Insulin

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.

***

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.

Diabetes at 3.14am

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I stirred in my sleep, registering the blaring red 3.14 on the clock radio beside my bed. Pulling my left arm out from under the covers, I fumbled around for the switch at the base of my bedside lamp. When my desk was finally illuminated in cosy warm white light, I heaved the remainder of my body up from the bed, reaching for my meter and test strips.

This certainly wasn’t the number that I was expecting to see, considering the full 2 unit correction that I had given prior to bedtime for a 10.7. (And in case you’re wondering, I’m only using the OneTouch Verio to deplete my final box of strips…)

I immediately ripped my pump away from it’s resting place inside my inner left pocket, and gave another full correction of 3.3 units for that very uncomfortable number. My frustration was only further fuelling my actions, as I set a 50% basal rate increase for the next two hours on my pump to ensure that this correction insulin did its job.

As I flicked off the lamp and rested my body back onto my bed, I couldn’t get back to sleep. I could feel the heat emulating from my pillow, and flipped it over to the cool side. My whole body felt stuffy, presumably a consequence of the higher blood sugar.

As I lay there, tossing and turning, my mind was quickly consumed with guilt.

I wasn’t happy that it had taken me this long into the night to finally stir in my sleep and check my damn blood sugar. I felt terrible for the fact that I had been sitting there, at that very uncomfortable level, for the better part of five hours. I felt frustration, because a mere two weeks ago I was super insulin sensitive and today I feel like I’m not getting enough.

Second guessing my prior decision in the darkness, I reached for my pump and lowered that 50% temporary basal rate to 30% before clipping it back inside my pants pocket.

Trying to purge those thoughts from my mind, I began thinking about all of the positive things that I am doing in managing my diabetes, reminding myself that numbers like those are isolated occurences nowadays.

If this had happened in the middle of the day, I’d have corrected the high without giving it a second thought. But laying there in the middle of the night with nothing else on my mind to worry about, was a completely different story.

By the time I woke up on a grey Sunday morning, last night’s occurrences felt like nothing more than a dream.

Feeling Tired With Type 1 Diabetes

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The final stretch of last year was a pretty challenging time for me, physically.

I felt tired. All. The. Damn. Time.

I would often find myself crawling into bed at the end of the day, feeling utterly exhausted. I was no longer waking up to my 1am alarms, and my blood sugars definitely suffered for it. I would wake up after a solid eight hours of sleep feeling bleary eyed, wanting nothing more than to close my eyes and go back to sleep again.

I honestly could not find an explanation for the way that I was feeling. Although the management of my blood sugar levels had slipped a little since achieving a personal best hba1c in July, my ability to manage them was still far better than they had ever been in my pre-pumping era. My bloodwork from July was also really good, and I had seen my endo in August.

I probably should have made an appointment with my GP, but I honestly didn’t feel that he would have been very helpful to me.

I felt more burdened than I had felt in a long time. in fact, I’d go as far as to say I felt equally or more burdened than I did during my start on insulin pump therapy. These feelings affected my work, my attitude around others and my overall quality of life. Part of me was ready to accept that these symptoms were simply a tradeoff of living with a demanding chronic condition like diabetes.

Living with type 1 diabetes creates somewhat of a complex relationship with food. We need food to fuel our bodies, but at the same time food spikes our blood sugar levels – and we want to avoid out of range glucose levels at all costs.

What’s the best nutrition advice for a person with diabetes? From my experience, It depends on what you’re reading and who you’re talking to. While I absolutely love my diabetes community, the overwhelming messages that seep into my brain is to avoid this food group or cut back on that one that and stop the spikes from happening.

I don’t want to single out any particular way of eating, but diabetes has distorted my relationship with food without me even realising.

The average male needs to consume about 8,000 kilojoules of energy per day to fuel his body so that it can function properly and match energy expended through activity. I don’t think I was even coming close to that. Not to mention having an active job where I’m on my feet all day expending even more energy by the minute.

I honestly cannot ever recall being taught to eat to fuel my body and meet my daily energy needs – from healthcare professionals and diabetes websites alike. Or perhaps I wasn’t listening carefully enough.

The past month or so has been a bit of a learning curve for me. Let me just say that it is pretty challenging to eat 8,000 kilojoules of quality food every day, and I have slacked a little at keeping tabs on this at times.

Of course, as with anything you make a major change to in life, diabetes management also demands attention and there have been a few tweaks to basal rates. I’ll share more specifics in time. 

But I’m sitting here in the sunshine typing this today, feeling far better than I have in quite some time.

Review: Fit With Diabetes e-Book by Christel Oerum

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As much as I like to proclaim that I don’t exercise, the reality is simply not true. While I might not partake in dedicated workouts or fitness regimes, there is plenty of physical activity in my day. My job keeps me on my feet all day, and I do enjoy getting outdoors and going for walks through my neighbourhood in the afternoons. Not to mention all of the incidental exercise involved with tasks like housework!

As with every other aspect of my life, my diabetes needs due consideration when I’m active as well.

I’m a big fan of reading offerings that give me practical information I can take away and apply to my own diabetes management at home. It’s one of the reasons why I’m such a big fan of Christel Oerum, a longtime T1D and co-founder of the website Diabetes Strong (diabetesstrong.com). Christel created her website after struggling to find information about exercise and nutrition with diabetes. 

Christel has recently launched an e-book, Fit With Diabetes, and kindly sent me a copy which I had the pleasure of reviewing.

The book kicks off with a chapter on goal setting and finding your motivation, which will likely resonate with most readers. Who doesn’t have something at the back of their mind that they’re aspiring towards? Even if your direct goal isn’t fitness related, I’m willing to bet you would find something in this book that will help you reach that goal. Improved blood sugar levels, better nutrition and healthier lifestyle comes to mind.

I was nodding my head as I read through the chapter on Cardio, the main form of physical activity that I tend to make adjustments for. Given that getting up and going to work every day involves cardio, I’ve had no choice but to endure months and months of practice, patience and frustration to finally reach a place where I can work, eat and navigate my blood sugar levels without so much bumpiness.

Most cardio workouts increase insulin sensitivity during and after a workout, causing blood glucose levels to drop. The book provides practical suggestions for reducing basal rates and insulin doses for meals in advance of a workout, right through to avoiding lows in the hours afterward. Christel’s lived experience really shines through as she provides plenty of real life examples for undertaking cardio with both an insulin pump and Multiple Daily Injections.

Have you ever noticed your blood sugar levels starting to rise after exercise is over? One of the lightbulb moments that I had while reading this chapter was that a reduced pre-workout insulin bolus might need a follow up if food is still digesting once the workout is over. Ding!

The book moves into resistance training, and admittedly this chapter didn’t speak to me so much as I haven’t stepped inside a gym in years! Christel talks through navigating blood sugars during these higher intensity workouts, which can cause blood glucose levels to rise.

This chapter is definitely written in the spirit of motivating the reader to get into the gym and move past any personal reservations or fears. There are several pages of sample resistance workouts and illustrations in the book, with exercises that will suit both the gym go-er and someone with basic equipment at home.

For me, however, the most valuable part of this book was the chapter on nutrition. I say this because the nutrition advice in this book makes the most sense, but in my opinion isn’t reaching enough people with diabetes. I’ll have more to share on this soon…

Christel talks through calculating your daily kilojoule (or energy) needs in order to fuel your body and match the energy you expend each day. It was refreshing to hear her recommending carbohydrates rather than avoiding them altogether. Based on her own experience, she recommends a diet of 30% carbohydrate, 40% protein and 30% fat, however of course you could adjust these percentages to suit your own preferences. 

Another handy tool that Christel suggests to help track your nutrition is the smartphone app, My Fitness Pal. I’ve been using it myself since reading this book and it is amazing.

There are also chapters on meal planning and recipes, losing weight with diabetes and further advice to support a healthy lifestyle.

The Fit With Diabetes e-book very much runs in similar veins as Gary Scheiner’s Think Like a Pancreas. It wasn’t screaming at me to change everything about myself, nor was it holding back on providing practical suggestions because ‘everyone is different.’ The book is simply there to help you get more out of physical activity while managing diabetes.

Even if you’re not a fitness nut like me, I am very confident that you will find something to take away from this book. You can purchase your copy of the eBook here, and you can also follow Christel at diabetesstrong.com.

Disclosure: Christel sent me a copy of the Fit With Diabetes e-book. There was no expectation that I would write about or promote the book, and all opinions expressed here are my own!