Laddie_Head SquareVery few people in the diabetes community want to be preached at about what they eat.  That is not my aim in this post and if Mrs. Preachy makes an appearance, I’m going to slap her upside the head and boot her out.  What I want to do is talk about where I am with food and explore some ideas about food and Type 1 diabetes.  Most specifically I will be talking about carbs.

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.

In recent years I have been reducing carbs or at least fast-acting carbs.  Ten years ago I would have argued (and did argue) with anyone who suggested that I couldn’t manage my diabetes well while eating a lot of carbs.  I knew that things like cookies and candy were guilt-laden treats and better left alone, but I loved my breakfast with cereal, milk, fruit, and cottage cheese.  Other meals weren’t much different and I got used to high post-meal spikes followed by crashing lows because I didn’t know anything different.

Why did I start exploring alternative ways to eat and finally commit to low carb?  Because I was tired of the lows.  My lows and highs have always been intrinsically connected.  I have never been able to match insulin well to high carb meals.  I’ve pre-bolused until I went low before eating; I’ve tried the super bolus; I’ve experimented with combo boluses.  I’ve used Novolog, Humalog, and Apidra.  I’ve never tried Symlin for a multitude of reasons, but other than that I’ve done it all.  Carbs spike quickly for me and short-acting insulin stays around for a long time.  When I have a series of lows I tend to throw caution to the wind and eat a boatload of junk food resulting in stubborn highs.  After too many highs, I start rage bolusing and then end up low again.  After a while this gets to be an exhausting way to live.

Every time that I adopt a carbohydrate restricted diet, I find that my diabetes is much easier to manage.  Do my blood sugars flatline on my Dexcom?  No, but the Himalayan peaks and valleys are replaced by less jagged tracings with few excursions outside of my target range.  I’m not as hungry as when I eat fast-acting carbs and my cravings are greatly reduced.  I truly believe that carbohydrates can be just as addicting as tobacco, drugs, and alcohol.

I previously wrote a post about why you should read Dr. Bernstein’s Diabetes Solution.  My diet is not as restrictive as he espouses because I incorporate berries, apples, nuts, sprouted grain bread, and wine into my life.  I’ve read a few other books that reinforce the idea that no one, especially those of us with diabetes, should be eating a diet high in refined carbohydrates.  Why We Get Fat by Gary Taubes is a scathing indictment of the low fat/high carb diet prescribed by medical professionals for the last thirty years.  A lot of what he writes makes perfect sense to me as this ubiquitous heart-healthy diet has been accompanied by a huge rise in the rates of obesity and Type 2 diabetes.  Wheat Belly by cardiologist William Davis is a similar criticism of high carb diets along with the assertion that genetically modified modern wheat is a culprit in the obesity crisis.

Glucocoaster_FinalI am increasingly convinced that the theory that “Type 1’s can eat anything as long as they bolus for it” is questionable at best.  I also believe that “diabetic” diets with 45-60 grams of carbohydrates per meal set many people up for frustration and failure.  The “glucocoaster rides” described by many Type 1’s are indicative of the difficulty of matching current insulins to the blood glucose effects of carb-laden meals and snacks.  My experience has been that reducing carbs and therefore substantially reducing my bolus insulin has measurably reduced my highs and extreme lows.

I am not so naive to suggest that everyone with Type 1 diabetes should eat exactly as I eat.  Even with the food decisions I am currently making, it is still hard to analyze and manage everything that affects my blood sugar.  But if you are struggling or even just attempting to improve your numbers, you might find that carb reduction is a powerful tool and easier to incorporate into your life than you might think.  Just remember that major diet changes have to be accompanied by major insulin changes with a lot of testing.

I’ve been working on this post for a long time and have yet to come up with a version that satisfies me.  Recently two other bloggers have written posts that say exactly what I want to say and probably do a much better job of saying it.  The first is a post by Katie at Diabetic Advocate where she talks about her decision to eat low carb and photographs a series of meals.  She sums up her decision by saying: “I have reached a point in my life where I want better BG control MORE than I want to eat high carb foods.”  The second post is by Katy at Bigfoot Child Have Diabetes and explores the idea that maybe normal as symbolized by Cheetos isn’t something we should be striving for.  She hypothesizes that we’ve gone too far in the idea that PWD can eat anything.  She says exactly what I’ve been wondering and have been fearful of putting on paper.

I have not pinky finger pledged to forever lead a life devoid of fast-acting carbs.  But every time I go back on a low carb diet after a period of falling off the wagon, I stay on it longer than the previous time.  It makes sense to me.  I feel good.  My diabetes is easier.  I have fewer lows.  I look forward to a day when we have faster and more precise insulins, but at least for today low carb is where my decision box has landed.


Laddie_Head SquareSometimes I jinx myself.

It seems that every time I write a post or just look in the mirror and think “Wow!  Things sure have been going well…” my blood sugar decides to go off on wild bumper car excursions.  Sometimes I can blame myself for the results–oh yes, I shouldn’t have had that double bowl of chocolate ice cream last night–but just as often it’s just one of those things.  It’s a reminder that hard work and good decisions usually lead to good results but that every so often diabetes throws a temper tantrum trying to remind me who’s in charge.

I get oodles of motivation when I do things right and I get good results.  However, when I think that I have done things correctly and I get bad results, I am very quick to say “What the hell!” and go off the deep end with bad decisions.

When the numbers are good, it’s easy to think that I am in control of everything that affects my blood sugar.  I can take my insulin adhering to all of the preset and tested ratios in my pump.  I can show incredible willpower and have an egg and spinach omelet for breakfast when I am starved for a bowl of cereal with bananas and milk.  Oh, how I do miss cereal for breakfast.

Things Going WellWhen the numbers are bad, I usually blame myself.  If I take responsibility for the good numbers, it seems logical that I should take credit for the bad numbers.  But there are times that I eat a low carb breakfast with an appropriate insulin bolus and my blood sugar soars into the 200’s.  If I understand correctly what books tell me, some of these morning blood sugar excursions are the result of hormones screaming at my liver to pump out glucose at the same time they try to interfere with the action of my insulin.  But where were those hormones yesterday and the day before when my body thought the same breakfast was hunky-dory and my numbers were great all morning.

Recently I participated in a study that was investigating whether blood sugar rises at the end of the two or three day life of a pump infusion site.  Today was the third day of what has been a fine infusion site, but when I was high through much of the day, I changed out the set.  My problem is that I usually go high when I have a new infusion set.  So I was high because of the old set and then high because of the new set.

So today I am ranting.  Highs are much more enjoyable when you have the guilty memory of a hot fudge sundae.  But I have been doing a really good job of eating low carb lately and totally ignoring the call of chocolate covered donuts.  So this isn’t fair.  You mean diabetes doesn’t play fair!  Wow, that’s not very nice.