From Cedar Rapids, Iowa, USA:
When our daughter is lectured by the "food police," we always try to explain that a limited amount of treats are okay for diabetics as part of a healthy balanced diet and that limiting sweets is a good practice for anyone, not just for those with diabetes. But, running into these attitudes made me wonder, what were the dietary restrictions suggested to type 1s 30 to 50 years ago, or at least before rapid acting insulins were available? Were sugar and candy completely banned except to treat lows? Were fruits like watermelon and grapes restricted as well?
Also, do you think changes in the types of foods permitted for diabetics came primarily from the fact that the old "diabetic diet" is difficult to follow, especially in the age of pre-packaged or "fast foods" or more from the fact that newer insulins and pump therapy allow better control even when eating a less than ideal diet?
There have been varied opinions regarding food intake over the past years. Thirty to 50 years ago, paradoxically, many of the diabetes specialists who didn't believe in strict control, still recommended avoiding all candy and sweets, while others, like the pioneer Elliot P. Joslin, believed in trying to get the best control possible, but allowed sweets in moderation using the exchange system. He believed in trying to balance the food, insulin, and exercise decades before it became more universally accepted to do so and before we had insulin pumps and newer, faster acting insulins. Regardless of what insulin you take, you can still try to match the food to your insulin, you just have more flexibility with pumps and the newer insulins.
Additional comments from Dr. Stuart Brink:Original dietary prescriptions really were proscriptions - strictly avoid most fast acting sugars/carbohydrates. Not many could follow this so religiously, but those who did usually did better and had fewer short and long term complications. As insulins became more purified and more flexibility, newer research suggested alternative approaches: Bernstein (and now Atkins) approaches that avoid most carbohydrates thus decreasing insulin needs; exchange systems to provide flexibility and choices; and, more recently, carbohydrate counting. There is actually not much information that such restrictions help very much perhaps because so few people actually can follow such restrictions for long periods of time. Our own treatment team philosophy suggests that figuring out the best balance of insulin, food and activity based upon frequent blood glucose monitoring, which means analyzing logbooks and/or using computers to assist in this process, gives excellent overall control and flexibility for day-to-day choices for most with diabetes and this is usually the current recommendation.
You may be able to find some old textbooks and manuals on line that have such original recommendations. Your library may have some as well.
Additional comments from Dr. Jim Lane:Yes, there is an element of the food police in counseling patients regarding diet. If it is not carbohydrates, it's fat. If it's not fat, it's about too many total calories. I think it is best to develop a well balanced attitude toward food. Absolutes never work. Something that is attainable, yet is effective is what most people strive for. Rapid-acting insulins do help allow some flexibility with carbohydrates in the diet. If treats are used intermittently for rewarding good behavior, I think it works out. In the days without rapid-acting insulin, any carbohydrates raised blood sugars too high. When treating children, the issue is more complex. The discipline to say "no" needs to be developed. On the other hand, a total ban is not realistic and probably not attainable. In the interest of staying on the positive with the kids, I think it is helpful to share a few foods they can eat with a group and have a strategy for bolusing with rapid-acting insulin. For those more complex foods, the kids may need mom and dad's help to figure out how much to take and how to follow up. It is pretty amazing to think that we have only developed insulin for treatment of type 1 diabetes within the last one hundred years or so.
Additional comments from Dr. David Schwartz:"If you had diabetes in "the old days," before insulins, you died. You either died a horrific death with DKA or you died a long-drawn out death with starvation? Why? The strictest diets were used essentially limiting calories, especially carbohydrates.
You reference the "food police" and I don't know who/what you mean. Have diets become more liberalized? Sure. Does that mean carte blanche diet? Of course not. And, despite rapid-acting insulins and insulin pumps and monitors and glucose sensors, etc, don't fool yourself: diets can be liberalized, but there is a consequence in providing adequate insulin. Do that without exercise and you get fat. Don't do it well enough and you get high A1cs. So, don't be too hard on the "food police." They want you and your child to make optimal food choices and decisions.
[Editor's comment: If you mean Aunt May or cousin Dorothy as the "food police," they are probably not educated about type 1 diabetes and may assume that sweets are not allowed because the older people they know with type 2 are probably supposed to avoid sweets. It wasn't that long ago that sweets were restricted. Diagnosed in 1989, our daughter was put on a diet allowing "no concentrated sweets." In general, we did not provide her sweets except occasional servings of fruit, unless we were treating a low blood sugar. Carbohydrate counting eventually came into our lives and our daughter now eats anything she wants. She exercises, maintains relatively "normal" blood sugars and does not have a weight issue. The problem with allowing "everything" in the diet is weight. It is important to encourage our children to eat a well-balanced diet and to exercise.BH]
Original posting 29 Jun 2007
Posted to Meal Planning, Food and Diet
Last Updated: Tuesday April 06, 2010 15:10:11
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