Living with diabetics - The Glycemic Index

[Hogmaster]

I sent this as an email to my extended family, but Hog's Nurse suggested I post it here as well for those of you who are or know a diabetic. Sorry it is so long, but it might be useful to some:

For those of us with diabetes, including bordliners, the link below provides some interesting information. But even for the rest of you, it is something to take note of in both meal planning for your diabetic friends, or even yourselves (especially if you are the least bit hypoglycemic), as research continues to expose that high-glycemic foods are something everyone should consider with regard to their diet.

Let me explain for those of you not familiar with it – The Glycemic index came about several years ago now (you’ll notice the chart in the link is dated 1999) when researchers started looking at how quickly certain foods raised blood sugars in diabetics.

But first, the basics. Sorry to be remedial for some, but it is fundamentally important to understand just a couple of concepts about diabetes, OK? Diabetes occurs in two forms. Type 1, like I have, occurs with the pancreas “shuts down” its production of insulin. Type II, the much more common form, involves a situation where the pancreas still produces insulin, but the body does not utilize it properly. Sometimes, with exercise, weight control, and diet, Type IIs can exist without taking insulin. Sometimes Type IIs are prescribed drugs which do not have to be injected, but are oral agents that help their bodies utilize the insulin they produce. Those drugs are not without side effects, however. Sometimes Type IIs take insulin in addition to any of the above.

Insulin is a hormone (protein based, which is why it has to be injected BTW – when it is swallowed it is simply digested in the intestinal tract as opposed to being absorbed into the bloodstream). The hormone serves to metabolize sugar that is absorbed into red blood cells as a function of digestion of food. Without insulin, the red blood cells carry the (excess) sugar to the kidneys, where (with a lot of work) it is extracted from the body as “sugary urine” (the translation of “diabetes mellitus”). Without insulin, “hyperglycemia” (high blood sugar) results, and not only does the body starve for nutrients that can’t be absorbed but the kidneys soon get overwhelmed and “ketoacidosis”, a toxic condition becomes the end game.

Stick with me here, I promise all this has a point.

In short, of the types of food groups – carbohydrate, protein, and fat, it is carbohydrate that raises blood sugar in a diabetic. Most of you know what a carb is, right? Bread, fruit (and their juices), noodles, starches and of course sugar are among the carb family. A carbohydrate, as a unit of measure (4 calories per gram) is the same no matter whether it is a bite of apple, a bit of toast or a teaspoon of sugar. At least as far as the calorie world is concerned.

But wait. It isn’t quite that simple after all. Especially from a diabetic’s perspective. It turns out that those “complex” carbohydrates that have been so in vogue now for years are beneficial for the reason of absorption into the bloodstream. Common sense would suggest that sugar, a simple and pure carbohydrate, would be the “quickest” thing to raise blood sugar in a diabetic, right?

Turns out, believe it or not, no!

As the chart in the link shows, there are several other forms of carbohydrate that are absorbed into the bloodstream faster than table sugar.

This information is important for a couple of reasons. The first and most obvious, for those of you who live with people who take insulin like me, you will, sooner or later, be with them when they have a hypoglycemic (low blood sugar) episode due to accidentally taking too much insulin, or not eating enough carbohydrate to offset the amount of insulin and/or exercise they recently got. When that happens, the diabetic needs carbs.

So what to give them? Ice Cream? A Snickers bar? NO NO NO!!!!

Those items, as you will see, are absorbed quite slowly. Which, as a tangent here for a minute, for those who may be naturally hypoglycemic, they SHOULD eat something like that. Why? Because their bodies naturally are producing insulin. If they eat a simple (high-glycemic index) food, like a piece of white bread when they feel shaky, their bodies will spurt more insulin into the bloodstream and potentially lower the blood sugar even more. By eating a low-index food, or mixing with protein and/or fat (more on this in a moment), their pancreas will not release so much insulin and their blood sugars will naturally rise to more normal levels.

But back to the diabetic with hypoglycemia. Give them a high-index food! Apple juice is still one of the top on the list (though it is not on this particular list) but an apple is considerably lower.

Now a little perspective. Though sugar is pretty far down, it (and anything close to that value) is still very quick, make no bones about it. But note what is right under pure glucose – a russet potato! That’s right, it turns out it is absorbed faster than even honey, another excellent choice to treat hypoglcemia. Do not try to jam a raw russet down the throat of a hypoglycemia victim however. Just as doing it to you, he/she would not likely enjoy it much.

Which brings me to the second point of this little primer.

When diabetics do not have low blood sugar, they are subject to eating meals just like everyone. But what they eat in a meal, and even when they eat it during the meal, can make a big difference in their blood sugar levels.

Think of it this way. If a diabetic starts dinner with desert, his or her blood sugar will skyrocket. Then if they add the protein and fat that are typically associated with a meal (like say a steak), those things slow the digestive processes and are absorbed slowly into the bloodstream, so their blood sugar will stay high for hours and hours.

Fortunately, meals are traditionally served with desert last. Hmmm… Somebody was thinking! By eating that steak, and even potatoes (which are slowed in digestion by the steak and the fat) first, the insulin the diabetic took to work with the carbohydrates of the meal can work gradually and the big sugary spike into the bloodstream does not occur. And by the time they add some desert (everything in moderation) the diabetic can do so and still maintain an even keel on the blood sugar front, which is what it is all about to avoid long-term complications.

Where many diabetics get into trouble is (especially) in the mornings. Because we all are not active as we sleep, in diabetics their blood sugar tends to creep up during the early morning hours. (Exercise has the beneficial impact of burning carbs and reducing insulin requirements).
This has been widely studied and is often referred to as the “dawn effect”. For Type 1s like me, most of us take some additional amount of insulin in the late evenings to help counteract the effect. Most Type IIs have their highest blood sugar readings in the mornings. But then they exacerbate the problem. How? Because they faithfully eat breakfast, often as their doctor has directed them to do. But what do they eat?

If you look at the list, you see corn flakes have a very high index. They are not alone. Think of it this way – if it is a carb with lots of surface area that is fluffy (like a corn flake, Rice Crispies, lots of other cereals or a piece of white toast), it is going to hit high on the index. Add to that a glass of fruit juice and there ya go – the formulary for a big spike in blood sugar. Again, and instead, think oatmeal. Think fruit, not juice. Think a bagel with cream cheese (slows absorption) and V8 being much better than high-index carbs, especially on their own.

Which also notice white rice is way up there. Is Gary suggesting no rice and no potatoes for diabetics? No chips? (God I love chips!) No. But I am suggesting that unless you are a diabetic with low blood sugar, you should not make either of those things your [entire] meal (or snack). Make sure those items are combined with protein and/or some fat, veggies (free foods!!! No calories, but they fill us up, provide nutrients and slow digestion) or at least some complex carbs to avoid a spike in blood sugar.

I wrote all of this because it is so frequently either misunderstood or ignored by so many. But now a little sobering reality. Ignore it. Lose a foot when bad circulation results from years of enjoying your juice. Ignore it. Then try to shop for those Rice Crispies when you can no longer see because retinopathy has caused your blood vessels to bleed you blind. Ignore it. Then make sure you schedule extra time in your day to take your loved one to their dialysis treatment. Consider it unnecessary and too much of a burden then make those arrangements for after the stroke takes your love away from you.

Look, for you diabetics, nobody can do this easily. It takes some conscious effort. I have come to realize that this is an incredibly complex and damndable disease. But please don’t ignore it. Try to do a few things to make the difference. Yes, test your blood sugar. No matter how much you do it, you aren’t doing it enough (including me). Because if you test, you know where you are. If you know where it is, you can adjust. Talk to your doctor or health care professional (or me) and impress him/her with your testing. Nobody drives with goggles that prevents you from seeing. Why do it to the only temple you will ever fully possess?

If anyone wants to know more, please feel free to PM me.

Here is the link:

http://www.diabeteshealth.com/read,2003,4932.html

I hope this helped someone.

Gary

[Hogmaster]

Here is another link, with more foods charted:

http://www.diabetesnet.com/diabetes_...emic_index.php

[Tilla]

Thank you!

[Hogmaster]

You're welcome, Tilla. For some, this information could help someone you know who has diabetes (and face it, almost everyone knows someone who has it these days).

Unfortunately, I have had it for so long much of this stuff is second nature to me. But I can't tell you how many times I have heard, usually from Type IIs, that "I just don't understand all that stuff."

And while the pricking of one's finger with an object specifically to draw blood is not something many easily adapt to, it needs to be done. The mean truth is that by staying in the dark about understanding the disease and the current state of one's body, those people are living in a big sea of denial that can lead to much more pain and darkness down the road.

It is a matter of choice. Pay now or pay later.

[JohnnyP]

Hogmaster,

Great post and thank you for the education.

Now here is a bit of reality that will hopefully help others take diabeties seriously........

A client of mine HAD a brother with diabeties and he did not do as he should and he passed away a horrible death by losing appendages one at a time......the first to go was, well..... the part us men cherish most! If that doesn't motivate you I'm not sure what will.

[cosmo]

With the numbers, is there a level that equals good versus bad, or a target below which the goal is to stay----like write off everything above a 50 or something?

I'm not a diabetic, and I want to stay that way. More importantly are my kids, who naturally gravitate towards refined anything. I don't want to write off cereal for them, but it appears the better choice is Life.

Any thoughts on quantifying the numbers?

Thank you.

[Hogmaster]

cosmo -

What I have read is that, generally speaking, anything with a value over 50 is considered moderate to high on the scale. For diabetics, it is best to avoid spikes by (trying) to keep to carbs under that.

However, and let me preface this by stating that everyone should consider the impacts of eating (simple) sugars, even a diabetic can eat white bread without significant consequences. The key is not (just) what is consumed, but when, with what else, as well of course as how much of it.

In other words, just make sure there is Peanut Butter on top of my mashed potatoes to slow digestion!

As I tried to explain before, there may be a good reason all our mothers kept telling us to eat desert last. It may spoil more than just appetites.

In fact, a traditional meal plan of salad first (ruffage to fill the stomach and start digestion) or (lower carb) soups followed by the main course and followed by desert is a very healthy way to eat.

There are some indications that eating too much unrefined (almost always high-index) carbs could contribute to diabetes. They haven't proved it as causual, it may be more a matter of association. But think about it. Who is eating the donuts, not getting any exercise, and generally meeting the definition of self-abuse? And the leading indications for Type II diabetics are to stay off insulin and improve their lives? Lose weight, exercise, stay away from high-glycemic foods. Hmmmm....

There is an explosive growth rate of this disease for a couple of reasons. One is simple heredity. More people are surviving with the discovery of insulin and other forms of treatment, which passes on the genes. But the other is likely due to lifestyle.

It is really a deadly disease, because it is so easy to ignore (especially for Type IIs). But the piper will come. Everyone should heed the advice to get more exercise and drop weight and bad eating habits whether you have it now or want to avoid it later...

[FrogPond]

I know diet sodas and such are high in sodium, but how do they effect a diabetic since they have neither carbs or calories? Do the artificial sweeteners have some effect?

[Hogmaster]

Originally Posted by FrogPond

I know diet sodas and such are high in sodium, but how do they effect a diabetic since they have neither carbs or calories? Do the artificial sweeteners have some effect?

No Josh, they don't. No carbs, no raise in blood sugar. But [i] have to watch - sometimes "Diet" drinks still have sorbitol or other sweeteners in small amounts in them, and they must be accounted for in my insulin balancing act [that is how it works for a Type 1 - eat carbs, take insulin in an offsetting way).

Now about a few other items of interest:

Protein actually does raise blood sugar, but it is a slow effect and it's impact is much later. It generally isn't considered in insulin requirements, unless there is a lot of it in the meal.

Fat does not raise blood sugar at all. However, there are some indications that it makes insulin less effective, and it certainly does slow the digestive system. That is why (some) fat can help limit the effect of high-index foods. Peanut Butter (high fat and protein) would actually be a good combo with mashed potatoes, but it is more commonly applied to Wonder bread.

This one is the one I get the most looks from people about. I have even had to educate doctors on this point;

Alcohol does NOT raise blood sugar.

In fact, it lowers it.

But you diabetics out there, read my written lips very carefully here.

I am NOT endorsing alcohol consumption. But, if you understand it, and how it works, then diabetics can drink like anyone else.

Remember, I wrote ALCOHOL does not raise blood sugar. In fact it slightly lowers it. Carbs raise blood sugar. But there are many things that have lots of both.

An example is a heavy wheat beer. Lots of carbs. Simple sugar, by the way. But a raise in blood sugar will occur if consumed.

But on the other hand, Bud Lite. 5 carbs in a can. Says right on it. The alcohol in it (in my case, based on body weight and metabolism) offsets the small amount of carbs. So I can drink Bud Lite without raising my blood sugar.

Another example. Rum and Coke. The Coke has 25+ carbs of pure sugar in every serving. There is no way the alcohol in the Rum will offset that. Drink Rum and Coke, big raise in blood sugar level.

But on the other hand, Rum and Diet Coke. No carbs in Diet Coke. Rum lowers blood sugar. If I were to drink Rum and Diet all night, I would need to eat a snack to raise my blood sugar.

Wine tends to be relatively blood sugar neutral, except for the real sweet wines. But most reds or whites don't have much impact.

It is something that, over time, I have learned what my body will tolerate and how to adjust to it. One thing about Type 1 diabetics is if the blood sugar goes up, insulin can be taken (and if on a pump, like I am, it can almost be done real-time) and the blood sugar will come back down. Type IIs in some ways have it worse because most are not on insulin, and if the blood sugar goes up, it tends to stay up, sometimes for days or worse.

I hear, "But Gary, if that's true, why do I always hear diabetics should not drink?"

The answer is that, lets face it - alcohol consumption can lead to bad judgment. Like buying an item you don't need. Like a boat. Or getting married. Or not recognizing the symtoms of hypoglycemia, and worse, someone else not realizing the person is not just inebriated, but in medical need of glucose due to it.

But everything in moderation. And under controlled circumstances, with a little awareness, this diabetic drinks with no ill effects or impacts to blood sugar control...