When you eat, you take energy into your body from three different sources: carbohydrate, protein, and fat. Each source is important to your body, and you can't live without the contribution of all three. However, when it comes to T1DM, the energy source that's directly responsible for the level of your blood glucose is carbohydrate. Protein and fat play a role but only indirectly and to a much lesser extent (I discuss protein and fat later in this chapter).
Most people who think of carbohydrate think of sugar, but there are many forms of carbohydrate. The following simple carbohydrates can be digested by enzymes in the stomach and intestine:
i Glucose is the sugar that circulates in the bloodstream and provides energy for movement and for all the chemical reactions taking place in the body. It's a monosaccharide because it contains only one molecule of sugar, as do fructose and galactose.
i Sucrose is a disaccharide because it has two sugar molecules. You may know it as the sugar in sugar cane and beets or as simple table sugar. Other disaccharides are lactose (milk sugar) and maltose (malt sugar).
i Starches are made up of large numbers of sugar molecules.
Other types of carbohydrate are complex carbohydrates including cellulose, the carbohydrate that forms the walls of plant cells; and fiber. Neither of these complex carbohydrates can be digested, which means that they provide no calories.
These are the important functions of all carbohydrates in the body:
1 They're the major source of energy for muscles.
1 The carbohydrate glucose stimulates the pancreas to release insulin, if the pancreas can. In the absence of effective insulin in the body, glucose can rise to very high levels.
1 They raise the level of the blood fat called triglyceride.
In the following sections, I explain what you need to know about the use of carbohydrates in the diet of a person with type 1 diabetes, including some smart food choices and the relationship between carbohydrate amounts and insulin intake.
Americans are eating less fat yet continue to get fatter. Analysis of the American diet shows that people haven't increased their protein intake, so they must be eating more carbohydrates. Carbohydrates can be turned into fat in the body, so if you consume excessive amounts, you'll gain weight. This ancient characteristic of mammals was fine when humans could only find food in the summer and had to live on body fat in the winter. Today, the conversion of carbohydrates into fat causes all kinds of disturbances like heart attacks and strokes. Experts recommend that 40 to 50 percent of a person's daily calorie intake should be from carbohydrates (1 gram of carbohydrate contains 4 kilocalories). And yes, people with diabetes can eat real carbohydrates rather than artificial sweeteners so long as they don't eat too many total calories. (I discuss sweeteners in detail later in this chapter.)
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