Being a nurse and managing eating

yeah i had a salad with chicken for lunch and I hadnt eaten anything in 5 hours went to do an IV and couldnt remember how to use the pump…same exact pump I had inserviced other nurses on and I yelled for help I was all confused and stuff and shaky and my sugar was 60…trying to eat healthy I had had a cookie for dessert too but I guess I had ran around so much and it was 5 hrs that that happened and I was on Metformin at the time. Never had happened to me before. Scary so I dont generally eat salads on my days I work to avoid this and I have made my bigger meal at lunch because I work 3-11.

oh and cottage cheese is alright and i like yogurt but unless I get a full fat kind I cannot stand aspartame…hardest part of this diagnosis for me. Luckily I like truvia but no low sugar yogurts that I have found are made with that unless someone knows something I dont know :slight_smile:

I didn’t “need” insulin, either, according to standard medical practice. But since I went in in and demanded it, my 6.9-7.1 A1cs have been in the 5s. I’m less interested in some textbook guideline than I am in having good blood sugars. Let the guideline writers think what they want; I like my mid-five A1cs. For me it’s about the bottom line. Eyes on the prize.

The beans are Broad Beans. Costco is a wholesale club, like Sams Club. Not sure where you are in MA, but they do have Costco. The brand of trail mix is “Enlightened” and you can buy them online too (click the link I inserted). A 1 oz service has 17g of carbs.

I am a T1D and a patient advocate, and my wife is a Health Navigator who runs a diabetes program for a large medical center in our area. Her suggestion is to eat breakfast, eat lunch before your shift, a small snack with a few carbs and protein between lunch and your dinner break in your shift to prevent the lows. Then add a few carbs to your dinner meal on your shift, and another small snack between dinner and shift end.

Greek yogurt is a healthy, low fat carb option to add to a meal and it has no aspartame. It has protein, so it will level out your blood sugars a bit. It will give you about 19g of carbs if you buy the fruit based ones. Again, her suggestion is eat it around 9pm, in the middle of your shift. If you want less carbs, Chobani Simply 100 is made with Monk fruit and Stevia. Dannon Oikos Triple Zero is a Stevia based Greek yogurt too. Dannone Danvia and Stonyfield are (non-greek) yogurts made with Stevia and are pretty good. I have seen these products in Whole Foods markets and I know there are Whole Foods Markets in the Boston/Cambridge area…

Being a Type 2 diabetic, you should be able to handle those smaller amounts of carbs without highs.

She also suggests you borrow a Dexcom CGM from the facility you work at (Endocrinologist’s office, or CDE) and wear it for a week to see the exect times you start to go low. This will help you figure out the best time to snack. If insurance will pay for it, you should probably get a Dexcom CGM of your own and wear it, so you get warnings before you go low, allowing you to correct the fall before it is too late.

She also recommends people read Dr. Neal Barnard’s Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes without Drugs. Read it with a grain of salt - she does not necessarily believe in the pure vegan lifestyle, especially when you have lows like you do. She recommends it more for general advice. I personally like Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars a bit better.

On injected insulin, I can reach “a respectable 6.1” as my doctor calls it. I use Afrezza to push it lower, now being in the high 5’s. I feel better there, though I often have to add extra carbs when I get exercise. I usually keep gel glucose handy at all times.

They’re more expensive, but I buy either Siggi’s Greek yogurts or Eli Quark (which isn’t actually yogurt, it’s a type of cheese that has the same consistency and of yogurt, and is sold in the yogurt section). I can only find the Eli Quark at Super Target and this one specialty grocery store, for the most part though. Eli Quark is high in protein and has no added sugar or artificial sweetener. It uses Stevia and Erythritol (same ingredients as in Truvia). Siggi’s uses some real added sugar, but is lower in sugar than many other brands of yogurt. Greek yogurt is generally lower in carbohydrate than regular yogurt because the whey (where the lactose is) has been strained off.

Your best bed for low-carb/low sugar yogurt though is to take plain greek yogurt, stir in a bit of Truvia, and add in your own fresh or frozen no-sugar added fruit in a measured amount.

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PCOS is pretty common and a hallmark of PCOS is insulin resistant. At some point PCOS/diabetes, it is all part of a spectrum of things that make up the plague of our lives. But knowing you have been diagnosed with PCOS gives you a key piece of information, you are extremely intolerant of carbs. I would urge you to think about a low carb high fat diet and I suspect you will find it not only helps your overall blood sugars but it can help your reactive hypoglycemia.

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I also think highly of Bernstein. Some people object to his approach as too strict or Draconian, but that misses the point IMHOP. It’s not necessary (or even wise) to follow any expert slavishly. The way to deal with any expert’s advice is to take what you can use and leave the rest. For me at least, Bernstein has an extremely high batting average.

For those interested, here is the full citation:

Richard K. Bernstein, Dr. Bernstein’s Diabetes Solution, 4th. ed. (New York: Little, Brown and Company, 2011)

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Short of gastric bypass, no one can reverse diabetes, regardless of etiology. One can only treat the symptoms, i.e. you can lower blood sugar by limiting carbs. But once you have Type 2 diabetes, you cannot make it “go away” via dietary changes.

Technically speaking, PCOS does not cause diabetes. It increases ones’ risk factors for Type 2 diabetes via causing insulin resistance. However, women with PCOS are three to five times more likely to develop Type 2 diabetes.

Taking (a small amount of) insulin for a high BG of 140 should not make you go low if you only take enough to treat the high number plus a small amount to cover the carbs that you will consume. Taking insulin should stop your phase 2 response from going overboard, which should stop reactive hypoglycemia (if that is what is causing your lows). Please refer to Brian’s explanation (contained in two of his posts above).

Unfortunately, when you-know-what hits the fan, one has to make changes in their eating lifestyles by themselves. Although support from others can certainly help a great deal, no one but you can change your eating habits.

rgcainmd The issue is that type 2 does produce insulin, but either not enough or not in time or doesn’t use it correctly. I can tell you that people with type 2 on diet only CAN run the glucoaster — just not as high up or as low down as someone with type 1 (or someone on exogenous insulin). Also, a lot of people with type 2 aren’t set up with an adequate metering program.

kellsbells79, since you’re a nurse, you can figure out meter use (fasting, before and 1-2 hours after eating or drinking ANYTHING, just before and after exercise, and any time you’re feeling “off”). The issue, I’d think, is finding the time to test, given the sort of busy schedule and making sure your numbers don’t get confused with your patients’ numbers, etc. and finding the time to log. You may need to do some serious food tracking to see if the issues are particular foods, or the quantities you’re consuming at the time. (For some of us, T2DM is better managed by grazing — eating 200-300 calories every 2-3 hours — than maintaining a “normal” meal schedule.) Shift work may also be an issue.

YES, this is doing a lot of the work yourself. The problem is, there are so many different underlying conditions that cause a “type 2 diabetes” diagnosis (and nobody’s bothered to find out what the real underlying conditions are) that there’s no single “just do this and you’re good” type of therapy. It IS a lot of “you have to do this yourself, for yourself” work.

FWIW, the “starving” feeling is not unusual for the first week or two of getting used to a new, restrictive diet. It’s one of those things we need to tough it through.

One issue with any people-traffic-dependent job (e.g. nursing and healthcare, sales, phone support, police, etc.) or any task-completion-dependent job (e.g. construction, firefighting) is that one’s meal breaks and other breaks are (despite scheduling) highly variable based on customer volume (many people waiting to be seen at the bank or cash register), customer task requirements (patient who needs a lot of help feeding or toileting, computer or phone customer with a complex or difficult-to-resolve issue), or safety requirements (fire must be completely out; building beam or surface must be completely secured). Staffing is also an issue that adversely affects our ability to take meal or snack breaks either as-scheduled or sometimes, even at all.

Not always. That is easily the most common pattern but not the only one. Especially for a long-time T2, insulin production can sink to near-T1 levels. Case in point: my last c-pep was 0.1.

I am well aware of the fact that most (but certainly not all) individuals with Type 2 continue to produce insulin, and that the problem lies more in the fact that they are insulin resistant. (Actually many folks with Type 1 continue to produce some insulin, even if it is in minute amounts, for weeks, months, years, and even decades after their honeymoons end. Additionally, a significant number of people with Type 1 also develop insulin resistance.) And of course I understand that all people with diabetes experience, to one degree or another, wider fluctuations in their BG levels than do “normals”. Some people with untreated, or inadequately or poorly treated Type 2 can actually experience more extreme variability in their BG levels than some people with Type 1 do, even if they are taking exogenous insulin. I am unsure as to why you believe that I think otherwise.

I’m not sure exactly what you mean when you said “Also, a lot of people with type 2 aren’t set up with an adequate metering program.” Do you mean that the majority of health care personnel do not instruct or expect people with Type 2 to test as often as people with Type 1? Unfortunately, you are correct. However, if you stick around on this Forum, you’ll see that quite a few Type 2s are just as vigilant (and maybe even more so) than some Type 1s are regarding monitoring their BG levels multiple times a day. Health insurance (I believe for the vast majority of folks with Type 2) covers the cost of a BG meter, and likely covers the cost of test strips (although likely fewer per month, as the unfortunate belief that Type 2s shouldn’t have to/don’t need to test as often as those with Type 1 still exists.) Also, there exist more affordable meters and test strips one can purchase out-of-pocket without a prescription on Amazon. (Hopefully, Sam19 will drop in and further address this issue, as he has accumulated and currently has the world’s largest stockpile of these test strips in his home in anticipation of the Zombie Apocalypse.) So the ability to test BG is not a “privilege” or “right” given only to those with Type 1.

In regards to your statement: “The problem is, there are so many different underlying conditions that cause a “type 2 diabetes” diagnosis (and nobody’s bothered to find out what the real underlying conditions are)…”:

Unfortunately, there still exists a vast deficit in the pool of knowledge regarding the exact and varied etiologies of both Type 1 and Type 2 diabetes. However, you are incorrect in your assumption that this is due to lack of effort on anyone’s part. The life work of quite a few scientists has been and/or currently is devoted, all or at least in part, to this very issue. Much like in many other areas of medicine, however, we still have a long way to go.

I do agree in part with a portion of what you’ve posted. Type 2, as Brian so accurately phrases it, is “a diagnosis of exclusion”. It appears that there are likely more subclasses of Type 2 that inherently have more variability regarding their etiologies, biochemical mechanisms, etc. than do the different subclasses of Type 1. At this point in time, less is known about these subclasses or variants of Type 2 simply because there are more of them and because there has been more scientific work done around Type 1 diabetes, likely due to the fact that is more often a “squeakier wheel” than is Type 2: without exogenous insulin, the overwhelmingly vast majority of people with Type 1 (who are no longer in their “honeymoon” phase) will die within a few days. This is simply not true for the vast majority of people with Type 2. Please, don’t get me wrong; I am definitely not downplaying the seriousness of all types of diabetes and do not in any way intend to imply that people with Type 2 do not struggle just as hard to manage their BGs 24/7 like Type 1s do. I am simply trying to explain why, historically speaking (and to a somewhat lesser extent currently) more work has been/is being done in the area of Type 1.

I’m not certain if I am understanding you correctly when you say that “that there’s no single “just do this and you’re good” type of therapy. It IS a lot of “you have to do this yourself, for yourself” work.” in reference to Type 2. I’m hoping that you did not intend to imply that this is not also the case with Type 1. Because managing Type 1 also very much entails the fact that "there’s no single ‘just do this and you’re good’ type of therapy.

Lots of great suggestions here. I love watching Diabetic Danica’s YouTube videos. She has just finished Nursing School, and is now working. I imagine she gets tons of emails, but you could try emailing her to see if she has any tips specific to surviving the rigors of your profession. Yes, it is SOOOO helpful to learn from our fellow people with T1D, and it might be great to talk to other nurses with T1D too. Good luck.

Hi,

Are you on any medication? I ask because you say eating a salade makes your BG go low. How can that be if you are not on meds?

Thanks Kells. Once I have that straight, I can participate more meaningfully!

Sen. G.

RG but I have heard you can indeed reverse diabetes. That should likely depend on how many beta cells you still have functioning. It takes a lot of discilpine yes.

Kells, personally I am leaning towards Taubes’ way of thinking. The issue there, though, is that as above, it takes discipline not to eat simple carbohydrates. I am not diabetic but I really try to watch what I eat in regards to starch and sugar, and lean more toward the paleo style. However, I’ve found that nothing both satisfies me (and curiously though gives me the itch) as much as certain processed carbohydrates. Perhaps it is because they have a faster and more <> action on the brain, I don’t know.

Carbohydrates do have an addictive effect. That is pretty well established. It’s not your imagination.

I would call that “remission” rather than “reversal”. It’s still there, lurking in the background, no matter what your numbers look like.

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