"Don't eat sugar" was the standard advice historically given to diabetics. The fear was that consuming refined sugar would negatively effect the diabetic's blood sugar, increasing it to unsafe levels. Current nutritional therapy for diabetes management does not exclude refined sugar from the diabetic's meal plan. "We now know that sweet treats can be safely incorporated into a diabetics's diet," states Constance Brown-Riggs, National Spokesperson for the American Dietetic Association and author of "The African American Guide to Living Well with Diabetes," released July 2010.
"Foods containing sugar, such as baked goods, do not have to be eliminated, but they do need to be counted as part of the total carbohydrate intake. The overall nutrition requirements for diabetics are the same as the general population--no one should take in excessive amounts of sugar," advises Brown-Riggs. "Sugar has no nutritional value and is not good for anyone and should be kept as low as possible."
Refined sugar is a carbohydrate. Carbohydrates comprise the main nutritional component that causes blood sugar levels to increase; therefore, refined sugar affects a diabetic's management of his blood sugar.
Definition
Diabetes is a disorder characterized by elevated blood sugar levels that result from impaired carbohydrate metabolism. There are three categories: type 1, type 2 and gestational diabetes. Sugar builds up in the blood of a type 1 diabetic because she is unable to produce insulin, a hormone needed for sugar uptake and use by the body's cells, tissues and organs. A type 2 diabetic experiences high blood sugar levels because her body either cannot produce a sufficient amount of insulin, or her body cannot make use of the insulin it generates. Gestational diabetes manifests during pregnancy and its cause is uncertain, although hormonal changes associated with pregnancy are speculated to contribute, according to the America Dietetic Association. The goal of nutritional management for all forms of diabetes is to maintain blood sugar concentrations near normal.
Blood Sugar Concentration
According to the January 2008 position statement of the American Diabetes Association, "Nutrition Recommendations and Interventions for Diabetes," blood sugar levels after a meal are determined by both the amount and type of carbohydrate eaten by the diabetic, with the total amount of carbohydrate being the biggest predictor. Ingesting too much refined sugar, as with any form of carbohydrate, can cause hyperglycemia in the diabetic, requiring adjustments in diet or medications. "The danger of [refined sugars] is consuming too much, which can lead to unexpected increases in blood sugar. The maximum amount of carbohydrate that can be eaten is different for each diabetic," states Brown-Riggs.
Acute Effects of Refined Sugar
Eating an excessive amount of refined sugar can lead to hyperglycemia, a condition characterized by too much sugar in the blood. According to the Mayo Clinic, the symptoms of hyperglycemia begin with a blood sugar value above 200 milligrams per deciliter. Feeling tired and sluggish are early warning signs of hyperglycemia, indicates Brown-Riggs. Increases in thirst, hunger and urination are also experienced when the diabetic's blood sugar values are too high, she explains.
Long-term Effects of Refined Sugar
Daily consumption of excessive amounts of refined sugar can lead to a chronic hyperglycemic state. If left untreated, the diabetic is at risk for ketoacidosis. Ketoacidosis occurs when the diabetic's body is forced to break down body fat to provide itself with fuel, due to its impaired ability to use the sugar circulating in the bloodstream for energy. As the fat is broken down, ketones--toxic waste products--are produced and start to build up in the blood, causing ketoacidosis. This is a life-threatening situation. Symptoms of ketoacidosis include excessive thirst and urination, stomach discomfort, nausea and vomiting, dry mouth, fruity-smelling breath, rapid breathing, weakness, disorientation and coma. Medical attention must be sought immediately if it is suspected that a diabetic is experiencing ketoacidosis.
Management
The recommended total amount of carbohydrates that should comprise a diabetic's diet ranges between 45 and 65 percent of total food intake, with a minimum consumption of 130 grams of carbohydrate per day, according to a statement by the American Diabetes Association, "Dietary Carbohydrate (Amount and Type) in the Prevention and Management of Diabetes," released in September 2004. Brown-Riggs recommends that every diabetic meet with a registered dietitian at least once to help with nutritional management of diabetes. She states that the best way to determine a diabetic's carbohydrate requirements is to monitor his pre- and post-meal blood sugar values. Once the maximum amount of carbohydrate is determined, the diabetic should monitor intake by using methods such as carbohydrate counting or exchanges.
According to the American Dietetic Association, carbohydrate counting requires a diabetic to know how many grams of carbohydrate he can eat for a given snack or meal and how many total grams of carbohydrate per serving are present in the food he wishes to eat. By tracking the amount of carbohydrate he consumes, a diabetic can include refined sugar products in his diet without negative effects on his blood sugar level. Use of the exchange system can also minimize the influence of refined sugar on his blood sugar by allowing him to "swap" one food for another as long as it is within the same exchange group. A registered dietitian can help a diabetic determine the number of exchanges per food group he can eat at any given meal.
Other ways that a diabetic can maintain blood sugar control when consuming refined sugar are to adjust his insulin or other blood sugar lowering medication to account for the intake or eat a whole-grain or high-fiber food along with the sweet treat, which will slow down gastric emptying, helping to control his blood sugar.
References
- "Diabetes Care"; Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications; M.J. Franz, et al.; January 2002
- Constance Brown-Riggs, MSEd, RD, CDE; American Dietetic Association National Spokesperson; Massapequa, New York
- "Diabetes Care"; Dietary Carbohydrate (Amount and Type) in the Prevention and Management of Diabetes; N.F. Sheard, et al.; September 2004
- American Dietetic Association: Diabetes
- Mayo Clinic: Diabetes
