The Paradox of High Blood Sugars and Diabetes

Healthcare professionals are always intrigued by ways of improving elevated blood sugars. Three of those methods are to encourage weight loss, change medications, or promote balanced eating.

The method of weight loss and restriction is often conveyed to clients with: “Stop eating so many carbs” or “Don’t eat bread, rice, or potatoes” or “Don’t eat anything white.” The second method, adding or increasing diabetes medications, is necessary for diabetes care, but it is expensive and requires the prescriber to engage in a time-consuming risk/benefit analysis fraught with uncertainty.  The third way, balanced eating instead of low-calorie eating — which can seem paradoxical to many healthcare professionals — encourages a person to eat a diet that is energy balanced and contains 1,800, 2,000, 2,200, 2,400 or more calories.

Nutrient-rich energy-balanced dietTo most healthcare professionals, the third option just feels wrong. Their immediate thought is: “These people have diabetes; they need to lose weight!” Most healthcare providers have been habituated to the idea that only restriction, dieting, and weight loss are effective in controlling diabetes. Considering another option such as eating an energy-balanced diet is so unfamiliar that many disregard the idea.

Think for a moment about why you would feel afraid, nervous, or uncomfortable recommending that your client eat a nutrient-rich, energy-balanced diet. Could it be that the information about diabetes care has been filtered through a restrictive-eating model for over 90 years, or that the culture we live in has twisted people’s view of nutrition into the belief that underfeeding the body is healthy and sustainable? Could it be that, like our clients, we are afraid to be wrong or to try something new — which leads us over and over again to reach for the quick fix of a diet?

The paradox of diabetes is that the cycles of undereating (restriction) and of overeating (not restricting) create a blood-sugar rollercoaster. When healthcare providers point to clients’ periods of blood sugar control and say, “Good,” instead of drilling down and asking, “What shifted here to improve your blood sugars?”, they unknowingly reinforce this blood-sugar  rollercoaster. When a client responds to the “What shifted?” question with, “I’m not sure,” the provider needn’t give the standard suggestion: “Don’t eat this, or only eat that.” Instead, see this as an invitation, an opportunity for the client to work with a weight-neutral dietitian/nutritionist to learn about effective blood-glucose management.

There are no studies that support the idea that restrictive eating, also known as dieting, is a sustainable behavior, which might make you wonder why it continues to be a treatment for diabetes care. Temporary, unsustainable changes are what create erratic blood sugars. They aren’t enjoyable for the client, because they drive a cycle of blame and shame and feelings of failure.  Additionally, these periods of erratic eating are impossible for the provider to rely on as an effective treatment.  In diabetes care, sustainable behaviors are the goal because they allow for long-term management of the disease.

So, if restrictive eating is not sustainable, and if it creates erratic blood sugars that make the management of diabetes care more difficult, what is the solution? The solution, paradoxically, is encouraging the client to eat.  Eating a consistent, energy-balanced diet improves blood sugar. When a person with diabetes eats a moderate amount of carbohydrates that are distributed throughout the day, blood sugars improve, and the overall management of the disease becomes more predictable.

To learn more about weight-neutral diabetes care, purchase Diabetes Counseling and Education Activities: Helping Clients Without Harping on Weight,

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