How best to track food reactions?

Type 2
1

In the past all I have ever done is test my morning fasting level and then sometimes 2 hours after breakfast, a late afternoon pre-dinner and then two hour after dinner/before sleep, and a middle of the night reading with occasional readings after exercise or if I think my glucose is low. Mostly I just do the morning fasting reading.

I have tried various diets and right now I am on Jenny Craig (JC). I have lost 15 pounds so far with probably 15 more to go. My morning readings are in the 80 - 120 range. If I do the treadmill in the evening I need to have a protein or long lasting carb snack before bed so that my glucose does not drop to 60 in the early am.

The Jenny Craig diet does not seem to be low carb, nor an emphasis on complex cards versus simple ones.

I have read hear that some have learned whether certain types of carbs or other foods or beverages affect them more than others. I switched to non-alcoholic beer for holiday or infrequent family parties and now only drink alcohol very rarely (<5/yr.). But when I drank more (1 or 2 beers) more frequently I never noticed any particular unexpected reaction, but never thought to check for low glucose as that has been rare for me. I don't really care about my reaction to alcohol as that is no longer a significant issue for me. But I never thought to check for how simple versus complex carbs affect my levels rapid peak versus quick fall off versus a longer but more level reading.

While the JC diet and weight loss have brought my readings down to an acceptable level, I am still maxed out on various oral medications and also take 34 units of Lantus before bed. I had been on a previous custom diet with a diabetes certified nutritionist where I was able to get the readings to an acceptable level on just 15 units of Lantus. I will be weaning myself off JC and will be going back to the nutritionist. The previous custom diet emphasized complex carbs (whole grain/wheat) and I am OK with that, but I prefer enriched bleach flour, for instance and most JC food does not specify that it is whole grain/wheat. For what it's worth supposedly JC is recommended by the American Diabetes Association and my endocrinologist was enthusiastic about me going on it. Supposedly they have a type 2 diet, but I am just on a standard one which is working. But I would like the diet to which I wean myself to work even better so my Lantus units and oral meds can be reduced while maintaining the same glucose level.

The JC diet emphasizes frequent snacks every 2 - 3 hours to avoid hunger pains that lead to binge eating and this works for me. But this makes it difficult to track glucose levels over the day.

I assume to tell my reaction to specific foods I would need to do many more readings and also log and match what I eat. But are there tips anywhere on how to do this - for instance how to isolate on which particular food in a meal causes what sugar level? Does one eat the same meal at every meal for a week, or so and just vary one ingredient such as a simple carb versus a complex carb? Of can you basically ignore food with just proteins, fats, etc. that have very low to no carbs? For instance, can you really isolate the reaction for enriched flour versus whole wheat or certain fruits (with similar glycemic indexes), or for potatoes versus jerusalem artichokes?

2

Others can probably chime in about better ways to track reactions, but my thought is to maybe test earlier than two hours. I have noticed, more incidentally that some foods spike my bgs up faster than I ever expected. The other day, I ate a muffin from Tim Hortons on the way to work, thinking I'll test and inject when I get there. Maybe 15 minutes from the time I ate it to the time I test and my bg's at 18 mmol! I don't recommend you do this, and it might not give you a clear picture seeing as you have medication in you all the time, but I think timing is the difference between good carbs and bad. If I had a homemade bran muffin instead, it would maybe go to 11 mmol in the same time period.

I'm happy that JC is working for you, but really diabetic or not, simple sugars, white flour is not good for anyone. If I were you I would look into doing the diabetic diet. Why bother figuring out what you can get away with? I didn't need to eat the Timmy's muffin to know it wasn't good for me.

3

Thanks for the reply and example. I converted 18 mmol and that's a 324.32 mg/dL increase. That's a lot.

Part of my what I am trying to find out is if the average increase is significant. For instance, taking your example, if it shoots to 18 mmol in 15 minutes but drops by half to 9 mmol 45 minutes later and then down to zero an hour after that, then the average is 9 mmol for the two hours, whereas if the bran muffin is 11 mmol for the entire 2 hours (as it lasts longer/does not drop as fast), then the average is 11 mmol, which is higher. So which is better? I have no idea whether either the regular muffin or the bran muffin act as outlined as I have never tried tracking just one item of food. I am just picking number from the air as an example.

The goal of JC is to wean yourself off it and I am now in the process of doing that.

I have found some whole wheat/grain foods that I like tolerably well - such as whole wheat pancake mix and a lite whole wheat bread - but there is nothing that will replace nice, hot French sourdough bread or a baked potato - once in a while. Some things can be done in moderation. Sorry, but I do want to learn what I can "get away with" and how often and I may (hopefully) find that what I thought was bad is not as bad as I thought, or that it really is worse than I thought.

4

When I was first diagnosed, I logged down everything I ate and tested every single food. Even a snack.

Yes this involves a large initial investment in test strips but most of us eat the same few foods most of the time anyway. It won't take a long time for you to collect your own data set to find out what works for you - which is not going to be the same as what works for the next person.

By testing after every food, I quickly found out that 'simple' or 'complex' carb makes no difference for me, and that wholegrain spikes me more than white bread. So to go back to your muffin example, I wouldn't be able to eat either of the muffins you mentioned. Both are equally bad on my blood sugar. The only muffins I eat are my own homemade low-carb ones which do not contain ANY wheat flour at all - they are made of soy flour, fax, eggs, cheese and bacon.

I do not follow any prescribed diet, eating plan or national association guidelines. The only guidance I take is the unbiased opinion of my blood glucose meter. That's the best way to track how food affects you.

5

I’m a type 2 and the best way for me was to test right before I put food in my mouth and i test 30 minutes after. I don’t wait 2 hours cause I won’t be able to tell if the food spikes me. During workouts I check every 15 minutes so that I don’t crash. I do use a lot of test strips though. I go through 1000 every 3 months. I get 600 from insurance and buy the other myself. But repeated frequent testing seems to work for me.

6

get a cgms if you really want to track food issues.

7

Thanks for the replies. The fact that people react differently to the same food is why I wanted to learn how best to test for my individual reactions.

Ii guess I was vaguely aware that people with pumps must have a way to continuously test. I will have to look into those especially if they connect wirelessly or by bluetooth to a smartphone monitoring program.

I have a large supply of test strips that expire shortly and anyway I am fortunately that my health insurance pays for them in full. The issue will be how sore all my fingers become. So a continuous monitor may be the route to go - my endocrinologist never suggested one.

Still while testing for the effect of a snack is relatively easy as that is only one item usually eaten with a time separation from other foods whereas a meal consists of many foods. So I was seeking advice about some regimen that can identify the reaction to one item out of many and how to allow for the effect of each day not being the same in terms of stress, activity, meal times, etc.

8

I hear your concern about a meal consisting of many foods but really, in practice, it is not that complicated. And the more you test, the more chance you have of identifying patterns.

As for the soreness, it shouldn't be an issue if you change the lancet regularly and remember to rotate fingers and sides of fingers. I test at least 20 times a day and my fingers are ok; being right handed, I just have to remember to rotate sides and test on my right fingers, not just the left ones.

9

At least 20 times a day! I am so thankful I do not have to test that often.

Jim suggested a CGMS. That seemed like a better alternative until while quickly researching I read that they are not that accurate and require patience. I am not sure what is meant by patience.

Again what I am seeking is a regime that will help me identify patterns and the reasons for them.

10

patience - dexcom speakease for fact of unit delay, interstitial flesh blood transit delays.

It means that one is using caveman machine to augment and ensure readings tracking. It means you, Dexcom and the Caveman machine are working hand in glove whereby when things are stable and slowly moving; Dexcom will be accurate and when sea changes occur, you need the fingerstick machine to see how what are the actual instantaneous readings. It also means you use the caveman machine always to check readings prior to insulin dose application to prevent errors.

Interstitial tissue cannot move its blood levels as fast as fingertips. Generally speaking - the unit is accurate at the interstitial tissue site but every time a sea change in glucose occurs up and/or down the readings at fingertip will be most accurate on caveman machine while dexcom is chasing to catchup. Its readings are not in accurate - simply delayed until stable. It unfortunately leads to being accused of being inaccurate.

I hate to suggest anybody go pay all the money for this - but if you really want to watch the digestion cycles and how the glucose output looks like, pipeline stalls/brownouts in digestion in gut and when the fats -slow digesting sugar products actually come off - 5 to 6 hours from ingestion of previous meals, then this is the tool. You get to see the ramps, the decay at ends and any discontuities from eating noodles et all.

Along with when the liver boots in glucose etc. Even when you sleep.

Just an fyi; I used this to watch when a digestion cyle from a meal decays and falls on average because that is where I found my liver would do a erroneous add glucose cycle when there was turbulence in digestion ending and if the gut tried to push BG back up even though body finger tip BG ws 140 to 200, the liver felt need to add more glucose.

I targeted my metformin dose 1 hour before meal as that ensured the met was up to strength in blood stream in the zone when the gut BG was falling at end of meal. This was enough to cut off erroneous liver dumps and have been free of 99% of that crap.

Have fun.

11

Jim,

Thanks. Your explanation was very helpful. I have not yet checked into CGMS other than a quick look at the Dexcom group here.

I wondering about how aCGMS got the sample and did not realize it just was inserted into fatty tissue rather than some vein like an IV. I can see how the lag could be interpreted as inaccuracy and now understand the"'need patience" comments.

I did check on the cost and unless my health plan paid for it I would just use up my large supply of test strips which are due to expire anyway. (Fortunately I currently have a great health plan which I hope does not get ruined until I am toes up to the tulips.)

I guess I have been kinda stupid about my metformin as I take it after meals and probably stupid about a lot of other things as well.

I expect to learn a lot here.

12

I could write a book about it. Actually I did.

But if you don't feel like spending money, I also post it all free on the web. Begin here: Getting Started

First, and most important, forget everything any "expert" has ever told you about ""healthy" and "unhealthy" foods. Let your meter be your guide.

In essence:

1. Find your peak time after meals, which is likely to be closer to one hour than two.

2. Test at that time to see what the menu you ate and drank did to you.

3. Change it next time you have that meal for a better result.

4. Keep repeating that process over time until the result is acceptable.

5. Review the resulting menu for adequate nutrition.

6. Include a wide variety of foods to ensure your meet micronutrient, vitamin and mineral needs, but test EVERY food you include.

7. Eat quality, not quantity.

There's more, but that's enough to start with.

I am still maxed out on various oral medications and also take 34 units of Lantus before bed.

I'll add a caveat.

As you use insulin sudden changes from too many carbs to too few can lead to changing your blood glucose levels from too high to too low. That is very unwise and can be dangerous.

Please proceed cautiously after discussing this method with your doctor. Test after eating and if the result is high review the meal. Make a small change to the menu at the next meal of the same type. Repeat the process at that meal and continue with small changes, without risking hypos, until you see good numbers.

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter.

13

You sound like someone at the perfect receptivity juncture to read a book such as Dr. Bernstein's 'The Diabetes Solution'. I wish I'd read it at the beginning of my diabetes journey.

14

Regarding the cgms readings and data; I forgot to mention that some foods, antibiotics, trick sugars and msg can override the power of metformin and cause the liver to really dump and add excess glucose over and above the gut. Using the patterns and activity on CGMS enables one to catch this crap and what foods upset /over stimulate your liver/system and ones to avoid.

I am truly sympathetic to the cost and insurance issues and sensor cost that plague present cgms tools making them very pricy and difficult to implement on regular basis. For me situation so bad, I needed timely and detailed data on this cranky old system to enable easier control of manually trying to run a broken automated system with no gauges on my front panel on full manual like running an old steam engine where there one had a fireman to help.

15

Tanstaafl:

You are not stupid about use and timing of metformin. Right now medical profession simply does not have latest research data on power and capability of metformin nor the ideal timing versus dosage approach that would be helpful

Read John Hopkins, Salk Institute and Pitt institue.

That some folks seem to be standing in dead end tunnel with the lights turned off is crying shame.

Official cures that use latest new known data not taking advantage of latest reserach data nor have their been extensive human trials and tests that would codify this data. Its a crying shame and unacceptable. The lab has not made transistion from mice to humans.

I found out quite by accident in the last 4 years on met and watching cgms performance.

Unfortuneatly, many of the key organixzations are actually sponsoring many forms of excellent research and then when they get reports that debunk the current orthodoxies, the reports get burried in the archives like the Roman Catholic Church and lanquish for years. Metformin data has been there for over last 4 years,