Diabetes and Food

A Type 2 Diabetes ‘Shake?’

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Last weekend, we were on the hunt for a dog friendly café to keep this little guy entertained.

My sister suggested a place, before casually mentioning to me that they had a ‘type 2 shake’ on the menu.

What, is that like a health shake or something? I asked.

No, it’s actually a shake that’s got lots of sugar in it, she replied.

We eventually drove there to find the place closed.

After we had driven elsewhere and I was finally caffeinated, I began googling this place in search of a menu. Indeed, it was an indulgent shake that the user was encouraged to try ‘at your own risk.’ I then migrated over to Facebook, where I eventually found a recent post promoting the menu item in question.

I was so frustrated. Yeah, they had specified the type of diabetes, but that wasn’t the point.

Nobody intentionally asks to get diabetes.

We all know that sugary treats in excess aren’t good for us. We all know that in excess they may eventually lead to obesity, insulin resistance and type 2 diabetes.

But that isn’t always necessarily the case.

We also know that some people are genetically predisposed to developing type 2 through things like family histories or previous gestational diabetes. Others are ethnically or geographically predisposed to developing type 2 diabetes. Then there are those who don’t have an equal chance because they may lack things like the basic education or quality healthcare that I take for granted.

The last thing that people living with diabetes need is reminders that make them feel guilty, blamed or shamed for their choices.

The last thing that people living with diabetes need are messages that further stigmatise a condition that is already surrounded by, you guessed it, a great deal of stigma!

Yet here was this shake that was making a mockery of people with diabetes. I’d be willing to bet that a Cancer shake would never appear on the menu, so I don’t know why the owners of this cafe felt that diabetes was okay to joke about.

So, back to that Facebook post. You bet I left a comment on it. There was no swearing or personal attacking in said comment. But it was a little strongly worded – something I regret in hindsight – indicating that blaming, shaming and stigmatising was not helpful to people with diabetes.

24 hours later, a notification popped up in my Facebook feed. I was expecting some kind of acknowledgement or explanation.

But nothing could have prepared me for the response I received in return.

To paraphrase, I’m a miserable troll who should pull my head in and stop being a keyboard warrior (they obviously had no idea who I was). This ‘type 2 shake’ was apparently a ‘statement’ that the sugar it contains is not good for you. But what do I know, apparently type 2 diabetes is a great catchline to sell a product!

With no time for such negativity in my life, I thanked the café for their kind words. After expressing that it was a shame that they were unable to the larger issue, I wished them a lovely day and bowed out of the conversation.

With every red notification icon that popped up on my Facebook, I was expecting to see others chime in with more ignorant replies to my comment.

Surprisingly, quite the opposite happened.

The diabetes community rallied behind me.

Within a mere three hours, I had at least ten comments on that post in support of what I had said. People were tagging their friends. I honestly don’t think it was the shake itself that was triggering commentary anymore. It was about the sheer ignorance that came from their comment.

Had the Facebook post survived few more hours, and it surely would have gone viral.

But it mysteriously vanished not long after.

While the cafe clearly didn’t like the negative attention that they were getting, I highly doubt that I got my point across given their highly ignorant response.

I can’t really say that it’s worth throwing any more of my energy towards.

I only know that I won’t be going back there again.

The Real Deal.

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I poured some dry packet mix into a mixing bowl on Sunday afternoon.

I added an egg and 40 grams of melted butter to the bowl, stirring it together with my wooden spoon watching it all combine together.

I scooped up little balls of this moist brown mixture, placing it carefully onto my baking tray 2cm apart. As I began to divvy up the remaining mixture among the 15 balls on my tray, my hands were beginning to feel sticky.

I had no temptation to lick any of the residual mixture that was stuck to my hands. I wasn’t even tempted to grab a small spoon from the kitchen drawer and devour all of the residual mixture stuck to the sides of the bowl.

As I opened the door to check on my creation that was baking away in the oven, there was absolutely no sweet aroma wafting its way towards my nostrils.

I kept poking and prodding at my browning vanilla almond biscuits, thinking that they felt far too soft for biscuits. After pulling them out of the oven and letting them cool for 15 minutes, they were still yet to harden despite having exceeded the cooking time. After putting them back into the oven for another ten minutes, I felt that I was at risk of burning them and switched it off.

As I later placed my cooled biscuits-that-didn’t-feel-like-biscuits into an airtight container, I was not even inclined to break one of these biscuits in half to taste. I sealed the lid and placed the container into my bag for the following day.

When I arrived at Monday evening’s meeting with my fellow Young Adult Diabetes Committee members, I placed the container of biscuits on the table. Despite watching my peers eat these biscuits and tell me that they were good, I didn’t really want one. Even knowing that the 1g carb count per biscuit would have minimal impact on my blood sugar couldn’t tempt me.

These vanilla almond biscuits that I had spent my Sunday afternoon baking were sugar free, sweetened with what I believed to be Stevia.

If this kind of baking is what you choose to do in managing your diabetes, then I completely support and respect you for doing so.

But if I am being absolutely honest, for me personally, low carb baking does not come anywhere close to the real deal.

I would much rather have those sweet smells wafting through my kitchen, lick my fingers clean, scoop residual doughy mixture from the side of my bowl, break a hot cookie in half, have the real taste of sugar on my tongue, swag bolus some insulin through it all and correct a high blood sugar afterwards.

Insulin Gone Bad.

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I couldn’t help but notice the reading of 14.1. Is that high? My friend asked me from across the table as I was demonstrating my FreeStyle Libre.

Yeah, I obviously haven’t given enough insulin for the banana bread, I replied, pulling my pump out of my pocket and bolusing for another 30 grams of carbs ever so casually.

I had already bolused a very generous 60 grams of carbs for the slice of banana bread and iced coffee I had ordered at the local cafe, but I wasn’t overly surprised to see the upward trend arrow on my Libre.

My blood sugar was still skyrocketing by the time I arrived home an hour later, with my Libre clocking in at a lovely 17.4. I bolused for another 10g of carbs, bringing the total for my mid morning coffee catch up to an overly generous 100g of carbs. I was certain that all of this insulin was bound to kick in any minute now.

After another hour had passed and my Libre clocked in at 25, I had figured that banana bread was the devil. After a prick of the finger came in at 20.4, I ignored all insulin I had on board and gave a full 4 unit correction. I also set a temporary basal rate of 100% to help get things moving in the right direction.

After a bucketful of insulin, my blood sugars slowly but surely began moving in the right direction over the course of the afternoon.

When dinner time rolled around and I was back in range, I bolused for the 50 grams of carbs on my plate. I drank a glass of water. I stepped outside and turned the sprinklers on. I washed some strawberries that I planned on having post dinner. I drank yet another glass of water. I stepped outside again, and switched the reticulation off. After distracting myself for a good 20 minutes or so for the bolus to kick in, I finally tucked into my dinner with the hope of avoiding another blood sugar rollercoaster.

Fast forward to me in front of the television 2 hours later, and my blood sugar clocked in at 16.1 with an upward trend arrow on my Libre.

I scrolled back through my pump history, noting that my last prime was four and a half days ago. As I swapped out the infusion site, my brain began to cotton on to other moments of particularly difficult-to-manage post meal blood sugars in recent days.

The lone milky coffee that sent my blood sugar upwards of 10. The hot cross bun that I’d carefully pre bolused for, but landed me close to 20. Rising blood sugars, despite a long walk fuelled by 10g of chocolate beforehand. Even a pasta meal had been extremely difficult to manage.

As I connected all of these recent occurrences together, I eventually recalled another occurrence of skyrocketing levels when my insulin had spoiled 2 years ago.

My insulin had spoiled! There was my answer! 

So, maybe Banana bread wasn’t the devil after all.

Learning to Fuel My Body with Type 1 Diabetes.

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Trying to stick to a diet of 8,000 kilojoules a day is hard work.

I know that when I do eat enough to sufficiently fuel my very active body, I don’t feel lousy, exhale air or yawn half as often as I’m used to. I have more energy, focus and enthusiasm to pour into my day. In fact, I’m so focussed on getting those kilojoules into my body that I don’t think think about chocolate or even coffee half as often (no, I am not kidding).

I also know that this 8,000 kilojoules a day business is hard work (have I said that already?). Organising meals and snacks takes time out of my day, even though I am more than capable in the kitchen. It’s been very easy for me to slip back into my old habits of existing on rabbit food until dinner time when I haven’t organised myself in the mornings.

I embarked on this new eating-to-fuel-my-body kick at the end of February, rebounded for some part of March after I got sick and the Cadbury Choc Chip Hot Cross Buns kicked in, and am only just getting back on track in the past week or so.

I first learned about eating to meet my daily energy needs after reading The CSIRO Total Wellbeing Diet and The CSIRO Low Carb Diet last year. Despite it all making perfect sense, putting kilojoule counting into practice on top of carb counting, checking blood sugars and all of those other diabetes tasks felt extremely overwhelming. Thankfully, the smartphone app My Fitness Pal made tracking my kilojoule intake really easy.

The biggest change since I’ve began eating more is increased insulin sensitivity. Which I guess is a good thing, right? It started with unusually easy to manage blood sugars in the evenings after dinner. I would then wake up low during the night, have a glucose tab or two, only to wake up low again a few hours later. Fun times, right?

I’ve dropped my basal rates by about 10% overall, and so far, so good. My biggest challenge is continuing to eat this way so that I can maintain the same sensitivity to insulin.

I’m not really focussed on skewing a particular way with protein, fat or carbohydrate, but do find myself eating more protein than I was before. At the moment I’m honestly just focussing on eating enough, eating well and getting a balance of everything in there.

I find myself eating more significant meals for breakfast and lunch, rather than a slice of toast or a toasted ham and cheese sandwich. Like this amazing Sunday roast of pistachio stuffed chicken breast wrapped in prosciutto that has doubled as Monday lunch.

I embarked on this way of eating for more physical reasons, but the benefits seem to have extended into my diabetes as well.

I have more energy and focus in the short term, and I’m hoping that this will only replicate further in the long run (if I can keep it up!). The increased insulin sensitivity is making blood sugar levels much easier to manage. In the past I’d correct stubborn highs with little or no effect, and override the suggested correction on my pump with a larger bolus. Now, a correction seems far more effective than before.

I get that balancing food and blood sugar levels is no easy feat, but I don’t think I ever truly appreciated just why it is so important to eat.

Four Foods I Cannot Bolus For To Save My Life

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I remember starting off on vague insulin doses of 5 to 10 units at every meal instructed to me by the hospital. Then I saw a diabetes educator, and learned to carb count. Adding up every gram of carb on worksheets supplied by my dietician only led to frustration over why logic was not translating into steady blood sugars. (Of course, little did I know about the gazillion other factors that could affect my blood sugar back then…)

For a few years in the middle, I just swaggered by and thankfully lived to tell the tale.

Fast forward to today where I’m using an insulin pump, carb count nearly everything I eat at home and have a pretty good idea of what most foods that I eat will do to my blood sugars. I know exactly why my blood sugar is high as I’m typing this right now (hello, potato bake with no pre-bolus). Overall, I feel pretty comfortable with being able to eat, give insulin and manage my blood sugar levels today.

That being said, there are still a few select foods that I cannot bolus insulin for if my life depended on it.

Pasta.

If there’s one food that confuses the life out of me, it’s Pasta. You can’t go by what’s on the packet, because most packets only refer to the uncooked weight. Seriously – who in the world eats dry pasta? If you were to make that mistake, I‘d be surprised if you weren’t chugging down litres of coke or making a dash to the emergency room.

Logic tells me that Pasta has around 28% carbs in it. The carb counts in our plates of pasta at home would be huge, because who on earth can only eat 1 cup of pasta? But if I were to give a massive insulin dose for all that carby goodness, I’d be eating glucose tabs for dessert.

All the extended boluses in the world can’t keep me from the Pasta lows, which can only mean that Pasta must be a really really really slowly digested food. These days I tend to settle for bolusing for 50 to 60% of the carbs at the time of the meal, accepting that the remaining 40% of the carbs that have absolutely no effect on my blood sugar whatsoever must be magic.

Soup

If there’s one meal that I despise purely for diabetes reasons, it’s soup. Who on earth can count the carbs in all those lentils, veggies and pastina that have been sitting there in the pot stewing all afternoon?

Then there’s the hassle of attempting to drain all of the liquidy goodness from the soup ladle for the purposes of weighing my plate, and then scooping up only liquid from the pot to add to my dry plate.

Add to this the same principles as pasta – all of those lentils and pastina are really slowly digested and would send me low quite easily. With carb free veggies and meat in the mix, I’ve sort of settled on bolusing for about half the number of carbs I would with Pasta.

Bananas.

Fun fact: I cannot eat a Banana without going low. Which is shit, because I actually happen to like them a lot. I very much look forward to my mid morning coffee and banana, while other times I slice it up to mix in with my Overnight Oats.

Logic tells me that a Banana with skin intact has around 13% carbs in it. But if I were to weigh my banana and bolus that much, I would be low within the hour. I’ve sort of settled on bolusing for around 50 to 60% of the carbs in my bananas, and some days this does the trick while other days it does not.

Steak and chips. Or Pizza. Or any kind of restaurant meal, really…

I have a love hate relationship with pub meals. I love how delicious and mouth watering and salty a steak and chips are, but I absolutely hate the night sweats and resilient high blood sugars that follow in the aftermath.

After learning that restaurant meals tend to be higher in fat to make them more delicious, I tend to set a temporary basal rate increase of 50% on my pump for 8 hours to combat the insulin resistance. I don’t prebolus for anything, given that fat slows down the digestion. I might also bolus for 40 to 50% of the protein in my steak after the meal is over, using a extended bolus over 2 to 3 hours.

Get the insulin in too early, and you go low. Get it in too late, and my blood sugars go up, up, up. It’s definitely a case of hitting the sweet spot.

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Ahh, food and insulin…if only it were as easy as counting the carbs, giving an insulin dose and catching a unicorn 2 hours later.