Diabetic Chef

Type 1 and LADA New to Type 1 Diabetes
1

Hello future friends,
I'm very thankful that I stumbled upon this forum a few weeks ago.

As the title of this thread suggests, I am a Chef. I have worked in the kitchen for 26 years. I earned my Culinary Degree from Johnson & Wales, and my Professional Chef level 2 certification from the Culinary Institute of America. I have been married to my college sweetheart for 16 years; and she is baker/Pastry Chef as well. I was ultimately diagnosed at 38 years old, with T1 in April 2013.

When I was initially diagnosed, I was terrified that I would not be able to continue to function at my job with this disease. To be honest, I still wrestle that fear daily. A major component of my job is... eating all types of food. Tasting and re-tasting. At this stage in my career, I'm not as much on the front line cooking anymore, but I am always the through point, and I ensure that what we are serving is right. I conduct cooking interviews for new cookes/bakers, and I have to taste what they produce, and provide critiques. I meet with vendors, and I sample products they wish to provide for me. And so on..

Everything I do revolves around food, and I am very passionate about it. However, I'm not sure if that feeling is 'love' or 'loathe' at present. As I mentioned before, my wife bakes cakes and pies, and cookies, and breads, and dozens of delicious carbohydrate dense goodies for a living. Carbohydrates are my enemy these days, as they do unpredictable and awful things that I still don't understand completely to my blood sugar. They are also an integral part of my family's livelihood. Eliminating such a broad food variety from my diet entirely, as a chef and as a husband to a professional baker, is arguably an impossibility.

My life has become so ironic.

Thanks for reading.

2

I understand what you are going through, Adam. I'm not a chef but I am very much a foodie and living in first New York and then San Francisco exploring different cuisines and finding and enjoying the best, as well as cooking it for myself was a big part of my life. I was diagnosed in 2007 but I was misdiagnosed as type 2 and pretty much didn't change anything until 2009 until I was correctly diagnosed as type 1 and began insulin. Then it all changed as I saw the impact on my diet of carbs and realized I needed to make changes to control my blood sugar. To make it harder I'm a vegetarian.

I realized pretty early on that I wasn't able - or let's say willing to go truly low carb and so my blood sugar would never be as good as I wanted it to be. Today I recognize that we make choices weighing different aspects of lifestyle with outcomes and my choice was to continue to enjoy food while adequately controlling my blood sugar and hopefully remaining vegetarian which I have been able to do.

The key for me was in making innumerable changes in what I ate. Some of my old favorites had to go for the most part. I used to keep a sourdough starter from which I weekly made bread and sourdough waffles. Pasta dishes, like most vegetarians was a mainstay of my diet, both quick and easy and more complex and interesting. I ate out at many different ethnic restaurants the Bay Area contained; some of my favorites being Thai, Ethiopian, Nepalese, Indian, Vietnamese. Much of that is gone. I thought about not posting to this thread but I have to be honest. It's just too hard to eat some things and figure out a bolus. My favorite breakfast of yogurt, granola and fruit is hopeless. Today I ate my every other weekend brunch treat of vegetarian eggs benedict, but I ate it on 1/2 a Owowheat Double Fiber muffin. I miss good breads. Sweets I don't miss as I stopped eating sugar 18 years ago due to an eating disorder. I don't miss sweets when once I was addicted to them, and I truly believe you can change anything you have to/want to. But part of my recovery from my ED was truly enjoying my food and I have managed to still do that.

The good news is I've become more creative. My friends always thought I was an excellent cook because I can make any recipe, do everything from scratch and am willing to take the time. But I rarely improvised. Today I've learned to improvise. My cookbooks are all marked up with alternatives and carb counts.

As I'm sharing all this I realize your situation is of another magnitude because it is your profession. So here comes the really honest part: You will not be able to continue doing the things you describe and also manage your D without making significant changes/learning new skills. The good news is you can do it! What I see: You may have to no longer be your wife's chief tester, and she may have to support you in that whatever way she can. If you continue in your current job where tasting is an important part of your profession you are going to have to learn a great deal about your blood sugar and its management. More than the average Type 1 (which is already a lot). Starting today with frequent testing you can start to accumulate information about how certain foods in certain amounts affect your blood sugar. Then you will learn your I:C ratio and how to bolus for those foods. The good news is that if the "tasting" is small amounts it should be easier to handle but frequent testing will be your best friend for a long while to come. In time you might look to a pump and/or a cgm as tools to further fine-tune how you manage your BG in your unique situation. We all vary in how hard or easy our D is to manage and right now you may be in your honeymoon which is an easier time. But you may in time learn that when you go into work when you know you will be tasting, a half unit (or whatever) will cover that intake and testing will ensure it is adequately covered. It will take a lot of trial and error to get there.

Another alternative you may decide on down the line is to find a slightly different area of your profession where there is more predictability in your eating. I don't know enough to suggest but some form of management, or owning a gourmet shop or writing cookbooks or reviewing restaurants or producing a cooking show where you can try out recipes in a controlled way as your meal rather than just random tastings. You know better than I what possibilities there are for you to stay connected to your talent and your love while still meeting the challenge of your D. I hope I've managed to say what I wished to which is, "It won't be easy, and it will involve change and a big learning curve, but you can do it!" People with Type 1 do all sorts of amazing things that you would think were not possible with D. You can too!

3

oh no.. sounds like a really hard situation. Before I was diagnosed I had started doing a lot of baking.. my grandmother was a really good baker and I guess I inherited that skill... I was doing the farmer's markets etc. and then it was just too physically tiring so I switched to skin care. Now I miss all my wonderful baked goodies such as hamentachen and fruit tarts... I just can't eat any of that stuff now.. :( But I think I may experiment with some low carb baked things at some point with almond flour and stevia. Is there any way your wife can add some low carb things into her repertoire? As far as the testing tasting, that must be soo hard.. how do you manage it all? do you schedule that into your meals etc.?

What I would do is to try to incorporate your needs into your work if possible and give good tasting lower carb options for people like us and for everyone else out there...

Also, I think you really have to put your health first and say my bg control is more important than the testing/eating the baked goods etc.

4

Zoe,
Thank you for your insightful reply. I knew posting here, many of you would 'get it'. As this was my introductory post to this forum, I did quite a bit of trimming down after writing my first draft, but many things you mentioned almost seem in response to statements/questions that I initially wrote, then omitted. I didn't want this to be a commercial for my therapy solutions, or a pity plea. I too was initially misdiagnosed with T2, and only started on insulin this year. My honeymoon phase was short, and my insulin requirements have risen as my pancreas finally fizzled out.

The fact that you are eating low carb AND vegetarian leads me to a whole other line of questions specific for you, especially about finding a variety of complete plant based proteins while still eliminating so much starch. Most non-animal proteins are not complete without the addition of starch: hummus & pita, rice and beans, etc. I know it can be done, but not without a lot of creativity, conscious effort, eduation, and (let's face it) willpower. It's so easy to eat poorly for our condition. Add vegetarianism, or allergies, and you've got a bigger whammie.

My T Slim insulin pump is already on order, and I started my Dexcom CGM a week ago today. This first week of getting to know the CGM device, and the effects of certain foods to my blood glucose has been inspiring. It is leaps and bounds of improvement over simple frequent finger pricks. I'm sure it's still in part to the 'new' factor of the device, but I find myself frequently referring to my trend line, to see where I am and where i'm going. Like anyone else, I've had good and bad days. The best of which were when I eliminated carbs from my diet. One 'slip' of something high in carb or sugar, and I can count on the next 12 hours being a rollercoaster ride.

I've spent a lot of time pondering and praying about what my 'next career step' would be. Considering my food background, my condition, my focus on proper nutrition, and need to transition to a more structured work schedule, I've decided to pursue my Registered Dietitian certification. That means a couple more years of classes, and an internship (that I'm still not sure how is going to work out). I also freelance as a team-building cooking class instructor, which is a lot more controlled, and I can control my carb intake by dictating the menu myself.

5

meee,
So far, my solution is to boost my basal (Levimir) insulin on days that I am working, and trim it back on my off days. Also, I tend to over-bolus a little at mealtimes at work. I'm more able to do this now that I'm on the CGM, so I can react before I get high or low.
My highs from carbs take hours to recover from. If I make one bad carb decision, it's a 12 hour rollercoaster ride for me.

6

I think that sounds like a wonderful career step, Adam! I'm retired from Mental Health (though I still teach) and have often thought that if I was younger when diagnosed, I'd gear my practice towards working with PWDs. You'll find out when you've been on this board for awhile that many of us have less than a stellar opinion of "white coats" and often rely more on this board, books and our own experiences than we do on professionals. Those professionals that people rave about are quite commonly those with Type 1 themselves. So you will make an enormously important contribution as a Registered Dietitian not only with your food background but who is himself Type 1.

Congrats on your pump and cgm.You will see when you get your pump the increased flexibility you have, just be sure and work on your basal rates first and then your I:C. It's not all that effective to use basal to cover food. I realized when I looked at your profile that you were diagnosed in 2011 not 2013 so you are further along in the process than I thought. I too feel I have two diagnosis dates - my original was 7/07 than my "actual" and beginning insulin was 2/09. Oh yeah, I diagnosed myself..lol.

7

Adam, first of all welcome to the family! I was also mis-dx for 2 years, and like Zoe figured out that I was T1 on my own, with the help of TuD. Later confirmed by testing, etc. The lack of control I had then was horrible. Once I had the right treatment and tools (for me, pump and CGM) everything started to look up.

I've had my CGM (G4 now) for 2+ years and still check it frequently. I think it's more the 'useful information' factor than the 'newness factor'. When you start downloading the information, you'll most likely see patterns in your BG that will be extremely useful for helping to set basal rates once you have your pump.

I'm also a foodie, and again, like Zoe, the thing I miss most is good bread! I don't keep any in the house, but if I'm out I will have one piece. I've learned different styles of cooking and different ingredients that I can use to keep eating some of my favorites (good LC tortillas with 5g of carbs, very LC black soy beans, etc.). I discovered spaghetti squash (5g per cup) is a good thing to use for some dishes where I used to use pasta. I'm not a fan of 'substitutes' - I still want good, real food.

I think, as you gain experience, and especially once you get your pump, you'll be able to do tastings. You can set a bolus over time, so if you know you'll be 'noshing' over the next hour, you can set a 2u (or whatever) bolus to be delivered over the course of an hour. There are lots of options/tricks.

I'm glad you found us, and look forward to talking food! We have another member who's a chef - Chef Robert The Happy Diabetic ( http://www.tudiabetes.org/profile/HappyDiabetic ). I'm sure you could offer each other a lot.

8

Adam there are situations in which we have to be pioneer and discover how to handle stuff. We wouldn't be here if it wasn't for the guys running everything and supporting the cause. Or we wouldn't have different diets, approaches, techniques, etc if it wasn't for the "foolish" persons out there.

In my opinion being a D chef can be an occasion to broaden your possibilities.
I remember when I started low carbing. Everyone around me was saying it would be impossible to keep a diet like that. Right now, I'm not only enjoy super BG and control but I love cooking that way. It's like to be creative and productive you have to limit yourself someway.

I really like cooking and sometimes I dream about opening some kind of low carb restaurant for D or something like that! Be open minded and exploit this obstacle to achieve results, don't be blasted about D!

9

Experimenting, and creating new things in the kitchen at work is my 'zen'. My primary job at work is to oversee our catering operation. So, I am dealing with banquet style service, and infinite special requests. Special dietary arrangements need to be known well in advance in my situation. Anyone who 'pops up' as a vegetarian, or with an allergy is likely to be served whatever the course may be, minus the elements that they cannot eat. However, if I know in advance, I prepare a special meal for them. I don't get many requests for a 'diabetic' meal, but it does happen on occasion. More often I am making arrangements for guests with gluten allergies these days. Unless we are serving some type of pasta as a main, I can always find some type of alternate cooking method (and sauce if necessary) or appropriate sides to accommodate. But pasta and baked goods...

I have never been a fan of processed foods that try to emulate other 'natural' foods. Things like: soy chicken, vegan cheese, turkey bacon, margarine, garden burgers and their ilk have annoyed me for years. I always preached moderation instead of eating processed copycat foods. Even from my new perspective, I still feel this way about such products, but I am going to have to carve out a new exception for pasta and baked goods. Whether by choice, or by necessity, people who cannot properly digest flour/carbs deserve to enjoy the miraculous thing that is fresh bread/quickbread/pasta. With a baker for a wife, and two school aged children, you can bet our home is loaded with the stuff. I just have to choose not to eat it, or reinvent it so that I can.

As far as the 'tech' goes, I'll have to wait for the Tandem before I can start downloading regularly (because Dexcom's software isn't ported for Mac). I've played with Dexcom's software on my work computer, and downloaded my first week's results. I imagine it will be more useful once there are a couple months of reference data.

10

Hi Adam, Usually people say don't change doses on long acting basal insulins from day to day, that can make you bounce around, not sure if that has been your experience. I hear you on the roller coaster, that is something we want avoid but sometimes it is inevitable. If carbs do that to you I hope you can figure out which foods are worse and find a better way to manage it.. maybe just by eliminating them. One thing I found is that any type of flour is like pure sugar really, and any type of potato is too, according to my bg! Have you tried waiting to eat after you bolus? That helped me a lot. As I'm sure you know, when you get your pump you'll be able to do really small bolus/corrections and adjust your basal which will probably help you a lot. I think becoming a dietician is a great idea! I have contemplated that myself too.

11

Adam, with your attitude you will have NO problem. Bread is well worth an occasional exception (for me). Every 3 months after my endo visit, I go across the road to the fabulous bakery and have a chocolate croissant. As for pasta... spaghetti squash and tofu noodles usually do it, but definitely not the same. A couple of times a year a home made pasta dish is another exception for me. I regularly eat sauces in a bowl with no pasta ;)

Yes, the G4 data will become more and more useful with each week. I have the same issue with mac, wish they'd fix it! Please keep in mind that when you do get your pump it won't be a quick fix. There's definitely a learning curve, and it takes time and experimentation to get your doses etc. set just right for you. It's so worth it in the end though ;)

12

I think coming to terms with our diabetes requires evolving a new relationship with food. We can love food for the pleasure it gives us and many of us spent large parts of our lives never considering the role food has in our health. But in the end, most of us need to evolve our relationship and make health a priority when we consider food. It doesn't mean that we need to give up good food, we just need to make choices that also redefine "good food" to be food that gives pleasure and is healthy.

There is no reason you cannot continue as a chef and be a husband to a baker. Look at Paul Prodhomme, over 500 lbs, I thought he was a goner. But he changed his relationship to food, lost 400 lbs over 14 years and literally saved his life. And the whole time he still pursued his life as a chef. Another good example is Jesse Schenker a NY chef who lost a lot of weight by going low carb, avoiding addictive foods and controlling his portions.

I expect this will be part of your growth. And while you might pursue an RD as part of that, you can also go in a range of directions. Many of us (like Jesse Schenker) do not agree with the definition of healthy used by dieticians. I ended up moving to a low carb diet based on whole foods that also incorporates sustainability as a factor in my choices. Unfortunately, this means I won't eat the foods that dieticians recommend, nor will I eat "diabetic" processed foods like Glucerna. Despite that I am happy with my food, I cook all my meals and look forward to your further posts.

13

That's a great post about your interesting story Adam! Thanks for sharing it with us. I do most of the cooking at home, obviously not as hairy as professional cooking (I worked as a line cook in various restaurants, waited tables, expoed, all that stuff for a few years after college...so I've done some of that, no fancy places though. I was in Champaign and volume= more $$ in the roles I was in there...) but still can be stressful and demanding, on top of a straight job, being the dancing/ poms chauffeur, working out, etc. I have had some pleasant successes getting rid of carbs but am having some challenges eating enough food. I have tried lowering carbs but seem to be able to keep my carbs a bit higher than low and still not gain too much weight. I've been able to achieve ok BG results by focusing on "balance", rather than "low", although it may also be that I "cheat" by exercising pretty regularly. I had two bizarro injuries this year which knocked me out of action for 7 weeks and that threw things out of whack for me.

I seem to be back on track now and it seems like you are already doing a great job as you know what to do and are approaching it very methodically. I will be intrigued to hear your thoughts s you get into the RD studies more deeply.

14

A low carb restaurant is a great idea!!!

15

Let's do it!

16

ok!

17

Welcome Adam.
It does seems ironic. I am not a chef (gave up on aspiring as well LOL) but I studied basic culinary arts, I love to cook and our family business is a restaurant. Im a foodie! It took me some introspection to overcome depression on the seemingly ironic relationship with food. I came to realize that there is more to consuming food: appreciating healthy food, creating beautiful dishes and experimenting on food that stimulate all the senses without compromising specific nutritional requirement.

There is no reason why you cannot be one of the best chefs out there :) I would love to learn from you.

18

From reading this thread, it looks like you are getting the usual terrific advice. I have read interviews on DX.com with other professional chefs with diabetes. You may find their experiences helpful.

There is a lot of nonsense on the web about diets and healthy eating. As you work to understand and control your disease, you might be in a position to help all of us. I am guessing that you have a great sense of taste, (my father could accurately tell how long milk was exposed to sunlight from taste alone). You also probably have a real mastery of the culinary palette (like an artist's mastery of color). Since we T1's can eat anything, wouldn't it be cool (and inspirational) if you combined your new hobby (diabetes) with your profession?

We would all benefit. There are people in TU that can suggest reading material. The people here have helped me improve my life. I hope and trust that you will have the same experience.

19

Carb replacement. I'm glad to say that this has been one of the good weeks for me. I'm starting to really dial in my insulin dosages and good insulin/carb ratios to keep my glucose numbers 'in range'. Complex carbs can still throw me for a loop, especially ones with a lot of fat content.
I am enjoying this week for another reason too. I've had oppportunity to experiment with recipes replacing flour with almond meal and flax seeds, with good success. I would say great success, but admittedly, nothing I've produced in this manner thus far has been photo worthy, and all the recipes (which I sourced from places online) still need to be tweaked before I claim one to use regularly, or share with others.
Low carb breakfast was my first priority. I was experiencing drastic spikes after breakfast containing carbs (due partially to improper insulin/carb ratios) so I needed something that could fill me up, and that I could grab on the way out the door to work. After bribing my wife with dinner, and doing the dishes, I convinced her to help me make some flour free blueberry muffins (similar to http://powerhungry.com/2013/05/paleo-almond-flour-muffins-master-recipe/). I used dried blueberries, very sparingly. My criticism of them: they were pretty 'eggy', and if not eaten warm, a bit greasy. But, one muffin fills me up, tastes good, and does so without really affecting my blood sugar at all. Without the berries, the muffin had less than a gram of carbs, so I figured at most 10 grams of carbs for the blueberries, likely more like 5.

That same night, while the oven was hot, we made some almond flour crackers as well. There are lots of recipes out on the web, and they're all pretty similar. We flavored them with garlic, parmesan cheese, mustard seeds & dried basil. Right out of the oven, they were really good (a tad too salty, but still, really good). But, even though wrapped airtight, the next day they had lost their crunch, and were soft.

Today, I experimented with the flax seeds. I ground the seeds in a coffee grinder, and made a 'phaux'caccia style bread, and some pretzels made with almond meal and flax flour. For the bread, i topped the dough with sliced tomato, herbs, garlic & grated asiago before baking it. The bread came out about the thickness of a slice of bread, so I used two slices to make a grilled cheese. The bread itself had the right texture, but the seeds were still a bit too gritty to be considered 'good'. So, I spent the next hour grinding and sifting flax seeds. I now have a container of flax 'flour' to play with tomorrow.


Last, I made some some almond & flax pretzels (I got the recipe here: http://caloriecount.about.com/flax-pretzel-recipe-r88058). I admit, when I was putting it together, I was thinking there was no way it was going to work. First of all, the production method ingredients didn't match the ingredient list, so it was apparent that the ingredient list was changed, and the method really wasn't. I knew the dough would be far too dense for yeast to actually rise, so I didn't wait for it to double, but I did allow half an hour for the yeast to activate, so it would provide that distinct flavor. I also didn't worry about punching down the dough, because without flour, there's no gluten developed. Rolling them out was challenging, because the dough was pretty brittle (like soft play doh) and my twists were pretty inconsistent. That being said, after egg wash, salt, and a few minutes in the oven, these were by far the best of the bunch, with a little dab of dijon mustard.


One of the best things about today was, I snacked on everything I was making all day long, and didn't have to adjust with a bolus for any of it. The trend line on my CGM is more stable than it has ever been, 105 and holding.

20

That is great Adam! I'm going to try some of these recipes when I have some time.