Disagree with relaxing diabetes standards

I don’t think so, because I have research to support my stance, and the ADA has no proof whatsoever that low carb diets are harmful. Uncontrolled blood sugars ARE dangerous, of course, yet many in my field continue to recommend diets that contain too many carbs (200-300 per day in many cases) to maintain good BG levels for the majority of PWDs.

Hi Scott,

I always let my patients know that there are different schools of thought regarding the best approach to eating for DM management. On one of my handouts, there is a blank line where the carbs per meal and snacks can be filled in. I talk to patients about their goals are and then write in a number they’re comfortable with, be it 20, 30, 40, 50, etc. I think most of my colleagues write in 50-60 for meals and 15-30 for snacks.

I’ve never understood the snack thing. No one needs to be eating constantly. I was reprimanded for not snacking. I wonder if it’s a throwback to the NPH days of needing to feed the unpredictable insulin.

I always thought it was a throwback to NPH.

I have seen a lot of people here say they were sent to a dietician after first being diagnosed and walked away being told to eat more carbs than they were before diagnosis. That makes no sense.

I certainly understand your frustration. I never lecture patients for not reaching their goals, but I do try to find out why their levels remain elevated. Frequently it has to do with timing of meals and meds, illness, and/or stress. Once I get an idea of what’s going on, we work together to figure out the best course of action.

BTW, I am in the early stages of diabetes, and although not on insulin, I see huge variations in my blood sugar readings from day to day. So I do understand a little bit of what you’re going through. My goal is never to make people feel bad or ashamed but rather to assist them in improving their glycemic control in whatever way I can.

I think you’re right, Gerri. I have patients who say they go low if they don’t eat something every 3 hours. I think in many cases it’s that they feel low as their blood sugars approach normal levels.

Yep. Too many are also instructed to feed the insulin rather than adjust doses. I had an endo who forbade me from changing doses without clearing it with him first. Yeah, right:) He was of the feed the insulin school & said there was no need to be tweaking.

Thanks for the link :slight_smile:


I’m lucky. I can limit myself to a single cracker, a small square of chocolate, a half a pear - whatever. That’s why what works for one of us might not be all that helpful for others.


I agree with you Maurie that what works for one person won’t work for another. If you saw the thread Jean first mentioned that, her problem was with the dieticians that kept insisting that she could do that when she knew she couldn’t. I always say my willpower comes from not buying the stuff in the first place - if it makes it to my home, I have no willpower but I do have willpower in the store for some strange reason!

There is one other potential problems for PWD on insulin as they get older which is the that lows can lead to falls which can lead to broken bones and hospitalizations. Achieving “normal” blood sugars is very tough if you aren’t willing to accept a lot of minor lows. Those lows might not be so minor for someone in their late seventies or eighties.


I have heard you talk about Starburst Jelly beans so much that when I found them I got them. Boy are you right those things are awesome!

Hi Gerri and Kelly,
I am Type 2. Never ever had a low. Didn’t snack before I was diagnosed. I wake up with DP and if I don’t eat the number goes higher. Forget my snack and I end up with high bs. I hate always having to worry about the snack but the price I will pay if I forget is rising numbers. Not sure how this works. I have always eaten low carb.

Hi Peetie,

Something before bed helps some people’s DP. Great this works for you & a simple solution to a difficult problem. Different than being told to eat snacks between breakfast & lunch & between lunch & dinner & then again before bed. Three meals & three snacks, all of which are high carb. Honestly, I couldn’t believe I was sternly lectured about not snacking. I was told I “had” to snack–lol.

I’m one of those. I was told to eat 3 meals, 45 cho each, and at least 2 snacks, 15 cho each. No way can I eat that much food! I’ve settled on 30-40 cho a day and my recent A1C was 5.9. I eat really well, don’t deprive myself. I wasn’t offered options, just told what I ‘should’ do.

Me too. Ignored her! I grew up in a diabetic family. It was always low carb until the cholesterol craze.

Hi Gerri,
I’m on met and I drink wine and eat protein before bed. I have to do all that snacking with small meals. I don’t go low overnight I’ve checked. I find if I eat small snacks between meals I’m okay (except for DP) I don’t think there is any cure for that. (perhaps insulin?) Maybe LCD can shed some light. Not sure why anyone would recommend snacks to a T1 with good control.

Well said! Everyone gets a trophy! Well, you can have my trophies. One thing is for sure, with these relaxed standards all your patients will be receiving the trophy of complications. First, do no harm, right?

I see in your post you identify yourself as a CDE but do not identify yourself as a diabetic.

As a diabetic myself… If I had struggled long and hard and gotten my A1C down to 7.1%… and then I went into a doctor’s office or a clinic and was told that my level of control was “UNACCEPTABLE” (to use a word from your original post and add a “UN”)… it would really make me doubt my self-worth and efforts.

Now if I was told “That’s great progress! Let’s work on even better control with (a variety of methods)” then I would feel good about myself and keep working harder.

I guess it depends a lot on where you want to focus your efforts. Imagine you’re a school teacher and have to divide your time between students. Should you be working hardest to turn your B students into A students, or should you be working hardest to turn your D students into C students? I agree it’s not really a “one or the other situation” in either a health clinic or at a school… but I would rather the docs work hard to get those with a 10% A1C down to 8%, rather than work on turning the 7% into 5%.

I think here on the internet, those who post their A1C’s tend to be a self-selected group that’s among the best control. To insist that everything at 6% or higher is poor or unacceptable control… simply does not reflect the enormous work and progress and expense we all put in.