Humana project: first question!

+100 for #4

You are amazing, Judith!!! Sending you a big hug.

Hi! This is Meghan from Humana. You guys bring up some really interesting points about “eating to your meter.” Its surprised us that, although people with diabetes talk about this, many doctors have no idea what it is. And it seems to be mostly unsupported trial and error - seems like an area ripe for new solutions!

When you did an eat to your meter program, how often did you test and log? Three meals a day? Just a few? Also interested in what your major insights were. Was it mostly about diet in general, or did you find you had certain “trigger foods”? Thanks so much for your generous insight!

We are happy to have more than 5! Thanks, David! (Meghan from Humana)

LOL. I would have listed "eat to your meter" if I hadn't been trying so hard to limit my list to 5. It's basic to any sort of tight control, and a common refrain here on TuD. Herewith, my responses to your questions:

  • Every meal. The idea is to let your meter tell you what effect food is having on your blood sugar.
  • It's definitely about the full diet spectrum. Effective control of diabetes has to be empirically based. If you don't know how a given food or portion affects you, how can you possibly know how to accurately counteract or balance it?
  • Most of us do have what you refer to as "trigger foods," if by that you mean foods that are especially prone to cause sharp spikes. But those foods will vary from person to person (see below).

Expanding on the last point, an absolute prerequisite to achieving tight control is knowing and understanding your own body's response to food and medication, which will usually be different from anyone else's. Every physiology is individual and responds differently to things. We have an acronym for it: YDMV (Your Diabetes May Vary). The point is simply that you have to know how a given food or dosage affects you, not the person next to you. And empirical testing is the only way to determine that. "Know thyself."


Excellent comments and suggestions. Thank you for sharing.

Hi Meghan, thank you so much for asking about our experiences with T2. The diabetes online community is a tremendous resource that is largely ignored by medical professionals. True the evidence is anecdotal, but when you hear person after person say they have achieved success with carb restriction it begs further investigation at the very least.

Here is an article in the Journal Nutrition that argues that carb restriction should be the first thing tried upon diagnosis. It also has a good review of what we know and what needs further study concerning carb restriction.

I followed the "Eat to Your Meter" system I found here. Initially I tested before every meal and then one and two hours after eating. It had an immediate positive effect on my numbers. The idea is to build a "database" of your reaction to specific foods and then use this knowledge to make intelligent food choices. After the "database" is built you can cut down on the testing.

Actually it's not trial and error but the the application of the scientific method to solve a problem. I eat a meal and it spikes me, I theorize it was the potatoes that caused the problem, I eat the same meal again and substitute a second vegetable, say broccoli, for the potatoes. I have a favorable result so my theory is confirmed.

As for trigger foods, for me anything with sugar including fruit but also anything with starch, potatoes, grains, legumes. That starch could be a problem comes as a surprise to most people. But starch is made up of a long chain of glucose molecules and our bodies are equipped with enzymes that quickly break the bonds between the glucose molecules. The end result is that for many of us starch = sugar as far as it's effect on our blood sugar. I also have a list of foods that are OK as long as I limit quantities, for example tomatoes and peppers.

David makes an important point, you wind up with a diet that is custom tailored to you.

Finally I should note that one impediment to the wide spread adoption of "eat to your meter" is the parsimonious attitude concerning the covering of test strips by insurance companies. Done correctly "eat to your meter" requires a significant investment in test strips. One a day or even three a day just won't cut it. I would hope that someday the insurance companies will realize that an investment in strips will yield significant savings in complications avoided down the road.

I feel impelled to add one comment about low carb eating.

There is a widespread perception that low carb diets are a modern gimmick or fad. I've even heard one widely quoted and highly respected diabetes pundit* refer to low carb diets as "new-fangled" and risky.

That is just blatant ignorance. Low carb diets were popularized (for weight loss) in the mid-19th century. (Look up the name "William Banting.") For a layman to be unaware of that is understandable, but for a supposed "expert" who advises thousands of people in the media to be that uninformed is simply reprehensible.

* Respected by the public, not by me.

Well said BadMoon and David! Really well said.....

1. If you take care now, there will be less pain later
2. It's not your fault
3. Insulin does not equal failure
4. Use your numbers to help you tweak your plan not to tell you how bad you are
5. Having a simple cold can morph into a bad infection if you don't keep your numbers tight

I agree that a low carb eating plan makes me feel the best

Thanks so much for the feedback BadMoon! Love the reference the Nutrition article will check it out. One concept that we are prototyping now (based largely on feedback from many on this blog) is a guided eat to your meter program, so instead of being having interpret results alone, you also have the option of looking at your results with a CDE who can help you interpret them. We are trying to think about what the "end result" would be...something like a "personal food scorecard" which sounds kind of like what you have - foods that work, foods that need to be eaten in moderation or paired together, etc. Does the idea of having a someone support you through the process make sense? Any thoughts on what else should be included for personal reflection?

And we hear you on the test strips!!! (Meghan from Humana)

Insulin Pump therapy

One problem I had concerning my initial instructions concerning testing was that I was given no goal for what my blood sugar should be. As I practice "eat to you meter" I set a goal of of never exceeding 140 and interpret my tests accordingly. I understand as an insurance company you would need to involve a medical professional but it's not really necessary to make the system work. It's not exactly rocket science.

The vast majority of T2s who use "eat to your meter will wind up on a low carb diet and this will be the fly in the ointment as far as medical professionals are concerned. I think you will have a hard time finding CDE's and RD's who do not believe such a diet is dangerous and unsustainable. The Nutrition article addresses this but it is hardly a mainstream position at this point. I should note this is changing slowly.

Thank you again for asking about what is working for actual diabetics. The current treatment protocols are not working, I hope change is coming.

I agree it would be wonderful to have things like education classes, counselling and support groups but it is not so easy when one lives in an almost rural African town and the nearest facilities are several hours away. This is where online resources such as Tudiabetes really come into their own.

How important it is that I exercise after and not before eating, as before eating results in a glucose dump and higher blood sugar readings while after eating means I am burning off excess blood sugars from my meal.

Be very skeptical of any supplements that start on gluco - all most of them will is slim down your wallet.

1. Choosing to manage diabetes is a choice.
2. You can do this but it is hard work.
3. Some of the changes that will happen if diabetes is not controlled will be more annoying than the life-threatening ones.
4. You're ability to function independently may be impacted.
5. There are a plethora of websites and apps that can help you manage your diabetes and make it fun.