I apologize for the wonkiness of the fonts on this post but Blogspot isn't playing nicely and I'm tired and have "stuff" going on so you're just going to have to deal with it. It may not be pretty but the content is so good!
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:
