Protein

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.

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.