How Many Carbs for Type 1 Diabetics?

If you have type 1 diabetes, you should be eating extremely low carb, right?  This keeps your insulin requirements to a minimum and assures the best possible blood sugar control, according to intuition and the personal experience of many PWDs.  But guess what? New research does not agree.

Yesterday, diabetes nutrition expert Hope Warshaw sent me an email flagging a new study published in the American Journal of Clinical Nutrition which concludes that — get this — “Among intensively treated patients with type 1 diabetes, diets higher in fat and saturated fat and lower in carbohydrate are associated with worse glycemic control, independent of exercise and BMI.”

The researchers, including Dr. David Nathan of DCCT fame, followed 532 subjects for five years in this study, the first to closely examine “the association of diet composition with subsequent HbA1c concentrations” in Type 1s who use insulin in various quantities throughout the day.

The substitution of fat for carbohydrate was associated with higher A1c levels, about a full percentage point, if I’m reading the study correctly.  Both Warshaw and the study authors seem to indicate that this data lends credence to the ADA recommendations that between 45% and 60% of a diabetic’s diet should be carbohydrates. WtF?*

* Excuse my language again, but can it really be that we’re all totally misled in our knowledge (belief?) that low-carb=better BG control. I think not.

I printed out the study and took a copy with me to my endo appointment yesterday.  She looked the document over and chuckled.  Research is so nebulous, we agreed.  “You can find all sorts of associations supporting contradictory hypotheses,” she said. Ain’t it the truth!  But here’s the really smart thing she said:

The way that carbohydrates effect people with diabetes is just so individual… Some people can eat English muffins or cereal for breakfast, take a certain amount of insulin, and they’re fine.  While somebody else might eat exactly the same muffin or cereal — exactly the same amount of carbs — and dose for it, and they’ll still go sky-high.  You just have to learn which type of carbohydrates your body can best handle.

My experience exactly!  My one type 1 friend at the gym once told me “I can’t do cereal.” But she eats sandwiches and pie…?  I, on the other hand, can eat a small bowl of cereal and sometimes even go low afterwards.  Yet a few simple corn crackers send me reeling.  Every-body’s different. Which sure doesn’t make BG control any easier.


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