Saturday, 4 December 2010

Baffling blood sugar

I was recently asked to help out a family member control their bloods sugars. They have diabetes type 2 (adult onset diabetes) and have noticed that their blood sugar levels are often high (over 7mmol/L) in the morning before eating breakfast. Starting out the day with high blood sugars often leads to high blood sugars for the remaining of the day because it is hard to lower already high blood sugars if insulin is not involved. Morning sugars reflect what was eaten the night previous and will reflect how our body is "handling" that last meal or snack. The same can be said for any time of the day. There are 2 general reasons why blood sugars sugars can be high after a meal:

1. Too many carbohydrate rich foods were eaten, meaning either portions were too big or too many carb rich choices were eaten, or both. We need to eat some carbs at each meal, but too much can lead to high sugars. Carbs are found in 3 of the 4 food groups: fruit, grain products (rice, barley, couscous, pasta, bread, bagels, cereal, etc) and anything made from milk (milk, yogurt, Yop, ice cream, but not cheese). The idea is not to avoid carbs, but to spread them out over the day.
If we eat too many carb rich foods in one sitting, they will turn into sugar and rush into the blood stream like a tidal wave. As you may expect, the body cannot handle a tidal wave as well as it can a slow drip of sugar. It takes longer for the body to deal with high amounts of sugar in the blood and thus the sugar stays in the blood longer than wanted (= high blood sugars). People without diabetes can handle higher amounts of sugar than diabetics.
Not everyone knows that milk based foods, fruit and grain products all get turned into sugar. Usually people will only look for the sugar content on the food labels BUT some nutrients are turned into sugar after digestion- mainly starch. You can't always read the starch quantity on the label and since it affects sugar levels as well, it is important to read the total CARBOHYDRATE content in foods and NOT the sugar content. Both sugar and starch are types of carbs, so by looking at the total carb content, you are looking at the bigger picture. One "carb choice" = 15g carbs. The average person needs 2-4 carb choices per meal. The general rule for one portion is 1/2 a cup (diced fruit, cooked pasta or rice, yogurt).
If we are eating over 4 choices of carb rich foods per meal, that may explain high blood sugars.

2. The other reason for high blood sugars may be due to an imbalance in the meal. If we don't have fibre, protein with carbs/starch present in a meal, there is a high likelihood that blood sugars may be high afterwards. Carbs get digested into sugar. Protein and fibre help to slow down how fast starch is broken down and absorbed by the body. Therefore they can help to prevent a tidal wave. Think of a sugar cube placed in a glass of water. It is dissolved quickly. Now, wrap the sugar cube up in a Kleenex. It is dissolved more slowly- the Kleenex represents the fibre in the meal. We find fibre in vegetables (non-starchy) and whole grains like brown rice, whole grain bread, whole grain pasta, etc. Now, imagine putting the sugar cube in a plastic container with holes, then put into the glass of water. The container represents the protein in a meal which will also slow down how fast the sugar is broken down. Protein is found in meat, chicken, fish, eggs, peanut butter, nuts, tofu, beans and cheese.
Not only does protein and fibre slow down the digestion of sugars, but by including vegetables and meat & alternatives in a meal, we naturally eat less of the starchy side dish.
The typical balanced meal would include half a plate of veggies, 1/4 meat and 1/4 starch. That roughly translates to be about 1-2 cups of vegetables, 3-5oz of meat and about 1 cup of starchy foods. Most people find these portions are small, so if you are a big eater and find it hard to cut all portion sizes down, the most important food to eat in moderation is the starchy food.

We have to expect that eating will raise blood sugars because most meals and snacks will contain carb rich foods. The goal is to have blood sugars raise no more than 4 points. To evaluate this, you have to take blood sugars before the meal then again 2 hours after the meal. 2 hours after the meal is when the blood sugars should be the highest. If you start off with high blood sugars before the meal, at least this method can rule out problems with the current meal. Some people blame the recent meal on high blood sugars, but if you started out at 12 and ate breakfast and you go up to 14 or 15- that's NORMAL. Why were you 12 to start with is the issue to deal with.

Reflect back on what you ate last, were there too many carb choices? Did I combine fibre, carbs and protein? If not, those are great goals to start with, before chosing a fad diet or increasing medications.
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