Humbled at Metabolic Center

Well, it has been quite a week.

I recently visited the Metabolic center in Montreal. I waited for almost a year in order to see the Endo - and the guy is totally cool. He doesn't take any guff, in a good sort of way.

Now, when I got diagnosed, I spent a lot of time reading, researching. I trawled through here, and many other forums in search of answers. I thought I had a good handle on things.

Part of my day was all about educmacation. You know - the standard given to every new diabetic patient. I found myself getting slightly annoyed at the "training," as I had either read it, seen it, experienced it, or whatever.

Then I asked myself, "what am I trying to get out of this?" In essence, why was I there?

Not just to see the endo, but to learn how to manage my disease better. What I was doing wasn't working out too well.

So, I shut off that part of my brain that resented relearning things I supposedly already knew. I started asking questions.

I got measured for the BMI chart. What an eye opener.

My belly? A hearty 47 inches. The obese rate is 40 and up. Oops.

At that point, what could I say? Sure, I guess I knew it all - but it didn't mean a dang thing. What I was doing was NOT working...

The truth? For the last couple of months, I have been very sporadic in actually taking my insulin with meals. It's not uncommon to have a huge bowl of pasta, no insulin (or maybe a unit or 2) and find myself at 15 mmol before going to bed.

So, after a little kerfuffle with the Dietitian, I was put on the exchange diet - but given the CDA standards. (Which is the same as the ADA...) So, I am on a "weight loss" part, with an exchange that has around 50% carbs a day.

So, my brain is telling me, "Oh no! That's not gonna work!"

Thing is, I was trying the low carb approach - Primal, if you will. REAL food, no grains. Very little insulin requirements.

Problem with that protocol is, I am "weak" when it comes to avoiding those grains. Tell you the truth? I like my rice, breads, and starchy stuff.

One thing that struck me right in the face with the exchange system is how much I was actually eating before. I never really thought about portions before - I did, but not like with the exchange - when you are sitting there thinking about what 1 fruit serving of blueberries looks like. (It's 3/4 of a cup!) I find that when I am eating by the exchange system, I have no problems waiting the 4-6 hours between meals. I am actually not that hungry!

So, I am in the middle zone here. I want to make my health better - but it's not working on the low carb paleo/primal way. The protocol looks good on paper - but it's not working for me so far.

OTOH, I am uneasy about the amount of carbs that I am prescribed. I am actually getting more regimented by my meals/insulin, so now at least I can see what is working. I have been put back on metformin to help me with losing weight, and now the diet is the exchange, with a set amount of carbs. (With a sliding scale based on meter readings before the meal.)

Well, that's my story so far. I am still not down with the 50-65% carb ratio. I slightly tweaked the diet to make the carb ratio more moderate, at 33%. I increased the fats and the lean proteins a bit - but I may be doing this too soon? Should I give the standard a shot first?

How many here are on the exchange diet? Any tips?

I don't do exchanges but am eyeballing my carb ratio w/ this phone gizmo and feel pretty good at 33% carbs w/ protein and fat varying. I will be intrigued to see what it does to my cholesterol when I go in in few weeks? If it's off the charts, I'll have to modify things a bit? I would recommend finding a good meat store and making the effort to visit it and try interesting meat ideas? I don't always make a special trip to our best butcher but, when I do, it's usually markedly better and the extra trip also engages my head w/ the process.

I have a different set of challenges but my job is busy and engaging enough that I eat pretty much the same thing for breakfast (eggs w/ veggies, sometimes ham and cheese...), 1/2 sandwich for lunch, nuts and veggies for snacks (sometimes cheese...) and still feel pretty good. I don't think that it's too soon to start. Somewhere when I was 35-37 I was up to 275 lbs and realized that from an actuarial perspective, 275 lbs + T1 was probably not a solid bet so I made changes. It helped having some fierce Tae Kwon Do instructors pushing me and the head boss, despite cutting down to 225 lbs, kept riding me. I had to leave that school but still am keeping at working out.

Hi Jason. I've tried exchanges before but like every other method that involves calculations beyond carb counting, it was a bit too math-y for me. I do think you're on to something with the portion control.

What I have found helpful is to "remake" some of my favorite meals in a lower-carb way. For example, you mentioned loving pasta. I've cut out all grains from my diet. What I do instead is steam up a pile-o-broccoli and put my chicken and red sauce on top of the broccoli (in a wide bowl) instead of on pasta. That way I'm filling up on a relatively low-carb veggie while still getting that Italian feeling.

Another example is serving my breakfast with home-made salsa (diced onion, tomato, garlic, avocado and lemon juice) instead of with fried potatoes or grits or some other starch.

A third example is -- instead of the famous red beans and rice of my Louisiana culture -- I cook some beans with chopped tomato, onion, bell pepper, etc. and make a kind of lower-carb chili/stew that I serve without rice or bread or any other carb/starch.

These are not Bernstein-level low-carb, but each one is a huge improvement over what I used to eat -- a lot fewer calories/carbs and a lot more vegetables/phytochemicals/micro-nutrients.

I lost eighteen pounds in January, so it seems to be working.

You might try tweaking the exchange program one meal at a time. For example, instead of a cup of milk (13 gm carbs) have a cup of Greek yogurt (9 gm carbs, more protein). Instead of a pathetic 2/3 cup of white pasta (30 gm carbs), have 1-1/2 cups of steamed broccoli (15 gm carbs) or 1-1/2 cups of zucchini and mushrooms (also 15 gm carbs.) You can eat more food (more filling) with less carbs if you tweak the Exchange program to reduce the carbs and boost the protein and veggies.

Hi Jean. Eighteen pounds in January -- Congratulations! Great advice as well.

Hey Judith, thanks for the idea! Stir-fry on a bed of sauteed cabbage sounds delish.

I think there's some wisdom to the exchange diet.

I was started on the exchange diet 30+ years ago and then went to carb counting.

But in the past few years I've realized that carb counting leads to some bizarre beliefs on my part. e.g. "Fruit is bad". "Fat is good". That's not a good place for my mind to be :-).

I think the exchange system is a pretty good way to keep from falling into the "only carbs count" trap. That doesn't mean I've forgotten all about carb counting - but I do manage to have some fruit once in a while!

When I was first "proto-diagnosed" (i.e. the doc was not sure, and there was no such thing as pre-diabetes") I was put on an exchange plan, and I was starving to death hungry ALL the time, and I couldn't think of anything but food -- when was I gonna eat, what was I gonna eat, how much, and then I had to wash the dishes. OCD in a handbasket. And I didn't lose any weight, although I was not truly obese -- I fell into the middle of the overweight category.

To tell you the truth, the only time I have ever been able to lose weight in my life is after I had a coma last year and realized that I had to get serious about food. And issue #1 for me is whether it will keep me full enough to last until the next meal. Making sure I get plenty of protein, fat and veggies does that; refined carbs or even "whole grain" carbs do not. Even whole grains aren't all that whole if they've been milled down enough to make a flour out of them.

I will also admit that I don't LIKE vegetables -- I have to force myself to eat them, but it seems to me that there are enough nutritional arguments for them that I need to do that. So, since Oct. 2010, I have lost about 32 lb. (now BMI 24.1), feel fine, have the best sugar and lipid control ever, and really don't miss the grains and potatoes.

Now, you can't just go from my, or anyone else's example, but you CAN experiment on your own body and see what works for you. My only proviso is not to give up too soon -- it took me a year to achieve the results I wanted. When Dr. Oz tries low-carb and gives it up after one day because he says it makes him feel icky, that's not a fair try. But one day isn't fair for a vegan diet, either, because our bodies just don't work like that.

Anyway, I wish you luck, and hope you can find what works for you! :-)

Thanks Judith!

Wow. These are really good ideas!

I still eat in between meals all the time but mostly veggies and nuts, and I know you like veggies and nuts are probably out with your tooth having been yanked? Maybe cheese?

Raw veggies (I detest cooked veggies) and nuts are out -- FOUR teeth were pulled, so there's no side capable of chewing comfortably. But I've been eating Greek yogurt, cottage cheese, peanut butter in the spoon (I LIKE it that way), and scrambled eggs. The dentist's assistant kindly suggested spaghetti, mac and cheese, mashed potatoes, oatmeal, and applesauce, so I just smiled sweetly and thanked her. Those WOULD work for glucotypical people! LOL!!