Carbs

Holi-daze

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I’m back home this week after some much needed time out in Melbourne, and unfortunately back to the grind tomorrow. I didn’t really believe that Melbourne was capable of producing so many nice days (sans an icky 44 degrees at the Australian Open on Thursday), but it was nice to spend so much time outdoors. 

As I was on the plane home over the weekend, I came to this realisation that I hadn’t once given a thought to work throughout the week. Nor e-mails. Nor meals. Nor agendas or general life admin. 

It was a stark contrast to the (very limited) time that I had off over Christmas. I spent my time clearing out my filing cabinet. Catching up on the magazines and newsletters that I hadn’t gotten around to over the year. Clearing some virtual space on my Macbook. Vacuuming the dust from the floor and wiping away the coffee and bloodstains from my desk. 

I was still thinking about the daily grind. The time was over before I knew it.

Going away is truly amazing in its ability to pull me away from my environment and take my mind away from the grind. No morning alarms. No work. Nothing to think about except for what I wanted to do today. By the time it was over, I felt as though I had been gone for ages. 

The only thing that I did have to bring with me, unfortunately, was diabetes.  

Holidays are always a bit of a fine balance. There are lots of extra carbs (read: plenty of coffees and trips to Brunetti). But there’s also a lot of extra walking, which has the potential to send me low. 

Overall, I was pretty happy with my BGs while I was away. I was more generous than usual with my insulin guesstimates, thinking about the greater likelihood of going high after the carbs rather than low. There were a couple of lows, but all of the walking around mostly helped to keep things level. There were a few stubborn blips, particularly in the evenings, but overall I didn’t spend my nights battling sustained highs. 

Now, reality has sunk back in. But I feel somewhat refreshed. And ready to tackle what this year has in store for me. 

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.

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.

Eating Some Carbs, and Moderate Protein

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A few months ago, I wrote about some of the changes I was making towards my carbohydrate intake, and I think it’s time for a bit of a follow up.

I’m quite a spontaneous eater. For a long time, I’ve struggled with trying to curb my snacking and be diligent inbetween meals. I would have weeks where I would be super diligent, have excellent blood sugars, but was super hungry and fidgety. Those good spells rarely lasted beyond a week or two, and I would eventually end up rebounding with more carbs.

I was also eating a lot of fast acting carbohydrates and empty foods that left me hungry soon after. Some days I would snack mindlessly in the afternoons, and I never felt great or super energetic at the end of the day.

I knew all of this, but never resolved to do anything about it until recently. In my mind, I never set out on this with the intention of going extreme low carb. Life is too short not to eat cake or drink coffee. For me, this was more of a way to try and improve my eating habits, incorporate more sustaining energy sources into my diet, and to feel better overall. Maybe, just maybe, that would be the key to making my glucose levels a little more manageable.

I now try to have at least one protein source with either breakfast or lunch. For breakfast, I’ve thrown eggs on toast into my rotation alongside Oats or Weetbix and Banana. For lunch, I’ve thrown steak sandwiches and tuna sandwiches into my rotation, rather than having toasted ham and cheese every day. Dinner is usually a cooked meal, and would likely include a protein source at least 4 times a week.

Significant protein meals do need a bolus. I’m still experimenting with this, but I’m finding that setting an extended bolus for 50% of the protein over 2 hours is too much. I would like to give this theory a go, where I would bolus for 100% of the protein amount over 20g.

On good days, I try to keep my snacks inbetween meals very low carb. I usually snack on nuts and cheese, and often have a milky coffee with it, which is about 8g of carbs.

There are still plenty of moments where I indulge. But it doesn’t necessarily happen every day like it used to. Treating myself is more of my choice now, not simply because I’m feeling empty and craving something sweet. If I’m guessing for a piece of cake, I do try to look at it and think about the carb count. It really does make all the difference. The Calorie King app on my iPhone is also really handy for finding carb counts on the go.

https://www.instagram.com/p/BMgOvS9DCjw/?taken-by=franksita

I don’t have a strict number of carbs that I hold myself to each day. As a ballpark figure, I would say that I would eat an average of 30g per meal. But it really does depend on the meal. A low day might be 70-80g of carbs. A high day might be 120g. I think I would rarely go near 150g in a day.

What’s surprising me the most is how much I have unconsciously reduced the amount of carbs I have eaten. For instance, there are days where I glance at my pump and realise that I’ve only eaten something like 75g without even noticing. My blood sugars are more manageable, in part because I have reduced my carb intake, but moreso because I don’t have that urge to snack mindlessly anymore. There is definitely more of a variety and satisfaction in my diet, which translates to less of a desire for junk food. I think I have brought my lunch once in the last month, as opposed to every Friday. Unless you count coffee.

I definitely don’t view carbs as the enemy, so long as I go about them sensibly, carb count and pre bolus insulin appropriately. Carbohydrates that I do eat regularly include nutritious lower carb bread, such as Baker’s Delight Cape Seed loaf or Burgen varieties. Greek style vanilla yoghurt, fruit, vegetables, milk and oats. I eat pasta and rice in moderation if they are a part of the evening meal. I also have a block of chocolate handy for a treat if I’m craving something sweet. 

I often receive e-mails and messages asking me if I would consider going on a genuine low carb high fat, or ketogenic diet. For me, what I am doing at the moment is realistic. That 30g per meal is a number that doesn’t send me rebounding on more carbohydrates. Super high fat or greasy meals don’t particularly appeal to me, either. And to be honest, I’m never going to be the kind of person who converts to low carb as a way of life.

As always, diet is a very individual choice, and I have come across a variety of different perspectives in the DOC. There’s no right or wrong approach. In my mind, the right diet is the one that is realistic, that you can sustain, and that will make you happy.

At the moment, I’m confident that this is the approach that I want to continue with going forward, and the one that will send me toward the a1c I am aiming for. 

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.