Ask the Expert: Myth and Misconceptions (Part 2)
November is Diabetes Awareness Month! In honor of the month, we asked our team of experts to clarify what myths and misconceptions they commonly encounter in the type 2 diabetes community. Here’s what our experts Meryl and Connie had to below.
Response from Meryl:
Carbs are the bodies preferred energy source. Our brain requires a minimum of 100 grams of carb each day. Choose nutrient dense carbs such a whole grains, fresh fruit, legumes, and low fat dairy. When purchasing packaged foods select items with at least 3 grams of fiber or more per serving. Also try selecting packaged foods with the shorter ingredient lists (shorter ingredient lists usually means the food is more natural and thus less processed).
MYTH: I can’t have sugar.
In numerous studies sugar has shown to have no greater affect on blood sugar than starch. Sugar and starch when digested break down into glucose. However, foods high in sugar are typically not as nutrient dense so they should still be consumed in moderation in the context of a balanced diet. Aim to keep sugar intake to less than 10 percent of your total daily calories. When choosing snack foods or cereals choose a product in which that sugar grams are less than half the total carbohydrate grams.
MYTH: I can take a pill “cure” my diabetes.
Be leery of products that promise a quick fix. If something sounds to good to be true, it likely is just that (unfortunately).
In some cases people make lifestyle changes (weight loss, exercise, diet changes) that help normalize their blood sugar and allow them to come off of diabetes medication. This may be more likely to occur if such changes are made shortly after being diagnosed.
In a journal article from Diabetes Care: the following was suggested as guidelines for defining “Diabetes Remission”:
Complete remission is a return to “normal” measures of glucose metabolism (A1C in the normal range, fasting glucose <100 mg/dl of at least 1 year’s duration in the absence of active pharmacologic therapy or ongoing procedures.
MYTH: If I need to take insulin I have failed.
Type 2 diabetes progresses overtime, resulting in the body making less insulin. Typically lifestyle changes and oral medications are started at the time of diagnosis, however if such treatments fail to meet target A1c (<7%) insulin may be indicated. Talk with your doctor to see if/when he/she thinks insulin may be the best option to optimize your diabetes care.
MYTH: Shots are painful.
Today’s needles are much shorter and thinner, making shots less painful. If you need to take shots to manage your diabetes ask your doctor to write you a prescription for a short needle and larger gauge (Gauge is the thickness of the needle. The larger the gauge number, the thinner the needle will be). In some cases you may be able to use a pen device instead of syringe. Pen devices are used with needles that in some cases are shorter and thinner than a syringe.
MYTH: When treating a low blood sugar, I should eat and drink until I feel better.
When treating a low blood sugar (<70 mg/dL) allow 10-15 minutes for the blood sugar to come up (at which time you should start to feel better). A low blood sugar should be treated with 15 grams fast acting carbs such as 4 oz juice or 3-4 glucose tablets. Avoid treating a low blood sugar with foods that contain fat (i.e. cookies or candy bars). Fat slows down the absorption of carbs and will delay the desired blood sugar rise. Eating until you feel better (while tempting) can result in overtreatment of a low blood sugar and thus hyperglycemia (high blood sugar).
Response from Connie:
“I was told that I can eat only 3-4 carbs at a meal. When I look at the Nutrition Facts Panel, lots of foods in the serving size shown are already 10, 20 or even 30 carbs! How can I eat only 3 or 4 carbs in a meal if just a serving has all those carbs? I’d starve!”
This might be a good time to step back and understand the difference between a gram of carbohydrate, and a carbohydrate ‘choice’. Once you know the terms, you’ll be able to understand how ‘grams’ are related to ‘choices’.
On the Nutrition Facts Panel, you won’t see a line that says “Carbohydrate Choice”. You will however, see grams of carbohydrate listed. Look for the small ‘g’ behind a number on the total carbohydrate line. That ‘g’ stands for grams. For instance, if the line reads: Total Carbohydrate= 20g, that means there are 20 grams of carbohydrate in the serving size shown on the label.
So, how are ‘grams’ of carbohydrate related to carbohydrate choices?
Oftentimes, people with diabetes are given a certain number of ‘carbohydrate choices’ they’re allowed every day. These choices are often broken down by meal and snacks, too. A typical allowance might be 3-4 ‘carbohydrate choices’ for a meal. Now here’s how those choices are related to the ‘grams’ of carbohydrate that you see listed on a Nutrition Facts Panel:
One carbohydrate choice = 15 grams of carbohydrate.
So, using the Nutrition Facts Panel example above, if there are 20 grams of Total Carbohydrate in a serving, and there are 15 grams in a ‘choice’, that 20 grams of carbohydrate is a little over one carbohydrate choice.
Using the quote above, where a person with diabetes is allowed “3-4 carbs” at a meal, it should really read: “3-4 carbohydrate choices”. And, if you do the math, with each choice being 15 grams, those 3-4 choices become 45- 60 grams of carbohydrate/meal.
Carbohydrate is an important nutrient for everyone, whether you’re a person with diabetes or not. Knowing the amounts of carbohydrate you need to keep your blood glucose levels in good range requires knowing how much and when you should eat them for best control. Always consult with your healthcare provider on what your needs are for best control!
Let us know in the comments below what myths about type 2 diabetes you wish others would understand.