FOOD & DIET

Of all the issues surrounding diabetes, the sharpest divide between ordinary diabetics and healthcare professionals/policymakers is probably seen on matters of food and diet.

vegetablesTraditionally, diabetics’ survival was based upon the idea of eating smaller amounts of carbohydrate – the part of food that directly raises blood glucose. In recent decades, however, the advent of the high-carbohydrate, low-fat, ‘healthy heart’ diet originating from the US Department of Agriculture and then sweeping the developed world has been seen as the gold standard for everyone – including diabetics because of an increased risk of heart disease which, it seems, has been judged to outweigh the effects of those high carbs. Allied to this is a debate on the role of cholesterol.

Diabetics have, for many years, argued that this thinking is deeply flawed, often making their situation worse and less manageable – unless by constantly ramping-up medications – rather than better. The consensus on forums and diabetes groups tended to be some variant of a “managed carb” approach, whereby carbohydrate intake was tested against the body’s ability (including with the help of medication) to maintain reasonable blood glucose levels.

At present there seems to be a small narrowing of the gap in philosophies. Some of the latest NHS diabetes education programmes do now advocate carbohydrate “portion control” and encourage diabetics to check the levels of spikes in blood glucose (acknowledged to affect risk of complications) after meals. Sadly the latest thinking is not necessarily available across the UK. Many areas cling to earlier ideas that good diabetes management generally involves high carbohydrate intake.

The forum has long adopted the philosophy that members should be sufficiently informed to set their own blood glucose targets, make their own choices about diet and should rely on their glucometer readings to guide them as to what works individually for them. So it has members who opt for a low-carb diet, those who moderate their carbs, those who rely more or less on medication to ameliorate the effects of carbs; it has T1s who eat what they want and shoot as much insulin as it takes to match the carb levels and it has those T1s who find management easier and more effective by moderating carb intake and insulin quantities. It has members who are happy with HbA1c levels of about 8%; it has those who are uncomfortable unless their levels are below 6.5%.

Whatever your own choices  – and these may be informed by asking questions in the forum or reading previous discussions there – this section of the site may help with some basic resources to achieve them.