“Do you like French fries?”
I looked at the nutritionist blankly. It had been a long day.
She smiled hopefully. “You can still eat French fries!”
The truth is, French fries were not my main concern the day I was diagnosed with diabetes. I didn’t stop at McDonald’s on the way home from the clinic.
Much has changed for diabetics since the discovery of insulin in 1922. I can eat French fries, so long as I inject myself with enough insulin. Though my pancreas is about as useful as an appendix, the development of insulin therapy has enabled me to eat, well, whatever I want.
That sounds too good to be true. So naturally, there is a catch.
In the wacky, weirdly controversial world of diabetes management, we can at least agree that carbohydrates raise blood sugar and insulin lowers it. So I can eat whatever I want, but the more carbohydrates I eat, the more insulin I’ll inject to keep my blood sugar level safe. There’s no getting around that. More carbohydrates, more insulin.
The American Diabetes Association (ADA) recommends 45-60 grams of carbohydrates per meal as a reasonable intake for people with diabetes. That’s the equivalent of a bagel per meal. So I should just eat the carbs, add a dash of insulin, and everything will be fine, right?
As anyone carting around an insulin pump or pen knows, it doesn’t work that way. There are so many factors that impact our blood sugar levels. There’s caffeine, and sleep, and exercise, and fat content, and stress, and hormones, and other mysterious powers that we can never quite track down to the source. Simply counting carbs doesn’t work. Our diabetic bodies are more complex than that.
Insulin can provide the stability that we need to avoid serious diabetic complications, but the question of how much insulin we need is impacted by how many bagels we eat. Or whether we choose to eat a cupcake at a birthday party. And because we never really know exactly how much insulin to take, because our bodies are fickle, eating food that requires more insulin is just asking for trouble.
It’s a numbers game, as Dr. Richard Bernstein explains in his book, Dr. Bernstein’s Diabetes Solution. A larger dose of insulin means that the same miscalculation yields a larger absolute mistake. You might be 10 units off the mark instead of just a couple. Repeated regularly, this practice will cause more dangerous highs and lows. So why do we voluntarily increase our risk? With our understanding of these basic facts, why do many doctors and the American Diabetes Association encourage us to rely so heavily on insulin? At the least, if we are going to increase our risk, we should acknowledge that we’re doing it and assess whether it’s really worth it.
While everyone requires a different amount of insulin, we all can benefit from minimizing our reliance on insulin. Whether you use 200 units or 20 units daily, if you can tug that number down even slightly, you’ll be playing with fire that much less.
So, 45-60 grams of carbohydrates per meal? A heap of pasta? A slice of pizza? Do we need that? Sure, we can eat it. But should we?
What if we do? We’ll send more money to the drug and device companies that rely on our carbohydrate consumption for profit. We’ll have more medical emergencies. Hypoglycemic seizures are more socially awkward than declining a birthday cupcake. We’ll go through more needles and collect more scars, try as we might to rotate injection sites.
We can eat whatever we want, but because we have diabetes, that freedom comes at a distinct price. (A price, it’s important to note, that’s different for each diabetic.) Why, then, are we encouraged to eat carbohydrates without seriously considering other options? Is it because we love carbohydrates? Is that why the ADA makes moderate recommendations that lead to mediocre health outcomes? These recommendations reinforce the notion that an alternative lifestyle – one free of fries – would be a countercultural, monastic deprivation and that our love of carbohydrates is necessary and good.
If our health care providers won’t direct us to restrict our carbohydrate intake and minimize our reliance on insulin, we can do it on our own. As diabetics at risk of serious medical complications, is this really such an extreme option? Once you get started, it’ll just make sense to choose a nibble of deliciously dark chocolate over a Twix.
But there is another way, one that’s safer and might feel better, even empowering. We can show doctors and advocates that diabetics are not all addicted to carbohydrates. Those of us who are can break free of the cycle of consumption and injection. That alternative approach to diabetes management – one that involves more restrictions and fewer injections – is ours to choose.