Diabetes and Food

A Basket Case?

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I’m sitting here, typing this, with a blood sugar level of 18.8. My FreeStyle Libre graph for the past 8 hours looks absolutely dreadful. I had to override the maximum insulin delivery limits on my pump so that I could give higher insulin boluses, and run higher basal rates to bring my blood sugar levels down.

I feel like crap. I feel ridden with guilt. I feel sick and tired of all the discipline that diabetes involves. I feel like I really don’t give a shit about diabetes today.

Rewind back to yesterday morning, when I woke up to a 9.1. Nothing too terrible, but far enough out of range to make my breakfast bolus less sensitive. Which, despite an added bolus for 10 grams worth of insulin with breakfast, still led to a reading of 15.0 afterwards. Which led to an I-don’t-give-a-shit slice of black forrest cake with lunch. Which led to an I-couldn’t-give-a-flying-f*** about being diligent attitude for the remainder of the day.

Diabetes demands so much discipline. Checking my blood sugar. Counting my carbs. Weighing my portions. Delivering my insulin. Pre bolusing that insulin 30 minutes prior for a optimal post-prandial result. Setting the alarm to check my blood sugar at 2am to ensure that I won’t wake up high the next morning. Foregoing so much temptation, for the sake of better blood sugar levels.

Diabetes already demands so much of me, and yet it never seems to be enough. It never seems to be enough, and that’s where the cracks begin to show. 

Yesterday afternoon, I was curled up in front of the couch with a coffee and an almost-finished (not by me) packet of melting moments biscuits. I had eaten one, and was sitting there staring at the last one in the packet for what must have been 10 or 15 minutes. Should I eat it? Or I should put the packet away?

I eventually ate the second one, and of course watched my blood sugar rise in the aftermath. As I gave corrections that couldn’t quite catch up to my rising blood sugar, I began to murmur to myself “you’ve got problem, mate.” “You need help.”

The funny thing being that if I didn’t have diabetes, this would hardly have been a problem. I would have eaten the second biscuit and enjoyed the hell out of it, instead of feeling guilty. I might have bragged to the next person I saw about eating those two whole biscuits, instead of feeling ashamed. I might have complained about feeling ready for bed after satisfying my stomach, instead of cursing my rising blood sugar levels.

If I didn’t have diabetes, this would hardly have been a problem.

If I didn’t have diabetes, I wouldn’t be talking to myself like I were a basket case because I ate two damn biscuits.

Navigating Diabetes Through a High Carb Breakfast

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I have always found diabetes extra challenging to manage around big meals. I’m the kind of person who likes to try a bit of everything at a party. I try not to let diabetes get in the way of enjoying myself on special occasions like birthdays or Christmases, because they only come around once a year. Often the consequence of this has been high blood sugar levels that are tricky to bring down in the hours that follow.

One of the biggest advantages of having an insulin pump is the extra flexibility that it gives me to work around high blood sugar levels. With tricks like temporary basal insulin rates, the pump has definitely saved me hours of frustration in trying to bring my blood sugar levels down in the aftermath.

Yesterday my pump got it’s first taste of a high carb meal, as I took the wheels out for a spin over breakfast. I had been craving pancakes all week, so my order was going to be a no brainer.

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In anticipation of the extra carb load, I set a temporary basal rate of +100% to ensure that my mealtime insulin did its job effectively. I did this before I left home, so that the basal rate would kick in by the time I sat down to breakfast.

The cafe looked pretty busy, and I wondered how long I would be waiting for my pancakes. I guessed that I would probably need insulin to cover somewhere in the vicinity of 60-80g of carbohydrates, but I didn’t know for sure how big the serving would be. I decided to play it safe, and pre bolused half my insulin when I placed my order, and the other half when my meal arrived.

When I left the cafe, my blood sugar was 13 mmol. When I checked again at home half an hour later, I was 13 mmol once again. I noticed my blood sugar begin to creep up again at around the 3 hour mark, as I would expect for a higher loaded meal. I entered my blood sugar reading into the pump, overrode the insulin on board subtraction, and gave a correction dose. I kept the temp basal running, anticipating that I would need it to cover the delayed fat/protein spikes.

By around 2pm, my blood sugar was almost back in range at 8.3.

The majority of my numbers throughout the morning were around the 12-13 mmol mark, save for one brief peak at 15.7 mmol. To put that into perspective, a loaded meal like that has the potential to send me well above 20 mmol. 

Safe to say I was pretty damn pleased with my handy work.

Take that, food police.

To Carb, or Not to Carb?

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I’ve read so many articles about low carb eating lately, that it’s left me wondering if there are any people with diabetes out there who still eat them. I’m not about to start telling you what’s right or what’s wrong, because I believe that diabetes management is a very individual issue. But I would like to weigh in with my own perspective on the age old question. I stress, these are my personal opinions only.

Quite honestly, I’ve never been a fan of low carb. The mere sound of the word makes me cringe, simply because it makes me think of restriction. I also think that eating low carb requires a greater level of commitment in the kitchen all through the day, rather than having just one cooked meal in the evening as I do.

The main reason I do not like low carb eating is because the trade off is usually foods that are higher in fat. Foods that are higher in fat tend to produce spikes in blood sugar levels several hours after a meal. I find that protein and fat spikes are very hard to bolus for, and high blood sugar levels are very resilient to insulin corrections. Personally, I do not like chasing highs several hours after meals and would much rather bolus my insulin just once. If there are any low carb people reading this, I’d be interested to hear how you work your way around this.

I am happy to put the work into the carbohydrates I eat. As I wrote last week, pre-bolussing for meals helps me to avoid the post meal spikes. Carbohydrate counting does work when I’ve got my ratios and basal rates right.

That being said, I definitely have changed my thinking around the way I approach carbohydrate foods. Over time I have slowly made gradual changes to the carbohydrates I eat.

I definitely try not to overload on the carbs at mealtimes. On the weekend, we had Turkish bread rolls for lunch, which were 70g. I cut mine in half, simply because I consider 70g way too much to be eating in one sitting. Ditto for the thick slice Cafe-style raisin toast that I have as an afternoon treat sometimes. I also make sure to weigh out my portions when I have foods like rice and pasta, to make sure I don’t overload on the carbs.

I only eat bread as either toast or sandwiches now, and not as a side or appetiser for my dinner plate. I always opt for lower carb, seeded bread, which also tends to carry greater nutritional value with it. Burgen Pumpkin Seed is a real winner for me, with just 11g carbs per slice. Baker’s Delight Cape Seed loaf is another good one.

I have also cut out a lot of the high sugar foods in my diet. Over one very painful year, I gradually cut the two sugars out of my coffee and tea completely. I no longer eat breakfast cereals, because even some of the better ones are still loaded with at least 20g of sugar per 100g. Ditto for muesli bars, which have been replaced by bananas. I often have microwaveable Oats sachets for breakfast, and I have recently switched from the sugar laden fruit flavours to Original.

My approach to eating has definitely centred around eliminating the carbs that I deem unnecessary or unenjoyable. I would much rather put these carbs saved towards foods that I do want to eat. For instance, those yoghurt pots with the stir through fruit jelly? I would much rather have that sugar in a plate of ice cream instead.

When I look at my Dad, who eats bread with anything and everything, I definitely feel that I eat far fewer carbohydrates than I once did. Would I identify myself as a low carbohydrate eater? I still eat the foods that I want to eat. I don’t feel as though I am depriving myself of anything. I’m simply eating a diet with far more balance compared to life prior to diabetes.

With lots of coffee, and the occasional cannoli or cake thrown in.

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A Pitch For My Kitchen Rules

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Last week, I sat down and watched a full episode of My Kitchen Rules for the very first time. As much as I hate to admit it, it’s pretty easy to get hooked in.

Do I watch it because I’m inspired by the “home” cooking? Nope. Do I watch it because it shows genuine “reality?” Absolutely not. Rather, I love sitting in front of the telly and picking the show to pieces.

Every year, the show trots out the same cliched characters and stereotypes that have been done to death. The lovebirds, the villains, the couple with big egos, blah blah blah. Watching the contestants’ behaviour and dialogue is cringe-worthy. It comes across so forced and so unnatural. I watch the show and I think to myself, ‘who the hell talks like that!’

I love watching the manufactured drama unfold as the couples prepare meals for the competition in their homes. 

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I say manufactured, because it’s so obvious that it isn’t real. (And the gif, because I’ve been watching Downton Abbey all weekend). One night, the oven’s burning. The next night, one of the dinner guests is making nasty remarks about the food served up. Another night the team has a meltdown in the kitchen, magically pulls it together before the end of the episode and wins a perfect score. Oh, and did I mention that crying is a prerequisite to be on this show?

I really feel for those poor contestants who are forced to sit at the dinner table for what appears to be a good 10 or 12 hours. In an episode last week, the guests arrived for dinner at what looked like lunchtime, and by the time the final scores were issued, it was dark. I can only assume the crew take their time filming several takes and gathering lots of footage to ensure the most dramatic on-screen effect.

As I was sitting in the lounge room watching last week, I realised that diabetes would be the perfect character for the show. The producers would surely eat it up.

Imagine the back story. I could say that I’ve lived with diabetes for years, and that I was bullied because of it. I’m going on the show to prove that diabetes won’t hold me back. All reality contestants seem to have something to “prove” these days, right?

I could dramatically feign lows in the kitchen. I could stop to check my blood sugar, with the result dramatically revealed after a commercial break. I could have a meltdown over my diabetes right before the guests are about to arrive, and then miraculously pull it all back together in time to serve them dinner.

I could be the contestant with a big diabetes ego. I could criticise all of my competitor’s dishes for not being diabetes friendly. I could whinge about there being no nutritional information or carb counts on the menu. I could test my blood sugar at the dinner table and blame the food for causing my levels to spike. 

While My Kitchen Rules is hardly about the actual cooking, there’s no shortage of people who continue to watch it here in Australia. At a time where we are facing issues around sugar consumption, unhealthy diets and obesity, it’s a shame that shows like these aren’t doing more to inspire people to cook simple meals at home.

We will be discussing online and offline diabetes peer support during tonight’s OzDOC chat. Join in Tonight from 8.30pm AEST by following #OzDOC on Twitter.

Exactly The Same

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Back in April 2010, I was a freshman uni student adjusting to newfound adult life outside of school. I can remember spending much of my two week Easter break feeling overwhelmed by a couple of 2,000 word university papers that were conveniently due the first week back after break.

It’s safe to say that I didn’t spend a lot of time thinking about Easter that year. I had no idea that it would be the last time that I would be able to consume a whole Easter egg with no consequences. Or stuff my face full at Easter get togethers without having to keep a close eye on my blood sugar levels hours into the night.

Looking back on that last Easter without diabetes, I don’t really have any major regrets. Because six years later, I can’t really say that too much has changed.

I’m still making an early start on Easter eggs, and trying to hide them from everyone else at home.

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I’ve still got a stash of Cadbury chocolate chip hot cross buns in the freezer that have become a convenient source of breakfast or lunch when I’m in a hurry.

  I still haven’t decided what I’m going to cook for Easter lunch, in my usual last minute fashion.

I’ll still have Fish and Chips for lunch on Good Friday, and go to Church at 3 o’clock in the afternoon.

I’ll probably still eat more than I need to, because hey, it’s Easter. Raffaello cupcakes, anyone?

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I’ll probably still receive a good haul of Easter eggs to spread out over my desk, despite how old I am.

And I’ll probably still scab up some bargain Creme Eggs and Malteaster bunnies at the shops on Tuesday, even though I don’t need anymore chocolate.

When I think about Easter, I certainly don’t think about the insulin injections, the finger pricks, the carb counting, the correcting, the bolusses, the highs or the hypos that have come into play since 2010.

I fondly think of all the things that have stayed exactly the same.

I hope you have a very happy, safe and relaxing Easter long weekend.

Thanks for continuing to read Type 1 Writes this year and for being ever so kind and supportive. If you enjoy reading this blog as much as I do writing it, please do share it with those around you.