"One point away from being diabetic"

Q. I was recently told by my doctor that I am 0.1 point away from becoming a diabetic. Needless to say, I'm worried and I started changing my diet and lifestyle to get me through this. But I am getting really confused on what I can and cannot eat. I was watching carbs, then learned I have to start watching the starch in foods, now I’m reading about eGL and have no idea what to eat. 

Question #1: Can you tell me how my body processes food and turns it into sugar? I mean: if I eat something with 2g of sugar, 15 carbs and with an eGL of 5, what am I actually eating in a sugar count?

Question #2: Do I really need to worry this much or just avoid junk food, fast food, potatoes, rice, grain products, start getting some exercise to loose weight and call it a day? 

A. I'm guessing that the number your doctor is referring to is your fasting glucose level.  This test measures the amount of glucose in the blood after you've gone 8 to 12 hours without eating anything and it's commonly used to screen for diabetes. The cutoff for declaring someone diabetic (often around 110 mg/dL) is abitrary, of course.  Obviously, if your blood glucose is 109.9, you are no more or less diabetic than if it were 110.1.  The thing is that it sure got your attention.  And if being "one point away from diabetic" motivates you to take action, all the better!

I can understand why you feel overwhelmed. When all the terms and concepts are brand new, it can be confusing.  As long-time readers of this blog will tell you, learning about diet and nutrition can be a life-long pursuit. In the meantime, let me see if I can clarify and simplify things a bit for you.  Of course, this is just the big-picture view, but it sounds as if that's what you could use most right now.

Type 2 Diabetes: The Big Picture

Type 2 diabetics and pre-diabetics are well-advised to eat a "low-glycemic diet." That simply means that you choose foods--and portion sizes!--that prevent large spikes in your blood sugar levels. This not only helps prevent the progression of the disease but can actually help you get back to a non-diabetic state-especially when accompanied by needed weight loss.

When you're trying to eat a low-glycemic diet, you want to consider both the quality and quantity of the carbohydrates you choose. Counting the number of grams of carbohydrates in your meals is simply a way to manage quantity.  Think of it as a budget: You have a certain number of grams of carbohydrates to "spend" and you count to ensure that you don't go over your budget.

You could stop right there. Many diabetics do. But a more sophisticated approach is to pay attention to the quality of carbohydrates as well as the quantity.

The quality issue refers to how fast those carbohydrates are converted into blood sugar. Carbohydrates break down into three basic categories: starches, sugars, and fiber. Many carbohydrate foods will be a combination of all three.  Foods containing more sugar will cause a higher and faster rise in blood sugar than foods that are high in fiber.  (Starches are somewhere in between.)  

For best results, you want to spend your carbohydrate budget on foods that are higher in fiber and lower in sugar.  One way to do this is to use the estimated Glycemic Load as a tool.  Instead of counting carbs, you could budget your meals according to their glycemic load. In this way, you'd be taking into account both the quality and quantity of the carbohydrates in your diet.

Think of it like this: Counting carbohydrates is like sticking to your budget of $50 for a new sweater. Counting eGL is like shopping for the best quality sweater you can find for that amount of money. 

Type 2 Diabetes: The Close Up View

I encourage you to explore our Type 2 Diabetes Resource Center for more tools and information that can help you make sense of all of this and start putting it into action. In the meantime, let me briefly address your questions: 

What should you count?

Both starches and sugars are broken down into glucose and absorbed into the bloodstream.  The difference is that sugars are absorbed more rapidly than starches and fiber slows down the absorption of both.

For your hypothetical food containing 15g of carbs, 2g of sugar, and with an eGL of 5, you ask how or what you should count. You can choose to count carbs, and/or sugar, and/or eGL.

For example, you could set yourself a budget of 200g of carb a day. In that case, this food would count for 15.  In addition, you could limit yourself to 50g of sugar a day. In that case, this food would count for 2.  Or, you could have set a daily target of 75 for your eGL. In that case, this food would count for 5.

That's a lot of accounting! If you have the energy to pay that kind of attention to your diet, more power to you. But it may not be necessary, which brings me to your second question:

The Quick and Dirty Option

Do you really need to worry this much? I think there's a lot to be said for the common sense approach you've outlined: avoiding junk food and sweets (don't forget sweetened bverages), limiting your intake of breads, rice, and pasta, getting regular exercise and losing any excess weight. If you did all that, I think you'll be very pleasantly surprised at your next check up.

An Eye-opening Experiment

A few days of measuring and counting carbs or sugar, or looking up the eGL of foods can be extremely illuminating without having to be a life-long practice. You'll quickly see where the excess carbohydrates are coming from and learn how to estimate appropriate portion sizes.

Read More

Sugars and carbs and GI, oh my!

What's a low-glycemic diet?

Counting Carbohydrates

I'm diabetic: Where do I begin?

The Type 2 Diabetes Resource Center

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