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Posts from the ‘Diet and Food’ Category

So Maybe Don’t ALWAYS Pre-Bolus.

I like to pre-bolus.  It helps keep my post-meal blood sugar spikes from rocketing out of range and taking a sizable bite out of my overall diabetes control.  (… I’m sorry.  I laugh every time I type the word “control.”  It’s not a word I toss around lightly when it comes to diabetes.  I’m not Janet Jackson.)

The art of pre-bolusing has been instrumental in keeping diabetes shit in line.

But it only works when it works.

Last night, we ordered pizza to go along with our birthday cake for Birdzone (we rounded out the meal by eating a stick of butter each and guzzling soda – healthy! – only the butter part is a lie) and the promise was “delivery in 30 minutes.”  Since pizza can be insulin’s kryptonite, I thought it wise to pre-bolus so that the initial carb influx of the pizza would be headed off by the first bolus, and then I’d chase my meal with more insulin to grab the fat-induced-blood-sugar-bump that hits about two hours later.  (I don’t have a #DIYPS, so when my food choices edge towards pizza party, I have to improvise a touch.)

Basic gist?  I took my insulin way too freaking early because the pizza arrived an hour later.

My Dexcom was freaking out by the time the pizza delivery man left – “Kerri, your Dexcom is vibrating like crazy over here, and says you’re low.”  “Like how low?”  “Like spelled out as LOW low.” – so the first piece of pizza was inhaled in a matter of seconds.  The second piece went just as quickly, and then I chased my dinner with a handful of glucose tabs.  (Wildberry – the perfect palette cleanser.)  Pre-bolusing doesn’t always work – its success leans on timing.  My pre-bolus was working right on schedule … if the pizza had arrived on time.  But due to tardy carb arrival, my blood sugar was in the trenches and covered in pepperoni.

“Mawm, is this good pizza?”

“The best!”  I answered her, through a mouthful of glucose tabs.

Plastic Apples and Measuring Cups.

Her desk was anchored on either side by tall bookshelves crammed with pretend food.  Plastic fruit – apples, bananas, oranges, kiwis that looked like fuzzy dumplings – and the cardboard shell of cereal boxes.  Plastic slabs of steak with edging to make it look like it had a pat of butter melting on top, and the entire plastic carcass of a chicken, woefully untrue to size, making it the same size as one of the kiwi dumplings. Measuring cups and food scales, lists and charts, meal plans and index cards covered with suggested serving sizes.

It always felt embarrassing, seeing the nutritionist and the dieticians, especially when I was in my teens.  I struggled with my weight as a kid but didn’t ever dip into “overweight,” just more settled on the heavier end of the approved spectrum.  I hated meal plans and the emotional influence of food on my life.  Visiting the plastic food lady as part of the flow every few endocrinologist appointments felt shameful, and I wondered what my classmates would think if they knew I was lectured about eating and food every few months.  Would they know how complicated my relationship with food really was?  Dietician appointments felt like mini-fat camps, and even though I did feel better-informed leaving the appointments, I still felt stupid and ashamed that there were required in the first place.

Moving forward a few decades, diabetes is still very much in play.  I don’t see a dietician as often now as I did when I was growing up, but I do attend a lot of diabetes conferences where registered nurses, dieticians, and nurse educators present, giving me access to refresher courses on food, eating well, and the latest in food and diabetes research. The plastic food is still in play, only the plastics aren’t relegated to my CDE’s bookcases anymore.  Now, the plastics are invading my home.  My daughter’s room is awash with kitchen playthings and miniature versions of what my dietician used as visual aids back in the day.  We talk quite a bit about food and why we eat the things we do.  I try not to let my food-through-the-lens-of-diabetes mindset invade how she sees her plate, even though it’s hard, since we spend so much time together and she sees so much of my diabetes day-to-day management (attempts).

“We need to eat healthy foods so we can grow to be strong and smart and healthy,” I tell her.  “Yeah, and we always need to eat something green with our meals,” she adds, knowingly.  “And sometimes we have juice in the fridge, but it’s for your low blood sugars.”

I don’t want my daughter to think that there are so many food “rules.”  I want her to eat things that make her feel good and that taste good, without looking at her plate and thinking her value as a person rests there.

In her room, she ‘cooks’ up a storm, throwing random items into the plastic stock pot on her pretend stove.  “We need an eggplant, and a hard boiled eggie, and some ash … ash … ASHparagust, and Wonder Woman,” with all of the aforementioned tossed into the “boiling” water.

“What are you cooking, Birdzone?”

“I’m making soup. It will be so delicious. When I’m done, you can have a bowl.”

“What’s in it?”

“Don’t worry, Mommy.  There’s something green in there.  There’s ashparagust.”

March is National Nutrition Month (more about that on the Academy of Nutrition and Dietetics website), and this year’s campaign encourages people to “Enjoy the taste of eating right.”  The phrasing of that message is so hopeful, and without residual shame:  enjoy.  Enjoy the taste of eating right, whatever “right” might be for you.Yes!  I’d like to!  I’ll do that!

My hope is to eventually shake the preposition off “eating with diabetes” and just focus on “eating.”

Do You Take a Probiotic?

Insulin is an essential part of my life with type 1 diabetes.  (See also:  duh)  But it’s not the only thing I take regularly in efforts to maintain optimal health.

(That sentence sounds so formal.  “Optimal health.” Also makes me think of Transformers.  Optiumus Health would be a badass Transformer … maybe a gas/electric hybrid instead of a tractor trailer?)

I use a lot of things to rein in diabetes that aren’t prescribed, and a probiotic is one, these days.  “Gut health” is a phrase I hear often in regards to autoimmune disease and overall health, and I’ve read several articles discussing the possible pros and cons of probiotics for people with diabetes.  (Here’s one from TheDX with an excellent discussion point at the end about the assumption that “probiotics can’t hurt” and one from HealthCentral about type 1 and probiotic use.  Lots of things to consider, especially once you start poking around in medical journal articles about probiotic use.)

Most importantly, I talked with my doctor about taking a probiotic and both my endo and my PCP were fine with that addition to my regimen.

But I honestly have no idea if it’s useful or effective. I don’t generally experience digestive trouble, but I’m not sure if I can attribute that lack of issue to taking a probiotic, since I’ve never really had digestive trouble.  Overall, my “gut health” is ultra-fine, much like my needle tips.

I’m curious, though:  How many of you are taking probiotics, and do you feel they actually have an influence on your overall health?  Do you feel better taking them?  Worse?  Taller?  Smarter?  Furrier?  No different?

 

More on Redefining the “Diabetes Diet.”

In keeping with the thought process from yesterday (talking about what makes me view food choices as something to hide), I wanted to reshared this video from last year about redefining my perception of what a “diabetes diet” really means.

I don’t want to view food as something I’m punishing or rewarding myself with.  But that mindset is hard to stick with, at times.

Do you subscribe to the whole “diabetes diet” mentally, or do you view your food as (gasp!) food?

Diabetes Food Lies.

So many rules were slapped into place immediately upon diagnosis, with diabetes feeling like a disease of “don’ts.”  Don’t eat cookies, don’t forget to measure your food, don’t leave the house without your meter or insulin or glucose tabs, don’t go to bed without checking your blood sugar, don’t eat too much sugar-free candy or else you will take up temporary yet violent residence in the bathroom.

But some of the don’ts were more subtle:  like “don’t allow the disease that’s built around obsessing about food to let you become obsessed with food.”

My mom used to hide packages of cookies in her closet, and I’d wait until she was in the shower to steal into her walk-in and grab cookies by the fistful.  I’d eat until my stomach ached and I didn’t take an injection to cover my indulgences, and to this day, I still grapple with the “why” of my actions.  I know I am not the only kid who did this.

Guilt and food went hand-in-hand right away for me, as a kid with diabetes.  I felt guilty about eating those closeted cookies, and even more guilty about lying to my mother about my actions.  And yet I did it anyway.  I have a very clear memory of hiding a carton of ice cream underneath the couch upon hearing my father’s approaching footsteps, afraid not of him telling me I couldn’t eat it, but being angry that I didn’t care enough to take insulin to cover it.  I have no idea why I never bolused for those furtive snacks; it was as if taking insulin for them forced me to acknowledge that I shouldn’t have eaten it in the first place, as though the bolus itself made the action real, instead of the resulting high blood sugar.  Or, you know, chewing and swallowing.

I never wanted to have that high blood sugar.  I just didn’t want to have the restrictions, and my way of rebelling against them seemed rooted in pretending I didn’t have the rules of diabetes to own up to.  Rebelling was so subtle, and so easy, for me.

Now, as an adult, I still find my feelings about food to be complicated.  I feel very lucky that I have never dealt with an eating disorder and I always accepted, even if I didn’t always like, the shape and layout of my physical body, but diabetes has a way of making me view food through a lens that my non-diabetic friends don’t share.  My mind knew that numbers on the scale or the size tab on the back of my pants didn’t matter as much as number on my meter, but still, it is always a struggle to remind myself of that fact.

But the guilt that comes with my relationship with food, as a person living with type 1 diabetes, is always on my plate.

I live in my own house with my husband and my daughter, and I still have that urge to hide my food.  Last night, I had an uncomfortable low blood sugar reaction that I decided to use the candy conversation hearts in the deli drawer of my fridge to treat, instead of glucose tabs, and as the deli drawer creaked as it slid open, I wondered if my husband thought I was just “sneaking candy.”  (For the record, Chris hasn’t ever, ever made me feel guilty or judged for what I’m eating.  The guilt isn’t borne from the reaction of others, but from my own projected perceptions.  It’s a weird head game.)  Some of the thoughts remain, but my mini-binges stopped long ago, once the don’ts of my mid-1980′s diagnosis of type 1 diabetes gave way to today’s modern insulins, meters, and mindsets.

A few days ago, a parent wrote to me and asked me why her child with type 1 diabetes would lie about eating certain foods.  And I had no idea what to say, because I still don’t know why I did it myself, or why I still sometimes have the urge to do it.  All I know is that even with a supportive family, friends who don’t judge, access to like-pancreased people, and a mindset dominated by confidence in my diabetes management, I struggle to explain what made me binge-eat those cookies, or binge-lie about doing it.  And I don’t know why, decades later, it’s still hard to say out loud.

[This week is National Eating Disorders Awareness weekWhile this post is not about an eating disorder, it is about the disordered mindset that can come along as part of a disease that is anchored in food.  If you've ever felt guilty about your food choices or perceptions, you are not alone.]

Green Drink Redux.

We have a rule at our house: “You have to eat something green with your meal.”  Caveat:  boogers don’t count.  Also, ew.

Even though it’s more of a “rule” (there’s flexibility), we try to keep it as a rule because it’s important to us as a family to eat well.  Taking a look at “kid’s menus” at restaurants is very frustrating – why is my growing child offered grilled cheese and french fries as standard fare?  And why does the waiter look at me funny when I ask for broccoli to be subbed in for the fries?

I can’t think about this too much or I’ll pop in frustration.  Moving on to green drink.

Green Drink is something Chris used to make well before we were married, and his version was delicious, if not a touch frothy.  Over the years, we’ve worked on different versions of this drink in efforts to make it tastier.  With “worked on” being a loose description – our attempts are anchored in “what’s in the fridge” and “how new is the blender.”  We burn through blenders in this house.

Birdzone knows about the “eat something green” rule, and she sticks with it.  (Even at my mother’s house, where she says, “I need to eat something green, too,” as my mom sets down a plate of spaghetti and meatballs.  So then then the meals becomes spaghetti, meatballs, and a rogue side bowl of peas.  Well-played, Birdy.)  The Birdzone respects the green rule, and will try any green drink we concoct, even if they get a little weird.

The last iteration of Green Drink was my favorite yet:

Ingredients:

1/2 apple
3/4 cucumber
1 cup of baby spinach
1 very ripe avocado
1 tsp lemon juice
1 stalk(er) of celery
1 cup of ice water
1 packet of Truvia (or whatever fake sweetener you prefer*)

The ingredients are simple, as are the instructions:

Take out your cutting board so you don’t ruin the counter tops and then hack the apple, celery, and cucumber into bits.  Throw them into the blender.

Since the avocado should be ripe-to-the-point-of-borderline-falling-apart, peel it and slice directly into the blender.

Take the spinach by the fistful and rip it up.  This is a pleasantly violent process, and is beneficial for stress release.  It also helps the blender to liquify the spinach.

Pour the ice water into the mix.

And now for the sweetener.  *I use Truvia in mine, because that is the fake sweetener packet-o-poison I have chosen for this drink.  You can feel free to add whichever sweetener you’d like, if at all.  The choice is yours!

Blend until the mixture is at a consistency you can either suck through a straw or drink straight from the glass.  Add a few ice cubes for maximum coldness (or snow, if you’re in New England and currently being blizzarded on.  Green slushy!)

Then drink it alongside your spaghetti and meatballs, because you need to eat something green, damn it!

The Art of the Pre-Bolus.

"Fucking frost on my eggplants."  Batman tries to wait patiently for his bolus to kick in.“So it’s a Wednesday night … what’s the chance we might not be seated right away?”

“Are you talking to me?” Chris asked, pulling the car into a parking spot near the entrance of the restaurant.

“Yeah.  Sort of.  I’m trying to decide if I should bolus now, because I’m 200 and I don’t want to be high all night.  Or eat ice for dinner,” I responded.

The science of a pre-bolus makes sense to me.  Take your insulin before you eat so that it’s active in your system when the food hits.  Or, in smarty-pants terms:  “A bolus of rapid-acting insulin 20 min prior to a meal results in significantly better postprandial glucose control than when the meal insulin bolus is given just prior to the meal or 20 min after meal initiation,” states the conclusion of this study from 2010 examining the influence of timing pre-meal boluses on post-prandial blood sugars.

I put this theory into practical application during the second and third trimesters of my pregnancy, when insulin resistance was constantly on the climb, as were my actual insulin needs (thank you, hard-working placenta).  Around the 22 week mark, I needed to pre-bolus approximately 25 minutes before a meal.  Around the 30 week mark, I was upping that time frame to 45 minutes prior to eating.  And now, without a baby on board, I still try to bolus at least 20 minutes before I eat.

Making the decision to pre-bolus is a precarious one, because the success of that decision rests in the quiet of variables.  (What, too esoteric?  I wrote that sentence from a cloud.)  Pre-bolusing only works when nothing else gets in the way of eating.

Exhibit A:

Yesterday morning, I woke up to a shiny 218 mg/dL on my glucose meter, so I wanted to make sure I pre-bolused for breakfast, since morning highs tend to stick with me well into the early afternoon.  (Little jerkfaces.)  I took my correction bolus and my meal bolus in combination with one another for my meal (eggs, avocado, and a slice of toast do not judge me for eating toast), and set about playing with Birdzone until it was time for breakfast.  Only the best laid plans of this PWD were derailed by a phone call, a frantic search for Carrots (Birdy’s stuffed rabbit, who happened to be in the dryer, a la Knuffle Bunny), and falling down the email vortex for a spell.  End result?  I skipped the toast and ended up chugging some juice with my breakfast.

Exhibit B:

Before dinner out at a restaurant, I decided not to pre-bolus in the car, assuming it would be some time before we were seated.  But (of course), we were seated and eating within 20 minutes of arriving.  Even though my blood sugar was in range when I sat down, I had a post-meal spike that looked like a rocket ship taking off.

Timing is only part of the art of the pre-bolus.  For people dealing with gastroparesis, trying to predict the absorption of insulin and food is tricky.  For kids with diabetes, the art is more Pollock-y, because who knows what a kid will eat/won’t eat/might lick and then hide in a plant?  The blood sugar number you’re starting from makes a difference (or at least for me), too.  I’ve found that if I’m high, I need to wait until I see a downward slope on my Dexcom graph before I can start eating; otherwise, I start high and end up higher.  And the time of day matters for me, too.  A breakfast pre-bolus definitely needs more time to kick in than a dinner one.

Pre-bolusing, for all of its variables, is one of the most useful things I’ve done to help lower my A1C.  Keeping my post-prandials lower helps my overall control, and every time I see my endo, she nods in agreement when I mention pre-bolusing.  (She also warns me about lows every time, because she’s a doctor and also extremely smart and always has cool sneakers on /digression)

Do you pre-bolus? 

 

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