Carb limits per meal (was: Skyrocketing)

[Guest guest]

> 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.

There might well be a problem in

getting people to think in terms of

averages. I suppose if you tell most

people that they can have as much

carbohydrate in their meals as they

like so long as the average per

running week does not exceed 70 grams

per meal, they might have a problem

keeping track of it.

But it can be done a different way:

If patients are eating the recommend-

ed way (mainly fruit and vegetables

and whole-grains) they will automati-

cally get approximately the same

energy from carbohydrates as from fat

and protein combined, i.e. 50% energy

from carbohydrates.

If the patient then takes on energy

(i.e. eats) at the rate of, for example

2000 kcal/day average they know that

they are going to get half that from

carbohydrates which is 1000 kcal/day.

Divide that by 4.2 kcal/gram and you get

an average of 238 grams carbohydrates

per day.

Obviously, with three meals a day that

makes an average 80 grams carbohydrate

per meal. With 2 meals a day that would

be an average of 120 grams per meal and

with 4 meals per day it would be an

average of 60 grams per meal.

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.

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.

> ... 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.

> i mean, for example, some type 2's

> manage without any medications at all.

Sure, I did for a long time. It crept

up on me quite slowly, though. I was

getting quarterly medical checkups for

my work and my physician at the time

warned me that with my weight slowly

increasing after I switched from field

work to a desk job, I should change my

diet and exercise regularly. I did not

stick to it and my weight increased

some more and I had to go onto oral

medication. The dose of oral medication

varies according to the severity of the

diabetes.

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.

> ... 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.

> 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.

And that is either because the hormones

are not being produced in a sufficient

amount or the cells are not responding

to what is there.

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.

> '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.

Regards