San Antonio Express-News (Sunday)
How to use food to improve blood sugar control
According to the Centers for Disease Control and Prevention’s National Diabetes Report of 2020, 1 in 10 Americans have been diagnosed with diabetes, while 1 in 3 have prediabetes. That’s a lot of people who are thinking about and, hopefully, regularly monitoring their blood sugar.
There are two main types of diabetes, Type 1 and Type 2.
Type 2 diabetes, often a result of a combination of genetic and lifestyle factors — such as poor diet and lack of exercise — that lead to the development of insulin resistance, is usually the type people think of when they hear the word “diabetes.” Patients who have Type 2 diabetes have varying degrees of insulin resistance, which influences the medication they need and factors into whether they need to take insulin. Prediabetes is essentially the condition that is the precursor to potentially developing Type 2 diabetes and is modifiable with lifestyle intervention.
On the other hand, Type 1 diabetes is characterized by absolute insulin resistance:
These patients’ bodies stop producing insulin altogether, which means that Type 1 diabetics need to take insulin multiple times each day. Type 1 diabetes is usually diagnosed in childhood or adolescence and is much less common than Type 2, accounting for approximately 5 to 10 percent of total individuals with diabetes. These patients are constantly thinking about their blood sugar, checking it and monitoring daily food intake and activity to manage their blood sugar.
I often hear and see the words “insulin resistance” thrown around, which can be confusing. Insulin is a hormone that our pancreas secretes in response to high blood sugar, or blood glucose. The nutrient with the most influence on blood sugar is carbohydrate, which is both the body and brain’s main source of energy. If you drink a glass of orange juice or eat a bowl of pasta, those carbs will break down into your bloodstream as glucose. Other carbs include bread, pasta, rice, beans, potatoes, corn, fruit, dairy products, desserts, pastries, chips, crackers and regular, full-sugar versions of juices or sports drinks. Many people view these foods as
“bad,” when they are, in moderation, actually necessary and helpful for energy and blood sugar.
The body does an excellent job of helping us naturally maintain our blood sugar levels. Stable blood sugar translates to stable energy, which helps us stay alert and productive. We don’t want our blood sugar to be too low or too high on a frequent basis. When the body senses that blood sugar is high, the pancreas releases insulin — the key that opens our cells and allows glucose to enter and be used as energy, lowering blood sugar.
With insulin resistance, these mechanisms do not work as efficiently and we are unable to bring glucose into cells for energy, resulting in high blood sugar.
You’ve likely had your blood glucose checked at the doctor; and if you have prediabetes or diabetes, you’ve probably also had your hemoglobin A1c checked. Both measurements are important in diagnosing diabetes and monitoring blood sugar control. Usually, your blood glucose is taken while fasting or before you eat, which gives your doctor a good idea of how wellcontrolled your blood sugar is in the absence of food. When we eat, our blood sugar naturally increases, as it should. The key is that we want it to come back down in the two hours following our meal, which is a sign that our body is doing its thing and that our blood sugar is in control.
Hemoglobin A1c is indicative of how well we’ve been managing our blood sugar over the past three months. Hemoglobin is a protein in your red blood cells; it’s where sugar attaches itself when it enters our bloodstream. Everyone has sugar attached to red blood cells, but those with less well-controlled blood sugar have a higher percentage of sugar-coated hemoglobin. Red blood cells live for about three months, so this measurement gives clinicians a look at how your blood sugar has been managed over a longer period of time.
Hemoglobin A1c is one way for diabetic and prediabetic patients to track their success with blood sugar control and outcomes after practicing behavior change, such as a specific type of eating pattern or a new exercise routine. If practiced consistently, the following nutrition tips can help control your blood sugar more tightly and, hopefully, even lower your A1c.
Eat a meal or snack every three to four hours
A lot of times, patients with prediabetes or Type 2 diabetes have a goal of weight loss in conjunction with lowering A1c. For many of these patients, there is an inclination to restrict food and go long periods of time without eating to lower calorie intake. When it comes to meeting your blood sugar and nutrition goals, this is not going to be a helpful strategy. When we go more than about four hours without a meal or snack, our blood sugar will be off and our energy levels will be diminished as we feel depleted without energy. Going long periods of time without eating can also set us up to miss out on getting enough important nutrients and food groups, like protein.
Aim for a consistent amount of carbohydrates at meals
There is no single optimal dietary pattern recommended for diabetics or for blood sugar management. Some common themes that have been shown to be effective in research and practice include a Mediterraneanstyle diet eating pattern, higher protein and moderate carbohydrate intake. While many people believe carbs need to be completely cut out to improve blood sugar control, thankfully, this is not the case! We never want to eliminate an entire food group, and eliminating carbohydrates is neither helpful nor sustainable. Rather, focus on eating the same amount of carbs at each meal. Depending on your body size, activity levels and individual needs, moderate carb intake is considered eating 1-2 cups of carbs at meals. That number varies depending on the person, but this is a good ballpark estimate to aim for at breakfast, lunch and dinner.
Focus on high-fiber carbohydrates
When planning meals and snacks, try to pick carbs that are higher in fiber — fruits and vegetables and whole grains, such as oatmeal or brown rice, beans and lentils. These foods tend to have a plethora of nutrients in addition to the energy in carbs.
Fiber also takes longer for the body to digest, leading to a slower rise in energy and blood sugar. Choosing carbs that are low in fiber, such as chips or juice, will give you a quick spike in blood sugar and energy without the extra nutrition offered by fibrous carbs. Additionally, foods high in fiber promote a healthy gut, which can enhance mood and metabolism.
Pair carbohydrates with protein, unsaturated fats
Pairing carbs with a protein and/or unsaturated fat can slow digestion and slow down any increase in blood sugar, too. Protein and fat do not impact our blood sugar the way carbs do, so eating these foods with carbs gives your body more nutrition and will lead to a better, steadier blood sugar response. Unsaturated fats are generally more protective and can be found in plantbased foods such as nuts, seeds, avocados, olives and olive oil. Most people choose snacks high in carbs, especially when going long periods of time without eating, but do not add other food groups to their plate. Instead of thinking of what you want to eliminate, think about what you want to add. If you want to snack on fruit, have a serving of fruit and add a handful of nuts. If you’re in the mood for carb-rich crackers or pretzels, pair a handful of pretzels with a protein shake or low-fat string cheese to balance it out with some protein.
Blood sugar control can be exhausting and frustrating, and different strategies work for different people. Try some of these tips to feel empowered and more in control of your numbers.