Food

The What-ifs of the Festive Season

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It’s that time of the year. Food, festivities, end of year exhaustion, and the promise of a fresh start come January 1. Add to that a nasty throat infection that I’m only just getting over, and the unpredictable glucose levels that have come with it.

This is a time of year where I have traditionally cruised along with my diabetes management, pushing all of my “priorities” back to January 1. It’s during this time, as I’m cruising along, that the diabetes what-ifs begin to cross my mind.

What if I had eaten less junk this year?

What if I had been motivated to count my carbs, and weigh my food more often?

What if I had been able to keep my blood sugar levels stable through the night more often?

What if I was able to log my readings and doses and look for trends more often?

What if I’m never able to get this right?

These feelings of guilt cross my mind moreso during the festive season, when I’m likely to be found ho-ing into plates of leftover desert in the days after Christmas and reflecting on the year gone.

This year, I do feel massively lighter. I still feel exhausted, but it’s more of a normal person exhaustion than diabetes exhaustion. It’s weirdly refreshing. It’s been a good year for my diabetes. I have made some impressive strides in my management. I’m in a place that I thought was impossible this time last year.

No, things are not perfect. There are still highs. There are still lows. And I’d be lying if I said that there aren’t still some what-ifs crossing my mind this year. I think we all feel that there is always more that we could do for our diabetes.

So, I’m challenging myself not to think about the what-ifs over the next couple of weeks. I’m really just looking forward to putting my feet up this festive season, and appreciating all of the things I have been able to accomplish in 2016. Diabetes, and otherwise.

I’ll likely be dialling up big doses of insulin, and using temporary basal rates on my insulin pump to help me cruise through the Christmas eating a little easier. I’ll be monitoring my blood sugar a little more often, but the focus will be more on enjoying myself than the numbers themselves.

If you’d like to spare a thought for those who don’t have the luxury of insulin this Christmas, consider making a donation to T1International or Spare a Rose. Both organisations advocate for, and provide insulin to people with diabetes in need all over the world.

While many Offices and workplaces have the luxury of a break over Christmas and New Years, spare a thought for those in industries such as hospitality, retail and health care who sacrifice time with their loved ones to serve us during the festive season.

Finally, dear readers. Merry Christmas. Thanks for reading Type 1 Writes this year. Wishing you a very happy, and safe festive season. See you in 2017!

– Frank

“Are You On a Diet?”

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I can’t begin to describe some of the funny looks I’ve been getting when I sit down with my bag of almonds at morning tea time. Those looks that just scream of “is that all you’re eating?” or “are you on a diet?” or “are you not feeling well?”

The young guy in the fluoro shirt who should be skulling choc milk and having a Woolies donut, eating almonds? Yep, I get it. While my diabetes is pretty transparent, people still forget or don’t realise it’s there.

Last week, one of my work Mums brought in a tray of leftover sweets to share from her weekend. As usual, I got the typical Nonna treatment. “Go on. Take it!” I politely said that I was trying to be good, and asked her to save me something for later. “Why?”

Last week, we had a bake sale in the staff room at work. I felt guilty for not buying anything. As I sat down in front of all of the tempting cake with my bag of almonds, someone remarked to me “you’re being good today, are you?”

I don’t put a lot of things off limits when it comes to diabetes and food. So long as I feel that I truly do enjoy eating something, then it is worth the effort. But I absolutely hate to perpetuate the myth that someone with diabetes can’t eat whatever they choose. I felt compelled to explain my choice not to indulge in cake at 10am on a work day to the staff room table.

After six months of experimenting and fine tuning, I am finally starting to see some consistency in the mornings while I am physically active at work. I am starting to feel that sweets are just not worth the effort while I am working. I will be guessing the carbs. I will be giving a generous dose of insulin. That insulin is more sensitive while I am physically active, and I am more likely to go low. What tends to follow is a day where I am trying to juggle highs and lows. I don’t feel very motivated to manage my diabetes well after days like this, and it’s just not fun. 

I eat a satisfying breakfast when I wake up. My treat in the morning is my Coffee Club Cappuccino with no sugar, enjoyed with my team mates. It’s 12g of slowly digested carbs, and I can handle that just fine.

But at 10am, I eat almonds. Almonds have minimal impact on my blood glucose while I am working. They don’t send me into a vicious cycle where I am correcting highs and warding off lows. Turning down cake is a small price to pay for the juggling act I so badly want to avoid while I am at work.

Plus, the cake will still be there to enjoy later, right?

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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.

Post Pizza Lows

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I had Pizza for dinner on Sunday night. Coincidentally, it was a meal identical to the one I’d eaten for dinner the Sunday prior.

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Pizza is one of those foods that I could simply eat and eat and eat, and easily lose count of how many slices I’ve had. I’ve been playing around with extended boluses on my pump a lot lately. Although I was extremely tempted to eat more, I behaved and stuck with two slices to keep my experiment on par with the pizza I ate the weekend prior.

Last Sunday, I had estimated 30g of carbs per slice, and gave a 30/70 split bolus extended over 4 hours. I went low on the tail end of the bolus, which carried through into the night and left me hypo again after midnight.

This week, I went for 25g of carbs per slice, and gave a 40/60 split over 3 hours. Levels were smooth sailing through the first two hours of the bolus. By the time I entered my third hour, insulin for 40 of the 50g of carbs had been delivered. Levels were still steady, and I had an inkling that I needed to cancel the remainder of that bolus.

Intuition proved right, and I was bordering on hypo territory within an hour of cancelling the bolus. By some strange miracle I managed not to over treat my hypo, and ended up at a perfect 5.9 mmol by bedtime.

By 1.37am, I found myself slightly hypo at 3.8. Being uber cautious not to over treat once again, I ate 5 skittles. When I woke up at 5.45am, my blood sugar was 3.4. I honestly don’t know what I felt more guilty for – running low for more than four hours or for sleeping over it.

You know how some people with diabetes say that certain foods just aren’t worth the effort? I’m starting to think that Pizza might be mine.

When I want to eat a donut, I can simply back up the math with a pre-bolus and avoid the skyrocketing levels.

But with Pizza, the effort is full on.

The low defies logic. I’m struggling to understand how I could end up so low. I find it impossible to believe a slice of pizza had fewer than 20g of carbs in it. I’m doubtful I need to spread out my extended bolus for longer than 4 hours. No matter how many different variations of extended boluses that I try, I always seem to end up low on the tail end.

Then there’s the night spent warding off lows. It’s been a while since I’ve had a night like that one. Sure, I still wake myself through the night to check my blood sugar levels. Some nights small correction doses are needed. But I normally go back to sleep and wake up in range by morning without even remembering anything. Nights where I wake up sweaty and shaking are a rarity these days. Yet an extended insulin bolus that runs much closer to my bedtime than normal, was enough to bring me back to the days of Lantus lows.

I never thought I’d say it, but maybe the day has come that Pizza is not so bolus-worthy anymore.