Carbs

Food, Glorious Food

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Last night’s OzDOC chat on food was engrossing enough to draw my attention away from the first ten minutes of Australian Survivor, so I’m elaborating on it today.

The dietary advice I first received after my diabetes diagnosis was to eat low fat, high fibre foods that were digested slowly. I was taught to count carbohydrates by my diabetes educator, which eventually faded into regular guesstimates while I was on insulin injections.


I think the most bizarre thing is this idea that we have to eat to avoid going low, rather than adjust insulin! I also hear it from healthcare professionals, and it’s often referenced in diabetes books and magazines. I sometimes wonder if they’re just trying to cover their backs! 

I relied on this advice heavily in the beginning. I religiously sought out foods that were low in fat and had a low glycemic index ranking, regardless of their nutritional value or carbohydrate load. I continued to eat a lot of processed foods that were seemingly healthy – cereals, juices, yoghurts, canned fruit, brown bread, muesli bars – and ridden with hidden sugar! I often remember testing my blood sugar at uni after breakfast, unable to make the connection between a level of 17 and the foods I was eating.

Since I began connecting with other people with diabetes, I’ve read a wide variety of stories and perspectives on food choices. I’ve certainly drawn inspiration here and there, but I don’t really feel that I’ve taken dietary advice from any one source in particular. Ultimately it’s about finding an approach that will make me happy, while achieving the BGLs that I aim for regularly.

In the beginning, I definitely used to shy away from foods that weren’t blood sugar friendly. And when I did eventually cave in and eat them, I would feel super guilty for the numbers that followed. One of my biggest shifts in the past year or so has been having more confidence in working my way around the foods that I want to eat. Carb counting and pre bolusing insulin have been my best assets in these past couple of months. I learn from experience. Over time, I’ve gained a pretty good idea of what effect certain foods will have on my blood sugar levels and how I can work my way around them.

Another big shift has been changing some of my old habits around food. Cutting the sugar out of my coffee and tea was one of the hardest, but most worthwhile ones. Ditto for sugary drinks. I don’t feel so guilty for my three coffees a day anymore! Afternoon snacking still remains my weakness, but I am trying to be a little more prepared these days rather than going back and forth from the cupboard and fridge. I still do eat carbohydrates, but in a lot more moderation and balance than I once did. I don’t shy away from higher fat foods either, especially for nutritional value such as iron or protein.

I still do eat chocolate. And cannoli. And donuts. When I go out for meals, I usually give it my best guess, regularly test and try to enjoy myself.

There’s no right or wrong approach when it comes to diabetes and food. But I know that this food approach is the right one for me at the moment, because it makes me happy and I can achieve the BGLs that I aim for regularly.

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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My Week on Diabetes Autopilot

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I went to give my insulin dose after lunch. I dialled it up and stuck it where it needed to go. As I put my insulin pen away, I stopped and tried to think about what I’d done. How many units had I given myself? What did I have for lunch? Less than a minute had passed, and I couldn’t even remember.

I’ve been stuck on diabetes autopilot, and that routine has been on repeat every day in the past week. A fairly busy week, mind you. I’ve had to shake off a cold without any sick leave because of my responsibilities at work. I’ve had to wake up an hour earlier. Despite my best efforts, my body refused to fall asleep an hour earlier at night. And after imagining all the possibilities of an earlier finish, the reality has been falling asleep on the couch in the afternoons.

It was morning tea time on Friday morning. I was having my usual apple and Muesli bar. My blood sugar was 13.1, thanks to the cappuccino with 1 sugar I’d had earlier. Driven by my urge to bring it back down, I grabbed my insulin pen and quickly jabbed in 5 units. Normally, being on my feet at work would cover the apple. Meanwhile the muesli bar was a nut and seed variety, and had a lot less carbs than the ones I normally eat. I wasn’t thinking straight that morning. I’d already set myself up for a hypo, I just couldn’t see it yet.

Half an hour later, I was beginning to feel exhausted as I carried out my work. I wanted nothing more than to sit down somewhere. I was constantly sighing and loudly exhaling air from my mouth. I was nodding along when others were speaking, lacking the energy to talk back to them. I felt warmer and sweatier than normal. I didn’t have to go and check my blood sugar, I already knew that I was hypo.

I grabbed a muesli bar from the stash in my locker (this one had 24g of carbs) and walked back out into my work area. There was only one person around at the time, who knows that I have diabetes, but I still felt rude for eating in front of her. “Have you not gone for morning tea yet, Frank?” she asked me. “No, I’m just low and need some sugar,” I replied. “Oh, of course you do!”

I knew that the hypo was fixed, but those feelings of exhaustion just wouldn’t go away. And there was just something about coming off of a bad hypo that made me crave those carbs and sugar even more. So I decided to head off for an early lunch and grabbed a Supershake, a Cheese and Bacon Roll, a block of Lindt chocolate and a Jam Donut doused in sugar (I know, not your model diabetic!).

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In that moment as I sat there in the staff room, those carbs had never tasted better. That rich cheese and salty bacon hit the savoury spot on my tongue perfectly. The sugar on top of that donut stuck to my fingers and my face, and I felt high. Drowning it down in that thick, chocolatey supershake was heaven on earth. And after a few squares of chocolate, I’d finally had enough.

I went easy on the insulin dose, because I knew I’d be on my feet for another 2 hours. By the time I got home, I was a lovely 21.3. I gave another 10 units, and then decided to play the waiting game. I was 17.4 an hour later, 14.9 after that, and 11.9 by dinnertime.

I have no explanation to offer. It was just one of those days. Thank God it was Friday, because I really needed some rest.

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My Diabetes Superpowers

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I recently discovered that I have superpowers. Well, I’ve actually had them ever since I became a diabetic. But I’m only just starting to realise them, thanks to Tuesday’s OzDoc Twitter chat. And chances are, that if you’re a diabetic, you probably have them too!

Like being able to force myself out from under those cosy covers in the middle of the night to check my Blood Sugar Levels. Just to be sure that they are not too low. And not too high either. But just right.

Like waiting for the right moment to make a mad dash from the dinner table to the bathroom when I’m eating out. Dialing up a big dose of insulin for all that mouth watering food I probably shouldn’t have eaten and hoping for the best. Trying to dial up my insulin as quietly, as discreetly as I can so that person outside my cubicle won’t notice. Won’t think I’m a weirdo. Won’t think I’m taking drugs.

Like being able to check my blood sugar levels in stealth mode during the day. Concealing my meter under the desk or heading over to the corner of the room. And being able to hastily finish and quickly hide those items the moment I hear footsteps. The moment I hear voices. The moment I can sense that someone is near.

Like being either a super gifted mathematician or a really good guesser when it comes to the carbs in my food. Working out that golden formula that goes something like “if I’ve eaten x grams of carbs, that means I need x units of insulin.” And “if 1 unit of insulin brings my blood sugars down by 3 mmol/L, then I need x units of insulin to bring me back in range.”

And being able to pick myself up again after a low point. After some diabetes related frustration. After some anger. After some shouting. Even after slamming things. Even after comfort eating. All without even letting it show to those around me. And being able to start all over again.

But above all of these ‘superpowers,’ I believe that just being able to live and deal with something as dynamic as diabetes day in, day out sure is worthy of superhero status in itself.

And the superpower I’m still waiting for? A personal diabetes assistant who can carb count, bolus, test me while I’m asleep and correct for me!

I couldn’t be more thrilled that I’ve finally realised my superpowers. I’m afraid I have to leave you now and use those mathematics superpowers to rescue my blood sugar levels from today’s breakfast!

Join the Oz Diabetes Online Community chat every Tuesday night at 8.30pm AEST by following the #OzDoc hashtag on Twitter.