Kate: I love food, who doesn’t? Unfortunately, I love bread way more than I love broccoli; pizza more than salad. I will admit that my diet wasn’t very healthy through most of my adult years. I tried, now and then, to “do better” but eventually drifted back to my usual fare. After my diagnosis of T2 I was faced with the need to make some significant changes to what I ate. It hasn’t been easy.
People with T2 may take oral meds, injectables and sometimes, insulin. They may control their diabetes with diet and exercise, for a while. The one thing that we all have to deal with is figuring out what we can eat and still control our diabetes. Here’s where it gets really frustrating. I have never been to a nutritionist or dietician for assistance with my meal planning. I know that there are many, many T2s who can say the same thing. I taught myself what to eat (and not eat). I also know some T2s who have seen a professional to learn what/how to eat and have been amazed at some of the recommendations they’ve received. If you participate in any online forums or FB groups, the myriad of recommendations you can receive for what you can eat is mind boggling! “You can’t eat that.” “You should definitely eat this.” “low carb” “low fat” “lots of fat” “whole grains” “no grains” “Okra water” “cinnamon” “vinegar” “whole cows” “no meat” “bacon wrapped everything” “sugar free” “never consume sweeteners” The list goes on and on and on. Can you blame people for being confused and frustrated? The fact that mainstream diabetes organizations continue to push lots of carbs has always amazed me. I am encouraged by this recent study that says that it’s better to lower carb consumption for people with diabetes. Ya think? I don’t push any specific way of eating for people with diabetes, that’s your choice, but I have learned that I simply cannot eat bread (even whole wheat), pasta, potatoes (even sweet), cereal (even oatmeal), crackers…so many things. And yet, when I read “diabetes friendly” recipes online they nearly always contain these ingredients. Heck, even “healthier” cookie recipes contain flour and sugar to a degree that makes them off limits to me.
I could go on forever on this topic. I could write a book! The point I’d like to make is that people with T2 simply must make drastic changes to what they eat in order to maintain good blood glucose in the long run and yet they aren’t encouraged to do that. Yes, stopping fast food and making your own burgers at home is better but shunning the bun is better yet. Don’t get your panties in a twist and tell me “but we can eat anything in moderation!” Maybe you can, for a while. I used to be able to do that too, but now I can’t. Without insulin to lower a high glucose reading, I have to deny myself certain foods unless I’m willing to deal with the consequences. That doesn’t mean that I’m eating cardboard. I eat a wide variety of delicious foods; foods that take preparation and planning. In this one area I feel that T1s have an easier time of it. Yes, you can eat anything you want because you can bolus your insulin for the carb consumption. I know that isn’t easy, but it’s possible. SO jealous here. So Laddie, what’s your take on food and how it fits into your diabetes treatment?
Laddie: Last September I wrote a blogpost titled “Food” and this is one of my favorite paragraphs from that post:
Like almost everyone with Type 1 diabetes, I’ve spent my life trying to find the magical balance between food as nutrition, food as pleasure, food as a social hub, food as a deterrent to low blood sugars, and food as an emotionally-charged addiction. Diets are prescribed like medicine with the assumption that if you play by the rules, things will work perfectly. Anyone who has had Type 1 for more than five minutes knows that food, blood sugar, weight control, and insulin rarely play nice together and it’s hard to keep guilt out of the equation.
Reviewing that paragraph, I could easily change all of the “Type 1” references to “Type 2” and everything I wrote would still be true (except maybe the insulin reference). Diets are handed out to people with diabetes with the implied guarantee that they are the ticket to success. Follow the plan and you will have good blood sugars, weight loss, no diabetic complications, and so on. Unfortunately diets are hard to follow and with diabetes, what you eat is only one piece of the blood sugar puzzle.
When I was diagnosed in 1976, I was given an Exchange diet with a prescribed number of bread, vegetable, fruit, protein, fat, and dairy portions for each meal and snack. Because of the limitations of my once-a-day insulin shot, that diet really meant: “Eat all of the time and hope to avoid passing out from a low at 4:30 every afternoon.”
Over the next 25 years, newer insulins led to more flexibility in the our diets and all of a sudden with carb counting, we could eat like a “normal” person. We were told that “a carb is a carb” and birthday cake was allowed as long as it fit into our nutrition plan. The “heart-healthy” diet mandated that fats were bad and carbs were good. More bread. More pasta. The fact of the matter is that as someone with Type 1 diabetes, I can’t match the digestion of carb-laden foods with the peaks and duration of my insulin. I go high; I go low. I eat carbs; I want more carbs. I feel guilty because my numbers aren’t good and I’m exhausted from rapidly changing blood sugars. That’s the glucocoaster life.
Some people, myself included, are looking for ways to get off the glucocoaster and these days you see many options for healthy eating with diabetes. At one extreme is Dr. Bernstein’s Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars with the recommendation of a diet high in fat/protein with a carb limit of 30 grams per day. At the other extreme are athletes who eat thousands of calories and 400-600 grams of carbs per day. In the middle are people doing their best to follow diets prescribed by their medical professionals with varying carb targets and varying degrees of success. There are people with diabetes following the Paleo diet, others eating gluten-free, and some paying no attention at all. We’re all searching and realizing that there is no easy or perfect diet.
I personally believe in Bernstein and have dramatically reduced my carb consumption in the last 10 years. Unfortunately as I write that, I am having a vision of chocolate-covered donuts (a constant theme in my blog). My current BG is 83 (Bernstein nirvana!). But it is the result of multiple boluses after afternoon highs in the 200’s from eating a bowl of cherries. Okay, it was two bowls…. I pre-bolused an appropriate amount of insulin and still spiked. I followed the rules, got a bad result, and ended up feeling guilty. I sometimes wonder if eating a mostly low-carb diet has made me more sensitive to carbs when I do eat them.
Kate is envious of those of us with Type 1 who are able to use insulin to incorporate more carbs into our lives. I can’t imagine seeing a high blood sugar and not having a tool to bring it down. At the same time insulin is not a fix-it-all and introduces the fear of severe lows without always eliminating outrageous highs. Insulin or not, eating with diabetes is hard.
Kate: We are so similar! Your comment about donuts really hits home. I know what I should eat and often feel very satisfied with lower carb meals, and yet the call to eat the carbier foods is never far away. Sigh. It’s also interesting what you said about possibly being more sensitive to carbs now that you’ve lowered your carb intake. I feel the same way. Two summers ago I tried an extremely low carb diet for a month and had great success. Once I tried to slowly add some carbs back into my diet (like a bit of bread or cereal) my blood glucose went through the roof!
One of my frustrations has been my HCP’s reluctance to let me try insulin. My A1c is quite good, even though my fasting numbers are in the 130s at best. I am better controlled than most of her patients and so my concerns over higher numbers are dismissed. I’m told to “lighten up” and eat a more “normal” diet but I’m commended for my better numbers which wouldn’t exist if I ate more normally. I will admit to having dealt with burnout recently mostly because I can’t just eat whatever I want. I’m tired of constantly thinking about food. Like you Laddie, it’s a daily challenge. I’ve actually “lightened up” a bit and have been allowing myself to eat things I normally wouldn’t eat and doing it (mostly) without guilt. I feel better mentally but my numbers aren’t so great. How do we find the balance we need between eating a healthy diet most of the time, allowing for splurges now and then and keeping the amount of medications we need to take at a minimum? I could eat whatever I want, ruin my good numbers and be allowed to add insulin to cover my carbs. Is that the right thing to do? I don’t think so.
I’ve been told by a D parent online that it would be nice if their child “only had to stop drinking soda”. I hope that this conversation shows that living with T2 isn’t that simple.
Laddie: Kate is right when she indicates that the best diet for someone with diabetes is often a compromise between nutrition/physical health versus emotional health/guilt-free living. Does that mean that we have to eat junk food to be mentally healthy? I hope not, but most of us enjoy sweets and carb-laden foods because they are delicious and probably addictive. Food is the centerpiece of many social functions and we want to be part of the crowd.
My mental health is the best when I follow my lower-carb diet and enjoy mostly in-range blood sugars. For whatever reason, the rewards of that lifestyle aren’t sufficient to keep me on the straight and narrow for long. So I try to accept deviations from my “ideal” diet to avoid a life mired in guilt. At the same time I find that every time I return to a lower-carb diet, I seem to be able to stay on it longer than the last time.
Food is delicious. Food is fuel. Food is fraught with temptation. We’re bombarded with mixed messages from medical professionals and popular media about what constitutes a healthy diet. I wish that I had great words of wisdom for everyone with diabetes. I don’t. My only advice is to keep learning, be open-minded, and do your best. And try again tomorrow.
Kate: It’s obvious from this conversation that food is big in the lives of people with diabetes, despite their type. It is a struggle for most, one that will never be easy I’m afraid. But hey, food isn’t easy even when you don’t have diabetes.
This is the last conversation in our series. I hope you’ve enjoyed them and that they have opened your eyes or prompted conversations between you and others. Next week we will be publishing a “wrap-up” post inviting you to start your own conversations. We’ll give you some suggestions and Laddie has generously offered to share the graphics that she has created. (Aren’t they great?) Thank you for joining us in our effort to knock down some of the barriers between types.
If you missed the first three posts, you can find them here:
This post was originally published on July 29, 2014 on Kate’s blog, Sweet Success: My Life with Type 2 Diabetes.