Do I Need To Cut Out Sugar If I Have Diabetes? Why It’s More Complex Than You May Think
By: Lindsay Hodgson, MSN
It’s important to acknowledge that managing a chronic disease is really hard. There is never a one-size-fits-all approach. Conditions like diabetes are difficult physically and mentally because individuals must learn numerous new skills in service of their health.
Lifestyle interventions like diet and exercise are especially emphasized in conversations about managing diabetes. Yet, diet culture and healthcare are so intertwined that it can be challenging to use food and movement in ways that serve your self-care and are authentic to you. When we consider living a healthy lifestyle, there are many tools at your disposal: medication, nutrition, movement, stress relief, community, spirituality, and more. You have the autonomy to take care of your health in the ways that best suit your needs
The intention of this article is to provide information to clear up a common myth. Further, if you have personal experiences with diabetes it is an invitation to think about it a bit differently than you may have otherwise been told. It is essential that you honor your own needs by choosing the kind of diabetes management that works best for you, working with your care team, and seeking support on your relationship with food if you’re struggling. It can be especially challenging to have a peaceful relationship with food and trust your body if you have diabetes. If that’s you, you're not alone.
How Does Diabetes Type 1 Differ From Diabetes Type 2?
When someone without diabetes eats a meal or snack, the digested nutrients are absorbed into the bloodstream. This triggers the pancreas to release a hormone called insulin. Think of insulin like a messenger that tells your cells and organs how to use the food you eat, as it helps process and store nutrients. One of insulin’s main roles is to tell your cells to take in glucose sugars (the smallest unit of carbohydrates). So, when there is a lot of glucose in the bloodstream, insulin will be released. If insulin could talk to your cells it would say something like, “look, there is a lot of glucose in the bloodstream that you can use for energy, you better let it in so you can use it.” Insulin therefore helps ensure the cells in the body take in glucose they need to perform their functions. In turn, the blood’s concentration of glucose stays relatively constant. This process is more complicated in someone with type 1 or type 2 diabetes.
Type 1 Diabetes- What is it?
In type 1 diabetes, the immune system has attacked the cells in the pancreas that make insulin. It's an autoimmune condition where insulin secretion is next to nothing. When someone with type 1 diabetes eats a meal with carbohydrates, the bloodstream becomes saturated with glucose. However, there is no insulin released to tell the cells how to use it. The blood’s concentration of glucose stays high, and the cells get low on fuel because there is no messenger (insulin) to let the cells know to take in the glucose and keep the body in a state of harmony.
Because of this people with type 1 diabetes use insulin injections or devices that administer insulin so that their cells can use the glucose from the food they eat. A key thing to remember here is that insulin not only lowers blood glucose levels, but insulin as a medication serves as the missing link in the person’s metabolism. The injections of insulin are essential and life saving because they tell the cells what to do with the glucose so the cells don’t become low on energy.
Type 2 Diabetes-What is it?
In type 2 diabetes things are a bit different. The cells in the pancreas are able to make insulin, but the cells are less responsive to its message. Typically in type 2 diabetes insulin is made and the cells will respond to its message, but it takes more effort. For this reason people with type 2 diabetes might have higher blood glucose levels over time. Depending on the individual, oral medications that improve the cells’ sensitivity to insulin or insulin may be prescribed to manage the glucose levels.
So now that you know a bit more about diabetes, we can see that there is some disruption that happens with hormones that then affect blood glucose levels and the organs’ ability to use glucose to make energy.
Do I Need To Cut Out Carbs If I Have Diabetes?
Managing diabetes means trying to keep blood glucose levels within a person’s goal ranges through medications (like insulin and otherwise) and other lifestyle factors. In the medical and healthcare sphere, nutrition is understandably discussed often with diabetes.
People with diabetes benefit from having awareness of the carbohydrates in their meals and snacks because it allows them to make informed care decisions. People taking insulin for example count carbohydrates because their doses depend on the amount of carbs in the meal. Their bodies cannot internally regulate the release of insulin to exactly match its needs. But this doesn’t mean that they need to cut out carbs! Individuals who have diabetes still need carbohydrates to support their brain, body and red blood cells.
For example, if someone with diabetes had a doughnut from Mighty-O Dounuts and did nothing else, their blood glucose would likely rise because either there isn’t insulin being sent to the cells or because insulin is having trouble communicating with the cells. BUT, it’s different if someone with diabetes had a doughnut from Mighty-O Dounuts and had given the insulin dose they needed or followed their management routine in whatever shape that takes. Then, their blood glucose will mimic a “normal” response of rising and falling upon eating.
In summary:
We all need carbs (yes people with diabetes too!). Carbs are an essential nutrient among the energy we take in daily.
People with diabetes type 1 (and in some cases type 2) have the added challenge of carb counting or accounting for carbs in some way because the carbs they eat will inevitably affect their blood sugars.
People with diabetes can have difficult relationships with carbohydrates in particular. Diabetes forces you to pay attention to carbs for the sake of managing a health condition. It reinforces a sense of rigidity with carbs. If blood sugars go high after a meal it’s common to blame yourself for eating a high carb meal. You're more concerned about the composition of your meals and the carbohydrates. It is harder to be spontaneous and enjoy foods with carbs.
Yes, it’s a challenge to figure out a management style that works best. AND YET, eating intuitively with flexibility and joy are all totally possible if you have diabetes.
Do I Have To Cut Out Sugar If I Have Diabetes?
Sugar, while demonized in our culture at large, is especially demonized in diabetes spaces. But why? When foods are in a more simple sugar form, they are absorbed into the bloodstream more quickly because the body doesn't have to do very much work to digest them.
For diabetics this can mean that eating certain foods (ie foods with simple sugars) can increase in their blood glucose levels more quickly than foods with complex sugars. This can be really difficult for people with diabetes because there is so much fear mongering about keeping blood glucose levels “in range.” But the reality is this will happen in the context of any carbohydrate and this is normal and ok. Again, eating a lot of sugar without any medication or plan for a person with diabetes is not recommended by healthcare professionals because their blood glucose will be high, they won’t feel very well, and chronic high blood sugars are associated with blood vessel and kidney complications.
Eating foods with sugar (because sugar is a carb) alongside medication use means that someone with diabetes is able to eat the foods they want and manage their blood sugars. [You might like this talk about diabetes and this talk about diabetes and sugar to learn more]
It is also important to note that sugar can be life-saving for people with diabetes when blood sugar drops too low (a condition known as hypoglycemia).
So people with diabetes can eat sugar. Now what?
Normalize carbs! It is very common for all people, diabetes or not, to feel intense carb cravings when they restrict carbs. It is a cycle of someone depriving themselves of carbs, craving the foods they’ve restricted, feeling “out of control” around those foods (maybe after a binge), then experiencing a sense of shame or guilt that perpetuates more restriction, and then so it goes.
It’s impossible to get your blood sugars “just right.” People with diabetes are more prone to restricting carbs because eating carbs results in more variability in blood sugar levels. There are compelling reasons to restrict carbs, and yet doing so can easily lead to the restrict-binge cycle, wreak havoc on someone’s relationship with food and cause disordered eating, and disconnect them from pleasurable food experiences.
There are many variables beyond food that affect blood sugar, which certainly complicates diabetes management. However, having many “tools” can be an advantage when breaking free from disordered eating patterns. It may be a process of experimentation as you notice how your body responds to different foods that you have not eaten for some time. It may also be a process of trying new routines with diabetes management (as you consult with your provider) to allow you more flexibility with your food to manage your blood glucose (i.e. medication changes, trying new technology to monitor your blood glucose or administer insulin).
It will take a while to develop a more neutral association with carbs and time for it to come with more ease. Though it’s much easier said than done, having compassion and patience with yourself is important because you're focusing on both managing a complicated health condition and shifting your relationship with food.
Being diagnosed with diabetes can be overwhelming, confusing and scary. And, there is a plethora of misinformation out there about what you “should” eat to manage you blood sugars and diabetes. Remember that having diabetes does NOT mean that you need to cut our sugar or carbohydrates. While there is more awareness that has to go into carb intake based on medication doses, you can still experience a sense of freedom with food even with a chronic disease like diabetes.
Resources: See pg 595 “Carb intake”. Mahan LK, Raymond JL, Franz MJ, Evert AB. Krause's Food & the Nutrition Care Process. 14th Edition. St. Louis, MO: Elsevier; 2017.
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