Chiqui Sweet: Five Injections a Day and the Diet Debate

Five injections a day and the debate over the official diet

When Lorena Aguinalea, from Málaga and born in 1975, took her daughter Sofía to hospital in early 2014, the girl had a blood sugar of 650 and was admitted to the ICU. The diagnosis: type 1 diabetes mellitus, the most serious kind, with five injections a day for life and eleven checks a day that the girl already does herself. From that debut—as it is called in diabetic jargon—first came a blog that reached 10,000 readers, with messages from Peru, Switzerland and Germany, and later Chiqui Sweet, the Sweet Side of Diabetes, the book in which the author tells, in an offbeat way, how a family from Málaga made an emergency landing in a world it did not know. The scene she herself recounts: she ran into Isabel Pantoja and her cloud of cameras at the hospital while she was being told that her daughter had to be admitted.

But what really burns is not the personal story. It's the plate.

Pasta and steak: the debate over what spikes glucose

The mechanism can be told in two lines and suffered over twenty-four hours. The body turns most carbohydrates—sugars and starches—into glucose, which enters the bloodstream and forces the pancreas to release insulin. If the pancreas does not produce enough insulin (type 1 diabetes) or produces one the body does not respond to (type 2), that spike becomes a roller coaster. One participant puts it bluntly: giving carbohydrates to a diabetic is "like giving beer to an alcoholic." The retort came quickly: if a diabetic is not given carbohydrates, what appears is hypoglycemia, a coma by the opposite route. No one moved an inch.

Some add an uncomfortable nuance: a steak also raises glucose. And some argue, charts in hand, that a high-protein meal produces a greater and faster insulin response than one rich in carbohydrates. Meat, some say, acts slowly; bread, all at once.

The menus cited in the debate: bread, Maria biscuits and pasta

The most uncomfortable front is not patients but guidelines. One participant cites a standard 1,800-calorie menu for diabetic pregnant women whose only explicit prohibition is sugar. So far, reasonable. The problem is what comes next: six meals a day, two of them with skimmed milk and Maria biscuits, and 40 grams of bread at every meal. Along the same lines, another claims that the recommendations from the Sociedad Española de Cardiología (Spanish Society of Cardiology) that come up in a quick search include bread at every meal, rusks mid-morning, a plate of pasta or rice a day and biscuits for an afternoon snack.

The conclusion several forum members draw is one: banning sugar while allowing Maria biscuits, bread and pasta is a textbook inconsistency. That refined starch and sugar end up being almost the same in the blood is the argument underlying the anger.

A1c from 8 to 6.5: the account of someone who tried it on their own body

Against the guidelines is experience. A type 1 diabetic who has had the condition for 17 years relates that with the classic diet he maintained a glycated hemoglobin of 8 and that, after two years on a paleo diet, it did not go above 6.5. His calculations: meat with salad requires 2 units of fast-acting insulin; an apple, 4; a chorizo sandwich, 6 fast plus 4 slow. Matching the bread spike with the insulin spike, he says, is a matter of luck. And luck, with a broken pancreas, is not a plan.

In the other corner, another case contradicts the account: someone who eats 500 grams of whole oats a day—about 350 grams of carbohydrates from that alone—and claims his tests never went above 55-60 glucose. The explanation he gives himself: glycemic index, exercise and a balanced diet weigh more than the food's label.

White rice, fructose and omega 3: the unresolved fronts

The trail extends to studies. A meta-analysis published in The BMJ associates white rice consumption with a higher risk of type 2 diabetes, with a relative risk of 1.1. For calibration: smoking and lung cancer yields a 4. The inconsistency of the data—significant in Japanese and Chinese women, not in men—leaves the finding hanging.

Around it, more noise. One participant argues that fructose is the worst sugar because it is metabolized in the liver and causes insulin resistance. Others argue about omega 3, omega 6 and their ratios. And in the background, the same old suspicion: analyzing a food in isolation without looking at the rest of the basket is a useless exercise.

Lorena Aguinalea's book provided the friendly headline—a smiling girl, a school with four diabetic children and a second part on the way. The behind-the-scenes story is different: some ask for meat, others for oats, others for sticking with the usual diet. The concrete data—an A1c that falls and a rice that rises 1.1—do not close any of the three doors. And there it remains, bogged down.