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I'm diabetic, how do I manage my carbohydrate and sugar intake?

It’s a common myth that people with diabetes can’t have carbohydrates and sugar. After all, diabetes is a metabolic condition with the hallmark feature of hyperglycemia (high blood glucose/sugar levels). So if carbohydrates, including sugar, increases blood glucose, then why can’t people with diabetes just restrict or eliminate carbohydrates intake?


More than just carbohydrates or sugar


Well, dietary carbohydrates are an important component of a healthy diet. Carbohydrates breaks down into glucose and is the main fuel utilised by the brain and central nervous system. Carbohydrate containing foods also provide many nutrients, such as vitamins, minerals and dietary fiber. Diabetic or not, it is an important macronutrient which we cannot remove from our diets.


Furthermore, blood glucose will increase for people with diabetes in both fed and fasted (un-fed) states. Although dietary carbohydrates increase postprandial (after meal) blood glucose levels, avoiding carbohydrates altogether will not make a diabetic’s blood glucose levels return to the normal range (Franz et al., 2002).


Due to these reasons, low carbohydrate diets are not recommended for managing diabetes. But, a primary goal in diabetes management would be to regulate blood glucose levels so as to attain near normal blood glucose levels. Hyperglycemia may lead to macrovascular disease (disease of large blood vessels), which is linked to coronary artery disease (type of heart disease), the leading cause of death in people with diabetes.


Glycaemic index/ load (GI)


Therefore, it is important for people with diabetes to choose the right sources of carbohydrates. Although most experts agree that the total carbohydrate intake in a meal is a reliable predictor of postprandial blood glucose, the impact of the type (or source) of carbohydrate may also be as important. Two tools which can be used are the glycaemic index (GI) and the glycaemic load (Ludwig, 2002).


The GI measures how blood glucose level changes following consumption of carbohydrates. Some foods cause a higher rise followed by a more or less rapid fall in blood glucose, whereas others have a lower peak followed by a gradual decline in blood glucose. Additionally, the glycemic load of a food is the product of the GI of the food and the total amount of carbohydrates consumed.


Here is a list of diabetes-friendly food, courtesy of the Health Promotion Board (HPB). Eating these in moderation as part of meals can help diabetics control their condition:​

  • Wholegrains (brown rice, barley, buckwheat, rye, semolina, corn)

  • Pastas and noodles (wholegrain semolina or durum wheat)

  • Legumes (beans, lentils, peas, peanuts, soybeans)

  • Bread (100% wholemeal, wholegrain, rye)

  • Breakfast cereals (all-bran, oats, wholegrain wheat)

  • Beverages (unsweetened coffee and tea, vegetable-based juice, water)

  • Reduced-fat dairy (milk, yoghurt, cheese)

  • Whole fruits (papaya, kiwi, grapes, apple, pear, orange, berries, melon, dragonfruit, starfruit, guava, banana)

  • All leafy vegetables

  • Snacks (nuts, oatmeal cookies, wholemeal biscuits)

It is also good to keep in mind that though carbohydrates have the greatest influence on blood glucose, other macronutrients, ie., fat and protein, also affect postprandial blood glucose level.


For instance, dietary fat hinders glucose absorption, and delays glycaemic response when a glucose-containing food is consumed. Additionally, though glucose is the main stimulus for insulin release, proteins increase insulin release when ingested with carbohydrates, and thereafter, increases the removal of glucose from the blood (Sheard et al., 2004).


Therefore, a good way would be to adhere to the HPB’s My Healthy Plate as a guide when planning meals. A quarter plate of whole grains (eg. brown rice, rolled oats, wholemeal bread) supply enough carbohydrates while providing ample vitamins, minerals and dietary fibre. Another quarter of protein can be made of oily fish such as tuna and mackerel or lean meat such as chicken breast. This ensures you get adequate protein and healthy fats in your diet. As for the remaining half plate of fruits and vegetables, choose mostly non-starchy, leafy vegetables and low GI fruits (GI less than 55) such as apples and grapes, just to name a few.


So yes, people with diabetes can still enjoy carbohydrates, but here’s the same ruling that applies to everyone, diabetes or not — always consume everything in moderation.


References

  • Franz, M., Bantle, J., Beebe, C., Brunzell, J., Chiasson, J., Garg, A., Holzmeister, L., Hoogwerf, B., Mayer-Davis, E., Mooradian, A., Purnell, J. and Wheeler, M., 2002. Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications. Diabetes Care [online], 25(1), pp.148-198. Available at: http://care.diabetesjournals.org/content/25/1/148 [Accessed 21 Nov. 2017].

  • HealthHub, 2016. Carbohydrates and Diabetes [online]. Available at: https://www.healthhub.sg/live-healthy/1301/carbohydrates-and-diabetes [Accessed 20 Nov. 2017].

  • HealthHub, 2016. Plan Your Meals with My Healthy Plate [online]. Available at: https://www.healthhub.sg/live-healthy/1332/plan-your-meals-with-my-healthy-plate [Accessed 21 Nov. 2017].

  • Hu, F., Liu, S. and van Dam, R., 2001. Diet and risk of Type II diabetes: the role of types of fat and carbohydrate. Diabetologia [online], 44(7), pp.805-817. Available at: https://link.springer.com/content/pdf/10.1007%2Fs

  • 001250100547.pdf [Accessed 21 Nov. 2017].

  • Khalik, S., 2016. Getting diabetes, white rice and GI all worked out [online]. The Straits Times. Available at: http://www.straitstimes.com/singapore/health/getting-diabetes-white-rice-and-gi-all-worked-out [Accessed 21 Nov. 2017].

  • Leopold, C., 2016. Fruits for Diabetes: All You Need to Know [online]. Medical News Today. Available at: https://www.medicalnewstoday.com/articles/311220.php [Accessed 22 Nov. 2017].

  • Ludwig, D., 2002. The Glycemic Index. JAMA [online], 287(18), p.2414. Available at: https://jamanetwork.com/journals/jama/article-abstract/194907 [Accessed 21 Nov. 2017].

  • Nuttall, F. and Gannon, M., 1991. Plasma Glucose and Insulin Response to Macronutrients in Nondiabetic and NIDDM Subjects. Diabetes Care [online], 14(9), pp.824-838. Available at: http://care.diabetesjournals.org/content/14/9/824.short [Accessed 21 Nov. 2017].

  • Sheard, N., Clark, N., Brand-Miller, J., Franz, M., Pi-Sunyer, F., Mayer-Davis, E., Kulkarni, K. and Geil, P., 2004. Dietary Carbohydrate (Amount and Type) in the Prevention and Management of Diabetes: A statement by the American Diabetes Association. Diabetes Care [online], 27(9), pp.2266-2271. Available at: http://care.diabetesjournals.org/content/27/9/2266.full [Accessed 20 Nov. 2017].

  • Sowers, J., Epstein, M. and Frohlich, E., 2001. Diabetes, Hypertension, and Cardiovascular Disease : An Update. Hypertension

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