History

Prior to 1921 and the discovery of insulin to treat diabetes, diet was the only thing we had to attempt to control the disease. The early 20th century was plagued with fad diets for the treatment of diabetes, much like today. Some diets included the oat-cure, the milk diet, the rice-cure, potato therapy and even the use of opium. Frederick Allen focused on low calorie diets to attempt to prevent ketoacidosis prior to the introduction of insulin.

The exchange system was developed in the 1950s between the American Diabetic Association and the U.S. Public Health Services. One would exchange one serving of a carbohydrate rich food for another on a complicated list, keeping the number of servings fairly consistent. The exchange diet has been revised a number of times over the years with different foods being counted or not counted as carbohydrate exchanges.

A simplified version of exchanges is probably the most common plan today. Carbohydrate counting treats all carbohydrates as relatively equal in meal planning. Instead of having to try to switch out whole or part servings of carbs, we count total carbohydrates. High fiber foods may have the number of fiber grams subtracted from the carbohydrate count since higher fiber foods tend to have a lower glycemic index.

The Role of Insulin

Using insulin, we transform the carbohydrates we eat into glucose to be used for energy. Once the cells have what they need, the excess glucose is sent back to the liver and converted to glycogen, which is then stored in muscle tissue. Once we’ve stored all the glycogen we can, excess glycogen is sent back to the liver again, where it becomes triglycerides, which are stored as fat. The body seems to have endless storage space for this fat.

Carbohydrates

Carbohydrates are not good or bad. Carbohydrates in excess will raise blood glucose levels and increase the likelihood of weight gain. The USDA recommends 45-65% of daily calories come from carbohydrates. High carbohydrate foods contain fiber, vitamins C & E, the majority of B vitamins, and the majority of trace minerals. Carbohydrates are the body's main source of fuel, are easily used by all our tissues and cells, and are necessary for the brain, heart, kidneys, and muscles to function properly. A dietician or nutritionist specializing in diabetes can help you design an eating plan with the right amount of carbohydrates for you.

Glycemix Index

Another method of blood sugar control is using the glycemic index to choose foods that may have less impact on your blood sugar than others. Although we tend to treat carbohydrates as relatively equal, they can affect your blood sugar very differently. Foods that are easily digestible increase blood sugar quickly, causing a blood sugar spike. Foods that take longer to digest, such as beans and other high fiber foods, generally cause a lower increase in blood sugar over a longer period of time. The glycemic index ranks different carbohydrates based on the amount they raise blood sugar. It should be noted that the glycemic index isn't perfect and each of us may have different reactions to different foods. That's one of the reasons it's important to test our blood sugars two hours after meals - so we can determine for ourselves what foods cause more of an impact on our blood sugars.