The slogan that goes with the DAFNE approach to diabetes management is "Eat what you want. Enjoy what you eat". Like many diabetes management regimes it doesn't encourage the routine measurement of blood glucose in the hour or two after a meal. The theory is that you are likely to go high during that time and their isn't much you can do about it, so focus on making sure that you come back down to normal over a slightly longer period (and don't go low).

The only problem with this theory is that if you have three carbohydrate laden meals a day you might be spending 6 or more hours with blood glucose levels higher than normal. At that rate you'll never get a low HbA1c reading and - more importantly - during that large chunk of each day you'll be running the risk of causing damage to your body.

There's a different theory to diabetes management that suggests that carbohydrate consumption should be left as low as possible. The key (but not the only) advocate of this approach is Dr Bernstein. He advocates that you eat only 30 grams of carbohydrates each day. Breakfast 6g, Lunch 12g, Dinner 12g. This compares to a normal western diet of anything from 150 to 250 grams of carbohydrate per day. He makes the very sound point that with small quantities of carbohydrate there is less room for dosing error and it's much easier to keep blood glucose under control. He also argues that this is a more natural and healthy diet and will generally aid health even without diabetes.

I'm not entirely convinced that it's necessary to lower carbohydrate consumption to that level. I find that with the aid of DAFNE principles and with frequent testing, I can get my HbA1c down to normal levels whilst still eating more normal quantities of carbohydrates.

That said, I still find high carbohydrate meals easily lead to large errors in control (with accompanying highs and lows). Unless you are meticulously weighing and counting ingredients it is easy to make a 10% error in estimating how much carbohydrate you are eating, and that can lead to your blood glucose going well out of range. And, try as I might, there are some meals that just have too many quick acting carbohydrates for me to be able to eat them and stay normal. So I'm tending to eat fewer and fewer carbohydrates.

As a result, I've ditched or curtailed a few meal types:

  • Pizza
  • Too many hot chips
  • Normal sized servings of white rice, including sushi platters

The key is to try out meals and to measure how high I go: including a couple of tests taken in during the two hours after after a meal. And I record what sort of meal I have eaten, and then I have the meal a few times over a few weeks to see what my usual reaction to it is. If a meal persistently sends me to high I either stop having it or reduce how much I have. So nowadays when I eat Japanese I avoid sushi platters and only have a few pieces with white rice: and concentrate on sashimi (fish without rice) instead.

The key here is keeping records of what I ate, how much insulin I took and how my blood sugars panned out. Ideally I'd never let myself rise about the highest "normal" reading (which I count as 7.8 mmol/l). (For those people in the US who insist on using a different measure to the rest of the world, that's 140 mg/dl.) In practice I'll often go to 9 mmol/l and sometimes higher.

I currently keep my records in a spreadsheet developed by Kevin on his Parenthetic (Diabetic) web site. His spreadsheet is excellent, and if you drop him an email he'll send you a copy.

Keeping meticulous records (of what you eat as well as blood glucose and insulin doses) might seem like a drag. I can't emphasise enough how liberating it is to be able to see a clear picture of how your body is reacting to insulin and food. Make a mental decision: decide that record keeping will be fun and useful, not boring and depressing. Make sure you even feel happy about recording bad results: you're going to learn a lot from them. If you get into the swing of it you'll learn to love it.

At some stage I'm going to do a statistical analysis to see whether there is a correlation between my low carbohydrate days (and my averages and my variations during those days) and whether they were statistically better than days when I ate more carbohydrates. The spreadsheet records have built up many hundreds of days of data so I should be able to get a clear indication as to whether lowering carbohydrates improves my control as much as I think it does.

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Anthony Holmes June 2nd, 2009 11:22:30 PM

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