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Here are a few facts that may be of interest to chefs so that we may provide a more knowleable service.
Blood sugar comes from the carbohydrates we eat. The digestive system converts any and all carbohydrates into simple sugars, which are released into the bloodstream. The pancreas produces insulin in response to an increase in blood sugar levels, which "unlocks" the body's cells so that they can absorb these sugars to give the body energy. Other hormones are produced to counteract the effect of the insulin once the sugar level has fallen to a 'normal' range again;
Type 1 diabetics (insulin dependant diabetics or IDD's) like me don't produce any insulin for themselves and also lose the ability to produce the counteracting hormones. Type 2 diabetics (non-insulin dependent or NIDD) produce some insulin and take tablets to stimulate this process. I inject insulin directly and therefore my body doesn't automatically deal with changes in blood sugar levels. The amount of sugar in my blood can easily become much higher (hyperglycaemia) or much lower (hypoglycaemia) than my body is designed to cope with; Frequent or severe hyperglycaemia eventually leads to extremely serious long-term health effects (kidney failure, heart disease, blindness, loss of feeling, gangrene/amputation, etc. .). Hypoglycaemia has immediate effects ranging from dizziness or confusion all the way to unconsciousness and even death, because the brain doesn't have enough sugar to function properly. We therefore have to maintain a three-way balance between diet, exercise and medication intended to maintainrelatively even blood sugar levels, as well as improve general health to offset the greater than normal risk of common health problems; Diabetics typically need to stick to low fat diets with a set amount of slowly-digested carbohydrates. IDD's have to eat about six times a day. If I don't eat enough carbohydrates in relation to my insulin & exercise regime then I become 'hypo' by the time my next meal or snack is due. If I eat too much carbohydrates or they are ones which are converted to blood sugar too quickly then the 'peak' insulin level until my next meal will be too high. For every one of my six meals/snacks, I guestimate the amount of carbohydrates (e.g. I aim for about 70 grams for breakfast) and I try to stick to slowly digested ones;
Until recently, it was believed that simple carbohydrates were quickly digested and complex carbohydrates slowly digested, hence more desirable. It is a relatively new revelation that the speed of digestion has little or nothing to do with simple/complex. It is more related to the type of starch present, how processed the food is and other things that affect the digestive system (e.g. acidity).
Each carbohydrate food has a glycaemic index ("GI") from 1 to 100 which indicates how quickly it is converted to blood sugars (low=slow); Diabetic dieticians now recommend a moderately low GI diet including some low GI foods at every meal. Type 1 diabetics like myself should have 6 high-carbohydrate meals a day (I typically eat 250 - 290 grams a day and little fat). I have to avoid common high GI staple foods you would otherwise think good for diabetics like rice, white/wholemeal bread, potatoes and weetbix. I also cannot delay a meal by very much at all without prior warning.
The above applies to all diabetics (about 2% or more of the NZ population), although a sizeable proportion of diabetics don't know about low GI eating, which concerns me greatly. I talk about it ad nauseum in an effort to increase general awareness because I think it will become a very important issue. For every 1000 people everyone knows, 20 are diabetics and 3 of those are IDDs so the cost to society of poor diet control for this group must be immense.
Very few people I have encountered thus far in the food industry know much or any of this. General public understanding is limited to a belief that diabetics simply can't have any sugar. In fact, sugar has only a moderately high GI and if I had to choose I would have a can of coke before eating white toast, boiled potatoes or streamed rice.
I've had diabetes for a year now and nothing about it is scarier to me than being trapped on a plane without suitable food.
If you are interested enough to want to read any more on the basis for the diabetic diet I would recommend a book called "The GI Factor" by K Foster-Powell, Dr S Colagiuri & Dr J Miller (the principal researchers into GI) or I would be quite happy to fill in any gaps.
NZ
Chefs Association Inc