total daily insulin showed clinically significant reductions with a low-carbohydrate diet. References: Diabetology & Metabolic Syndrome 2012 May 31; 4(1):23, Asia Pacific Journal of Clinical Nutrition 2016; 25(1):78-84, Diabetes Care. 1992; 15(11):1499–504, Metabolic Syndrome and Related Disorders 2003 Dec; 1(4):291-8 & Diabetes Care. 1980 Jan-Feb; 3(1):140-3.

Hyperinsulinemia is associated with; excessive weight gain [JAMA. 1998 Jul 8; 280(2):140-6], development of the metabolic syndrome, inflammation, and atherosclerosis [J Diabetes Complications. 2013 Jan-Feb; 27(1):70-4], Alzheimer’s Disease [Neurology. 2004 Oct 12; 63(7):1187-92] and cancer [Gastroenterology. 2004 Oct; 127(4):1044-50].

It suggests that low-carbohydrate intakes may assist in reducing or preventing hyperinsulinemia in type 1 diabetes by decreasing the absolute amount of insulin required for tight glycemic control.

Blood triglycerides level goes down on a low carb diet.

When people cut carb intake, there is a dramatic reduction in blood triglycerides. Reference: The Journal of Nutrition, Volume 136, Issue 2, 1 February 2006, Pages 384–389.

Low carb diet has increased the levels of blood HDL cholesterol.

One of the best ways to increase HDL levels is to eat high fat low-carb diets. Reference: Arteriosclerosis, Thrombosis, and Vascular Biology 1992 Aug; 12(8):911-9 and The American Journal of Clinical Nutrition 2003 May; 77(5):1146-55.

Low carb diet lowered the blood pressure in hypertension patients.

Low-carb diets are an effective way to reduce blood pressure. Reference: Archives of Internal Medicine 2010 Jan 25;170(2):136-45 and JAMA. 2007 Mar 7; 297(9):969-77.

A low-carb diet is effective against metabolic syndrome.

The metabolic syndrome is a cluster of biochemical and physiological abnormalities associated with the development of cardiovascular disease and type 2 diabetes such as abdominal obesity, elevated blood pressure, elevated fasting blood sugar levels, high triglycerides, and low HDL level. All these five abnormalities are improved dramatically on a low-carb diet. Reference: Nutrition & Metabolism 2005; 2: 31 and Metabolic Syndrome and Related Disorders 2003 Sep; 1(3):189-97.

A low-carb diet is beneficial for brain disorders.

Studies show low carb diet help reduce seizures, epilepsy, Alzheimer’s disease, Parkinson’s disease, and other brain disorders. Reference: The Lancet Neurology Volume 7. Issue 6, June 2008, pages 500-506, Nutrition in Clinical Practice, Volume23, Issue 6, December 2008, Pages 589-596 and Behavioral Pharmacology 2006 Sep; 17(5-6): 431–439.

Carbohydrates

Dietary carbohydrates raise both blood glucose and insulin higher than other macronutrients (fat raises blood glucose and insulin the very least).

Carbohydrates have the most significant influence on your blood glucose. After eating carbs, it appears as blood glucose in your bloodstream within hours. So, you need to count the carbs you eat.

What are the different forms of carbohydrates? 

There are three forms of carbohydrate; they are sugars, starches, and fiber.

Starches - Starches are complex carbohydrate with many glucose units bonded together. During digestion, just like sugar, starch is broken down into glucose for energy.

Fiber - Fiber is also a complex carbohydrate found in non-starchy vegetables, fruits, nuts and seeds, beans, and whole grains. Fiber is indigestible; it passes through your intestines and comes out as it is. Dietary fiber help grows healthy bacteria in your gut that aid digestion system. There are two kinds of fibers soluble and insoluble.

Different types of carbohydrates 

What are the different types of carbohydrates? There are two types of carbohydrates; they are simple and complex carbohydrates.

Simple carbohydrates (monosaccharide and disaccharides) are easily broken down and dumped glucose into the bloodstream causes blood-glucose spikes.

Simple carbohydrates contain one or two sugar molecules. Fructose (the sugar found in fruit) and glucose are Monosaccharide’s; it includes one sugar. Lactose (the sugar in milk) and sucrose (table sugar) are Disaccharides; it contains two sugars. Simple carbs are absorbed almost immediately into the bloodstream and thus raises your blood sugar level. 

Complex carbohydrates (oligosaccharides and polysaccharides) require time to break down and slowly release glucose into the bloodstream. 

Complex carbohydrates consist of three or more sugar molecules. They absorbed slowly into your bloodstream than simple carbohydrates. Complex carbs are starchy vegetables (such as potatoes, corn, parsnips, and sweet potatoes), legumes (such as lentils, black beans, and kidney beans), and whole grains (wheat, oats, rice, corn (maize), barley, sorghum, rye, and millet).

Fat – The gigantic fat lie

How fallacy it is to say eating fat will make you fat?  Just like saying eating beetroot will turn you red color!

The medical school says, “Fat made you FAT.” All leading, so-called reputed organizations and government recommend eating no more than 35 percent of calories as fat. This low fat mania leads to increased intake of sugar and refined carbs. Sugar, refined carb, and a lot of starches can make you fat, not dietary fat.

More people become obese/overweight and sick, requiring medication for high blood pressure, diabetes, cholesterol, and the list continues. Because we choose to overeat refined carbs by avoiding fats and become lazy; that is overeating and moving too little. 

Fat is the least insulin spiking macronutrient. So numerous people adding butter or coconut oil to their coffee (Bulletproof) in the morning.

Our ancestors did not suffer from today’s health problems. They consumed foods provided by nature; hunted animals, fish, eggs, nuts, roots, fruits, vegetables, and greens. The foods loaded with nutrients such as vitamins and minerals.

Actually, sugar is dangerous, not fat!

The human body is primarily built from saturated fat. Your brain is predominantly saturated fats. Every cell in the body needs saturated fat to construct the protective cell membrane. Additionally, saturated fat can even found in mother's breast milk. Then, how can it be poisonous? Strange is not it?

Saturated fat depicted as dangerous. So what is it? Fats are of two categories; they are unsaturated and saturated fat. Unsaturated fat is liquid at room temperatures, such as olive oil or sunflower oil. Saturated fat is solid at room temperatures, such as animal fat (butter, lard) or tropical plants (coconut fat, palm oil).

Why saturated fats are solid at room temperature, and others are not? Fats consist of chains of carbon atoms with attached hydrogen atoms. Saturated fatty acid contains abundant of hydrogen atoms, so straight and in solid form at room temperature. If one or more hydrogen atoms removed, it crooked. Depending on the number of the missing hydrogen atom, they are unsaturated or polyunsaturated fatty acid.

Protein

50 to 60% of excess protein ingested are converted into glucose.

The protein will slow the absorption of carbohydrate. In theory, the excess intake of protein through gluconeogenesis converted into glucose. It would mean 100 g of protein could produce 50 g of glucose; protein will have one-half the effect of carbohydrate on blood glucose levels. However, overeating protein can damage the kidneys.

"Proteins" are foods like meat, cheese, and peanut butter. Between 50 to 60% of protein becomes glucose and enters the bloodstream about 3 to 4 hours after eating.

Benefits of high protein are low appetite, slow digest, lower blood lipid level, improved insulin level, control blood glucose, and weight loss.

To understand why overeating protein is a bad idea because excess protein also converted into glucose. Your body requires to remove more nitrogen waste products (kidney strained), and calcium gets eliminated (thus need extra calcium).

How much protein can you eat? To maintain the muscle mass, you need to consume at least 1 to 1.2 grams of protein per kilogram of ideal body weight. It would be 69 to 84 grams of protein daily, whose ideal body weight is 70 to 85 (155 to 187 pounds).

You should maintain the protein content at a particular meal constant all days. 

Protein-rich foods with zero carbohydrates are Beef, lamb, veal, chicken, turkey, duck, eggs, pork, fish, and shellfish (fresh or canned). Protein-rich foods with a small amount of carbohydrate (1gram carbohydrate per ounce of protein) are Cheeses & Soy products (up to 6 grams carbohydrate per ounce of protein).

Too much protein intake require calcium to handle it.

Protein digestion produces Phosphate as a by-product. Elimination of phosphate from the body requires calcium; every 10 ounces of protein foods require about 1gram of calcium. If you don't eat calcium-rich protein foods, then it would be advisable to take a calcium supplement. It will help prevent slow calcium loss from your bones. It is better to take a calcium supplement that contains magnesium and vitamin D.

Best wishes for your easy low carb diet adaptation and better blood sugar control :