Re: Carb limits per meal (was: Skyrocketing)

[Guest guest]

hi derek!

> > hmm. i thought carb limits were

> > a *bigger* factor for type 2's -

>

> Well, not for this type 2! Nobody

> ever told me that there is a " limit "

> per meal. It does not make much

> physiological sense to me. Nothing

> much changes after a single meal,

> it is all a matter of averages. The

> HbA1c demonstrates that. It can be

> measured on an empty stomach or

> right after a meal, that makes no

> difference.

well it is very interesting about the averages thing. where i go,

they look at the HbA1c average, but also the patterns throughout the

day (and of course things like blood pressure). the averaging can

disguise numbers that aren't really in control.

> That is not a " limit " that is imposed

> on somebody but just the way the averages

> work out if they eat the recommended way

> and keep to an average of 2000 kcal/day.

oh yes, i hear what you are saying on that. if you eat the

recommended healthy way, it just works out. perhaps it is a matter

of perspective, in a way. personally, i have a *limit* that i define

like this: never eat any meal that is bigger than your head!

and i'm only half-joking about that, because tons of restaurants -

at least in the U.S. - do just serve mounds and mounds of food as if

it were normal. with that in mind, yes, *i have my limits* - if you

know what i mean.

> To turn the 80 grams carbohydrate into

> a hard limit that may not be exceeded

> for any meal under any circumstances does

> not make any sense to me. That is much

> too restrictive. I don't know how the

> nutritionists work it out in the US but

> I don't suppose that it is very much

> different from that.

can't say i know really what all the nutritionists out there

recommend. the *limits* recommended by my dietician are really a

range, so there's flexibility. actually, i find it quite hard to eat

all the carbs in my *allotment.*

> > ... that diet and exercise were more

> > significant in controlling blood

> > sugar.

>

> That was my point. Our metabolism con-

> trols our blood sugar (I am talking about

> non-insulin-dependent type 2s here) and

> diet and exercise indirectly over a long

> period provide the right conditions for

> that to happen and the medication makes

> it directly possible for our metabolism

> to do the job. The more " diet and exercise " ,

> the less medication is required.

> You could consider that the people you

> mention are on oral medication with a

> dose of 0 mg. As their diabetes

> progresses, they could be on oral medi-

> cation with maximum dose and no exercise

> or on a much lower dose and regular

> exercise.

you know, it's funny. initially, they thought i was type 2 and the

type 2 program of diet and exercise felt impossibly tough and

regimented to me. but those were my hyper early days and, of course,

the program would never have helped my metabolism sufficiently.

but anyways, no, i am with you. as far as i know, my lifestyle

really hasn't changed...i ate fairly healthy and so forth...all i've

added are an injector pen and a meter.

> > ... or like, type 1's can take more or

> > less insulin for the meal they are

> > eating, whereas the oral medications

> > are not flexible this way.

>

> No, but they don't all work that way.

> There are some oral medications that

> work much like insulin in that you

> take them with the meal (e.g. repaglinide)

> or they accumulate in your body (e.g.

> metformin hydrochloride) and you take

> a daily dose to top up. Not all diabetics

> using insulin take the trouble to match

> their dose to each meal, though.

oh that is very interesting. hadn't heard of repaglinide.

> > although, must say, in class they said

> > everyone - diabetic or not - has a limit

> > as to how much carb they can eat, over

> > which they will go high.

>

> I don't know about that. Everybody's BG

> increases when carbohydrates are eaten,

> diabetic or not. That is the way it works:

> carbohydrates are converted to glucose

> which is carried around the body to the

> cells by your blood - that is the way

> it gets there. It is a matter of regu-

> lation, a non-diabetic's BG is regulated

> to a safe value automatically by the

> hormones insulin and glucagon, a

> diabetic's is not, or not satisfactorily.

the way the nurse educators explained it, there is actually a point

where anybody's BG can pass the *healthy* range. that is, go beyond

the normal rise after eating a normal healthy meal. the body just

can't get enough insulin out there in time to stay in the desired

range.

they may have even give a number, perhaps something like >120 carbs,

in one sitting. that would be like one of those old-fashioned, seven-

course, make-me-morbidly-obsese-and-increase-my-risk-of-developing-

diabetes meals.

> That is the way it is taught in the

> classes I went to but I never heard of

> any lower limit or threshold value below

> which there is no detectable BG

> increase. You might miss it if you

> measure at the wrong time but that is

> a different matter.

i have never heard of a lower limit either.

> > 'course, for a non-diabetic that high

> > eventually comes down, wheareas for a

> > diabetic not so.

>

> I am not sure what you mean by that. It

> always eventually comes down for both

> of them, either naturally or with

> outside help. For a non-insulin dependent

> type 2 it always comes down anyway but

> without adequate medication, it comes

> down too late to avoid glycosylation at

> an elevated level. That is the only

> difference, I reckon.

yeah, i looked at that sentence twice myself. not a perfect one. i

was just thinking the metabolic mechanism is faulty for us folk with

diabetes. it's not enough to cope adequately without intervention of

some sort and you'll be heading for complications.

there is down and then there is down, so to speak...

rach

[Guest guest]

> well it is very interesting about

> the averages thing. where i go,

> they look at the HbA1c average,

> but also the patterns throughout the

> day ... the averaging can disguise

> numbers that aren't really in control.

Sure, but that is a different matter.

I believe you will find that they are

looking for signs of deep hypos that

might be masked by a number of post-

prandial highs.

> personally, i have a *limit* that

> i define like this: never eat any

> meal that is bigger than your head!

> and i'm only half-joking about that,

> because tons of restaurants - at least

> in the U.S. - do just serve mounds

> and mounds of food as if it were

> normal. with that in mind, yes, *i

> have my limits* - if you know what i

> mean.

Yes, I have heard about that. But that

is just another symptom of unbridled

capitalism! There is no incentive for a

restaurant owner to care a hoot for the

health of his customers - all that

matters is the bottom line! Talking

about the " bottom line " , we have heard

a lot over here about the boom in the

US restaurant fittings industry.

Restaurants all over the US are said to

be ordering new, wider, chairs to fit

their supersized customers. Customers

go to the restaurant that has the

chairs to fit them.

Why didn't the " pack of cards " measure

catch on? The USDA recommended years ago

that Americans should limit their meat

consumption to a piece of meat the size

of a pack of playing cards and then eat

meat only three times a week.

I have a pack of cards near my dining

room table anyway and I regularly check

by eye when we have meat that my portion

is about that size. It usually weighs

in at about 120 grams or about 4 oz.

That way, everybody ordering an 8 oz

steak should know to eat half of it and

put the other half in a doggy bag.

Provided your " head-size " meal is mostly

vegetables, you should have just about

the right proportion but don't forget the

pack of cards. True to my " averaging "

principle, you could, of course, sit

there and eat a steak three times the

size of a pack of playing cards but for

the next 7 days you are a vegetarian!

> can't say i know really what all the

> nutritionists out there recommend. the

> *limits* recommended by my dietician

> are really a range, so there's

> flexibility. actually, i find it quite

> hard to eat all the carbs in my

> *allotment.*

Yes, me too. When I was diagnosed with

diabetes, my meals were mostly fat and

protein and my diet change was to try

to add carbohydrates to get to the

recommended 15/30/55 balance. Now years

later, I still have problems keeping my

protein intake down below 20e% and my CHO

intake above 48e%. It is not easy to do.

> but anyways, no, i am with you. as far

> as i know, my lifestyle really hasn't

> changed...i ate fairly healthy and so

> forth...all i've added are an injector

> pen and a meter.

My " lifestyle change " was what CAUSED my

diabetes, I am quite sure of it. I once

worked as a radio engineer in the field,

climbing hills on foot carrying equipment,

climbing antenna towers, on the move all

the time. I had regular checkups all that

time and my records show that my fasting

BG was always around 85mg% and I estimate

my food intake at about 2500 kcals/day.

Then I was given a desk job but kept on

eating exactly the same way. It took about

7 years but at the end of that time I had

gone up 4 or 5 pants sizes, had a belly

and therefore insulin resistance, ignored

my physician's orders to cut down on food

and get in some serious exercise - and in

the end showed up with an HbA1c of 13% and

a full-blown diabetes type 2.

Lifestyle change works both ways!

> oh that is very interesting. hadn't

> heard of repaglinide.

Repaglinide is the active ingredient of

what is sold in the US as " Prandin " , in

Canada as " Gluconorm " and in Europe as

" NovoNorm " .

> there is down and then there is down,

> so to speak...

Yes, it is probably better to give a

numerical range instead of talking about

high and low, up and down. One person's

down could be another person's up! You

can read people here who believe that

a 180mg% is horribly " high " and others

with their 250s who would be glad to

have it!

Regards

[Guest guest]

hi derek!

> > well it is very interesting about

> > the averages thing. where i go,

> > they look at the HbA1c average,

> > but also the patterns throughout the

> > day ... the averaging can disguise

> > numbers that aren't really in control.

>

> Sure, but that is a different matter.

> I believe you will find that they are

> looking for signs of deep hypos that

> might be masked by a number of post-

> prandial highs.

that's true. and i think the point. it is something to watch out for.

i do *human performance measurement* (haha!), but one of the things

is the *key results* you focus on really shapes outcome. if one only

emphasized quarterly A1cs, that would be iffy.

frequent testing has been shown to significantly reduce risk of

complications. there is also a another set of *key results* called

the *ABCs of diabetes* - A1c, blood pressure, and cholesterol - that

gives a better picture of overall health and risk for diabetics than

the A1c average alone.

of course, one does have to weigh the personal costs and benefits of

all the possible activities one could embark on to manage diabetes.

but i digress a bit, here. i believe our topic was hard limits meal-

by-meal or not, yes?

> Yes, I have heard about that. But that

> is just another symptom of unbridled

> capitalism! There is no incentive for a

> restaurant owner to care a hoot for the

> health of his customers - all that

> matters is the bottom line! Talking

> about the " bottom line " , we have heard

> a lot over here about the boom in the

> US restaurant fittings industry.

> Restaurants all over the US are said to

> be ordering new, wider, chairs to fit

> their supersized customers. Customers

> go to the restaurant that has the

> chairs to fit them.

what a lark about the chairs! isn't that just so pathetic?

it's so strange to me that mounds of food equals value in anyone's

mind, would make a restaurant more attractive.

> Provided your " head-size " meal is mostly

> vegetables, you should have just about

> the right proportion but don't forget the

> pack of cards.

if only! i swear, had a meal out recently, the veggies were no more

than garnish.

> Lifestyle change works both ways!

no joke, eh?

but on the subject of *restrictive lifestyles for health,* i do

think it hurts to view one's self as an invalid, to *limit* one's

self or let others impose such limitations on you. i do believe one

should just think *normal and healthy.* in a contrary way, it can

backfire: expect doom, get doom.

> > oh that is very interesting. hadn't

> > heard of repaglinide.

>

> Repaglinide is the active ingredient of

> what is sold in the US as " Prandin " , in

> Canada as " Gluconorm " and in Europe as

> " NovoNorm " .

hmm. prandin. ok. have heard of it, but not often.

i imagine, though, none of the oral meds are really adjustable for

individual meals?

> > there is down and then there is down,

> > so to speak...

>

> Yes, it is probably better to give a

> numerical range instead of talking about

> high and low, up and down. One person's

> down could be another person's up! You

> can read people here who believe that

> a 180mg% is horribly " high " and others

> with their 250s who would be glad to

> have it!

if only one could pick! i have heard so many recommended

ranges...what a mess. just learned of yet another set, based on the

type of meter you use.

crazy!

cheers,

rach