Confessions good for the soul?

1

Okay, so I have a few things I need to confess because it seems like everyone out here on this site is fantastically awesome at their blood glucose 99% of the time and to be honest, frankly, I am NOT.

I eat what I want when I want. I generally try to be reasonable and I rarely fit in over 200g of carbs a day. But you name it, I eat it with very few exceptions. When I was first diagnosed, I tried to do everything the "right way" but now I am burnt out and since I have gotten my pump and started going to an Endo, she even said herself I need to relax and try eating different things.

So, here goes nothing... I eat pizza... I mean a lot of pizza. And sometimes I try to be healthy about it and limit myself to 2 pieces but there are days when I just say "fudge it" and I eat half a pizza. I sometimes try to make homemade pizza. I eat spaghetti at least twice a month. I eat mexican food. I eat out at least 3 times a week... almost have to with my job. And as I said I try to make healthy choices but it doesn't always work out... after busting my behind ALL day and I'm tired and I'm cranky and I still have 12 hours left of a 24 hours shift... I give up and I eat the cheeseburger.

I still do not nor have I eaten McDonalds, potato chips, fruit juice, or pop. I try to not eat brownies, candy, cookies etc. I have recently tried eating 1 ice cream a day because at least that's dairy and it makes me feel like I got to eat something "fun".

I think a big part of my problem is there are SO few food I actually like to eat. Even before I was dx with diabetes, I had suffered from malnutrition multiple times from my picky eating habits. I don't eat pork, beans, nuts, most dark green veggies, potatoes (no lose there!), and I rarely eat chicken or beef (unless its in spaghetti sauce). That leaves me with Turkey, cheese and yogurt for protein.

I know the long term consequences. I work in the medical field and I see and treat people day in and day out suffering from complications of diabetes. I am terrified of ending up like them, and yet I am also unable to get the motivation to just eat better. By the time I get ready to eat, I am so hungry and so tired and so ready to just eat something I just tell myself, it's only one meal.

My A1C was 6.2 which isn't bad at all. My blood sugars are generally okay at night and with the exception of post lunch this past week, my postprandial readings are below 145. I am finding that I use a bit more insulin than the previous few months, and that bothers me...

So, my Basal/Bolus ratio is about
4u basal
and 6-10u bolus a day (moving more and more towards 10)

Is it okay to eat carbs like this if I am able to keep my blood glucose under control? Does having the Basal/Bolus ratio so different really matter in the grand scheme of things? I'm not gaining weight from the extra insulin. I am very active. I run and play soccer A LOT.

2

I'm really glad you put that all out there, Juliannaegirl, because yeah, it's good to do! I hope people will respect your honesty. First of all I do not think everyone on this site is fantastically awesome at their bg 99% of the time! Hardly! It's just easier to notice the ones who are. When people say "I keep my blood sugar between 80-100 at all times" it's easy to think, "what am I doing wrong?" But I just think that's great for them, but my diabetes isn't as stable as theirs and/or they do things I am unable or unwilling to do. From my experience on here I think there are some of those, some people who don't do much work on their D and have the results they expect and some people who work their butts off and still struggle with numbers. But I think most of us are somewhere in between. We set our goals in terms of diet and blood sugar targets and sometimes we achieve them, sometimes not. Personally I'm better at the diet part than the bg part, because I feel I have more control over the former.

First I think it's utterly irrelevant what your basal/bolus ratio is; that's just one of those formulaic guidelines that some of us match and many of us don't.

Now to the hard question: Is it ok to eat like this if I am able to keep my bg under control? I'm not sure what you believe or feel about it but if you are posting it here I'd assume you are concerned. The "if I am able to keep my bg under control" is part of the answer. Your A1C is good if it reflects genuine numbers and not many highs and lows that average out. For me, if I ate that way I would have very very high blood sugar and I'd gain tons of weight. But you are very active and don't gain weight so that's great. So what would be the problem? I see two things coming down the pike at you: 1) You are using very low doses of insulin and given your diet I'm assuming you have very generous I:C ratios - like 1:30? That may change. You aren't brand new but you're still early enough in the game that you could be honeymooning and given that TDD I assume you are. (Have you had a c-peptide done?). When that honeymoon ends things may change drastically and then you may really have to reevaluate. 2nd: Along the same line, if you do have increased insulin needs down the road and continue the same diet you could be putting yourself in line for Insulin Resistance. You really don't want that! As you get older you may also find your ability to burn off calories decreases and you will gain weight (which also increases IR) Finally, you're a paramedic so you know that poor diet has other impacts on the body aside from blood sugar.

So if you do want to make changes in your diet, what would motivate you? To me, diet is all about planning. I know it's easier for me than you because I don't work your busy schedule. But it is possible to plan a better diet by shopping weekly for the foods that you can eat quickly when you get home hungry but which are healthier. When I was working (two jobs) I would cook on the weekend and then freeze it and eat all week long just by using the microwave so I'd have tasty and healthy foods ready in minutes. Also are there things you can take with you, or store at home base so you have good alternatives when you are hungry on the go? Just some thoughts.

3

What I have to say probably isn't very useful, but quite frankly..

I have eaten McDonald's and pizza, what's wrong with that?

I love the heck out of some Backyard Burgers.

I eat pasta- but only Dreamfields because everything else wildly tosses my BG out of control; and it actually tastes good.

I totally ate 2 cookies for breakfast the other day.

And I haven't gained anything... BG's were mostly under control (well, until I started the pump on Sunday)...

But I love veggies and salads and eat tons of them as well. I think it's all about moderation..

4

I did that for long time but gained weight through my 30s and 40s *before* I started running all the time, peaking around 275, from 120 at DX when I was 16 (having lost 30?). I'm leery of saying anyone is bulletproof but I think running a lot will help reduce the risk of heart stuff. I also have to admit that I eat junk food pretty regularly and drink more than the AMA probably recommends for straight people. Recently, I've taken a couple of weeks off of garbage and drinking and seem to feel like I'm recovering better from the extra running training for the Chicago Marathon. It's not a ton but, instead of dragging myself out in the AM, I've got pretty good energy that I may be able to attribute to eating a bit cleaner. Not entirely clean but I mostly only eat garbage in the evenings.

I moved a bit in this direction last year as the week I ran my fastest 1/2 marathon (Sunday) and 20 mile run (the following Saturday...not the week of last year's marathon...:-(), I had been eating more veggies for a month or so after a higher "bad" cholesterol (110) and noticed I didn't feel blown out. A couple of months later, after switching to veggies at breakfast and for snacks, my "bad" cholesterol was 86. Not a huge difference but it was the main change. I was still drinking for what that's worth! These are very small and subjective increments of feeling better but, when I am pounding myself, I want every little bit I can get my hands on?

I agree that 6.2 is a great result but, if you plug it backwards into the chart it shows that to be an "average" BG (this is not exact...) of 143, into the range where DCCT found an increased risk of complictions, > 140 (I think that was the study, it was a while ago so maybe there's a new study or I got the acronym wrong? sorry!). There's many long-time survivors who report BG perhaps higher than that, particularly in the "dark ages" before BG testing and fast insulin, so it may be utterly safe to keep rolling but my experience has been that I feel better when I eat better so, despite my bad habits and utter addiction to potato chips, I am working to eat as well as I can.

5

I do eat healthier than almost everyone I know... and I use almost every trick in the book to eat healthier. I shop and only buy whole foods, I buy organic food. I make most my food from scratch. I freeze a lot of things for later. I even have pack my lunch in a cooler with snacks and drinks and everything in an effort to eat more diabetic friendly and save money at the same time. It just don't adhere to the low carb diets that I see are typical here.

I have had a c-peptide done. It came back 0.81. I know I still make some insulin and I know it is starting to fade which will increase my TDD. It doesn't bother me to have to take more insulin. ANd I know that it may cause weight gain eventually and that it may sound as though I think their is something wrong with my eating habits.

I don't necessarily think their is something wrong with them so long as my B/G remains stable. I just worry that its not okay because of all the stuff I've read about TDD and Basal:Bolus ratios and now my head is spinning. I suppose I just wish I fit into that "perfect" diabetic role so I could know what to expect. Instead, I have been "blessed" with what I have which I feel affords me the option to eat more than most diabetics ut probably still less than others around me.

6

I agree about moderation and I do try for that. I love salad and veggies and will eat them regularly.

I find Dreamfields Pasta kind of throws me for a loop. I like the idea of it, but I usually end up low because I over bolus, or high if I don't. I have also heard that it works over a longer period of time which would cause me to go higher later... I have no idea, so I just bolus the crap outta regular pasta, lol.

Thank you for eating cookies for breakfast. That makes my day!

7

I do agree when I eat better I feel better... it's just sometimes I feel better when I eat half a pizza. Sometimes salad isn't gonna cut it.

There are nights when I would just do anything to go to bed full and satisfied.

8

Everyone's different... my ISF doesn't match my I:C, and neither of them match my TDD... but it works for me..

And insulin doesn't directly cause weight gain, it's the eating more and exercising less which makes you need more to keep things stable..

I doubt any of us fit into a perfect diabetic role... (obviously) I don't follow a low carb diet... though I try to keep it less than 150g a day or at the very least less than 45 to 60g of carb per meal. But if you're like me, you gotta allow yourself a burger or a cookie occasionally.. because if I don't, I'm likely to want to gorge myself on said burger or cookieS and then have food hangovers...

9

*disclaimer*. I had pizza and chicken wings for dinner. *urp*

10

I miss potato chips. It's the one thing I can't bring myself to buy for me because I KNOW I will eat them ALL in one sitting!

Sometimes I steal one from a friend. :/

11

It sounds like you're doing pretty good, if not excellent! Cut yourself some slack. First, you cannot be perfect all the time. It's just not possible. If you are so strict that you deny yourself the occasional slice of pizza or ice cream cone, you're going to burn out.

Second, with an A1C that good, you're clearly doing something right. Remember, with T1, you need insulin regardless of what you eat. The trick is in dosing it correctly for your body, food, activity, etc. You're clearly doing that, otherwise you wouldn't have an A1C that nice!

Third, everyone's diabetes is different. There are some folks who simply look at fruit and have massive BG spikes. For some reason, I can eat fruit, bolus, and not have a single issue. Some T1s can eat more carbs and still managed to have good BGs. Others have to stay on a really low-carb diet. We are all different and you have to just find what works for you. You may be someone who can eat pizza for breakfast, lunch, and dinner and still walk away with a normal BG. Just be happy that it works!

It sounds like you're doing all the right things to take care of yourself, so I really wouldn't worry. If you're not gaining weight and your BGs are that good, I really wouldn't be concerned. If you see your numbers consistently start to go up, then you may need to change something. Also, like you, I'm really active and I do find that I can "get away" with a bit more than other T1s I know because of my activity level. It's one of the reasons I stay active!

12

OH, and about once a month or so, I do get pizza because it's so darn good. I get Papa John's thin-slice pizza (22g carbs per slice). And I wash it down with a beer. Sorry, but there are just some things I'm not willing to give up to D!

13

I might have misunderstood your description of what you eat; I thought you were concerned about your diet because you eat a lot of pizza, cheeseburgers and ice cream. I understand we are all different, and I'm glad you explained some of your healthy eating habits - although to be honest, due to your schedule it sounds like you don't always adhere to the standards you set yourself. In a way you remind me of me when I got diagnosed: I told the dietician I ate really healthy because I was a vegetarian and never ate sugar and like you I made things from scratch and ate few processed foods. But now I understand that as a vegetarian I ate way too many carbs. I think there is a difference between a true "low carb diet" and just some restriction of carbs. For me, if I ate some of the foods you mention my blood sugar would be all over the place and I'd find it very hard to bolus accurately. As your honeymoon ends you may find the same to be true as well as, like I mentioned the possibility of gaining weight and developing Insulin resistance. Perhaps you can make some adjustments to your diet without having to go true low carb - I think it's a continuum and it isn't all or nothing. I just think the "eat whatever I want and just bolus for it is frought with peril.I don't want to push my views, but then you did post out of a concern so I figured I'd give my opinion.

Again, I don't think the basal/bolus ratio is at all important.

14

I actually used to be the first person to say insulin doesn't make you gain weight. I believed that people who gained weight were either in the early stages of their insulin treatment where their body was switching over to healthy blood sugar, or that they took insulin as permission to "eat whatever they want and bolus for it". But I've changed my mind about that. Over the 3 years I've been on insulin I stayed pretty much under 100 carbs a day and even used low fat products though most people disagree with that. I didn't reduce or change my activity level. Yet I slowly but surely gained 12 pounds during that 3 year period. Most people think I "eat like a bird" so the insulin is the only factor. Age definitely contributes to that tendency but yes, I do believe insulin can lead to weight gain, not just from my own experience but from many others I've spoken to. Sigh.

15

Just wanted to add something because I re-read your original post and it said: "When I was first diagnosed, I tried to do everything the "right way" but now I am burnt out and since I have gotten my pump and started going to an Endo, she even said herself I need to relax and try eating different things."

I have a name for that; I call it the "twinkie granola syndrome"! I think if we try and be the "perfect diabetic" and really restrict ourselves we feel deprived and burnt out and then go in the opposite direction. Shawnmarie said it perfectly when she said the "middle way". I also think it's necessary to really work at finding things to eat that are reasonably diabetes friendly but also are tasty and satisfying. You shouldn't have to go to bed feeling hungry! I think part of it is carb addiction. When people are used to eating loads of cards they have a physiological as well as psychological addiction to them ( I myself had one to sugar and I know it's real!). So then when they have less of them they feel unsatisfied (physical) and deprived (psychological). Once you've made some cut in carb intake those cravings will go away. Personally when I eat a very carb laden meal like pizza or pasta now I can feel it sitting in my stomach like a lump and I feel generally lethargic

Finally, yep, most endos, cdes and dieticians have bought into the ADA line about "eat whatever you want". To me it is all a part of catering to what they feel is the non-compliance of diabetics. I think it does us all a disservice by expecting so little from us!

16

Hi,

You're doing fine. I currently use about 15u of bolus and 9 units of basal per day five years after diagnosis. As Zoe said the guidelines are just that. You might want to understand why you don't fit the norm but there is no reason to force yourself to fit a norm that doesn't match your needs.

I also try to have something fun with most meals and eat fruit and dark chocolate every day. On the other hand, I think you'll be happier in the long run if you can grow to like more green vegetables. They're healthy and provide variety. Who knows you might just post a question about is it possible to eat too much kale :-)

You're going to have diabetes a long time and your endo is right - cut yourself some slack.

Take care,

Maurie

17

Good points, Shawnmarie. But my weight was quite stable before diagnosis and I've significantly decreased my caloric intake significantly since I've been on insulin, so I'm convinced that the insulin is a factor in the weight gain. But (like many things) I see it as a combination of the two (at least) factors of menopause and insulin. Btw I have further reduced my carb intake (from "under 100" to 39-59) and am finally seeing a slow weight loss which I'm convinced is from less carbs but also from the less insulin needed to cover those carbs.

18

As a random but related aside... in cats and dogs, post-spay or neuter, metabolic demands decrease due to decreased levels of hormones... so you can feed them less.

Yet another reason to spay or neuter... smaller pet food bill :)