Why Aren’t We Having a Meaningful Discussion About Carbohydrates?

As a person with diabetes (type 1 diabetes), my primary goal is to keep my blood sugar in a healthy range (for me that is 65-140 mg/dl).

There is only one thing that consistently causes me to go above that range.

It’s carbs.

Now, I know there are many other factors that can cause blood sugar to rise: stress, illness, allergies, exercise, lack of sleep, menstruation … the list goes on.

But let’s focus on the one overwhelmingly clear and incontrovertible variable that causes blood sugars to rise. It’s carbs — the one variable we can actually control.

So, Why Not Just Eliminate Carbs?

I’ll start by acknowledging that we’re in an undeniably tough spot: with the industrial food supply system, carbs are everywhere and hard to avoid.

While we no longer have to spend time preparing food from scratch with real ingredients — convenience! — we must instead contend with food that is mass-produced in the most efficient, profitable way possible: using government-subsidized corn products.

It’s no surprise that there are 415 million people with diabetes on the planet today (and counting!). Extremely cheap corn sugar calories have been introduced into nearly every single processed food product on the planet.

From yogurt to salad dressing to canned soups to tomato sauce — most of us have learned (often the hard way) that many everyday foods pack a surprising carb punch that can send our blood sugars soaring.

But what about all the not-so-surprising carb-loaded foods that we continue to eat?

Bread, cereal, pasta, rice, french fries... Armed with our meters and meds, we navigate nutrition facts, reflect on experience, make quick calculations, and hope for the best, right? 

Why? It's carbs.

Technology

So much of the diabetes technology we use today — blood glucose meters, CGMs, insulin pumps, rapid-acting insulins, fast-acting glucose, glucagon, etc. — exists primarily to deal with the consumption of carbohydrates, the subsequent rise in blood sugar, insulin overdose, and the subsequent drop in blood sugar.

Believe me, I’m appreciative of all of the progress that’s been made and I understand the value of these tools.

But we must admit: the technology is far from perfect and can be downright cumbersome. Meters, pumps, infusion sets, syringes, sensors, tubing, tape, batteries, site rotation, kinked cannulas, air bubbles, scar tissue, lipohypertrophy, incessant alarms... Not to mention, some of it can be prohibitively expensive!

So how do we decrease the burden of diabetes, improve blood glucose control, and reduce our dependency on all this stuff? What’s causing that dependency in the first place? It’s carbs.

Another Approach

For me (and many others), a dramatic reduction in carbs has eliminated most of the risks and everyday frustrations of living with diabetes.

Few highs because I've nearly eliminated the primary cause.  Few lows because I am not making carb counting errors and overdosing insulin. (Let’s face it, carb counting is hard and no one gets it right.)

My routine: I eat a low-carb pescatarian diet and exercise regularly. I check my blood sugars 8-10 times a day using a handheld blood glucose meter. I inject 19 units of Lantus (basal insulin) every night, and no Novolog (bolus insulin) during the day unless I eat carbs.

The numbers don’t lie: A1c = 5.9%; 30 day Average BG =104 mg/dl, 17% variance. (Check your numbers here.) I sleep well at night and I feel great during the day. And I don’t worry about complications because I know that I’m doing everything I can to prevent them.

It's not always easy — I feel tempted just like anyone else. And I’m not always perfect — when the mood strikes me, especially on business travel, of course I've thrown caution to the wind and gone for that grilled cheese and fries.

Yum! Life is to be lived! But each and every time I do it, I end up out of range, taking extra doses of insulin, and further correcting in one form or another. It's just not worth the effort, anxiety, and frustration - which frankly I know we all can understand.

And one moment of impulsiveness doesn’t derail me. I make sure to consider the no carb option and get it right the next time. And, believe it or not, it really does get easier over time. Because the bottom line is, there's only one thing that really makes it hard. It's carbs.

We are in control.

We have the power of choice.

We can do this.

Why are so few willing to step up and just say it with confidence?

• Eat fewer carbs and you will not be high as often.
• Eat fewer carbs and you will not need as much insulin.
• Eat fewer carbs and you will not be as at risk for lows.

Reducing carbs is proactive! It puts you in control. You reduce blood sugar variability by preventing it in the first place, rather than attempting to regain stability after a carb-spurred disruption has already begun.

We all know it. And in most — if not all — other aspects of our lives, we proactively avoid known risks. We wear seat belts, we lock our doors, we avoid dangerous neighborhoods, we don't smoke, we don't leave young children home alone…

So why carve out an exception just for carbs? We were all told the day we were diagnosed, “you can live a long, healthy and normal life if you manage your diabetes.” And, this is 100% true. We know that managing diabetes well means taking control of the inputs (food, exercise) and dealing with the outputs (blood glucose).

You can pay for it up front (not eating as many carbs), or you can pay for it later (enduring extreme highs and lows and risking serious complications). These choices are entirely within our control.

But you say, “I like carbs!” “I want to be normal!” Well, we all do, but which normal do you like more?

The carbs and all the gear, incessant alarms, anxiety, frustration, insecurity, midnight meals, sleepless nights, and ever-present fear of complications? Or, eating low-carb? The choice was easy for me. It's not carbs.