Carbohydrate Debate: Are They Okay for Diabetes?


Experts agree that following a diabetes diet is one of the most important choices you can make to manage diabetes, and that is where the debate begins. What kind of diet is best to keep blood sugar in check? 

Since diabetes is a disorder of carbohydrate metabolism, are carbohydrates safe to eat? Should you follow an ultra-low-carb, ketogenic diet? Or are healthy carbs okay in moderation? Can you lose weight while eating carbs?

As you can see in this table, a “low-carb” diet has many possible definitions. 

Diet Type i Notes Carb Grams per Day Calories from Carbs
Ketogenic
Possible concerns in near and long term
20 to 50 grams
2-10% of total
Low-Carb
Lower than most people with diabetes
Under 130 grams
Under 26%
Moderate Low-Carb
Considered low-carb
130-230 grams
26-35%
High-Carb
Average American
Over 230 grams
Over 45%

The carbohydrate debate continues in the quest to find the best diabetes diet to lower high blood sugar. As research into diet and diabetes continues, here are some current thoughts on carbohydrates and the pros and cons of low-carb and high-carb diets. 

Good Carbs if You Have Diabetes

Less processed and high in protein and/or fiber, and portion-controlled

  • Non-starchy vegetables
  • Whole-grain bread and bread products, such as whole-grain bagels, pita, English muffins
  • Oatmeal and cold whole-grain cereal such as bran flakes
  • Brown rice, whole-grain pasta
  • Beans, lentils, split peas, tofu
  • Starchy vegetables, such as sweet potatoes, acorn squash, peas, corn
  • Fresh fruit
  • Frozen fruit (no sugar added)
  • Nuts and peanuts
  • Plain yogurt

Weight Loss


Low-Carb Pros: Some people lose weight faster when they first start on a low-carb diet compared to a high-carb one. These quick initial results can be motivating. A low-carb diet can lead to continued weight loss because the limited food choices and satisfying nutrients such as protein and fat can help you eat less.

Bad Carbs if You Have Diabetes

More processed, sugary or refined, and oversized portions

  • White bread and bread products, such as bagels, pita, English muffins, rolls
  • Refined breakfast cereal
  • White rice and pasta
  • Refined crackers, pretzels, potato and tortilla chips
  • Baked goods, such as cookies, cake, croissants, muffins, pies
  • Fruit juice and fruit drinks
  • Dried fruit
  • Sugar-sweetened beverages, such as soft drinks, coffee beverages, sports and energy drinks, sweet tea
  • Sugar-sweetened yogurt, oatmeal, condiments, cereal

High-Carb Pros: A high-carb diet may have slower initial weight loss, but weight loss may be steadier due to the loss of body fat. The rapid initial weight loss on a low-carb diet is often due to the loss of body water, not fat.

Bottom Line: Research suggests that weight loss over the course of a year or so is similar whether you go low-carb or high-carb.

 

Maintenance of Weight Loss


Low-Carb Pros: A low-carb diet can be simpler because it includes fewer foods and less decision-making. That simplicity can make it easier for a low-carb diet to become habitual for you. 

High-Carb Pros: A higher-carb diet can feel less restrictive in the long-term because you can eat a wider variety of foods. It gives you more flexibility in your diet choices, which makes it easier to fit in special occasions, such as restaurant meals and parties, into your eating plan in a positive way.

Bottom Line: The more flexible nature of a higher-carb diet can be the difference between a temporary low-carb “diet” that ultimately ends and leads to weight regain, and a longer-term higher-carb “way of life” that allows you to maintain that hard-earned weight loss.

 

Blood Sugar


Low-Carb Pros: A low-carb diet can lower high blood sugar levels within weeks. A ketogenic diet can be especially effective. The low amount of carbs, along with the high amount of protein and fat, helps prevent blood sugar spikes that eventually increase insulin resistance.

High-Carb Pros: While sugary foods and refined starches have earned their reputation as bad if you have diabetes, small portions of nutritious, high-fiber carbs are not likely to cause more severe blood sugar swings. Furthermore, red meat and saturated fat are likely to be lower than on a low-carb diet, and limiting them can be good for blood sugar.

Bottom Line: Low-carb or healthy-carb can each help control blood sugar, and each is more effective if your other food choices are healthy, too.

 

Diet Quality


Low-Carb Pros: A meal plan that limits sugar and refined starch can only be good, since cookies, chips, and white bread are not doing your body many favors – they are high in carbs and low in nutrients. If you go low-carb by choosing nutritious low-carb and carb-free foods, such as fish, avocados, and non-starchy vegetables, your diet quality can improve.

High-Carb Pros: It is more likely to include high-fiber, nutrient-dense carbs that are linked to better health. Beans, oatmeal, and apples are some nutritious superfoods. You are also less likely to select excessive amounts of butter, bacon, and other fatty foods that are linked to poorer insulin sensitivity, just because they are low in carbs.

Bottom Line: A higher-carb diet can include a wider variety of healthy foods if you choose carefully.

 

Everyday Energy


Low-Carb Pros: As a low-carb diet prevents blood sugar spikes and drops, it can prevent the energy roller coaster that goes with it. You could have fewer periods of severe fatigue and intense hunger during the day.

High-Carb Pros: A very low-carbohydrate diet can make you feel tired and sick in the beginning as your body shifts from using carbohydrates to fats as the main fuel source, while a high-carb diet avoids this trouble. Getting enough healthy carbs can help you feel more energetic for workouts and help you recover faster from them.

Bottom Line: This one is up to you, since individual people are different. Cut back on carbs if they make you feel like taking a nap instead of taking a walk, but help yourself to them if your body tells you that you need them to get through your workout. 

 

Long-Term Health Effects


Low-Carb Pros: Your health could improve in some ways if you replace sugary and refined starchy foods with nutritious proteins and healthy fats. 

High-Carb Pros: A higher-carb diet can have more of the nutrients and foods that are linked to better diabetes, heart, and other health outcomes based of plenty of long-term research. You are also less likely to depend on red meat and other not-so-good foods.  

Bottom Line: Since the jury is still out on the safety of a low-carb diet for the long haul, a higher-carb diet with healthy choices may be safest.

 

Our Recommendation: A “Healthy-Carb” Diet for Diabetes


Healthy carbs, in moderation, are okay for people with diabetes. Be sure to ask your doctor about any meal plan that you are planning to follow, and be sure to make any necessary adjustments to diabetes or blood sugar medications if your doctor suggests them. 

As you create your “healthy-carb” plan, try to aim for:

  • 2 to 3 servings (30 to 45 grams) of nutritious carbohydrates at each meal 

  • 1 to 2 servings (15 to 30 grams) of nutritious carbohydrates at each snack 

  • Some lean protein at each meal and most snacks

  • Small servings of healthy oils instead of artery-clogging fats

Here is a sample day’s menu with about 1,800 calories. You may need more or fewer calories, depending on your size, age, gender, weight loss goals, and activity levels.

Meal/Snack Foods
Breakfast
½ cup oats and ½ sliced banana mixed into 1 cup yogurt
Morning Snack
1 medium apple in slices with 2 tablespoons peanut butter
Lunch
Taco salad with romaine lettuce, ½ cup fat-free refried beans, ½ cup cooked brown rice, 3 ounces cooked chicken breast, ¼ avocado in slices, diced tomatoes, and salsa
Afternoon Snack
Pizza with ½ whole-grain English muffin, tomato sauce, 1 ounce mozzarella cheese, olive slices, and bell pepper slices
Dinner
4 ounces of tilapia, ½ cup diced onion, and 1 cup sliced mushrooms sauteed in 1 teaspoon olive oil with thyme and black pepper to taste. Serve with ½ baked acorn squash and 1 cup of steamed broccoli

Lark can coach you as you follow a healthy diet and make other healthy decisions to prevent or manage diabetes. Your personal health coach can be with you 24/7 to help you develop habits that can benefit you for years.

 


Reference

  1. Dyson P. Low Carbohydrate Diets and Type 2 Diabetes: What is the Latest Evidence?. Diabetes Ther. 2015;6(4):411-424. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674467/

Diabetes Prevention Programs and Your Bottom Line

Do you know how much prediabetes and diabetes are costing your organization? These two chronic conditions may be draining more of your finances than you realize, as they are placing a large and increasing burden on workplaces. 

What you may not also realize, though, is that there is good news. The current environment nationwide is to fight prediabetes and diabetes, and as an employer or insurance provider you can take advantage of programs to improve health and save costs for your workers or patients. 

The Diabetes Prevention Program (DPP) is a program for individuals with prediabetes and high risk of diabetes. It is a strategy that the Centers for Disease Control and Prevention (CDC) has recognized as an effective way of delaying or preventing type 2 diabetes. Its success has led to opportunities for reimbursement for patients. In addition, offering a DPP can lead to cost savings for your organization within a relatively short amount of time.

 

What Is Prediabetes and Why Should You Care?


Do you know how much prediabetes and diabetes are costing your organization? These two chronic conditions may be draining more of your finances than you realize, as they are placing a large and increasing burden on workplaces. 

What you may not also realize, though, is that there is good news. The current environment nationwide is to fight prediabetes and diabetes, and as an employer or insurance provider you can take advantage of programs to improve health and save costs for your workers or patients. 

The Diabetes Prevention Program (DPP) is a program for individuals with prediabetes and high risk of diabetes. It is a strategy that the Centers for Disease Control and Prevention (CDC) has recognized as an effective way of delaying or preventing type 2 diabetes. Its success has led to opportunities for reimbursement for patients. In addition, offering a DPP can lead to cost savings for your organization within a relatively short amount of time.

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Preventing Type 2 Diabetes Is Good Business

As you can see, prediabetes and diabetes do not affect only the patient. They affect you, as the employer or insurer. How much are you paying for diabetes? [2, 3]

  • $7,900: the annual extra cost of medical care for a patient with diabetes.

  • 10%: the proportion of healthcare dollars going straight to diabetes care.

  • $5 billion: cost of excess absenteeism linked to diabetes (up to 7% extra).

  • $20.8 billion: cost of excess presenteeism due to diabetes (up to 38% extra).

Human cost aside, your best business move is to keep your employees healthy. For nearly half of your employees, that means targeting blood sugar and prediabetes. How? The National Diabetes Prevention Program (DPP) is one promising answer. 

 

Background on the Diabetes Prevention Program


The National DPP is a CDC-recognized program designed to lower diabetes risk among patients with prediabetes[4]. It was first tested in a clinical trial that compared the effects of a lifestyle intervention – the DPP – to those of metformin and to a placebo group. 

The DPP was so successful in lowering diabetes risk that it has been expanded nationwide. There are over 1,800 organizations offering a DPP. Furthermore, the government recognizes its value and is willing to pay. The program can be cost-effective even without external support, as well.
 

Effects

Compared to those in the placebo group, those in the lifestyle intervention (DPP) group had a 58% lower incidence of diabetes over the next 2.8 years! In comparison, metformin use led to a 31% lower risk for diabetes.

These results are welcome news for everyone.

  • Patients can enjoy better health without drugs or side effects.

  • Providers can offer a treatment plan for prediabetes that does not involve medications.

  • Employers and insurers have a clear way to lower healthcare costs and increase productivity.

Diabetes Prevention Program Goals and Curriculum

A CDC-recognized DPP must deliver a year-long curriculum based on the CDC’s materials or similar material. There are 16 modules to cover in the first 6 months, and the second 6 months must include at least 6 more lessons.

The main goals are to lose 7% of body weight and achieve 150 minutes per week of physical activity. Lessons are focused on education and on strategies to implement and maintain healthy eating and physical activity. Participants must record their weights at each session. They are also encouraged to log diet and physical activity.
 

Diabetes Prevention Program Participant Eligibility

Providers can refer patients if they are overweight or obese, are over 18 years old, and have prediabetes or a history of gestational diabetes, without ever having a diabetes diagnosis. Additional participants are welcome to the program if they have risk factors.

 

You Can Afford a Diabetes Prevention Program


The DPP is a nationally recognized program, led by certified lifestyle coaches, with dramatic results. That sounds expensive, right? Actually, no! Once you see the figures on cost savings and return on investment (ROI), you might agree that the only question is whether you can afford not to participate!
 

Cost and Return on Investment

The average per-person cost for participation in the DPP is $500 per year. [5] That amount of money is too much to be taken lightly, but there is justification for it. 

  • Each patient with diabetes costs an extra $1,000 to over $10,000 per year. [6]

  • The program usually breaks even by 3 years or before.

  • The ROI by 3 to 5 years can be $500 to $1,500 or more.

  • Each prevented case of diabetes can have an estimated cost savings of $65,000 over 10 years. [7]

  • Medicare enrollees could have cost savings of $2,670 per enrollee within 5 quarters. [8]

Participating in a DPP can do more than improve employees’ health and happiness and make you feel good about your coverage. It can be good for your bottom line, with a positive ROI in a few short years.
 

Funding and Medicare Reimbursement

Some healthcare providers and employers offer the DPP as part of an existing wellness program. You might pay the entire participation fee for your employees or covered individuals, or you might ask them to contribute part or all of the enrollment fee.

Because of the program’s overwhelming evidence of success, Medicare has included DPP as a reimbursable benefit since April of 2018. [9, 10] You can apply for reimbursement based on the number of sessions each participant attends. Reimbursement rates are higher when participants hit their weight loss goals.

 

Getting Started with a Diabetes Prevention Program


You can choose whether to start your own program or allow your covered employees (and their covered family members) to participate in an existing one. The CDC offers plenty of resources for starting a DPP[11], but be warned: the standards are tough.
 

Starting Your Own Program – Expensive and Burdensome

To start your own program, you will need to be aware of the CDC Standards and Operating Procedures (DPRP Standards)[12]. These are the guidelines, or rules, that you must adhere to to get initial and ongoing CDC recognition. 

The requirements include:

  • Meeting weight loss goals.

  • Achieving certain participation/attendance rates.

  • Delivering an approved curriculum.

  • Having a designated diabetes prevention program coordinator.

  • Having at least one trained lifestyle coach.

  • Completing and submitting initial and ongoing paperwork and data.

Starting your own program may not be the right choice for your organization if you are not ready to dedicate the personnel, space, and resources to it. You might also have trouble achieving the CDC’s requirements for attendance and outcomes.
 

Partnering with an Existing Diabetes Prevention Program – More Economical

It can be easier and less expensive to offer employees the option to join an existing program. This lets you avoid the start-up concerns of training staff, finding a location and time to hold meetings, and registering with the CDC. You will not need to worry about data collection or submission as time passes.

Look for a program that:

  • Has CDC recognition.

  • Is convenient for your employees – they are more likely to benefit if they attend meetings, and more likely to attend meetings that are convenient.

  • Has resources available to facilitate participation.

You can look for a DPP offered online or in your area at the CDC’s website, and you might want to search not only by zip code, but also for an online option. A digital DPP, such as Lark DPP, can be your best bet.
 

Lark Diabetes Prevention Program – A.I and Outcomes at Scale

Lark DPP is a digital DPP with the innovative feature of being fully automated, with a very high coach-to-participant ratio. It is a health coach app, designed by leading experts, that uses artificial intelligence (AI) to deliver DPP curriculum as well as other health coaching. Benefits of being a fully automated AI app include: 

  • 24/7 accessibility for participants to be able to get through their DPP lessons or interact with their health coach on other aspects of health, such as stress or sleep.

  • Lack of stigma: Participants can be more honest with their AI health coach without fear of judgement, as they may feel in face-to-face interactions.

  • Responsiveness: Participants receive instant, individualized feedback on aspects such as weight, diet intake, and physical activity.

Lark is not just good for employees. It is designed to work for insurers and employers, too!

  • Seamless integration. Health tools, such as a digital scale, are delivered to participants and are designed to work with the app.

  • Support. Lark’s support team has experts ready to get you started and continue supporting your employees through the program.

  • Results. Lark has proven engagement and weight loss results to help your employees stay healthy.

Ready for a Diabetes Prevention Program?

Prediabetes and type 2 diabetes are among the most expensive and devastating conditions of our time, but there is a way to reduce the burden. Offering your eligible employees and covered individuals the chance to participate in a DPP can be the right human choice, and the right business choice. Get started today!