Totally confused - count carbs or calories

[Sheila of Eskdale]

I have been doing lots of reading about controlling blood sugar and am getting confusing and conflicting messages about whether all calories count or whether its just carbohydrate calories. Lots of information giving the general "fat is bad for you" , "just eat a normal healthy diet" type advice. It seems there's gadgets/apps to count carbs, but other things suggest "a low fat diet helps control blood sugar" and something about fatty food affecting digestion hence stopping your insulin from working, which I don't understand. Is it because the pancreas is too busy producing digestive juices to produce insulin?

Basically I need to know when I'm trying to get to the bottom of why my Dad's blood sugar levels are high, do I just look at carbs he's eating or total calories including fat.

For those that haven't read my other posts, he also has Alzheimers so trying to control his diet is very difficult as he has no comprehension of diabetes and can't keep track of what he has consumed. So this is a sort of crisis control situation, sensible advice "normal healthy diet" and take plenty of exercise just doesn't work.

 

[Sally71]

Hi Sheila

I have been reading some of your posts and am so sorry to hear about the situation you are in! Well done for sticking with it and trying so hard to understand everything, I know you love your Dad but it sounds sooooo hard!

Anyway, in a nutshell, only carbohydrates will make blood sugar go up, some make it go up quicker than others (sugars are quicker, starches are slower, that's what the high/low GI thing is all about). Calories are something else entirely and are only really interesting if you are trying to lose weight.

Where fat comes into it is that it slows down digestion so it will take longer for the blood sugar rise to happen (think in hours rather than minutes). My understanding though is that BG will still eventually go up. To be honest though I think I would send myself completely batty if as well as carb counting I also had to work out how long each food item would take to be digested and whether there was any fat present to slow it down even further. So I tend not to worry about that too much and usually it works for us!

So I would suggest to start with just look at the carb content of everything your dad is eating, if you are looking at packets you need to look at Total Carbohydrate content, not the Just Sugars bit or the calories. Most packets will show it per 100g so that you can compare different items to see what is higher or lower. Then when you start to understand that a bit better maybe you could progress to understanding more about high/low GI foods. But what with everything else you have to deal with I would take it one step at a time and don't worry about that at first.

Hope that helps 🙂. {{{{hugs}}}}

 

[Vicsetter]

In simple terms carbs=sugar. The more complex a carb the slower it gets converted to sugar. Fat will bind to a carb and slow down the conversion. but everything you eat that is digestible will get converted to glucose eventually.
In order to improve our blood sugar readings you need to reduce the quantity of simple carbs that are eaten. Be aware that fruit contains sugar in the form of fructose and shouldn't be eaten in quantity.

A lot of so-called dietary advice is based on 'healthy eating' and not on blood sugar control. You will also find that dietary advice changes over the years. Diabetics used to be told to eat plenty of carbs and eat 'healthily', this advice is still given by people who have not caught up with the latest thinking.

It must be a nightmare dealing with your father, I can only suggest you try gradually changing things. Make sure he doesn't take any sugar. Replace white bread with grain bread (a lot of D's like Burgen linseed bread). Porridge or scrambled egg for breakfast. Avoid wheat products and rice.

Good luck

 

[Sally71]

Me again - just had another thought!

If you are interested in buying an app or a book then Carbs and Cals is excellent, you can get it as Apple iOS or Android apps, or as an actual book if you aren't very technically minded. It contains lots of lovely pictures of all of the most common foods with carb and calorie info (it's only the carbs that you need to look at). It will help you with things like fruit, which you are always told is healthy, and indeed fruits do contain fibre and lots of useful vitamins, but they also contain lots of natural sugar which will make BG go up!

Yes a balanced diet is good but you need to understand exactly how it will affect your dad's blood sugar.

 

[Pumper_Sue]

Basically I need to know when I'm trying to get to the bottom of why my Dad's blood sugar levels are high, do I just look at carbs he's eating or total calories including fat.

.

Hi Sheila, it's the carbs you need to keep track of. Which in your dad's situation will be very hard.
My suggestion would be to put lower carb stuff in the kitchen if he snacks a lot and the rest in the freezer out of sight. So meat cheese eggs veg etc in the fridge so he can munch as he pleases. Does your dad like nuts and more to the point is he safe eating them?
My dad has vascular dementia so can appreciate where you are coming from.

 

[Sheila of Eskdale]

Thanks for all the replies, Its great to get so much helpful advice in such a short time.
I wasn't going to get an app as our problem is knowing what he is consuming and controlling it. Unless my mum actually watches him 24 hours it can't be done. There's an issue that the kitchen is downstairs from the living area and she has bad knees so can't keep going down to see what he's eating and also he drinks and snacks in the night.

He also has very few teeth left so that limits what he can eat. We're already on brown bread rather than white. We suspect that most of the problem is the amount of milk he has and snacking on sandwiches.

 

[Pumper_Sue]

As I suggested in an earlier post use lactose free milk it doesn't taste any different to semi skimmed milk. If things have to be in the same pkt/bottle for him then transfer the lactose free to an ordinary milk carton.

I can't remember what treatment your dad is on. If on insulin perhaps discuss with the Dr or nurse about increasing his background insulin a bit to help cover the food consumption.

 

[Sheila of Eskdale]

Sue, I'll look into lactose free milk.
We battled for a year to get the doctor to put him on insulin, his sugar levels were high but the doctor said we had to control it with diet. He seems to have no concept that the only way we could do that would be to get a stronger, lockable door on the kitchen. He just doesn't get that my Dad can't remember anything and can not understand why he has to be careful what he eats and drinks. My Mum does the insulin injection and she sets it according to the sugar levels. I don't know if its that his sugar levels are getting high through the day before the injection and whether he'd be better on something that is injected twice a day. I'll maybe try discussing it with the pharmacist as the doctor is pretty useless.

 

[Bloden]

Had a look at lactose-free milk at supermarket today. It's 3g carb per 100ml, and normal milk is just under 5g carb per 100ml. Not such a big difference really, if you don't drink much, like me. But maybe a bit different if you drink lots, like your dad, Sheila. Good luck with your dad. He's lucky to have you.😱

 

[Copepod]

If a person is overweight, then reducing body weight by counting calories, both in / eaten and out / exercised, will help reduce insulin resistance. If overweight, counting carbohydrates is also important. For someone who doesn't need to reduce body weight, then concentrating solely on carbohydrates is the appropriate strategy.

 

[Sheila of Eskdale]

Just as an update on this. We're not getting very far! His glucose levels were up one morning even though he hadn't had any milk during the night. I suspect his liver is releasing glucose and if the liver is misbehaving for no apparent reason and affecting glucose levels, I'm not sure there is anything we can do about it.
He does need to loose weight as well, and this is apparently important for his heart too.

Due to a complete lack of exercise apart from trips to the kitchen and toilet, I doubt that GI is all that relevant as the energy isn't getting used up. That's not to say that we can completely ignore GI, just that I suspect advice from the diabetic nurse that wholegrain bread is fine, isn't actually correct. It may be better than white bread but the carbs are still getting absorbed and not used. Anyone have any thoughts on this?

I can find information about the percentage of calories that should be from each group (simple carbs, complex carbs and fat) but I'm not sure how applicable this is with someone that is so sedentary.

 

[Northerner]

Hi Sheila, the main point about GI is that the energy is released slowly, so the rise in blood sugar levels takes place more gradually, over a longer period of time, instead of spiking the levels up high very quickly then dropping them down quickly afterwards which often makes people sleepy and/or hungry again sooner. Spikes can also be more damaging over time.

Sorry to hear that progress is slow. I would imagine that a mostly sedentary person would need less calories than an active person, but I'm not sure if there is a formula for calculating it. I hope things do improve for you all 🙂

 

[DeusXM]

Given the issues you've been having re:snacking, and also the issues with him being sedentary and having an impaired ability to control his blood sugar, my gut feeling is you need to start looking at removing carbs from his diet quite significantly.

How easy that will be, I don't know. But I think you're absolutely right on the white vs wholemeal bread - regardless of the GI, it's still too many carbs for his system.

If weight loss is important, cutting carbs is crucial. Carbs stimulate an insulin response. Insulin blocks body fat metabolism and encourages fat storage. No-one can lose weight without reducing their carbohydrate intake - even those who lose weight on a non-low carb diet do so because they are eating fewer carbohydrates than they were before (even if the carbs might comprise a larger percentage of their overall diet).

Most of those on low carb diets will generally split their food ratios as 60/20/20 for fat/protein/carbs - some might actually do nearer 70/20/10. There is also a school of thought that runs you should have 12g of carbs for breakfast, 6g for lunch and 6g for dinner and everything else should primarily be fat with some protein.

The question is how easy it will be to swap out the carby parts of food that he currently eats. There isn't really a low-carb direct alternative to sandwiches - you end up having to go down the road of low-carb wraps, which are very expensive and difficult to find outside of specialist online stores. So really, you have to start looking at more radical alternatives - salads, meats with steamed veggies, omelettes etc. which I'm guessing might not be appropriate for your situation. Sorry I can't be more helpful right now!

 

[DeusXM]

the main point about GI is that the energy is released slowly, so the rise in blood sugar levels takes place more gradually, over a longer period of time

True, but my personal experience of GI is that you're really talking about a 1 hour total covering period, ie. the difference between a high GI food and a low GI food is that high GI will spike me in 15 minutes while low GI will spike me after about 45 minutes to an hour. All of which renders GI completely irrelevant for my personal blood sugar management.

The blind faith many dieticians have that low GI raises glucose nicely and gradually can be extremely misplaced...particularly as they tend to forget even bolus insulins act more gradually than any foodstuff. The only foods that have the mythical and treasured 'gradual' effect on my blood sugar are precisely the ones dieticians keep saying I should eat less of ie. fats and proteins.

 

[Hanmillmum]

It may be easier to reduce his portion sizes of his *normal* foods bit by bit as a means of reducing his carb load each meal, hopefully to minimise any confrontations or resistance to change from him if he doesn't completely comprehend the need to manage his diet due to having diabetes.

Are these sites any help? There isn't a lot of info out there despite strong links between dementia and diabetes :-/

www.trend-uk.org/documents/Diabetes_And_Dementia_Guidance.pdf‎

www.northerntrust.hscni.net/pdf/Eating_well_with_dementia_leaflet.pdf‎

I can't seem to get the first link to work now, if you google "dementia and diabetes management" it is there on the trend uk.org site (sorry)

 

[Sheila of Eskdale]

Thanks for the answers, I think in my father's case we need to go for reducing carbs and replacing with fats. That'll be cheese sandwich instead of peanut butter, probably more protein and less carbs at meals (he'll only eat so many vegetables).

Hanmillmum - I have emailed various diabetes organisations and various dementia and old age organisations asking for advice in dealing with both conditions. None of them have given me any help whatsoever, they all see them as two unrelated conditions. Its startling that these documents are available and the respective charities know nothing about them.
There's lots of good advice in those documents, especially the NI one. However, as with most advice on dementia they seem to assume that people with dementia are either only mild and can take care of themselves with a little help, or incapable and need everything done for them. What they don't seem to get is that some people don't have the mental capacity to manage their life correctly but still insist on doing lots of things. In my Dad's case he keeps helping himself to snacks and milky coffee, its not just the odd one it can be lots. So advice about giving them small portions doesn't really help. Also the NI booklet seemed to focus on hypoglycaemia whereas our problem is in the other direction. Its not even as simple as leaving suitable food out on the table as he won't necessarily use what is in front of him. If there's a carton of fruit juice open in the fridge he can still go to the store room and get a new one, his thinking is erratic and illogical.

Part of his snacking is probably boredom but we can't get him to do anything to keep him occupied, he doesn't like much on TV and finds the background music makes a lot of things hard to hear. He won't play games of any sort, such as puzzles etc. He can't concentrate enough to read.

 

[Sally71]

Sheila it is heartbreaking to hear of your struggles. I can't believe that the organisations you have tried are so little help, they might be unrelated conditions but obviously that doesn't stop someone being unlucky enough to get both at the same time!

Could you try hard boiled eggs or meat as alternative sandwich fillings? Things such as ham, salami, corned beef etc are so low carb we don't bother to count them. And as you say cheese is good too. And try to use thinly sliced bread. Other than that I don't know what to suggest but I think you are right, in your situation the only thing you can do is try to keep your dad's cupboards stocked with as much low carb food as possible. Good luck 🙂