Eat what you want and bolus like crazy?


#1

My nutritionist and endo would give me a good slap on the wrist for thinking about it, but one of the things I’ve noticed about meal time boluses is that you can really get away with a lot of naughty eating if you count your carbs just right. I know, I know its unhealthy but sometimes you just want that birthday cake or tasty ice cream! I’ve managed to keep pretty good control, even when my diet isn’t the best.

So how do you manage your diet with regard to avoiding sugary goodness? Do you eat what you want and then just fire up the bolus, or do you avoid sugar as much as possible?


#2

Tim,

I do eat pretty much what I want, but on most days I avoid things I know will do me in, such as Chinese, pizza, bagels.

I do eat regular foods and avoid sugar free foods as the sugar alcohols do me in. I must admit I am a cookie-aholic along with donuts and can bolus perfectly, but…then the weight issues.

So yes I can eat what I want and bolus accurately on most days, but the weight gain is something to think about.
Also fat is soooooo bad for us diabetics, well also for non diabetics, but that is when I don’t feel hungry so quickly after a meal, if it does have some fat in it.


#3

I was told today that insulin is a fat storing hormone.
I’ve always eaten what I wanted but 7 years ago had to start bolusing like crazy to keep up. Over the last 7 years I’ve gone from carb ratio of 25/1 to 7/1 so now I go through a ton of insulin.
2 years ago I started gaining weight and I don’t like my new “high score”.
So … I told my doctor today I’ll cut out 150 grams of carbs a day & start exercising. It was a fun ride but I don’t like my new “tire”.


#4

JB,

That is soooo me and it started this year after 41 years of this disease. I have gained a tire and my carb ratio is 6/1. ahhhh!!! :frowning:


#5

I generally try to eat a good healthy balanced diet (fruits, vegetables, healthy grains, proteins, salads, yogurt, etc.) and I keep my meal carb count between 30 and 60 most of the time. But hey, if I want that snickers bar and my BG is OK, pumping in an extra 3.5 units of insulin for 2 minutes of pleasure does a person good :slight_smile:

And when I go out to a restaurant noted for it’s desserts, well … I guess we all need a little “sin” in our lives. Moderation is the key.


#6

My doctor hasn’t restricted me from sugary foods at all. I am in good enough control I can eat what I want as long as I don’t go overboard and as long as I don’t eat it on bad days when my sugar is being erratic which is few and far between


#7

I try to avoid sugar as much as possably but lets face it I’m only human so yes I have been known to do that myself!!!


#8

My insulin to carb ratio is 1/6, 1/7, & 1/8. And I’ve only been a diabetic for 22 years. I think that it depends on the person. I do try to eat healthy, but if I want a dessert, I eat it! I spent my childhood being forbidden to have that stuff. Now that I can, if I want it, I eat it. Does that make me a “bad diabetic”??? I hope not. I really do try to take care of myself.


#9

I eat sugar when I want it as i stated in my earlier post, my most recent hba1c was 7.0. Honestly I dont care if people say I am a “bad diabetic” because of that. The hba1c doesn’t lie about how in control or out of control your diabetes is.


#10

I do a bit of both. There are well controlled days where I know I can get away with a dessert, and there are crummy days where I know I have to avoid stuff. Experience teaches me to listen when my head says no! It’s too easy to end up miles high or low after a high carb munch.

If I’m out - especially if I’m driving home - it’s easier to avoid the crap foods. I don’t want to feel like crap while trying to be sociable, I don’t want a low when I’m driving home, I don’t want a crappy nights sleep if I have something on the next day, etc. But If I’m at home and there’s no reason to avoid munchies, I’ll go for it.

In general I think a good balanced diet, with as little fast acting carb as possible, is the sensible way to go. But since when were humans sensible??!! So long as we manage to have some sort of balance, and general good health, then we can do as we please. With care :smiley:


#11

applause well said Leah!!

The only thing I’d add is that a balanced carb diet (low carb for some, whatever works for you… moderated is really what I mean though) is the best way to avoid bad spikes and lows. Bernstein’s law of small numbers sort of thing. (less carbs = less insulin = less chance of a high or low = easier days all round).

As much as I totally believe what I’ve just said above, I also believe BALANCE is the key. If balance means having a pig out once in a while then so be it! If you have a craving for something, then find a way to fit it into your life!

The law of small numbers is a wonderful theory for when you really need happy blood sugars, but a happy person needs less limitations I reckon. So I work both ways - careful carb eating when I need to, and eat what I bloomin well like the rest of the time :smiley: Something must be working since I keep my a1cs in the low 6s. Still worry a little about meal spikes though… and still would like an a1c under 6!


#12

My endo recently told me to up my insulin and eat more carbs so that I could gain back some weight. I have found that it is way harder to stay in my target range when I do this. I would love to eat what I want and cover it with a larger bolus but it just doesn’t seem to be possible. I have an A1C of 5.6 due to following Dr. Bernstein’s law of small numbers, which for me means 20-30g of carbs and 3-4 units of insulin. I test at 45 minutes and find that I can stay in a completely normal range, under 100, even right after eating. When I have been upping the carbs and doing 5-6 units I have been down to 50 or up to 190 after eating. So it’s back to the lower amounts for me, except for eating out or other special occasions. One time when I can eat more is if I exercise immediately afterwards. I can have cereal for breakfast and then go for a walk and not go low or high. I much prefer oatmeal to bacon and eggs, and the cereal gives me energy for exercising.


#13

Its good to know that most people are following the same plan: match your insulin to your food, not your food to your insulin. Diabetes can be restrictive enough in a many annoying ways, so being able to eat like a “normal” person is a great thing.

I often get comments, on a daily basis in fact, from co-workers, family members, etc. to the effect of, “You’re diabetic! You shouldn’t be eating that!” Not only are comments like that irritating, but it makes me sad that people don’t get it. I usually try to use those opportunities to educate and explain how my management works, but diabetes is still considered by many to be a “food disease.”

Long story short, a balanced diet is key: low saturated fat, and carbs in moderation with the occasional cheat!


#14

Cody,

No the A1c doesn’t lie. But an A1c of 7.0 is high enough to give you every complication of diabetes. It represents an average blood sugar of something like 172 mg/d. All the research points to neuropathy and retinopathy beginning when blood sugars spend any significant time each day over 140 mg/dl.

There are no “bad diabetics” but there are a lot of diabetics who FEEL bad because of the damage that high blood sugars have done to their bodies over time. It doesn’t happen all at once. You may get away with it for as long as 10 years, but eventually you won’t.


#15

Tim,

I love being able to eat something carby from time to time. I had to control with diet alone for many years as I had no access to insulin due to misdiagnosis and eating over 15 grams of carb at once could spike me over 250+, So being able to eat 30-40 grams of carbs at once without going up to 250+ is heaven for me.

But I find it very hard to cover more than 40 grams at once without getting a spike–even if it is a brief one–that will end up making me hungrier, and because I’m at an age where the body is optimized to store fat (Middle Age, alas!) I can’t afford to make myself hungry.

So periodically (like, say this past 2 weeks) I have to throttle down on the carbs to avoid getting into a cycle of spiking and physiological hunger that leads to eating patterns that, though they are not too hard on my blood sugars (I’m rarely going over 160 mg/dl) can pack on weight.

But that’s true of ANY woman my age with or without diabetes. Carbs ==> hunger ==> fat. That’s why low carb dieting is so popular even with many people who don’t have diabetes.


#16

Libby,

I see that you’ve only been T1 for about 6 months. It’s not easy getting good control and enjoying a moderate level of healthy carbs, but it’s definitely possible. One thing that might help is to realize that keeping post-meal levels below 100 is not considered the normal range. Studies of non-Diabetics have shown that normal post meal BG levels on average go up to the 120 range, with some going as high as 150 - 160. There’s a moderate (and healthy) post meal target range between the 100 and the 190 you mention that would make any Endocrinologist delighted with your level of control. While I think the ADA target goals are not nearly tight enough, the AACE target of A1C < 6.5 and 2-hr post meal < 140 are very reasonable.

For me it comes down to a balance between tight BG control (I’m currently achieving the AACE targets most of the time), benefiting from nutritional carbs, and quality of life (which for me definitely includes eating a moderate amount of carbs). And if you personally prefer oatmeal to bacon & eggs, before exercise, why not combine the two in moderate levels?

The key to keeping post meal spikes down after a meal with moderate (35 - 45g for me) levels of carbs is timing. I have to bolus in advance (15 - 45 minutes, depending on time of day and BG level) of a meal.

Ken


#17

Ken,
Do you have any references for the studies of non-diabetics going up to an average of 120 after meals? I have found that people with completely normal pancreatic function don’t go up even that much. They tend to go up 20 points at most, staying between about 80 and 100, which is what Dr. Bernstein also says in his book. And they “spike” just briefly at 30-45 minutes after eating,and don’t stay up there for two hours. My husband drives me crazy because I can test him an hour after 100g of carbs in a mixed meal and he’s still only 85! I believe that the people who go to 150-160 may have some early impairment. That said, I don’t try to drive myself nuts to try and stay between 80-100. I don’t think it’s possible without doing the extreme low-carb diet which creates its own problems. When I was doing that diet (pre-insulin) I was eating more fat and protein and have slightly elevated cholesterol now. I am not sure if very brief spikes are harmful or not, but I don’t like how they make me feel. My fasting level is about 95, so going to 150 represents a sharp rise of more than 50 points and then I have a quick descent to about 75 which keeps me cycling up and down. All of this happens in the first hour and I think that’s why it doesn’t feel good to me. I’m still in the honeymoon phase so my own second phase insulin kicks in and makes me crash. So I am trying to compromise and doing a tad more insulin and a couple more carbs with the hope that I’ll find the right balance.


#18

Libby,
Your husband may simply be on the low end of change or possibly without CGMS you’re missing his actual peaks.

Here’s a good web-cast presentation of the study I had in mind:
What Is Normal Glucose?

Rapid changes (up or down) and roller-coaster BG does cause one to feel poorly. What I’ve found is that as long as I include some fat & protein along with moderate levels of carbs, I don’t typically experience those really fast changes. My CGMS has rapid change arrow indicators (up/down arrow for a 20 - 40 mg/dL change in the past 20 minutes and a double up/down arrow for a change > 40 mg/dL in the past 20 minutes). I occasionally see the single arrows, but almost never see the double arrows (unless I completely do a known no-no). I also occasionally get an almost completely flat BG trend line (causing me to do multiple finger tests to make sure the CGMS is accurate).

If you don’t have a CGMS, it can be harder to learn how various meals react. But by experimenting with earlier bolusing and finger tests at 90 & 150 minutes you can get a pretty good sense.

Ken


#19

Hi, Ken,
Yes, I had seen that study which is pretty interesting. However did you look closely at the chart showing number of minutes spent at each BG level? These non-diabetics spent more than 19 hours out of each day below 100, 3.5 hours between 100-120, one hour between 120 and 140 and only 10 minutes in the 140-160 range. Above 160 was just one minute. Normal people spend 80% of their time under 100, 94% of their time under 120, and less than 2% over 140. That’s very different from spending two hours above 140 for each meal, which adds up to 6 hours or 25%.


#20

Libby,
I was only trying to offer help on how to achieve good control (as defined by the AACE) and still enjoy the benefits and pleasures of carbs. If you prefer Dr. Bernsteins plan, that’s OK with me. I don’t try to convert people :slight_smile:

But FYI, it’s not an unusual day for me where my CGMS report shows me spending 95% of my day below 140 and 90% below 120. I could do even better, but I’m still trying to master my control during and after long distance runs (which is often the only time of the day I go over 120). I don’t always choose that tight of control (I snack and get lazy as much as the next person), but a person can enjoy carbs and stay within normal healthy glucose fluctuations. I just want you to realize that there are other options.
Ken