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Diabetes Disaster Averted #43: Carbohydrate Education

A new patient who was diagnosed with diabetes last year became my patient after his insurance required a change of clinicians. He is very active, watches what he eats and how much, but still his labs show otherwise. He was frustrated that even after exercising every morning, and eating very little for the last three months, his recent labs values showed an increase in A1c from 6.9 to 7.8. His glucose readings were running in the 255-305 range….

He was confused and tired of his disease and now had started taking alternative medicines to solve the problem. I know he is very health conscious, so it was alarming to find that his blood sugar had increased. He is currently taking metformin and he has started taking cinnamon pills and chromium.

I asked him to describe what his normal day looked like? What and when did he eat? He reported that he does 2 hours of physical activity first thing in the morning which is either swimming, running, walking, or golfing. Usually for breakfast he has two cups of tea (i.e., chai) which has whole milk, and eats two pieces of wheat bread toasted with margarine on it.

For lunch he had stopped eating regular food but takes fruits to work, and eats about three to four different kinds of fruits which include apples, plums, peaches, grapes, pears, any fruit that is in season. At dinner he has wheat pita bread with curry, and usually he gets hungry at night and he drinks fresh orange juice or eats a couple of pieces of fruit.

When I asked him if he was ever educated about carbohydrates, he said yes and told me that that his former doctor’s office had told him to restrict the carbohydrates and to avoid pasta, potatoes, rice, white bread, and anything white.

This patient and many others I have come across are almost completely unaware of which foods have carbohydrates. He had no idea that everything he was eating during the day was composed mostly of carbohydrates, and because of these choices he felt hungry the whole day.  I gave him much more detailed information on carbohydrates, making him aware that fruits have carbohydrates, and told him to incorporate more protein rich food choices in his diet which would allow him to cut the carbohydrates and will keep him full longer. Also, for snacking, nuts are one of the best options at night rather than orange juice.

Lesson Learned:

“Know the carbohydrates, count the carbohydrates, and cut the carbohydrates”

The patient first needs to know the carbohydrates which means we need to equip them with an easy way of knowing how much and what type of carbohydrates are in a particular food choice. This will make them more aware of what they are eating and patients can make more informed decisions. Once patients can start identifying carbohydrates then move to the second step of counting the carbohydrates, which will help them to realize how many carbohydrates they are consuming in a day and how far they are from their goal of carbohydrate consumption in a day. This process will help and motivate them to cut the carbohydrates in their meals and glucose monitoring pre and 2 hours post meals will allow them to see the results of their efforts.

Diabetes patients do not need to starve to reduce their blood sugar levels: rather they need to make the correct food choices.

Denise Palaguzza, NP
New Stanton, VA
 

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