What can diabetics eat?

May 20, 2021 1:26 PM

My sister has diabetes, and I'm curious about her eating habits.

My sister has diabetes that, lately, is becoming harder to control. She told me becoming harder to control is the natural progression of the disease. But she talks to me about things like the delicious chocolate doughnut with chocolate frosting she recently ate and the takeout chicken empanada she had for dinner. She orders takeout food quite often. I know very little about diabetes. Is okay to eat sweets (e.g. a doughnut) sometimes? Can eating restaurant food on a regular basis negatively affect diabetes since, I assume, there really isn't a way to truly know what is in the meal and what the carb/protein/fat/calorie-count is? BTW, I plan to offer her no advice, and to leave the issue between her and her doctor; I am just curious.

posted by SageTrail to Health & Fitness (15 answers total)

A lot of it has to do with what type of diabetes she has and what other things she is doing to manage it. Here's a good explainer from the Mayo Clinic about how to manage it. The big deal (as someone who was the child of a diabetic who was terrible about managing it) is that managing diabetes is, for some people, incredibly difficult. There are whole programs in medicine devoted to helping people manage their diabetes because the combination of lifestyle changes and constant monitoring (and random curve balls like how stress affects things). So it may be that her situation is harder to control because of the type of diabetes she has, or it may be harder to control because she's having a harder time making the changes that need to be made. In either case, being supportive and listening is the best way through this most of the time.
posted by jessamyn at 1:49 PM on May 20, 2021 [7 favorites]

Type 2 diabetic diagnosed in the past 5 years here, but not a doctor:

It depends on how her diabetes is treated, and what does 'harder to control' mean -- like, is she on insulin, or just medications? Is her A1C 15, or 8? A lot of this is stuff only she or her doctor may know and can't be seen from the outside. If she doesn't have to use some sort of machine to check her sugars, it's pretty likely she's not in really bad shape and just controlling through diet and meds.

For me, when my diabetes was 'harder to control', I switched meds and my sugars came way down over time without any change in diet. I had already been really controlling my diet, low processed sugars and carbs, so a med change made more sense.

I can eat sugary things, as long as I don't overdo it, or make it an everyday thing. I have a bowl of ice cream a couple times a week, but not nightly. I don't drink sugary pops if I can avoid it, but some restaurants only have gross diet options so I get a regular soda. Eating out brings sugars and sodium (also bad for diabetics), so it could cause trouble, but not necessarily if managed properly. Simply eating less is a big thing for controlling diabetes, and sugar isn't an instant poison. For most diabetics its a long-game thing; how you eat on any particular day isn't going to break you, but how you eat over weeks or months is a bigger deal.

That is, unless you're super-fragile and controlling things with insulin and other more intense regimens; some diabetics, primarily type-1 diabetics who have had it all their life, really do need to watch their sugars on a meal-by-meal basis. But, I had an uncle who was on insulin since childhood and had a lot of problems until his thirties, but modern diabetes control medications had gotten good enough that he went off insulin altogether (with diet and other restrictions still, but better managed).

So, don't panic that she has a sugary donut once in a while, and eating out all the time is fine if she's getting normal-sized (i.e. smaller than you'd think from a restaurant) and without a sugary soda every time, but if diet is her problem any single meal isn't going to cause a problem, it's consistent diet control and the correct medications over time that reduces "harder to control" diabetes.
posted by AzraelBrown at 1:49 PM on May 20, 2021 [3 favorites]

Hi;
This has helped me a lot:

https://www.diabetescarecommunity.ca/
posted by LOOKING at 1:50 PM on May 20, 2021 [2 favorites]

It's probably more complicated than you imagine. Diabetes basically makes the pancreas less able or totally unable to regulate blood glucose levels, to keep them in the rather narrow range that doesn't cause a variety of nasty effects either very quickly (extreme hypoglycemia leading to loss of cognitive function and muscle function, even coma) or very slowly over time (persistent hyperglycemia leading to poor circulation to extremities, nephropathy, retinopathy, etc.). Foods that are quickly digested and converted to glucose create spikes that are exceptionally difficult to regulate. Simple sugars, juices, and alcohol are the worst. Simple starches are a little easier to deal with. Complex carbs, fats and proteins are easier still. Sweets are rarely a good idea unless maybe they coincide with vigorous exercise that requires a lot of energy throughput.

I have no medical background, but was once married to a very brittle type 1 diabetic. My experience around this is extensive, but 20+ years in the rear-view mirror.
posted by jon1270 at 1:58 PM on May 20, 2021 [2 favorites]

I live with my MIL, who has Type 2 diabetes that was very out of control -- ulcers, kidney damage -- and who has turned it around a lot over the last few years.

All I can say is that it took a medical team that was determined to get her the right treatment, including different medications until they got the right ones, and getting in with a doctor who has taken a pretty controversial/experimental approach to diet. She too had been told that the disease only progresses downwards and she actually moved in with us 5+ years ago in part because we thought she would be in dialysis within two years. She is not. Things are much better.

I would be hard pressed to say whether it was just the medication or just the weight loss or just the reduction in stress and infection/inflammation that helped.

I am pretty sure it was not about her willpower or the occasional doughnuts. If anything she probably has a doughnut more often now and her health is measurably much better. We don't eat out much but I'm not sure she was before either. What she needed was the right treatment for her.

It am ashamed now at the thoughts I had before she moved in with us. I think when we love someone and see them suffering, we kind of want to set up in our minds that there's a "good" path and if they would only "be good" then they would return to health. Diabetes is scary. But it's also super complicated.
posted by warriorqueen at 2:47 PM on May 20, 2021 [28 favorites]

My sister has diabetes that, lately, is becoming harder to control.
For women with diabetes who menstruate, hormonal changes can add a layer of difficulty in controlling the disease. Women with diabetes have more to manage. Navigating Menopause and Perimenopause with Diabetes.
posted by Iris Gambol at 2:52 PM on May 20, 2021 [2 favorites]

New research in the UK, which is now being adopted by the NHS, shows that type 2 diabetes is reversible with dramatic weight loss. So, theoretically diabetes doesn't have to be harder to control as the disease progresses. But the treatment is something that people have to a) know about, and b) have the ability to follow. Drastic weight loss and long-term diet changes are difficult.

I suspect, however, that knowing this is not going to help your relationship with your sister...
posted by EllaEm at 3:10 PM on May 20, 2021 [1 favorite]

[note: OP did not specify whether it’s about type 1 or type 2 diabetes]
posted by Namlit at 2:20 AM on May 21, 2021 [2 favorites]

[note: OP did not specify whether it’s about type 1 or type 2 diabetes]

Indeed, Type 1 and Type 2 are different conditions, and the advice will be specific to the type they have. Someone in my family is Type 1 and they can eat whatever they want (within reason), as long as they pay attention to how much sugar/carbs the food contains and plan ahead to take the correct about of insulin (ideally they take it in advance of a meal). It's not necessarily healthy for them to have a huge amount of sugar or refined carbs (pizza and baguettes are the worst) and have to correct with a huge amount of insulin though.
posted by EndsOfInvention at 2:43 AM on May 21, 2021 [1 favorite]

Indeed, Type 1 and Type 2 are different conditions, and the advice will be specific to the type they have.

The bigger variable, AFAIK, is how it's treated, not which type it is. If you treat diabetes with insulin (via injection or pump), it's relatively easy to take the correct amount of insulin for the number of carbs. Type 1 diabetes is always treated with insulin, whereas Type 2 can be treated with insulin, but is more commonly treated with other medications. People often conflate Type 1 as being treated by insulin and Type 2 as not, but that's incorrect.

Is okay to eat sweets (e.g. a doughnut) sometimes?

What do you mean by "okay"? Is it "okay" for anyone to eat a doughnut sometimes? Clearly there are ways in which doughnuts are unhealthy, which people can mitigate (e.g, by exercising, etc). For people with diabetes, mitigations will probably include taking insulin or some other medication. That doesn't mean the doughnut is the healthiest possible thing, the question is whether the person who's eating it thinks the tradeoff of the effect it has on their health is worth the experience of eating the doughnut. For many people with diabetes, the effect on their health is minor (with correct treatment), and thus the tradeoff is worth it.

Can eating restaurant food on a regular basis negatively affect diabetes since, I assume, there really isn't a way to truly know what is in the meal and what the carb/protein/fat/calorie-count is?

In the case of someone who is treating diabetes with insulin, this isn't a large problem — if someone misestimates the amount of carbs in food, their blood sugar will end up a bit low or a bit high, and they'll correct it when that happens. One has to do this regardless of whether it's restaurant food or any other type of food, since there are actually a ton of variables that affect blood sugar (storage temperature of the insulin, amount of physical activity they've recently done, exactly where in the body the insulin is injected, and many more), and things like fruits and vegetables have varying amounts of sugar depending on growing and transportation conditions, so this problem exists as long as you're not eating entirely prepackaged, factory produced food (and even prepackaged food, I'm not 100% convinced has accurate enough information to get insulin dosing spot on the first time).

I'm not sure about how medications used to treat Type 2 diabetes work, but in that case, the medication is already much, much less precise than insulin would be, so I don't think counting carbs exactly would matter for getting the right dose? But I don't know much about that.



Now, it can make it easier to control diabetes if one has lower-carb meals, etc. But whether that's what someone wants to do is a personal choice, and it's definitely possible to control diabetes while still eating carby foods.

BTW, I plan to offer her no advice, and to leave the issue between her and her doctor; I am just curious.

This is good, but your questions seem quite focused on her behaviour, rather than more general curiosity about diabetes. Maybe it's worth thinking about why that is? To put it plainly, your questions seem quite focused on judging and policing your sister, which doesn't seem to me like a useful perspective, regardless of whether you act on it.
posted by wesleyac at 3:29 AM on May 21, 2021 [5 favorites]

My mother was Type 1 diabetic and entirely insulin by injection dependent and could and would eat pretty much whatever she wanted and adjust her insulin depending on what she ate. She had also been a diabetic for 40+ years and had controlled her diabetes before home blood tests where a thing so she was pretty good at guestimating the changes in insulin needed. Though she did try to eat well and low GI/carb most of the time when she was older. Her diabetes never got worse perse, but the side effects of the condition did the damage to her eyes, her heart her kidneys, the nerve damage to her feet all slowly added up over the years.

If your sister is a she's Type 2 and diet controlled and or on an oral medication then diet is very important. But there are so many other factors as well, as others have said diabetes is harder for women to control due to hormone fluctuations, stress, broken sleep or just changes in routine can be a big problem. Celiac disease or eating disorders & digestive issues can make blood sugar levels swing like crazy. Stress can be a huge factor.

Then there is the factor I saw effect my mother when I was a kid, which I never see anyone talk about, sheer angry denial at the disease and the control it now has over your life. My mother didn't always manage her diabetes well, when she was a young woman with young kids she did a lot of stupid shit because, well because she didn't want to be "sick". Throw in my father was a complete unsupportive asshole, who refused to eat the foods she needed to eat so she often had to cook 2 meals, or in all their decades of marriage never learned how she did a blood test so he could do one in an emergency, or the difference between a hypo or a hyper and left me at the age of 6 to help my mother manage her condition.

So what I'm saying here is some of the most difficult things about managing diabetes is not the medicine or the diet. Letting go of comfort eating is hard or foods you enjoy is hard, as is the convenience of take out food. Managing a condition you have to manage all the time at every meal ever for now and forever is hard, your sister most likely knows she probably shouldn't be eating the donuts or take out, if that's the answer you're looking for but diabetes has so many more layers than some foods bad and take your meds on time and it's all OK. It's a condition that takes over your life and pretty much every choice you make in some way ends up having to be about your diabetes, and having to make good decisions every single time grinds you the hell down. Source, I watched it do that to my mother every day of her life for decades.
posted by wwax at 6:12 AM on May 21, 2021 [7 favorites]

Response by poster: Thank you all of you for your input so far; it has been extremely enlightening and I truly appreciate it!
posted by SageTrail at 9:36 AM on May 21, 2021

I’ve been a type 2 diabetic for many years, and not very well controlled for most of them. I started seeing a new endocrinologist in December, who recommended a low-carb diet in conjunction with insulin therapy. Prior to being on insulin I had eaten mostly low-carb for years, while taking increasing doses of Metformin and watching my A1C climb the entire time. I would eat eggs and bacon for breakfast, check my blood sugar a couple of hours later, and be so frustrated to see it at 250 or more for no goddamn reason I could see. And this made it hard to keep motivated to stay on the low-carb diet since I wasn’t seeing much in the way of results. Of course, going off the diet jacked my blood sugar even higher but I solved that problem by not checking it very often (but of course dreading my doctor visits and the inevitable day of reckoning once my test results came back.)

Now that I’m taking a daily dose of basal (long-acting) insulin, I generally have decent pre-meal and fasting BG, and I can vary the amount of mealtime insulin I take based on what I’m eating. Thanks to my new CGM (continuous glucose monitor) I have learned that now, due to the basal insulin, a meal with a low or moderate amount of carbs affects my blood sugar very little. So if I’m having eggs, bacon, a slice of toast and a small piece of fruit for breakfast, I don’t need to take my mealtime insulin at all and I maybe go up to 115. Whereas a portion of pasta and a salad requires a pre-meal shot of short-acting insulin, and if I really throw caution to the wind for a particular meal (like ordering a burger on a bun with fries and a milkshake) I take even more mealtime insulin to cover it.

Theoretically, I could take the higher dose of insulin at every meal and eat as much sugar and carbs as I want and still keep my blood sugar in check. However, the insulin does not prevent the other health problems that can arise from eating a junky diet, and can actually promote weight gain if you overdo on a regular basis. (One of the ways insulin clears the glucose out of the bloodstream is by ushering it into fat cells.) This is a thing I’ve discovered in the last couple of months of pushing the envelope carb- and junk-wise… it’s easy to kid myself that because my blood sugar is in line I’m doing great, and then I step on the scale and I’m like… whoa. So there is clearly a need for some restraint here, but not necessarily perfection.

My diabetes educator stressed to me that in order for a healthy diet to be sustainable long-term, you have to be satisfied with what you are eating, and for most people that is going to mean having a donut or chips or a burger and fries on occasion. She suggested adding a few healthy carbs such as grains and fruit to some of my meals, and not to sweat the occasional indulgence.

Of course, not every diabetic is treated with insulin. Some people can manage their condition with some combination of diet, exercise and oral medications. A CGM would be so helpful here too though, as it shows you what effect various foods and exercise has on your blood sugar. My husband just got his and is learning a ton about how his food choices affect his blood sugar, which has inspired him to make some changes.

One thing I want to mention is that type 2 diabetics can find themselves being subjected to a lot of fat-shaming. Everyone “knows” that type 2 can be controlled by weight loss and so there is a certain amount of disdain for type 2s having “done this to themselves” or that they could cure themselves if only they would put down the donut and pick up a kettle bell. The thing is, weight loss can help but it isn’t necessarily a cure-all for everyone. I lost 50 pounds over a period of a couple of years, and my A1C went steadily up during that time period. A woman I’ve worked with for 10 years has never been fat, and she is a type 2 who takes insulin. I just mention this because being judged gets really tiresome. I’ve even seen type 1s insinuate that type 2s are lazy for taking insulin because they presumably could control their condition with diet. Meanwhile I struggled to for years eating low carb and even losing weight with no corresponding improvement in A1C, when apparently I just needed some basal insulin to make my body work right and be able eat a friggin’ donut once in a while like everyone else.
posted by Serene Empress Dork at 11:01 AM on May 21, 2021 [5 favorites]

As a diagnosed Type II diabetic, I can eat whatever I want. Seriously. Eating that chocolate covered donut won't kill me.

But it can make me feel sick and ill if I'm wasn't on the right meds and make me tired. So yeah, I can eat anything, but I do have to do a cost benefit analysis on eating the carbs and sugar. Basically anything that goes in my wife should be thought about in terms of its affect on me, which gets exhausting over time.

It's impossible to say much about your sister, since there's so little information given. But I am alarmed by her *seemingly* shrugging her shoulders and saying, "well the disease gets worst, might enjoy all this delicious stuff that isn't good for me. "

I'm guessing you want to help her with this disease and if so, that's great, folks tend to need a lot of help, because it can be so overwhelming on a day to day basis. My advice would be just listen to her for now and see where she struggles. Just listen and be there.
posted by Brandon Blatcher at 11:35 AM on May 21, 2021 [1 favorite]

Yeah, it's not like an allergy where there's specific foods that you're not allowed ever. It is, VERY approximately, more like Weight Watchers where you need to be aware of how much you're consuming and what types of food.

Some things that might make diabetes harder to control, a spectacularly incomplete but serious list: Aging. Weather. Tightly constrained schedules, or unpredictable schedules. Pain. Other medications. Change in physical activity level. Stress. Illness. Other dietary limitations. Lack of sleep. Etc. VERY approximately again, if it's something you can picture giving you a headache, it can probably mess with your blood sugar.
posted by february at 12:25 PM on May 21, 2021 [2 favorites]