From "eating anything" to "not eating everything"

Type 1 and LADA
1

OK, so to make a long explanation short:

* I have been Type 1 for more than 20 years; most friends never knew me before diabetes.

* As a kid, for years, I lived a REALLY restricted diabetes life (both in terms of what I ate and when I ate, this being two shots of R+NPH days).

* Then in the mid-2000s I started counting carbohydrates and could suddenly "eat whatever I wanted" as long as I bolused. And you bet I did—I tried things like brownies and milkshakes and countless other goodies I had literally never had before. My friends still find it unbelievable when we come across some common childhood candy that I've never had.

* I went on the pump five years ago. I'm very discreet and don't make a big deal out of counting carbohydrates or bolusing when eating out with friends, so many people meeting me don't even pick up on the fact I have diabetes until some comment comes up, and/or they "know" I'm diabetic but forget.

* I have a severe food allergy and this I DO make a big deal about double-checking ingredients and asking for no side dish, etc. Everyone knows about my allergy since it comes up often.

* Over the past six months I've made major changes to my way of thinking ... specifically, I'm starting to see food as an important aspect of diabetes (in addition to insulin and exercise), and when I'm at home I'm good at sticking to lower-carb stuff and weighing/measuring what I eat.

* I'm also good at not eating out as much and, when I do eat out at restaurants, sticking to generally health stuff (most of the time).

* However, what I am NOT good at are gatherings where the entire group decides to order a meal. Like when I go to a workshop and they order pizza for lunch. Or I'm with friends and everyone spontaneously wants to go for sushi. Or like tonight when I went to a gathering of friends and we ordered Chinese. This is the ONE area I will go ahead and eat the food ... and usually end up with high blood sugar for hours afterward, even though I do massive combo boluses. Tonight I got home to a blood sugar of 19.6 (353 mg/dl) a few hours after eating, and I'm sure that's going to take a many hours to sort out.

* My problem is, I don't know how to deal with this without either a) not eating, or b) making a huge, big deal about it. I know diabetes is common but for some reason at these types of things there are never any other diabetics. I have tried talking to my non-diabetic friends about it, to try and "break them in" to the idea that I would rather not eat that type of food, and their responses tend to be something like, "Oh well, how often do you eat that food? Not like a few hours of high blood sugar will kill you." Well, no, but that's easy for them to say when they aren't the ones having their cells slowly killed ... Part of the problem, too, is that I don't feel unwell or get sick when my blood sugar is high, so they don't get to see any change. Plus, it's not like my food allergy where I would NEVER eat or touch it, because there aren't really any "off-limits" foods with diabetes ... it's not as simple as that.

What do other long-term Type 1s who have changed their eating do? I realize this is something I just need to do myself, but it's hard when I'm with friends who have known me for years and when my diabetes has not really gotten worse, developed complications, or anything like that. I'm just really wanting to do everything I can to get tight control, because tight control is extremely hard for me under the best of circumstances so if I can avoid foods that I *know* will make me spike high for hours it would make sense to do so. But it's hard when, for years, I've told people I can "eat anything" as long as I bolus for it, and it's not like anything has changed diabetes-wise to change that philosophy other than my mindset. It's also hard because, no matter how much I try to explain it, most friends still do not understand the difference between carbohydrates and sugar nor how my blood sugar can still go super high even if I take insulin to cover something like Chinese food, or why " a few hours" of high blood sugar matters even though it won't kill me. My friends are absolutely NOT "food police" but a large part of that is because I've gone on and on in the past about how I can eat anything ... and now I'm suddenly trying to backtrack and contradict that at these types of events.

2

I agree it's challenging at "those type of events" but I don't bother with "combo boluses" (do you mean square wave/ dual wave?) as I haven't found them that useful for "Big food" events, like Chinese food. I "cover" Chinese w/ extra basal, like just crank it to 200% for a couple of hours. I also just take small portions of stuff. Part of that is because I am a psycho about watching my weight and, if I eat as much as 275 lb acidrock ate, I'll gain a couple of pounds. Last night I went to my friend's house to watch zombie shows and he made pizza and has carbier beer than what i usually drink. I had one piece of pizza. It was good and I could have eaten 3 more pieces easily but I didn't. Beer was "limited" by having to drive so it was ok. At my in-laws, the either family or Korean, or maybe both, tradition is to to heap the food on so I just put the rice back in the rice cooker now. I'm certain it'd be worse manners not to clean my plate and, while they thought it odd at first, I just go with it.

There's a lot of reasons, besides diabetes and food allergies, that pigging out is not good for you and those are good ones to stress to yourself. If you've known people for a long time and they say "what, you used to eat 1/2 the pizza" you can cite numerous reasons to not want to eat pizza "my cardiologist would like me to eat 1/2 the pizza" or "[insert fashionable pants store] would like me to buy more pants" or whatever. I haven't encountered a lot of situations where people are paying that much attention to what I shovel onto my plate when we are sharing food.

3

I eat moderate to even high amounts of carbs but I have never allowed myself to eat what I want. Yes, I can handle high loads of carbs if I know the food very well. But I would never eat something like that after 18:00.

a) it could mess up my sleep > risk of low BG at night due to corrections and miscalculations. The point is that this could happen. Most likely all will work as planned but I am not willing to take the small risk because I need my sleep.

b) it could mess up my mood > risk of high BG on the next morning due to late digestion of proteins.

Of course I will get social with friends but I will not eat anything different from my normal. My friends know that I am pretty knowledgeable about my diabetes management. Of course they would like to see me share the same experience of eatig as they are. At the same time they have respect for my decisions.

I also think that friends who think that you can eat what you want with the right amount of insulin have not understood the task of glucose management at all. You need to reeducate them. Show them that there is a high risk of failure involved. Show them that you are not willing to take these risks anymore. Make it clear that complications are the summary of little mistakes, misjudgements and randomess of life. The right choice of food will help you to reduce the likelyhood for these problems. You are on a marathon for your whole life and you need to pace oneself for all the years to come.

4

Sometimes, we are just caught in situations where the food becomes uncontrolled. But you know, it is not totally uncontrolled, while you may not get to choose what to eat, you can choose how much you eat. And maybe that is the key, simply choose a small portion and fill yourself up in other ways. It doesn't have to be about diabetes, this is just as much about your weight and health. So serve yourself a half or even quarter portion.

And so now, here is my trick. Water. Yes. Water. You can get it anywhere. And when you drink water, it fills you up. I could fake eating a monster dinner anywhere, eating just a few morsels of probably anything as long as I can get unlimited glasses of cold water. I'll often ask for some lemon wedges to give it a little flavor.

5

Most old-timers have a good idea what is going to happen when they put food in their mouth
but for many of us it's hard to always say no, no, no, no...when we eat we feel good even
if it only lasts for a short time. It's hard to keep your head in the sand 24/7.

[This is me Me] how come you didn't say something to me...[Wife] I didn't want to be the bad guy again.

I have good eating habits but sometimes I just need a treat, if you have good control and play by the rules why not jump off the high board occasionally. Sometimes it's just going to be a big belly flop.

6

I find that portion control and eating slow as molasses helps me the best. My parents don't quite understand diabetes because when I was diagnosed you had to have carbs at every meal and snack. Yesterday they bought me lunch at the ski lodge and the special was spaghetti with sauce, garlic bread, bread pudding and a side salad! Ack, I just pushed the food around my plate for 30 min, My BG went up a little bit but it was tempered by the snowboarding I did later.

I hope that helps, it's just there is just a lot of discipline involved with everything.

7

I have gotten to taking a stock amount in these meals: 1/2 to 1/3 of the starch portion.
I made a list of 10 starches and their carbs: breading, flour, tiramisu, penne.
With Chinese, I revert to the 1/2 of 1 serving. If I eliminate rice, entirely, I can eat more.
And I made a list of what I had eaten that had real numbers with "hours later" at the top. My friends laughed. But they seem to tolerate my quirks better now.

8

I'm in a similar situation because when I'm at home and can control what and how much I eat, I do pretty well, but in party or restaurant situations, I fall apart. I really need to learn to be smarter about those situations. One idea I haven't tried yet, but seems more reasonable than eating a whole entree (once I start, I DON'T stop) is to just order an appetizer and iced tea, where I can use artificial sweetener. Also to kick myself in the solar plexus if anyone even mentions dessert. Dessert is my worst downfall -- a friend of mine had a birthday party last Friday, and there was lentil soup, salad, an appetizer of avocado and walnuts and other stuff, and a large chicken breast with a fruit sauce, Thai curried rice, candied carrots, and a HUGE piece of cake with ice cream. It would have been marginally acceptable if I had refused the dessert (who can refuse birthday cake???), and skipped the lentil soup, candied carrots and Thai rice -- I would have done a lot better on just the chicken and the salad. But it's REALLY hard to say no to the majority of the meal, that this lady worked hard over all day. And ironically, she has T2, and didn't test at all, and I wonder what HER BG was!! Mine went up to 311, and I spent all night and much of the next day correcting, and my belly didn't feel empty for 15 hours. And my BG WON'T come down until my belly is empty. I need to remember that next time I'm tempted to pig out!

I think we need to revert to being 2-year-olds, and just say NO!!!!!!

9

I dunno if you *have* to say "no" but you have to be willing to evaluate monster food correctly and not be too shy about saying "well, that looks like about 120G of carbs, maybe 130 to be on the safe side" and blasting away with both barrels of your pump or syringes or pens or whatever?

I think the "good" vs. "evil" characterizations of stuff like cake doesn't exactly help as I "think" I'll blow it off but then it's there in front of me and I'll eat it, or check the CGM (which will still be low, as dinner hasn't quite hit yet...) and forgo the obvious "take enough to cover another 30G of carbs..." solution to run higher. I'd be a lot better off to pre-plan the cake but I don't do it all the time.

If someone works hard on a fabulous feast, you can still eat it but just cut the portions, leave the rice down to a minium, like an absurdly small portion to taste it. In my head, I do ok if I use those "happy meal" light and lively microwave food trays as a model for what an appropriate serving size is. Not the "Hungry Man" round tray-sized ones but the 200 calorie versions. It's not just endocrinologically sound to cut back. I always razz people posting pictures of heaps of fried garbage on facebook by saying *your cardiologist likes this* but you could extend it to nephrologists, orthopedists, podiatrists, GPs, risk managers at hospitals, etc. will ALL benefit from getting carried away. They are cutting back on that though as several of them have hopped on the P90X bandwagon and are eating much more sensibly than I ever do...

10

The crazy part is that times like last night I AM eating small portions and am still ending up super high. My friends are not the type who push seconds and thirds on people if they say no, so that's not a problem. I took probably less than 1/2 the food that others took, partly because I can never get Chinese right and partly because it feels horrible eating so much that I feel too full afterward. So it's not like I go to these things and eat uncontrollably, I can just NEVER get Chinese food and other take-out stuff right if I eat more than a few bites, it seems.

I use a combo bolus but I don't do it like most people, I dial in the number and then make the split 100%/25% or something by increasing the dose more than that recommended. Not quite the same as putting a 200% basal rate, but then I never use a basal rate over like +25% so +200% would kind of scare me.

11

Your last paragraph is exactly right. I think they don't understand diabetes because they don't spend more than a few hours around me on any given day. So they see me testing but don't necessarily see me up half the night dealing with my blood sugar. And I really don't make a big deal about diabetes—half the time they don't even notice me testing/bolusing because I do it in the open but don't draw attention to the fact I'm doing it. I just don't know how to suddenly start mentioning I don't wan to eat this, don't want to eat that, because of diabetes when, up till now from what they've experienced I've had no problems eating that stuff. Someone above suggested I explain that I'm wanting to get tighter control than I've had in the past, and I think this is a good explanation because it's simple and accurate.

12

You should try again, take a picture of your plate and we can discuss it? Holger had included an app to take pics of your food w/ the Glucosurfer droid app and I think that it might be a useful idea? If you are guessing "80G of carbs" and are getting 120G of carbs one way or another, that would likely explain the variance, regardless of what sort of stylish basal or bolus tricks you are hitting. I still sometimes think of using the dualwave boluses but I can't think of too many times that they worked as well as just taking a big bolus and riding the storm out. Chinese is very hard as they toss a lot of cornstarch, which is milled very finely, making it denser than say big fluffy oatmeal or couscous or something and then the food has that slathered all over it. If General Tso's army makes an appearance, that's another ton of carbs in the crunchy stuff on the outside, honey sauce and/ or plum sauce, there's all kinds of carbs that pile on there. I do ok w/ Chinese if I stick to the stirfried undeepfried meat and a moderate pile of rice.

13

I do eat what I "think" are smaller portions (last night at about 1/2 what everyone else ate), but it still makes my blood sugar go crazy when it's something like Chinese. So maybe my portions aren't as small as I think. I HATE eating so much that I'm overfull afterward, so that stops me from just going crazy and eating huge portions.

I think part of the problem with these types of things is that frequently we're all out shopping or for coffee or something beforehand. I thought of trying to eat something healthier before going but we ate around 5:00 and I'd been out with these people since around 1:00 and hadn't eaten since long before then. So I really was kind of hungry, which isn't the best when I'm about to eat.

14

I think this is a difficult situation for many diabetics. I would use one of three approaches.

  1. I am not hungry. If it is your choice not to eat or not eat much then others will not likely say much. You will just have to change your schedule around to accomidat your choice.

  2. Tell friends something like while current standards say T1s can eat whatever they want; I am able to maintain better control and a better life by following these rules (or recent studies have shown doing this (X and Y) helps even more). Also throw in that current standards do not lead to the long term outcomes and healthy life that you want to achieve.

  3. Lastly I would educate. I know I should educate more, but I feel like I am talking to a brick wall most of the time. If someone earnestly cares or wants to learn than I am happy to share.

I also think that you may be thinking that people are paying attention to what you are eating more than you think. IMO most people don’t pay attention or take notice to what you will be eating if you do not make a big deal of it (or maybe I am too dumb to notice).

15

Well, I don't really have as good control as I would like. I don't know if stuff like this contributes much but I figure every bit helps, and spending 8-12 hours with high BG from one night of Chinese food can't be helping very much.

16

It took my parents forever to understand carbohydrate counting and that I don't need to eat exactly on time. Eating slowly is a good idea and something I am good at when I'm alone (maybe to a fault!) but I tend to speed up when I'm eating with people.

17

There's a spot in "The Kids are All Right" where a perky rock journalist asks Pete "there's been rumors about you and the band doing drugs, does this mean that you're 'blocked up' when you're onstage" to which Pete replies "No, it means we're 'blocked up' all the time..." which is very much the case w/ diabetes, even if you are where you are supposed to be, you sort of have to keep an eye on it and all that?

18

I love appies at restaurants. I will usually get that as a meal with a salad and skip dessert. I used to have problems with high blood sugar whenever I ate out, but now it's mostly only when I eat stuff like burgers, Chinese, sushi, pizza, etc.

Luckily I don't have the problem with my stomach emptying ... I left at 8:00 and continued doing corrections till about midnight, at which point I just went to bed with my blood sugar still at 17.0 (306 mg/dl). I woke up at 2:30 to test and was 7.9 (142 mg/dl) which I probably should have corrected but just left. This morning I was 9.2 (166 mg/dl). So not horrible, but not sure it's worth the "already reduced" (or at least I thought so ...) portion of Chinese food that I had.

19

I like your idea of telling people I want to get tighter control than I've had in the past. It's simple and also true!

20

Last night I bolused for 100g of carbs and thought THAT was overestimating, but clearly it wasn't. I think you are right that there are a TON of extra carbs in there. I stayed away from the "obviously sugary" stuff but maybe I need to do some more research. It's like Starbucks and Boston Pizza, after actually looking at how many carbs most of their stuff has I've limited myself to one or two different things at each that I know aren't 80-100g of carbs. I wish Chinese places had nutritional information available, a lot of restaurants are starting to do that and it's really useful.