[Diabetes-talk] excellent article

[Lynn Baillif]

Mike,
 
Interesting blog.  I have a couple comments.  First, don't hate on us dietitians.  As a profession, we work hard to provide quality nutrition care using our background in the hard sciences and nutrition science.  We follow nutrition practice guidelines that are compiled by panels of experts based on current scientific data.  The most recent guidelines for nutrition management in diabetes are found within the 2012 Guidelines for Medical Management of Diabetes published in the January 2012 issue of Diabetes Care.  Here is a link to the full text.
http://care.diabetesjournals.org/content/35/Supplement_1/S11.full
The section on medical nutrition therapy is quite a ways down the article.
 
As for the specific question of should a person with diabetes consume starch/sugar (carbohydrates) at every meal, I make the following points.  First, the current recommendation is that the majority of calories in the diet come from carbohydrates- preferrably from whole grains, fruits, vegetables and dairy.  Carbs are the preferred food source of the body (biochemically speaking) and adequate carbs from a variety of sources is needed for adequate micronutrients.   Secondly, depending on the type of diabetes you have and the type of medication you are on, spreading carbs throughout the day may help maintain blood sugar levels.  If you are on some medications, eating too little carb will cause blood sugar to drop.  Or, for some folks with type 2, the liver releases too much glucose from storage when inadequate carbs are eaten.  So, eating too few carbs can cause the blood sugar to rise in this situation.  On the other hand, if you take fast
 acting insulin with your meals and adjust your dose based on the carbs you eat- you could eat few carbs at the meal without affecting your blood sugar.  But the question arises, was it a well balanced meal?
 
 In conclusion, should people with diabetes have carbs at every meal? It depends.  But, I caution against the belief that carbs should be cut out totally in order to control blood sugar.  As usual, moderation is the key. And, indivualization of meal planning is key.  
Lynn