The Glycemic Index and Diabetes

The glycemic index indicates the after-meal response your body has to a particular food compared to a standard amount of glucose. If that sounds complicated — it is! Many factors come into play, including your age and activity level, the amount of fiber and fat in the particular food, how refined (processed) the food is, what else was eaten with the food, what the composition of the food is in terms of carb, protein and fat, how the food was cooked, and how quickly your body digests the food (which varies from person to person).

In general, fiber-rich foods are often the same foods that are thought to be low glycemic foods and seem to have less effect on blood glucose. Sucrose (table sugar) also has a lower effect on blood glucose than some starches, such as potatoes. There are lists of such "high" and "low" glycemic index foods.

Health professionals agree that the more complex a meal plan is, the less likely people are to follow it. The glycemic index is a fairly complex meal planning tool, and the fact that people's blood glucose can react differently to so-called "low" and "high" glycemic index foods has limited the usefulness of the index in teaching patients with diabetes how to manage their food intake to keep their blood glucose under control. However, the glycemic index may be be used as an additional tool together with a patient's current meal planning system. Registered dietitians often encourage patients to determine their own individual glycemic index of foods based on how their blood glucose responds to the various meals and snacks they tend to eat.

Most dietitians and other healthcare professionals working with patients prefer to talk in terms of the number of grams of carbohydrate in a food, rather than the "glycemic index" of a food. Carbohydrate has the greatest effect on blood glucose, so in general two foods that have the same number of grams of carbohydrate in them will have a similar effect on your blood glucose level. Your dietitian works with you to determine — based on your weight, how active you are, and other factors — how many grams of carbohydrate you can eat at each meal and snack to keep your blood glucose under control. This type of meal planning is simpler to use, offers greater flexibility, and enables many people to manage their diabetes successfully.

See also:
What is carbohydrate counting?
How does fiber affect blood glucose levels?
How much carbohydrate should I be eating in a day?


Food ‘Cravings’ and Diabetes

If you have type 2 diabetes, you may have been advised by your healthcare team to change your diet, and incorporate healthier foods. In addition, you may have visited with a dietitian and mapped out a personalized meal plan to help you reach weight-loss or glucose-control goals. But what happens when despite your best efforts, you still crave a food that’s not so healthy? For people with diabetes, this can be a serious problem.

"Everyone experiences cravings for foods," states Karen Hanson Chalmers, M.S., R.D., CDE, and Joslin's Amy E. Campbell, M.S., R.D., CDE, in their book, 16 Myths of a Diabetic Diet. However, Chalmers and Campbell say that it is crucial to learn how to manage these cravings before they become a more serious problem. Here are a few of their ideas:

Know the difference between hunger and appetite. According to Chalmers and Campbell, few people understand the difference between real hunger and appetite. "Hunger is more physiological, whereas appetite is more psychological," they state. The authors advise that it may take some time to distinguish one from the other, but eventually, it can be done. So the next time you experience a "craving," remember to ask yourself whether it is hunger talking, or your brain only imagining it needs food. Also, it is important to check your blood glucose (sugar) when you experience these feelings to make sure you’re not low.

Know your "emotional triggers." Many people use food as a source of comfort, which can lead to the consumption of excess calories, and, as the authors point out, eating for comfort doesn’t really solve the problems that cause us to eat in the first place. If stress causes you to eat, Chalmers and Campbell recommend channeling that energy elsewhere—such as going for a walk, calling a friend, or participating in any other activity you enjoy.

Know when to give in. Yes, you read that statement correctly. Chalmers and Campbell don’t recommend completely cutting out your favorite foods, or always denying yourself what you truly crave. They say this is especially true when you’ve tried all other measures, and still feel the need to indulge. The authors recommend you indulge with reservation, however, and only eat a small portion of what you crave, since satisfying a craving and binging on a particular food is not the same thing.

"If you need help, don’t hesitate to talk with a therapist or counselor who specializes in the area of eating disorders. He or she can help you change how you think about and react to food and eating," state Chalmers and Campbell.

Important note: People with diabetes should also check their blood sugar frequently in order to differentiate between low glucose and a craving. Be sure to always carry your glucose meter with you and test when you can’t tell if your craving is actually low blood glucose.