Download 14 Common Questions About Diabetes

Q & A: Answers to Commonly Asked Questions
Is it true that I have to avoid all white foods?
Absolutely not! People with diabetes do not really need to avoid any foods, as long as they fit
into their prescribed carbohydrate-counting pattern. For instance, a large baked potato is 4
carbohydrate choices, which is what many people are allotted for their dinner meal. If you eat
that baked potato with meat, poultry, or fish and a small tossed salad, this meal would fit your
plan perfectly!
Why do I need to eat a bedtime snack every night? It seems it would just make
my blood glucose higher in the morning.
Depending on what type of insulin you take and the results of your self-glucose monitoring, a
bedtime snack is recommended. The bedtime snack is not what causes some people to have
high blood sugar in the morning. The glucose in your body comes from the foods that you eat,
but your liver releases glucose as well. People with diabetes either do not make enough insulin
to usher this glucose into the cells or their cells are resistant to the insulin that is available.
Sometimes morning glucose levels are high because the intermediate- or long-acting insulin
that a person uses wears off during the night.
Dawn phenomenon: This is when insulin resistance and glucose levels increase near waking
time. This is caused by certain hormones that are released in the body. This can show up as
high fasting glucose, or some individuals might need extra insulin to cover their breakfast.
Somogyi effect: This is when blood glucose rebounds after a person becomes hypoglycemic
while sleeping. However, this is not as common as was once thought.
If your blood glucose level is high all or most of the night, the problem is most likely that your
insulin is wearing off in the middle of the night. If your blood glucose is stable during the night
and then rises sharply before dawn, this is the dawn phenomenon. If you are hypoglycemic in
the middle of the night (between 2 and 3 AM), this is most likely the Somogyi effect.
You can help with the Somogyi effect by eating a bedtime snack that is rich in carbohydrates,
such as milk and crackers or yogurt with fruit, before bed. People experiencing the dawn
phenomenon should make their bedtime snack richer in fat and protein, such as cheese or nuts.
Check with your registered dietitian and/or certified diabetes educator to determine if you need a
snack at bedtime to help control your blood sugar.
Why do I count milk as a carbohydrate, but not cheese? Why do I count beans
as a carbohydrate, but not peanut butter?
Cheese counts as a fat, and peanut butter actually counts as a high-fat meat using diabetic
exchanges. Two tablespoons of peanut butter contains around 6 grams (g) of carbohydrate, not
enough to count. One ounce of cheese contains even less—about 2 g. For comparison, 1 cup
(C) of milk contains 12 g of carbohydrate and ½ C of baked beans contains about 20 g of
carbohydrate. A food that contains 11–20 g of carbohydrate counts as 1 carbohydrate choice.
Should I test my glucose 2 hours after I start eating or right after I finish
eating?
You should test your blood glucose 2 hours after your first bite of a meal. The American
Diabetes Association® sets your postprandial (after eating) goal at below 180.
What should I do if I am sick and do not have an appetite?
When you are not feeling well, usually your blood glucose is higher than normal. You may
need extra insulin when you are not feeling well, and you will want to test your blood glucose
even more frequently—every 2–4 hours. You should drink a good amount of clear fluids and
take your regular dosages of medicines. You may need to test for urine ketones when you are
ill.
Even though your blood glucose is high, you still need to consume carbohydrates. Try the
following suggestions:
 Juice
 Regular Jell-O®
 Freezer pops
 Sherbet
 Crackers
 Soup
 Toast
Contact your doctor if you have these symptoms:
 A fever for 2 days or more
 Diarrhea for more than 6 hours
 Vomiting for more than 6 hours
 Glucose levels that are way out of range
 Moderate or large urinary ketone levels
Is it OK to eat sugar?
Yes, you can eat sugar. One tablespoon of table sugar counts as 1 carbohydrate choice. You
usually do not need to purchase sugar-free foods. Sugar-free foods often have as much
carbohydrate as the regular versions, which generally cost less and taste better. However, you
can benefit by choosing some sugar-free, diet, or reduced-sugar products.
Here are some good choices that really are lower in carbohydrates in the sugar-free, diet, or
reduced-sugar form:
 Fruit juices
 Sodas
 Jams
 Jellies
 Jell-O
 Hard candies
 Freezer pops
Look at the Nutrition Facts label closely when deciding whether or not to purchase the sugarfree or reduced-sugar version of a food.
Can I save my carbohydrate choices for a special event?
This usually is not OK to do, but a few exceptions do exist. If you are going out for breakfast,
and you know that you will eat lunch within 4 hours of breakfast, you can possibly add your
mid-morning snack carbohydrates to your breakfast meal. If you are going out for dinner and
you know that you will eat this meal within 4 hours of lunch, you can possibly add your midafternoon snack carbohydrates to your dinner meal. Other than these two possible scenarios,
you should never “save” your carbohydrates for later.
Is it true that insulin causes weight gain?
On rare occasion, individuals who have just begun to use insulin may gain some weight. This
is possibly because of a few things. People who become hypoglycemic too often have to eat to
normalize their blood glucose frequently; this could lead to weight gain. People who use
insulin may gain a small amount of weight, because they are able to better utilize the food that
they eat. Lastly, before beginning to use insulin, sometimes individuals are dehydrated, which
can make it appear that they have gained weight, when actually it is that they are no longer
dehydrated.
Someone told me that you can subtract the fiber from carbohydrates before
counting them. Is this true?
If a food contains at least 5 g or more of fiber/serving, you can deduct half of the grams of fiber
from the carbohydrate. For instance, a food that contains 36 g of carbohydrate would normally
count as 2½ carbohydrate choices. However, if that food contains 6 g of fiber, you would
subtract 3 from 36 to get 33 g of carbohydrate, which only counts as 2 carbohydrate choices.
Can I really eat as much meat as I want?
Meat does not contain carbohydrate, so as far as your diabetic diet goes, unless the meat is
heavily breaded or contains a large amount of bread crumbs, you do not need to worry about it.
However, for many reasons, it is best to not overdo it on meat. In general, you should limit
yourself to about 4–6 ounces of lean meat or other high-protein foods each day.
Is it true that carrots are really high in sugar?
Carrots are not considered a starchy vegetable. This means that you would need to eat 3 C of
raw carrots or 1½ C of cooked carrots before they would count as 1 carbohydrate choice.
The only starchy vegetables (½ C=1 carbohydrate choice) are:
 Beans (not green beans, but kidney beans, baked beans, black beans, etc)
 Sweet potatoes
 White potatoes
 Winter squash
 Corn
 Peas
Did eating too much sugar cause my diabetes?
No, it did not. Genetics and still unknown factors cause type 1 diabetes. Overweight is a
serious risk factor for development of type 2 diabetes, and certainly eating too much sugar can
lead to weight gain, but the sugar itself did not cause your diabetes. Insulin resistance, which is
what leads to type 2 diabetes, sometimes is caused by a defect in the insulin receptors on your
cells or the insulin may bind to the receptor, but the cells do not interpret the signal to
metabolize the sugar. The truth is that scientists still are trying to figure out what causes
diabetes, but we know that it is not sugar consumption.
What is prediabetes?
Prediabetes is when your blood glucose levels are higher than normal, but they still are too low
to receive the official diagnosis of diabetes. The good news is that you can fix this and prevent
diabetes from developing.
At this stage, it is necessary to see a dietitian to learn about the carbohydrate-counting diet, and
you must follow all of your doctor’s advice. You also want to make sure to exercise several
days a week and to regularly self-monitor your blood glucose levels at home. Take advantage
of this situation to better your health.
What is the glycemic index? Should I use it to manage my diabetes?
The glycemic index (GI) is a numerical index that ranks carbohydrate-rich foods according to
their effect on blood glucose (ie, blood sugar) levels—the higher the number, the greater the
rise in blood glucose. Pure glucose is used as a reference point and is given a GI of 100.
However, your body’s glycemic response (ie, conversion of carbohydrate into glucose)
depends on both the type and amount of carbohydrate consumed. The measurements are not
very precise. Ripeness, storage time, type of processing, location of growth, variety,
preparation method, and the types of foods eaten with a particular food may affect the GI.
Everyone’s metabolism is different, and how you are impacted by eating a food is possibly
very different from how another person is impacted. Generally speaking, if you are counting
carbohydrates and eating a high-fiber diet, you do not need to concern yourself with the GI of
foods.
References and recommended readings
American Dietetic Association, American Diabetes Association®. Exchange Lists for Meal
Planning. Chicago, IL, Alexandria, VA: American Dietetic Association, American Diabetes
Association; 2003.
Mahan LK, Escott-Stump S, Raymond S. Krause’s Food and the Nutrition Care Process. 13th
ed. St Louis, MO: Elsevier Saunders; 2012.
Review Date 6/12
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