Monday, January 18, 2016

The Life Of A Compliant Diabetic- Do The Math

Most of us are aware of the ADA guidelines for carbohydrate consumption for diabetics.  We come across these all over the place; online, at the diabetes education classes, at the docs office and on facebook groups too.

 The daily carb intake for male diabetics recommended by the American Diabetes Association varies between 135 and 180 grams for your three basic meals along with up to 60 to 90 grams of extra carbohydrates at snack time. Your daily recommended carb intake could therefore vary between 135 grams a day if you don't snack up to 270 grams a day.  In many cases I've seen dietitians allow up to 60 grams of carbs a meal.

Let’s just use the 45 grams a meal and 25 grams of carbs at 2 snacks and the recommended 3 meals and 2 snacks scenario that most diabetics are told to stick to.   Get a picture in your head to start off with.

4 grams of carbs in any form, sugar, rice, bread etc. is equal to 1 teaspoon of sugar.     Our bodies can handle at most 1-2 tsp of sugar at ANY time! Keep this picture in mind.
4 gr carbs= 1 tsp sugar.

 If we take Dr. Bernstein's math from his book "The Diabetes Solution" 1 gram of carbs raises blood sugar by about 5 points.

 Barney, our patient in this scenario was given the standard ADA advice that he needs 45 grams of carbs for breakfast.    Barney's blood sugar before breakfast is 120.  This is a common number for many diabetics in the morning.

For breakfast he eats 45 grams of carbs; a bowl of Special K with some sugar, toast with margarine and a glass of skim milk.   Within 30-45 minutes his blood sugar will rise and continue to rise over several hours. 45 X 5 = 225

That isn't all! Barney started with a blood sugar of 120 and he is still making insulin to try to get the original high blood sugar down. Now he has added 11 teaspoons of sugar to his bloodstream and his blood sugar rises to 350 (19.5 mmol/l).   Remember our blood stream can only handle 1-2 teaspoons of sugar. This is an emergency!   The pancreas pushes out massive loads of insulin! The insulin gets the glucose out of the blood and tells Barney's fat cells to store all of the extra sugar in the fat cells.

Barney took his pill so that he can make more insulin to help get his blood sugar down. 2 ½ hours later his blood sugar is 200. (11.1 mmol/l) He is already starving and it is time for his work break and his snack.   He eats a large apple and 2 pieces of string cheese at 25 grams of carbs.   His blood sugar rises by an additional 100 points and once again the pancreas must work hard to make insulin and try to get rid of an additional 6 teaspoons of sugar in his blood.

After break, Barney feels sluggish and thirsty. He remains hungry and is thinking about lunch already.   Lunch comes two hours later!   Since Barney is following his dietitian's guidelines to the letter he has his low fat turkey and cheese sandwich on whole wheat bread.   That is pretty much his 45 grams of carbs allowed for a meal.   He has a diet Coke and a piece of string cheese on the side.

 He doesn’t take another blood sugar reading at this time but we can figure that it is still high from his earlier snack.  Now the math again is 45 X 5 = 225.   Barney takes his pancreas stimulating medication again at lunch to help get his blood sugar down.   With his earlier snack and a high blood sugar that was never able to come down due to the snack earlier Barney’s blood sugar never goes below 200 on this day.

 At 3:00 Barney can’t wait for his snack! He is starving! He checked his blood sugar and it was down to 180 since lunch. That is in the range that his doctor says is okay so he heats up one bag of microwave low fat popcorn. He eats the whole bag at 23 grams of carbs. 23 grams of carbs X 5 = 115 added to the 180 reading he just had is going to drive blood sugar up to about 300 (16.7 mmol/l)  He doesn’t take any medications at snack times.

 After work Barney makes a quick trip through Wendy’s for a regular sized grilled chicken sandwich with a side salad and a packet of the low fat ranch salad dressing. He also ordered an extra large Diet Coke because he is so thirsty.  This is his 45 gram carb meal.  At home he checks his blood sugar and takes his diabetes pill that will help his pancreas to flood his blood with insulin.  His blood sugar reading is 195 at the start of his meal tonight. He shrugs because this is just the reality of his life with diabetes.

Again the 45 grams of carbs is equal to a blood sugar rise of 225 and he has put more than 11 teaspoons of additional sugar in his blood stream by eating this meal.   His pre-meal reading was
195 so adding another 225 points will get him up to a reading of over 400.  It's a good thing he has his diabetes pill because that will once again help make a lot more insulin to try to reduce the blood sugar.

Barney is hungry again but he is afraid to snack.   His post meal number was just too high and his doctor has told him not to eat after supper unless his blood sugar goes low.  At the end of the day, Barney takes his 1500 mg metformin pill and goes to bed with a blood sugar reading of 260 (14.4 mmol).

This is a day in Barney’s life that repeats over and over again because no one has taught Barney the diabetes math.  Barney is a compliant diabetic.  He follows all of the rules given to him by his diabetes educator.  He doesn’t cheat although he would love to have chips with his lunch or fries with his burger sometimes because he is always so hungry eating the low fat diet.

Not too many people eating a diet like this would be able to avoid the carby sides that Barney has worked very hard to try to avoid.  This poor man just has no idea to help his diabetes.  He is becoming more and more upset and thinks about his grandchildren and wonders how much time he will have left with them.

It is my hope that Barney, like so many of you, will find the LCHF Ketogenic diet like I and many others have.  Learn the diabetic math and have the beginning of a new life.   I hope this helps many of you understand the blood sugar roller coaster as Dr Bernstein calls it.


  1. I am only asking this to further my understanding as I work to help my husband (diagnosed diabetic, with numbers about like Barney's until I got him to put me in charge of his diet) and myself (not diagnosed diabetic but with suspiciously high numbers ranging 120+/= fbg when not following lc). You stated that Barney's bg never falls below 200 during his day, and then the narrative is that his reading at 3:00 pm is 180. Did you mean it wasn't below 200 thus far?
    Also, what likely happened w/Barney's bg over his night time fast, as we can assume he follows doctor's orders not to snack at night. Is that how his number starts at the 120 that his Special K breakfast adds to, first thing in the morning?

  2. I also remembered another line of questioning I have for you. You stated that Dr. Bernstein (purchased but haven't started reading his Diabetes Solution book) states that 4g./carbs raises our sugar 5 pts. and we can only handle 2 tsp. or 8g. at any one time. So, if that is a good number for anyone (diabetic or not??) than can I assume that if my husband comes home from work with a before meal reading of 215 (215 current reading - 90 pts. of normal fasting or pre-prandial points to = 125), he is still carrying 3.12 'servings' of glucose in his blood? (125 excess pts/40 pts per 2tsp. of sugar)
    If he has followed the lc plan I have sent him off with, my estimate is that he had roughly 12g./carbs maximum, with snacks when he feels shaky (a frequent result) of nuts, boiled eggs, pork rinds or cream cheese on a spoon. It appears to me, this is too high of a carb allotment even though it qualifies on paper as a vlc plan. If I lower his meals to 8g./carb, won't he just feel the need to snack more often? I can't be there to micro-manage his learning curve and it is very hard for him to stop and take readings or time his snacks as related to his meals to get 1-2 hr. readings after each time he eats anything. I can only see how he is doing at the end of the day and the beginning, the next morning after sleeping.
    I thought we handled carbs better or worse, depending on body size and exercise/stress factors. Help me understand, please.

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