Nutrition Corner: Simplifying the Complex Topic of Carbohydrates

Simplifying the Complex Topic of Carbohydrates

Expert: Lauren Cherry, MS, RD, LDN, CDCES

Congenital Hyperinsulinism Center Lead Clinical Dietitian

Everybody requires carbohydrates as a source of energy, but not all carbs are created equal when it comes to the effect on blood sugars.

Some, informally known as simple carbs, are absorbed more quickly and raise your blood sugar quickly. Some examples of simple carbs include sugar and white flour.

Others, labeled complex carbs, can be absorbed more slowly, raising the blood sugar in a slower fashion. Common complex carbs include whole wheat flour, vegetables and beans.

A main objective of nutritional management of patients with glucokinase hyperinsulinism (GCK HI) is to optimize glycemic control. Though blood sugars are often managed medically through use of medications and/or continuous enteral dextrose, food and formula choices that promote healthy blood sugars can be helpful. One way to do this is by choosing complex carbs (such as whole wheat bread) instead of simple carbs (such as white bread) when you can.

Doubling up on macronutrients

Another approach may be to include at least two macronutrients at every meal and snack. Carbohydrates-plus-protein or carbs-plus-fat is the basic format for this recommendation.

Carbohydrates are primarily responsible for raising the blood sugar, while protein/fat slow down overall digestion and absorption of the food, resulting in a slower blood sugar rise. Often, patients have an easier time doing this at meals. However, snacks can be trickier, as many are primarily carbs.

• Carbohydrate sources – breads, pastas, cereals, grains, fruits, starchy vegetables (potatoes, corn, green peas), vegetables, snacky foods (chips, pretzels, crackers), milk, yogurt
• Protein sources – meats, fish, eggs, cheese, yogurt, milk, legumes/beans, nuts/nut butters, seeds, soy (tofu)
• Healthy fat sources – avocado, vegetables oils (olive, canola), nuts/nut butters, seeds, fish

Kid-friendly snack combinations could be: apples with peanut butter, yogurt with nuts and berries, tortillas with guacamole and cheese, crackers with cheese, or pretzel sticks with hummus. Mix and match from the groups to find snacks your child likes while keeping their sugar levels steady.

Add fiber to control glycemia

Another way to improve glycemic control after eating is by including fiber. Fiber — which can be found in any plant-derived food, such as fruits, vegetables, legumes and whole grains — is what differentiates a simple from a complex carb.

Though many of these foods are primarily carbohydrates, the presence of fiber slows down the gastric transit of food, and in turn reduces the potential for a blood sugar spike. Formula-dependent patients with HI may see some improvement in glycemic control when using a fiber-containing formula.

Other ways to help the pancreas do its job

Patients may have part of their pancreas removed as part of their GCK HI treatment. Patients who have had this type of surgery may experience pancreatic insufficiency, meaning that the other jobs their pancreas does are diminished. Specifically, the digestion of fats can be impacted.

One frequent intervention to help the pancreas is a medication known as PERT, or pancreatic enzyme replacement therapy. There are numerous enzyme formulations that have different applications, depending on the needs of the patient. For instance, some enzymes can be taken by mouth, but some should be mixed with formula and given via feeding tube. Patients who use these enzymes are then closely monitored for signs and symptoms of malabsorption, which means difficulty absorbing the nutrients from food. If patients are not able to absorb the necessary nutrients from their food or formula, they may need a higher enzyme dose.

In addition, fat-soluble vitamin levels are monitored closely, as these may become low if the body is not able to digest fat well. These levels can be checked during routine labs. If supplementation is needed, we may recommend specialized fat-soluble vitamin formulations.