Type 2 diabetes skipping meals

The Dangers of Skipping Meals When You Have Diabetes

Pictured recipe: Mushroom Scrambled Eggs

It’s tempting — and even sounds logical — to skip meals: You’re busy, you’re not hungry, you’re trying to lose weight, or your blood sugar is too high. Skipping meals, however, may actually increase your blood sugar and cause you to gain weight. Here are seven rewards of eating regularly scheduled meals when you live with diabetes.

Reward 1: Improve fasting blood glucose numbers.

During sleep, when you’re not eating, the liver sends more glucose into the blood to fuel the body. For many people during the early years of having type 2 diabetes, the liver doesn’t realize there is already more than enough glucose present. “Your morning (fasting) blood sugars have much more to do with your liver and hormonal functions than what you ate for dinner last night,” says Kathaleen Briggs Early, Ph.D., RD, CDE, assistant professor of biochemistry and nutrition at Pacific Northwest University of Health Sciences in Yakima, Washington

Real-life example: Until recently, if Cheryl Simpson’s blood glucose meter flashed a high reading before breakfast, she might delay eating until midafternoon in an attempt to lower that number. Now Cheryl, PWD type 2, won’t leave home without eating breakfast. Her blood glucose numbers have improved. “Plus, eating breakfast makes it a whole lot easier to make good food choices later on,” she says.

Reward 2: Stay off the blood sugar roller coaster.

Irregular eating can have you “bouncing back and forth between normal blood sugars and high blood sugars,” Early says. A meager meal can give you a meager rise in blood sugar. If you take one or more blood glucose-lowering medications that can cause low blood glucose (hypoglycemia), skipping meals or eating too little can increase the risk. Spreading out foods, especially carb-containing foods, over three meals each day (and snacks if you want them) can help maintain steady blood sugar levels.

Real-life example: Cheryl, PWD type 2, would make her way through the meat, the vegetables, and each of the rice and noodle dishes at a Chinese buffet before topping off the meal with ice cream. She thought a big meal wouldn’t hurt as long as she held back at other meals that day. Cheryl now understands the damage done by a big glucose spike after a big meal and that splurging won’t prevent hypoglycemia if she skimps at another meal.

Tip: If your meal is delayed and you’re worried about low blood sugar due to the medication you take, choose a snack with about 15 grams of carb, such as a small box of raisins or handful of pretzels. If you’re at risk of experiencing hypoglycemia frequently, always try to carry one or two portions of 15 grams of carb.

Reward 3: Fight fatigue and boost energy.

Eating meals spaced throughout the day provides a consistent fuel source and can help combat the feeling of fatigue. For people who want to snack, a small amount of carbohydrate can help keep energy levels up, and including protein will help you feel full.

Snacks that contain some carbohydrate and protein are:

• 1/2 cup carrot sticks and 2 tablespoons hummus

• 1/2 cup cantaloupe and 1/2 cup cottage cheese

• 1 small apple and 12 almonds

• 1 small apple and 1 string cheese

• 1/2 cup banana slices and 1 tablespoon peanut butter

Real-life example: Cheryl, PWD type 2, has a little more kick in her step now that she doesn’t skip meals. She didn’t realize how drained she felt every day until she started feeling better. Along with other eating changes, spreading out her foods has helped her accomplish more throughout the day.

Tip: Tired or thirsty? A glass of water and a bit of exercise may help you beat fatigue (with no added calories).

Reward 4: Learn how foods affect your blood sugar.

It takes a bit of detective work to sort out the causes of high and low blood sugar and to determine the best eating, exercise, and medication strategies for you. If your blood glucose numbers are unpredictable, eating similar amounts of foods at similar times each day and keeping accurate records will help you and your health care provider identify trends and guide adjustments to your treatment plan. Eating randomly makes spotting trends and controlling blood glucose levels much more difficult.

To learn how a meal affects your blood sugar, do a blood glucose check with your meter just before you start to eat and about two hours after the first bite.

Tip: Set up a simple experiment with the following steps.

1. Wash and dry your hands, then check your blood sugar before your meal.

2. If you take blood glucose-lowering medication with meals, take your dose as usual.

3. As you take your first bite of the meal, set a timer for 2 hours.

4. Check your blood sugar again 2 hours after the first bite.

5. In a journal or on a notepad, record the date, times of checks, blood glucose results, foods and drinks you consume, and portions.

6. Repeat the experiment on another day to compare information and check for trends. If results are off-target, talk to your provider about meal, exercise, and medication options.

Reward 5: Meet weight-control goals.

Skipping meals is like skipping your medications. It causes erratic blood sugar levels, making weight control difficult. Well-controlled blood glucose helps manage appetite, and when blood sugar is high, the pancreas kicks out extra insulin (if it’s still producing insulin) to compensate. Because one of insulin’s jobs is to store fat, it’s telling your body to pack on the pounds from any excess calories, not get rid of them. Last but not least, skipping meals can lead to overeating later, especially at your evening meals.

Tip: If you find it’s healthiest to bring food with you to work or daily activities, plan what you’ll need and pack it the night before.

Reward 6: Help some medications do their jobs.

Insulin and some blood glucose-lowering pills “don’t halt their action if you decide to skip a meal,” says Kathleen Stanley, dietitian and author of 50 Things You Need to Know About Diabetes (American Diabetes Association, 2009).

Instead, the medications that stimulate insulin production can continue to lower blood glucose even if levels are not elevated. The common pills that can cause this include: glimepiride, glipizide, glyburide, nateglinide (Starlix), and repaglinide (Prandin). These medications may increase the risk of low blood sugar (hypoglycemia).

Having frequent low blood glucose reactions can make weight control more challenging due to the need to eat or drink carb-containing foods or treatments to quickly bring blood sugar levels back into a healthy range. Because having a low blood sugar may make you feel panicky, it’s easy to overeat. You may easily consume more calories than you need to treat the low. Ask your provider whether the glucose-lowering medication you take can cause hypoglycemia and what you can do to prevent it. If you’re experiencing low blood glucose reactions frequently, talk to your health care provider about making medication changes or adjustments.

Reward 7: Create order in your day.

Regular meals can provide structure and a framework for organizing your day and scheduling time for exercise, fun, and relaxation, says dietitian and diabetes educator Kathleen Stanley. Both exercise and leisure time help you manage stress, which helps you control diabetes.

Structured meals tend to be more nutritious, too, adds Kathaleen Briggs Early, Ph.D., RD, CDE. If you’re skipping meals or grabbing food on the go, you may choose less-healthy foods that lack vitamins, minerals, antioxidants, fiber, and other nutrients.

Consider that most of us need at least 5 cups of fruits and vegetables daily. That’s pretty hard to accomplish if you skip meals or eat on the run.

Tip: Plan to eat three meals daily, each with at least three food groups, such as protein, starch, and veggies.

  • Related:
  • The Best 7-Day Diabetes Meal Plan
  • Packable Diabetes-Friendly Salads

Ask D’Mine: Our Lifespan Sans Insulin?

Got questions about navigating life with diabetes? Ask D’Mine! Our weekly advice column, that is — hosted by veteran type 1,diabetes author and educator Wil Dubois.

This week, Wil offers some thoughts on that universal question: “How long can I really go without insulin?” Please take a read; his findings might surprise you and even bust a myth or two.

But as a precautionary reminder: this topic would fall into the category of “Don’t try this at home”!

{Got your own questions? Email us at [email protected]}

Jake, type 1 from Minneapolis, writes: I’ve had diabetes for 18 years and I had someone ask me a question the other day that I didn’t really have an answer to. The question was how long I would be able to survive without any insulin. I told them 3-4 days, but I don’t know if this is true. Any info from a cinnamon whiskey-swizzling T1?

[email protected] D’Mine answers: If Tom Hanks’ character in Castaway had been one of us, he would’ve never lived long enough to go half-crazy and end up talking to a volleyball named Wilson.

OK, so that’s a mixed blessing. But I guess the lesson there is: don’t get washed up on a deserted island if you can avoid it.

To be honest, like you, I had always pegged my zero-insulin survival time in the “couple of days” zone; but once I got to thinking about your question I realized that I didn’t know how I knew that, where I learned it, or if it was even correct at all.

So I set out to do some fact-checking.

Now, as background for you sugar-normals, type 2s, and type 3s—in type 1s like Jake and me, if we run out of insulin hyperglycemia sets in. That leads to diabetic ketoacidosis (known as DKA by its friends), which then (untreated) leads to death.

This is old news. But how fast is the process, really?

Well, there are a number of variables, the most critical being: Are you really out of insulin, or just low on insulin? Some type 1s use basal insulin, which has some effect for a full day or more after the last shot. Others of us PWDs use pumps, and the insulin from the pump only lasts for four hours. The bottom line here is that if two type 1s were captured by terrorists (hey, it could happen!), and if the terrorists took away their insulin, the guy on the pump dies before the guy on shots.

Generally, the first signs of DKA show up once one of us T1s has been north of 300 mg/dL and out of insulin for four hours; but how quickly things get out of hand at that point is highly variable. For some of us the shit hits the fan quite quickly. Others can wander around in a daze for days. I think the two largest driving factors are the carb and insulin loads. If you have even some insulin in your bod, it can hold DKA off even when you are high. Also, if you keep it Atkins-style when you are high, you’re not adding fuel to the fire; while if you gobble down pecan pie a la mode when high, it only makes matters worse.

But those variables aside, let’s cut to the chase. Let’s assume the insulin is gone: zero, zip, nada. Insulin has left the building. Regardless of the carbs that caused it, let’s assume the smoky fires of DKA have started. The clock is ticking. Without help, your doom is only a matter of time. So how much time, exactly?

There’s no end of info on the pathophysiology and pathogenesis of DKA. I found 1,590,000 links to articles on the condition on Google. All of them say that, left untreated, DKA is fatal. But none of them says how fast death comes. I know, because I read all 1,590,000 articles myself, and am now out of cinnamon whiskey. And there’s no end of speculation on the subject in the online community, but can we find any facts?

Looking at historical records from doctors Joslin and Allen before the advent of medical insulin, we see that they were generally able to keep patients alive for months, sometimes more than a year, by starving them to death. Literally. Joslin proudly wrote that,”Whereas formerly the prognosis for children less than ten years of age was measured in months, today it is rare for a child to live for less than one year.” But, of course we now know that the onset of type 1 is a messy affair. The autoimmune process that drives it isn’t an overnight process. Insulin production lingers for many months. Ultimately, all of Joslin’s pre-insulin patients died. 100% of them. I suspect that the ones who didn’t starve succumbed once their insulin production dropped to zero.

So, I don’t think we can really look to history to answer our question. History can only show us how long we can suffer starved in the honeymoon phase of the disease; not how long a full-fledged type 1 will last sans insulin.

Next, it occurred to me that most cases of DKA in our country, even the 2,400 fatal ones each year, receive some sort of medical intervention. And what we need is deserted-island DKA data. I thought to look to the Third World for some info, as type 1 outcomes are pretty grim there. Did you know that lack of insulin is the leading cause of death of children with type 1 in Africa? But, alas, while I was able to find cinnamon whiskey-inspiring life-span statistics, I was unable to get any hard data on how many hours/days/weeks/or months Third World type 1s last without insulin.

So in the end, I reached out to one of the smartest endo’s I know, Dr. Silvio Inzucchi, who runs the Yale Diabetes Center (and who, ironically, got his MD at arch-rival Harvard). Dr. Inzucchi admitted this is a tougher question than it appears on the surface. He pointed out that many type 1s can have some “residual beta-cell capacity” even “years” after diagnosis. He tells me that how fast DKA advances also depends on how well you keep yourself hydrated, and how many carbs are feeding the highs. But, quoting the good doctor: “I will see that in someone with 0% insulin production, they’ll begin to fall ill within 12-24 hours after last insulin injection, depending on its duration of effect. Within 24-48 hours they’ll be in DKA. Beyond that, mortal outcomes would likely occur within days to perhaps a week or two. But I could not see someone surviving much longer than that.”

Of course, he helpfully points out that “if they made some insulin, the course could be protracted to weeks or months,” giving me flashbacks of Joslin and Allen and starving children.

So, Jake, I see you just got your 18-year pin as a member of our club. I wouldn’t put much money on you having any insulin production left. No insulin buys you DKA within a day, two at the most. Then Dr. Inzucchi predicts “mortal outcomes,” possibly within days. Two weeks at the outside.

Huh. Sounds like a two-week notice we should both avoid giving.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

It’s time for this week’s Q&A about intermittent fasting:

  • Can you get low blood sugar during fasting?
  • Does skipping breakfast lead to a higher risk of type 2 diabetes?
  • Does protein powder raise blood glucose?

Dr. Jason Fung is one of the world’s leading experts on fasting for weight loss and diabetes reversal. Here are a his answers to those questions and more:

Can you get low blood sugar during fasting?

Hello Dr. Fung, I am prediabetic, and I have had great success with fasting in helping me to lose weight, and to lower my HbA1c (when last checked it was at 5.9).

I am a menopausal woman and am 53 years old, and also have mild case of Hashimoto’s disease (my antibody count when last checked was 15). I take levothyroxine, and liothyronine, plus estrogen, and progesterone the first 10 days of the month. I also mainly follow a ketogenic diet.

I am a huge fan of you, Jimmy Moore, Dr. Nally, and this website. When I go on longer fasts (7 days) by about day 5, I start to experience low blood sugar and have measured my levels at 48 mg/dl (2.7 mmol/L). Is there anything I can do to avoid having low blood sugar episodes?

I have done two 7-day fasts. The last time I only drank water and herbal tea the first 3 days, then I started having a cup of broth or two each day. I also supplemented with a teaspoon of Himalayan pink salt each day, as I was concerned about my electrolytes. I started the fast at 168 lbs (76 kg), and I am 5’7″ (170 cm). I finished at 161 lbs. and then went back up to 163 lbs (73 kg).

I really enjoy fasting and have a family history of diabetes (both parents), and cancer (father), so I really want to continue doing longer fasts. I understand that you can’t give specific medical advice, but I am hoping that you can talk about experiencing low blood sugar while fasting in a general way since you have fasted such a large number of people.

Thank you in advance for any help you might offer,
Lisa

Blood glucose is supposed to drop while fasting. However, you are not supposed to have symptoms, since most of the body is now powered with fat and ketones. The body has compensatory mechanisms to produce glucose from stored glycogen and fat called ‘gluconeogenesis’.

Symptoms of hypoglycaemia include shaking, sweating and disorientation. Occasionally, people do notice some mild symptoms. There are certain people who do notice symptoms and should generally stop fasting. If you would like to continue, you may build up fasting slowly – going longer and longer until your body gets ‘used’ to the gluconeogeneis.

There is also a disease called ‘reactive hypoglycaemia’ where people develop symptoms after eating.

Dr. Jason Fung

Does skipping breakfast lead to a higher risk of type 2 diabetes?

If you routinely skip breakfast, you may be headed for trouble, says Leah Cahill, PhD, of the Harvard School of Public Health. One of Cahill’s studies found that women who skipped breakfast regularly had a 20% increased risk of developing type 2 diabetes.

Another of her studies — this one in men — linked going without a morning meal to heart disease. “Our bodies need to be fed food regularly in order to maintain healthy levels of blood lipids such as cholesterol, hormones such as insulin, and normal blood pressure,” Cahill says. “As we sleep all night we are fasting, and so if we regularly do not ‘break fast’ in the morning, it puts a strain on our bodies that over time can lead to insulin resistance, type 2 diabetes, and blood pressure problems.”

From this web page:

Robert

Almost all breakfast studies that show a benefit were sponsored by the food companies. Almost all breakfast studies not funded by food companies showed no benefit to breakfast eating. In fact, the studies on breakfast eating are so bad and full of conflicts of interest, an entire paper was written to demonstrate how to distort evidence called ‘Belief beyond the evidence‘. So be very careful. People tell you that ‘studies’ show that eating breakfast will make you healthy, wealthy and be more attractive – it doesn’t make it true.

The other statements you quote here make absolutely no sense. It simply sounds made up. Our body needs to be fed regularly to stay healthy? Where is the evidence or even common sense in that? Does that hold true even if severely overweight and diabetic?

How about ‘fasting strains our body leading to type 2 diabetes?’ Where is the evidence? Fasting lowers blood glucose and insulin, which, if you do it all the time, will lead to high glucose and insulin? Are you serious?

Dr. Jason Fung

Does protein powder raise blood glucose?

Does protein powder made from raw sprouted organic grains, legumes, and seeds raise blood glucose?

Melina

No, protein does not raise blood glucose, but it may raise insulin. In general, I advise eating natural whole foods. This does not include protein powder. So if you want to eat organic legumes seeds and sprouted grains, then great. But I would avoid ground up, processed protein powder that claims to be healthy.

Dr. Jason Fung

More

Intermittent Fasting for Beginners

How to Reverse Type 2 Diabetes – The Quick Start Guide

Earlier Q&A sessions with Dr. Fung:

  • How Much Should You Fast Once Type 2 Diabetes Is Reversed?
  • “Do You Have Any Suggestions to Improve Sleep When Fasting?”
  • When Should You Eat While Doing Intermittent Fasting?
  • How Permanent Is the Effect of Intermittent Fasting on Insulin Resistance?

Many more questions and answers:

Intermittent Fasting Q&A

Read all earlier questions and answers – and ask your own! – here if you are a member:

Ask Jason Fung about intermittent fasting and type 2 diabetes – for members (free trial available)

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