Self-Care Regimen

Wow. So I guess a 4.8 is pretty low, huh? As a new diagnosee I’ve had crazy amounts of food-related anxiety (learning just how many carbs one eats as a beans-n-rice vegetarian can do that to you) and have had to reinvent the wheel when it comes to diet, again. Luckily for me, the food issue is finally stabilizing; otherwise my mom would have cause to drag me off to a clinic for anorexia, and my endo and GP would help!

A few words of warning. First, I have no clue what I am doing. The more I learn about diabetes, the less I know and the more confused I get. Second, I do not do constant with anything. My life, and my schedule, is always in flux. Rather than fight that, I’ve been learning to live with it, and a lot of diabetes-related habits are drifting towards tortoise-brain. Thank goodness!

So, the principles I use for making decisions and controlling my blood sugar:
1. Bernstein’s First Rule: Small inputs result in small errors, big inputs result in big errors. My own experience corroborates Bernstein’s allegation that big injections are more imprecise and unreliable. I avoid the carbs, and thus large units of insulin, as much as I can.

2. Know what you are putting into your mouth. I read labels and have gotten used to remembering carbs per serving and serving size on most common foods I still eat. I don’t eat anything anyone else has cooked unless I do remember a baseline estimation of serving and carbs. When in doubt, head for the vegetables.

3. Avoid the roller coaster whenever possible. My biggest errors (and my sole voyage to the terrifying land of “300 BG OMG where are the syringes and what do you mean I have to drive home in the dark 60 miles by myself?”) have come when I munch without thinking. There aren’t many of those moments – one of my mantras whenever I see food of any kind is “kidney damage, think of the kidney damage” – and they almost invariably come in the form of overcorrections to hypoglycemia. I hate hypoglycemia, but I still prefer it to kidney damage. This is one I’m working on very hard to perfect.

I have never been much of a craver; once in a while I’ll overeat candy bars (nowadays as diabetes-sized “Fun Size” Snickers, 10g carb each, or the occasional handful of peanut M&Ms) but for the most part it’s not an issue. (I was off sugar, as opposed to carbs, for a long time before I was diagnosed as a diabetic.) Unless I am hypoglycemic, in which case get the hell out of my way, I’m going to eat something. In fact I am going to eat everything I can find until I start feeling better. I hate hypoglycemia.

Hypoglycemia comes from insulin. Thus, I reduce my insulin use as much as I can manage.

Another thing with insulin. For the most part I try to keep my post-prandial BG spikes under 100. Ideally post-prandial is the same as pre-prandial. It can be done. Easily. Two units of Humalog or less. That’s twenty grams (or less) of carb per meal.

The low carb thing… is hard, as a vegetarian who isn’t particularly good with vegetables. I’ve given up grains for the most part; little by little I am eating up what is in the house, when I can stomach it, or feeding what isn’t too healthy for him to my candy-holic roommate. I am dreadfully sick of eggs and cheese. I’ve gotten a few low-carb vegetarian cookbooks in from England (thank you, Amazon!) and am going to start in on those, even though they are full of vegetables, and vegetables spoil. I guess I will just have to go to the store more often, and eat them faster, as really spoilage speed and store-bought freshness factors are my primary gripes against veggies.

Anyway, those are the principles that guide me. Beyond that, it’s just math, and math is something I have a lot of practice with. During a disastrous meeting with a terrible diabetes educator nurse person I was asked what my insulin doses were, and I tried to explain. It didn’t really work; she wanted to hear a straight ratio. I use a basic ratio of 1 unit Humalog to 10 grams carb, and then fudge depending on the GI of the food and my current blood sugar. For a while I tried to do the Bernstein thing but it is non-sustainable for me. There are just too many eggs! I don’t even like eggs that much but I have learned how to make a good cheese omelette and devil the little suckers, and that comes in handy for feeding others even when I cannot abide them myself. I am trying to work up to a sub-100g carb/day diet. There will be vegetables, many vegetables, and lots of tofu and wheat gluten, which I have finally learned to cook in a tasty tasty fashion. One of these days I need to try stuffing a slab of gluten with Muenster; I bet that would be tasty.

Speaking of which, it’s time for breakfast.

Oh you sound just like me. My diet pre-diagnosis was about 95% vegetarian, light on the vegetables. I am a grain, bean and fruit hoarder and was shocked when I started figuring out carbs for my normal foods. I also started eating lots lots lots of eggs and cheese until an omelet almost made me vomit one morning. I’ve settled on a very-high fiber diet w/ a few constant fruits (my blood can barely tell a difference between strawberries and water), large salads and certain grains. Oh, and I’m back on cheese. I’ve found barley to be a particularly non-spiking grain. I’m actually going to start getting more raw and hope to become a sprouter/dehydrator. This must wait until we finally get a better grocery store in my neck of the woods. Kroger just doesn’t cut it for that vegetarian/raw diet.

I’ve followed the Bernstein regimen since my diagnosis and keep my BG below 100 as well. I’ve started cooking differently too. if you’re interested in some of the vegetarian low-carb recipes that i’ve come up with, you can read my blog at http://www.srirambala.com
Select the diabetes category. I also post regularly on the Vegetarian-Diabetic forum on tudiabetes - http://www.tudiabetes.com/group/vegeteriandiabetic
There are a ton of choices if you’re a vegetarian. It takes some creativity and patience, but you can pull it off.
I guess i’ll know if my regimen works tomorrow, when I get my A1C results(the latest after my diagnosis).

Kimberly – I’m looking at sprouting quinoa, hopefully that will cut the carbs down a bit. Thank you for the barley tip, it’s one I don’t use often and should definitely check out. (Besides, it’s coming up on soup time here in the northern hemisphere!)

Sri – thank you for the vegetarian links, I really appreciate it. I finally sat down this morning and went through my new cookbooks and wrote out a shopping list (lots of cauliflower and eggplant, apparently) and will hopefully have some nifty neato recipes to share soon.

Lentils are a good choice too. A half cup have 54g of carb, but 21 of those are fiber, so it’s closer to 33. And don’t forget frozen vegetables. They don’t spoil, and a lot of them are very good. They even make bags of frozen veggies that you can put straight in the microwave. I mix together mustard and a tiny bit of butter for a sauce.