The proof of the pudding is in the eating, so they say. For diabetics, that may be literally true.
Food is turned into sugar (glucose), the fuel that runs our bodies. In diabetes, glucose builds up in the blood because cells cannot utilize it properly. The type of food eaten affects the rise in blood glucose after a meal.
One of the biggest controversies in diabetes management these days is how diabetics should eat. This is no tempest in a teapot. Experts estimate that 20 million Americans now have diabetes, and perhaps another 20 million are prediabetic. Many don’t know they are at increased risk of heart disease, stroke, kidney failure and loss of vision as a result of abnormal blood sugar.
Diabetics used to be told to avoid sugar so that blood glucose wouldn’t spike dangerously high. Back then no one knew that a baked potato could raise blood sugar as much as a scoop of ice cream. In fact, the usual recommendation for diabetics is a diet rich in complex carbohydrates (starch).
Now some heretics are suggesting that too much starch is contributing to the epidemic of diabetes. Foods such as pasta, rice, bread, cereal, waffles, crackers and chips can raise blood sugar almost like cookies and candy. Fruit juice and starchy vegetables (beets, carrots and corn) may also pose a problem for some people.
These critics advocate a diet rich in low-starch vegetables and lean meat, fowl and fish. Tofu and soy meat substitutes may also be beneficial.
Diabetics have a powerful tool to help them find out how specific meals affect their blood sugar. Using a home monitor periodically throughout the day, a diabetic can measure the effects of food, exercise and stress on blood glucose. Such conscientious attention allows an individual to tailor his or her regimen to the daily challenges of blood sugar control.
Many diabetics would prefer to take a pill or insulin injection and not worry about diet. But for optimal control, careful attention to food intake and exercise may be needed along with medication.
Drugs can play a role not only in treating diabetes, but unexpectedly, in triggering elevated blood sugar. A surprising number of medicines can alter metabolism and raise blood glucose. Diuretics such as hydrochlorothiazide (HCTZ), corticosteroids like prednisone and some beta-blockers may have this effect.
Hormone replacement therapy can also raise blood sugar. One reader related, “Six months ago I had a physical, including a blood sugar test for diabetes. The test was high, and my doctor insisted I was diabetic.
“I looked up Prempro and found it can raise blood sugar. I quit taking it and now my blood sugar is normal.”
To manage blood sugar and prevent the consequences of diabetes, people must balance diet, exercise, stress and medications. With regular monitoring this is now feasible.
For an up-to-date overview of diabetes treatment and dietary controversies you may want to listen to a one-hour radio interview we recently conducted with diabetes experts. To order this CD please send $15 (includes postage) to People’s Pharmacy #462; PO Box 52027; Durham, NC 27717-2027.

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