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Macronutrients and Blood Sugar
Let’s begin by talking about the impact of macronutrients on blood sugar. Each of these contributes to blood sugar levels in different ways. Having an understanding of the role these nutrients play will help improve the self-management skills of the person with diabetes.
Carbohydrates Carbohydrates cause the greatest impact on blood glucose--by far. When a person eats a carbohydrate, it breaks down into a simple sugar called glucose and enters the blood stream. Glucose is then allowed to leave the bloodstream with the help of insulin and is used by the cells of the body for energy. In fact, carbohydrates are the body’s preferred energy source.
In the absence of insulin, the glucose is trapped in the bloodstream and levels escalate quickly, such as in the case of type 1 diabetes onset. A person with type 1 diabetes must learn to count carbohydrates in order to calculate appropriate insulin dosing. A person with type 2 diabetes will have some level of insulin resistance. This contributes to elevated blood sugar levels and causes the pancreas to work harder in order to produce enough insulin. A person with type 2 diabetes will take various medications to help with blood sugar control. They would also benefit from a consistent carbohydrate diet in which they will eat about the same amount of carbohydrates for each meal throughout the day. Regardless of the type of diabetes, carbohydrates directly impact blood glucose levels.
Proteins Proteins can slowly convert to glucose. When consumed with a meal of <20g of carbs about 50% of the protein will eventually convert to glucose. When eaten in large quantities of >60g about 20-30% will be converted even in the presence of dietary carbs. This conversion takes place through gluconeogenesis and happens about 3-4 hours after the start of a meal. The person with diabetes will need to account for a percentage of these protein grams when dosing insulin and use a split or extended bolus to cover the rise in blood glucose that will come later on. An example of a low carb meal with protein would be a salad with shredded cheese and chicken breast. An example of a high protein meal with average carbs would be a salad, ˝ baked potato, a small roll, an 8 oz steak.
Fats Fat slows the digestion of carbohydrates causing a moderate rise in blood glucose over a longer period of time. You can see this in the graph below that this process can take up to 7-8 hours in which you see an impact on blood glucose. During the digestion process of a high fat meal, there is an increase of triglycerides in the blood stream. This causes temporary insulin resistance for up to 8 hours post-meal. During this time the liver will also secrete more glucose than usual causing a higher blood glucose. Insulin timing is very important when consuming a high fat meal. The person with diabetes can split the injection, 50% at the start of the meal and the remaining 50% after the meal or with a pump they can do an extended bolus starting with 50% up-front the remaining 50% over 1-2 hours. This will help account for the slow and long rise. The person can also set a temporary increased basal rate for 6-8 hours. An example of a high fat meal is pizza.
Sugar Alcohol Sugar alcohols are a sugar substitute that is added to many foods labeled sugar free/reduced or low sugar. They are also found in many keto or paleo foods. They are made from fermented fruits and vegetables and have slow effect of blood glucose. They do need to be considered in carb counting for insulin dosing. They amount of sugar alcohols can be found on the nutrition facts label under “total carbohydrates”. These sugar alcohol grams can be cut in half and deducted from the total carbohydrate count.
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