Diabetics: do you count fiber in your carb totals?

[NickB79]

My wife was recently diagnosed with diabetes. She's 41, BMI of 40, A1C of 8.5ish. Her doctor put her on 1000 mg of Metformin twice a day, and told her to keep breakfast, lunch and dinner under 45g of carbs. She can also have 3 between-meal snacks a day between 0-30g of carbs. Her doctor didn't tell her to make any exceptions for fiber, just total carbs. And to be honest, we're both struggling with this in the past few months.

I'm the main cook in the house, and while our meals are 90% home cooked, with lots of vegetables and proteins, they do typically have a good amount of carbs. My wife is having trouble with portion control, and since I'm a pretty active guy, grew up on a farm, who does a lot of manual labor and weight lifting, my portions are pretty large since I'm burning 2500-2600 calories most days just to maintain my weight. When I'm trying to gain muscle, I can hit 3000 calories a day. To be honest, I feel guilty about her diabetes diagnosis because she only started eating these huge portions when we started dating.

She's lost 15 lb in the past 2 months, mostly from trying to control her portions and the undesirable effects of the Metformin, but I don't feel she's in a good place mentally. She's constantly stressed from work, and can't stress-eat like she used to to compensate. I've been trying to get her to work out with me, to limited effect. The best we can do is go for walks in the evening. Yesterday she started talking about how badly she wants pizza and truffles, and she had this manic tone to her voice that really freaked me out. I've told her she could benefit from seeing a counselor, but she's adamantly against talking to one at this point.

I'm trying to research recipes that are lower in carbs, and keep wondering if her dietician was wrong to say she should count fiber as part of her carb intake? I see a lot of references to net carbs, which simply subtract the fiber carbs. Our lives would be so much easier if I could discount the fiber carbs, because a lot of what we used to eat (brown rice, whole-grain pasta, beans, lentils) are high in fiber already. But I don't want to second-guess her dietician, who clearly has an educational background in this.

Any help would be appreciated!

[RegulatedCapitalistD]

1. I eat Dirty Lazy Keto. I don't count Fiber or Sugar Alcohol.

[I_UndergroundPanther]

14. Same here the lazy keto

It really helps me manage my diabeties tho.

[Mosby]

2. Fiber doesn't count as carbs

I'm not sure why she would tell you that. Worth double checking.

Eta cauliflower rice and zoodles are great subs. You can buy a machine to make zoodles. I go to an Italian place that will sub any pasta for zoodles, but you have to ask.

Be careful about cauliflower pizza crust or crackers. It's still mostly wheat flower.

[padfun]

3. It does count but doesnt spike the BG level

I found that it is like a delay and avoids those 400 readings I get if I just eat bread and other carbs. (Rice will get me to 400 also.)

So when I count, I kind of count Dietary Fiber about a third of what is listed. Now Sugar Alcohol does something similar to me. It will raise the BG level but only a small amount, so I count that for about a third as well. If it says 6 grams of Sugar Alcohol, l then I count is as 2 grams. Erythritol seems to not raise it at all so it is a good sweetener however eating too much gives me indigestion.

This isn't scientific but it is something I have been using for about five years now.

[NickB79]

5. Since she isn't insulin-dependent, she hasn't been monitoring her blood sugar yet

Which is both a blessing and a curse, because she can't get any real-time feedback from what her diet is doing.

[enough]

6. I'm not isulin-dependent but I do find that monitoring (not constantly but regularly)

really helps a lot with keeping focused on reality, which can be calming.

[I_UndergroundPanther]

15. I check 4 times a day

Not insulin dependent but testing 4 times a day gives me peace of mind.Anxiety raises your blood sugar too.

[TexLaProgressive]

11. Using a meter like the Contour Next or Next One is really helpful

One doesn’t need to be using insulin to gain good information from a meter. Medicare is even reducing the requirements for those with T2DM to be prescribed CGMs like Dexcom and FreeStyle Libre because it really shows one how and what foods affect BG. This is an odd thing, not everyone with T2DM reacts to food the same.

Now rice is almost universal among both T1DM and T2DMs in spiking BG very high

[IbogaProject]

4. It comes up in the way the measure the calories

But for now leave them out of your carb goals. Metformin will help. Lowering Carbs for now will help. And doing things to improve blood vessel health and to improve the body's use of insulin are important too. Have her try Melatonin, it is sold for sleep, it is a very healthy anti-oxidant which can make insulin work better in the body. Unsaturated fats like olive oils help reduce the risk of diabetic complications. Best wishes.

[Dave in VA]

7. Here is something

that I used to make for low carb eaters:

https://healthyrecipesblogs.com/meatza/

Hope this helps!

[TexLaProgressive]

8. On nutrition labels, dietary fiber comes in 2 types.

Soluble (digestible) fiber and insoluble (undigestible) fiber. Most food products just list fiber as dietary fiber which includes both types. The formula that works best for me is to take 50% of dietary fiber from the total carb grams. This isn’t perfect but works pretty well. Don’t go by the hype in big font ZERO NET CARBS. They are subtraction all the dietary carbs from total carbs.

I hope that your wife can find a way to lesson stress. Stress leads to the fight/flight hormonal releases which increases glucose release from the liver and steroids which significantly increase insulin resistance.

I know all about work related stress personally increasing my blood glucose levels.

One person mentioned sugar alcohols. These sweeteners are common in sugar free candies. They are not free foods and can cause a rise in BG, and in combination with Metformin can keep her on the toilet more often than not. These are the most common; erythritol, hydrogenated starch hydrolysates (HSH), isomalt, lactitol, maltitol, mannitol, sorbitol, and xylitol.

Here’s a couple of links to an Australian type 2 diabetic’s blog that are helpful starting points.

http://loraldiabetes.blogspot.com/2006/10/d-day.html

http://loraldiabetes.blogspot.com/2006/10/test-review-adjust.html

Alan has also written a book that I believe is available on Amazon, “What On Earth Can I Eat.”

I have had less than stellar advice from dieticians. The 3 I met with back in 1990 seem to have a hate relationship with food and were pushing ideas that were not helpful in gaining and managing good blood glucose levels.

[I_UndergroundPanther]

16. Stevia is my go to sweetener.

Never have to sit in the bathroom after eating it too.

[TexLaProgressive]

18. I use stevia and Splenda sparingly

Those are not sugar alcohols which can cause gastric distress. Neither is aspartame, but I avoid it like the plague. It makes my pain and touch nerves ultra sensitive. The skin on the front of my thighs was painful with no visible signs. Then I would have a rush of sensation starting at the feet to the middle of my upper legs. That seemed to have a visual stimulus, like seeing a base runner sliding to base.

After years of avoiding aspartame it is nearly gone, sometimes I'll get a bit on the soles of my feet. Strange but true.

[LatteLady]

9. Not a simple answer but,

Your best bet is to count total carbs since net carbs will always be lower than total carbs.

Net carb proponents will say that the fiber content is not absorbed and does not affect blood sugar. This is not 100% true. Different people have different metabolisms. For purely natural food with purely natural fiber, this lack of fiber effect is more true, and this natural fiber is good for you. But processed food producers have figured out the net carb craze and so they add artificial fiber products to processed food to make you think that unhealthy food is not so bad for you as it really is.

The take home here is to eat more natural foods and avoid processed foods where possible. Avoid starches as much as you can, bread, pasta, rice, potatoes, corn, etc.

I agree with you about the counselor. She has been diagnosed with a serious chronic condition that has very negative consequences (stroke. amputation, vision loss, etc) if not managed. Getting herself to accept this new reality and emotionally in a good place to act in her own best interests is important.

See if you can find a Chronic Disease Self-Management Program for Diabetes near you. She may feel more l for table talking to peers, at least at first.

[MOMFUDSKI]

10. It is simply

counting carbs. There are a gazillion carb count lists online. Diabetes is really hard and she should take it seriously. Must have a meter to understand how food affects your sugar. It is a whole lifestyle change. She needs some time right now to adjust. It is not a disease for sissies. A visit to a diabetes educator will be very helpful.

[LetMyPeopleVote]

12. I am on Trulicity which is a sister drug to Ozempic

Last edited Tue May 23, 2023, 05:20 PM - Edit history (1)

I have been a diabetic for a very long time. After three months on Trulicity, my AIC was 5.3 and my doctor has cut back my insulin a great deal. I am down 20 pounds. Ozempic is better for weight loss and control of AIC but my AIC was at 6.3 before I started Trulicity.

Good luck with the diabetes.

[Grasswire2]

13. maybe metformin isn't the best route

My numbers improved significantly with Glipizide.

"Metformin and Glipizide are both medications used to treat type 2 diabetes. However, they work differently. Metformin is an antihyperglycemic agent that improves how the body responds to insulin and is effective for the treatment of type 2 diabetes1. Glipizide is a hypoglycemic agent that helps lower blood sugar levels by stimulating the pancreas to produce more insulin2.

It’s important to note that both medications have different dosages and side effects. You should consult your doctor before taking any medication."

[Elessar Zappa]

17. I've always been told,

by my doctors, that fiber should be subtracted from the carb total because fiber doesn’t raise the blood sugar.