Carbohydrates

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.

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.

Insulin Resistance, and Bolusing for Protein

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Last night I had Duck for dinner. Roast duck. With a side of Chicken salad.

It’s not often that I have a meal completely free of carbs. Or a meal that is Duck. But my blood sugar levels were looking decent, so I decided to opt out of having anything else after dinner. I set an extended bolus on my insulin pump for the protein portion of my meal (I usually bolus for 50% of the protein amount over 2 hours), and sat down to watch the latest episode of A Place to Call Home.

As my blood sugar level climbed into the 8s, I decided to give a correction bolus with my pump, overriding the insulin on board subtraction. As I sat on the couch for the next hour, I watched my blood sugar level continue to climb into the 9s and 10s, before finally levelling off at 11.

Although very tempted to give another correction bolus, I decided to wait until an hour had passed and that extended bolus had definitely kicked in. When I checked my reading again at the end of the episode, I was hovering at around 15 with upward trend arrows.

At this point, I gave up all logic and set a temporary basal rate of 200% on my pump. I gave another correction bolus, once again overriding my pump’s insulin on board subtraction.

I’ve been experimenting with the effect of protein on my blood sugar levels quite a lot in recent weeks. This means I am weighing the meat on my dinner plate, and paying attention to the nutrition info on my can of tuna or bag of Burgen Pumpkin Seed Bread. Most of the time, an extended bolus over 2 hours for 50% of the protein seems to do the trick for me.

I thought my protein bolus last night was very generous. My duck pieces were fairly small, and I didn’t think that the protein on my plate would add up to much at all. Yet it strangely led to hours and hours of insulin resistance that only temporary rage-basal rates could bring down.

So what was the difference?

According to this very useful article (thanks, Google), this meal was consumed in the absence of carbohydrate.

To quote the article “Protein’s effect on blood glucose is minimal when it is included as part of a complex meal. But when protein is consumed in the absence of carbohydrate, upward of 50% of the protein may be converted into glucose within a few hours, resulting in a moderate blood glucose rise.”

I am consciously trying to incorporate more protein in my diet. Eggs for breakfast. Almonds for morning tea. Steak or tuna with lunch. Not so much as a way to forgo carbs, but more as a way to build my energy levels. But I almost always eat my protein with a source of carbohydrate. A slice of toast, or a piece of fruit.

I understand that people on Low Carb High Protein diets would likely combat the insulin resistance with increased basal rates. But because my diet is not purely protein, I think I need to make sure that there are some carbs next to the protein on my plate.

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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