How important is diet *really* for a diabetic?
December 7, 2019 2:02 PM   Subscribe

My mother is a type 2 diabetic. She insists that because her blood sugar is controlled with medication and insulin there is no need to watch what she eats. Really?

I am a bit worried about her, she eats what looks to me like a lot of sugar. In a recent outing to Starbucks she had a venti Frappuccino and a slice of lemon cake. But I don’t want to nag if she’s right, or unless there are really dire consequences. I am starting from about zero on diabetes knowledge. I’ve tried to google but all I see is generic stuff about eating a balanced diet.

A few details in case it’s relevant:

- she’s on daily insulin and metformin, plus something for leg and foot swelling
- she sees a general practitioner once a month and gets bloodwork once every three months. The bloodwork I’ve seen shows a13 levels around 6.8-7.
- she has a history of misunderstanding what her doctor tells her, sometimes I think intentionally?

Can you please help me understand what the stakes really are? Thanks.
posted by ohio to Health & Fitness (18 answers total) 7 users marked this as a favorite
 
Sorry, a1c, not a13. I told y’all I don’t know much about this!
posted by ohio at 2:06 PM on December 7, 2019


Recently (in the past 2 years or so) diagnosed with Type 2 Diabetes myself: yes, I'm absolutely sure her doctor has told her to watch her diet. You can essentially undo the good the medication is doing by eating too much sugar. Her doc is probably trying to get her A1C under 6, and the only way to do that is a combination of medications, diet, and exercise.

The stakes are that consistently high blood sugars increase the chances of stroke, heart attack, and other cardiovascular diseases, stuff you don't think are necessarily tied to diabetes but are interconnected. She may never have the directly-diabetic things (ketoacidosis, low blood sugars, diabetic coma, etc.), but the heart stuff is a big risk if diabetes is untreated.

Something to consider: if she's super craving sugar, is she testing her sugars throughout the day and finding low blood sugars? I ran into where my blood sugar was getting low mid-day, so I was ravenously hungry at lunch and then I'd have high blood sugars in the afternoon. My doctor cut back the glipizide, which was doing too good a job, and now I'm eating less which should have a net benefit on my sugar. She should talk to her doctor if she is craving sugars, it may be a med problem.

But diet is definitely a component in staying healthy with Type 2 Diabetes, meds aren't a magic bullet that way.

Edit: I missed that you said she's on insulin: if she's that bad (a lot of type 2 diabetes just need a pill once or twice a day), being on insulin makes it more serious, she really needs to watch her diet.
posted by AzraelBrown at 2:16 PM on December 7, 2019 [9 favorites]


I should add: just from your post I don't know that proves she's not watching her diet, you can still have sugary stuff, you just need to make sure you're not going crazy. Like, is she drinking a couple two-liters of Mountain Dew a day? Probably a problem. Eating well most of the time, but letting herself "cheat" when having a nice time with her kid, knowing she may need to adjust her insulin dose later? Not that big of a deal.
posted by AzraelBrown at 2:29 PM on December 7, 2019 [8 favorites]


I don't have direct experience with your mother's situation, but I can report on my father. He was diagnosed in his early 60s with Type 2 diabetes. Initially he was prescribed insulin, but after a while he successfully controlled it with diet and exercise, and he was able to go off insulin. He did eat sugary foods, but in moderation: for example, he would walk 2 miles to an ice cream shop, have a scoop of ice cream, then walk 3 miles back home. It worked well for him until he developed oral cancer and could no longer eat solid foods. Then he had to go on a liquid diet, which unfortunately meant a lot of high-sugar formulas, and consequently he had to start taking insulin shots again.

If your mother can be physically active, regardless of her age, I'd recommend that she meet with a nutritionist who specializes in Type 2 diabetes and that she develop a regular exercise habit.
posted by brianogilvie at 2:36 PM on December 7, 2019 [3 favorites]


My husband is a Type II diabetic, controlled with medication (metformin & actos), daily insulin, and a weekly injection (currently Ozempic; previously Trulicity).

An A1C below ~7.0 is considered good control; getting it under 6.0 is tough. I'd be thrilled if his were under 6.5 but his endocrinologist is happy with it being around 6.7. But an A1C is only an average over the prior three month period and your mom's A1C of 6.8 could be attained through pretty steady blood sugar readings or by wild swings from high to low. The wild swings are much more of a problem because the highs can do real damage to the body and the lows can cause fainting which can, depending on what she's doing when she passes out, cause some big problems.

I think you're right to be suspicious when she tops off a sugary drink with a dessert, especially since it doesn't sound like there's a lot or protein or fat involved to help slow down the hit to the blood sugar. With that said, though, every diabetic is very different. My husband used to get blood sugar spikes more with starches than with sugar, although that seems to have reversed itself in the past few years.

In general, and with the caveat that as I said every diabetic is very different, it's a good idea to keep a relatively low carbohydrate diet. And when there's a hit of carbs - my husband is a nut for baked potatoes, for example - it should be kept to moderation and consumed with fat/protein to balance things out. The standards for post-meal blood sugar readings are under 180 after an hour and under 140 after two hours.

It sounds like a visit to the diabetic educator/nutritionist is in order for your mom and you, if that hasn't already happened. I've found that a good educator is worth their weight in gold. Another thing that could help is for your mom to get a continuous glucose monitor. It's a small device that attaches to your skin and reads your blood sugar frequently. We found it was a great opportunity to learn the effects of different foods and exercise. This site is a good information resource as well.

Feel free to Memail me if you have other questions.
posted by DrGail at 2:47 PM on December 7, 2019 [2 favorites]


I’ve been to a doctor’s appointment with my dad (in his 80s, type 2 diabetes since his 50s) and my mum was getting agitated about the fact my dad sometimes eats sweet things. The doctor said that advice had changed significantly over the years - it used to be that you should eat nothing sweet at all to keep your blood sugar under control, but now it is to allow a varied diet and adjust the level of insulin taken accordingly (I assume, from my understanding, to slightly increase the insulin taken, to control the raised level of sugar in the diet).

So I guess it’s maybe a matter of whether she’s having regular, moderate, predictable treats that are allowed for in her insulin dose, or whether she’s overeating so much her weight is out of control.

But I don’t know how universal that advice is, and IANADiabetic (or doctor).
posted by penguin pie at 2:57 PM on December 7, 2019 [1 favorite]


An a1c of 7 reflects diabetes that is overall under control. However, having your diabetes under control does not remove the heightened risk of stroke or heart attack or several other things that just come from having diabetes at all.

Basically general health requires some extra attention when you’re diabetic. The butter in the lemon cake may be as much of a problem as the carbohydrates.

(I say this as a man who regularly commits grievous sins against his Type 2 diabetic body. But hey, at least I know they’re sins?)
posted by Tell Me No Lies at 3:03 PM on December 7, 2019


Her diabetes is currently well controlled. However she would need to give herself less insulin if she ate less sugary foods.
posted by amy.g.dala at 3:06 PM on December 7, 2019


Diet, exercise, and weight control are all components of self-care management of diabetes. As well as taking meds as prescribed, checking blood sugars, and following up with health care provider. It sounds like she's doing the last three. If she's on insulin your mom is most likely performing blood glucose checks. If your mom's diet is fine most of the time, she might be okay and her A1C isn't bad.

When it comes to Type II diabetes, saying it doesn't matter because the medications take care of it is denial or a lack in diabetes education. Some people with Type II diabetes can control blood sugars with diet and exercise alone.

As AzraelBrown has mentioned the fact that she's on insulin is more of an incentive to watch diet. Often with poor diets (resulting in higher blood sugars) the insulin dosage requirement increases. Some people with diabetes, no matter how hard they manage diet, weight, and exercise, end up requiring insulin. Still, not paying attention to diet is not a good lifestyle choice. People with diabetes type II still produce insulin. There is a chance your mother could decrease or eliminate the need of insulin with exercise and diet.

People with diabetes can still have occasional treats. However, the fact that your mom is ordering sugary drinks in the is a red flag. One of the things that diabetes educators emphasize when teaching about diet is to eliminate sugary beverages. Drinking this amount of sugar (or any sugar) tells me that your mom is either in denial or needs to see a dietician. Sugary drinks are easy to eliminate and having them anyway seems like throwing caution to the wind.

I am not a doctor. I don't have diabetes. I am a nurse. However, I am nowhere near expert when it comes to diabetes. I know the basics and I see a lot of people with diabetes who are denial. It's a horrific disease that increases risk for other serious problems (heart disease, kidney disease, neuropathies, blindness, limb loss, stroke).
posted by loveandhappiness at 3:15 PM on December 7, 2019 [1 favorite]


I'm a Type 2 diabetic myself. I can tell you that diabetic care seems to be very paint-by-numbers for a lot of physicians nowadays, since they're dealing with huge numbers of patients -- do x, do y, do z. There is not a lot of focus on food except for the mere fact of saying 'get it under control', with very little focus on exactly how one does that, and next to no focus on the psychological roles food has in people's lives. Even nutritionists that are part of health systems usually focus on numbers over standing care. (No offense intended to anyone reading here who's different; I'm speaking of the generalities I've been exposed to.)

There is a feeling of learned helplessness ("my blood sugar's never going to behave, why not enjoy myself") and negative self-talk ("I did this to me, I can't believe I ate that, I"m not supposed to") that people often get with Type 2 diabetes. And God help you if, like 99% of the population, you're used to self-soothing yourself with food and don't have good alternatives lined up.

If she's with just a primary care physician, she needs to get fixed up with an endocrinologist. If this is the path her endocrinologist has her on, she might need one who has a better sense of her compliance and/or of the psychological side of things. There are also nutritionists -- sometimes you pay for them yourself -- who can better address the psychological role of food in her life.

Just my $0.02, take it for what it's worth or not worth.
posted by WCityMike at 3:54 PM on December 7, 2019 [13 favorites]


You might want to consider reading what Dr. Jason Fung has written on low-carb diets and diabetes. I found it very illuminating.
posted by ClaireBear at 3:59 PM on December 7, 2019


About what ClaireBear just posted – I won't bring that debate into a back-and-forth here, it's not the place for it. Just be aware it's contested, and a metastudy (a study of all studies) by The Lancet (the American Medical Association) disputes the low-carb fad. For my own decisions on things, I've considered that fairly convincing evidence.
posted by WCityMike at 4:10 PM on December 7, 2019 [6 favorites]


I was diabeticc during pregnancy and am pre diabetic now and on metformin.
WcityMike has it.
Also regimes can vary widely i researched quite a bit. Basically here in Europe there are two approaches that are common: FIT, short for flexible insulin therapy, which i did in pregnancy. You very closely among other things monitor blood sugar levels ,(measuring every 60-90 mins and writing down carb intake and injecting insulin in direct proportion to intake, a F.I.T. practinior can teach you.
Second approach is more common. Doctor determines how much Insulin you should inject and this amount determines how much you can eat.

As someone who did both, i prefer the FIT method.

One thing in general, never tell a diabetic what not to eat unless you are a specialist doctor or ntrisionist. I hate nothing than people telling me but you cant have sugar, your condition is caused by eating sugar.
No its not. Causes od diabetes are varied.
And causes of high blood sugar levels even more so and include emotional strain among other reasons.
posted by 15L06 at 4:39 PM on December 7, 2019 [3 favorites]


Forgot the link to FIT https://www.diabetes.co.uk/insulin/flexible-insulin-therapy.html
posted by 15L06 at 4:42 PM on December 7, 2019


My mother in law is a patient of Dr. Jason Fung's and was insulin-dependent...now she's not, and has lost 90 lbs. I can't speak for everyone but for her his methods have turned her health and her kidney function around, which is astonishing.
posted by warriorqueen at 4:59 PM on December 7, 2019 [3 favorites]


There's a lot of good advice here, but as AzraelBrown said, if she's a T2 on insulin (and her A1c is under 7), that means that her diabetes is pretty advanced, but she's also somewhat well-managed (compared to what it could be).

When I was diagnosed (and I'm a T2, but a weird kind of T2, and had no pre-diabetes, and onset was more like a T1), my A1c was 15.8. (Yeah, wacky high.) I took insulin (and metformin) for 10 weeks until I could see an endocrinologist, and by which time my A1c was down to 7.8, and he took me off insulin, adding another oral med. By 12 weeks late, it was down to 5.7, just on oral meds, as I've been for 8 years. When the dietician looked at my diet, very few changes were suggested for glucose control. (I eat a lot of cheese, which meant they thought my cholesterol would be freaky, but it was fine.) However, my flavor of diabetes is not typical. The thing is, NOBODY'S diabetes is typical, not even among T2s or T1s, and while diet and exercise are important for everyone, hormones, stress, genetics, and so many other elements play a part.

Most people who don't have diabetes are ill-informed about current recommendations. We can eat sweets. We can eat carbs. It's about moderation and balance. There are two kinds of insulin, long-acting (usually taken at night) and short-acting (taken before meals), and people with T1 (and T2s on insulin) can bolus or "cover" for what they're about to eat. (Those of us not on short-acting insulin don't have that option.) I know I wouldn't have a frappucino and a slice of lemon cake, together, even as a treat, but I don't know if she bolused for it. If by "daily" you mean she only takes one injection per day and does not take insulin before meals, she is not bolusing, in which case, a 6.8 or so isn't terrible (assuming she isn't having terrible hypoglycemic lows, bringing up the average against the highs). The question is whether her A1c is trending up, down, or remaining stable over time.

A banana is high in carbs, but most people think it's healthy because it's natural. (Nope.) Pasta is high in carbs but certain types (like Dreamfields) have much lower net carbs because of fiber. Some people with diabetes have no issue with air-popped popcorn and for others, it's highly problematic.

A balanced, healthy diet with carbs, protein, and some fat is important, but we don't know what you're mother is eating overall (and even if we did, we don't know her situation), and you don't know what's the right eating plan for her. Any attempt at a lower-carb, let alone keto or protein-based, diet made me violently ill, for example. Intermittent fasting makes my blood glucose go up. I am curvy but muscular, and not overweight. We are each unique. This is a job for professionals in concert with their patients.

That said, many primary care doctors are ALSO ill-informed, or under-informed about modern, let alone innovative, diabetes care. I would absolutely recommend she get diabetes guidance from an endocrinologist, not a primary care physician. An endo will probably have a dietician in the office (to to whom to refer your mom) to provide care.

Your mom probably isn't going to listen to you, but you would be well served to offer to learn with her, going with her to the endo. I'd also encourage you to tell her about DiabetesSisters, which is a national organization with local chapters (called PODS). The leaders tend to be diabetes educators or those who've attended training, and it's like a very social support group, where disinformation is combated and nobody feels they're being talked-down to, which is key.

I'd also recommend you read Diabetes Do's and How-To's by Riva Greenberg (and really any of her other books, too) and Bright Spots & Landmines by Adam Brown, two excellent books for providing introductory knowledge and clarity for both of you.
posted by The Wrong Kind of Cheese at 5:11 PM on December 7, 2019 [7 favorites]


With that said, though, every diabetic is very different.

This. Every diabetic does an individual balancing act using medication, diet, and exercise as treatment. (Some people are able to use diet and exercise to get off medication, some can’t exercise, some aren’t as able to control their diets, etc.)

It sounds from your question like your mother has a medical care provider and is able to look after her own needs. I will tell you what my doctor, who helped me successfully treat prediabetes, told my mother: Being the food police doesn’t help anybody, this is not your condition, your body, or your life even if it is your family member.

Nagging is not helpful. Managing this condition means some days your body cries out for things you shouldn’t have, and sometimes you’re able to resist and sometimes you can’t. (Which is why sometimes you lean on exercise and medication.)
posted by sallybrown at 5:53 PM on December 7, 2019 [11 favorites]


Thanks everyone!
posted by ohio at 9:15 AM on December 8, 2019 [1 favorite]


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