The suggestions for thetop 23 low carb snacks are great ones.
Beef Jerky travels very well. Some of the others are perishable, may require refrigeration, crushed/smashed...tec. Any additional ones? or out of the box "portable" solutions? (I do feel like a bag lady quite often - go nowhere without my glucometer, insulin, Dex4. As Ginger Vieira states in her book Dealing with Diabetes Burnout, "No vacations or Days off? This is the worst job ever!" The "positive" aspect of the disease is that we have the ability to "manage" diabetes as well and as actively as we choose to do so.)
The suggestions for thetop 23 low carb snacks are great ones.
My favorite low carb snack is raw almonds. They travel well, they're easy to pack and carry, and you can find them for sale almost everywhere these days.
You're very right about the psychological burden we face in having to manage this 24/7. I greatly empathize with your observations and trepidations you've shared as a recently diagnosed T1 in your various posts. I've been at it for about three years myself and I've found the best way to keep the burden of this disease at bay is to try to relegate this to nothing more than a minor annoyance and not let it define me or dominate my life. Of course, every so often I risk sometimes getting a little too cavalier and it will bite me and remind me how serious it is, but for the most part it has been a successful approach. Essential tools in achieving this for me have been a good CGM (Dexcom), a low-carb diet devoid of all processed foods and regular exercise. Key is also developing a comprehensive personal database of what causes what with respect to food, medications, insulin, activity, stress, weather and illness.
Yes, it can be daunting at first, but it is manageable and should not stand in the way of leading a happy, healthy fulfilling life. I'm a firm believer in diabetics being able to do anything non-diabetics can do, it just takes a little more planning. :-)
I have a question. Personally when I think of carrying "snacks" I think of mom's with their bag of necessaries including diapers, wipes, toys, and juice boxes. I eat three good meals a day and never get hungry in between. Which is a good thing because I gain weight easily and if I ate "snacks" I'd probably weigh 300 pounds!
So what I'm wondering is: Did those of you who regularly eat snacks do so before your D diagnosis? I do understand some people prefer several small meals to 3 larger ones. Or is it something that you have found you need to do or were told you should do after your diagnosis? I understand that with the older insulins it was sometimes necessary to eat snacks to prevent lows. And even those people on MDI's sometimes can't stabilize their doses to prevent lows. So I'm wondering if the "diabetics need to snack" is a left over from an earlier time that is maybe no longer needed. On the other hand maybe it's just a good excuse to nibble on something small and tasty during the day and if it works for you, it works! I guess my late afternoon cappuccino serves a similar purpose though I've never thought of it as a "snack". Just curious.
Very good question, Zoe. I think there are several things at play that drive this:
- A legacy treatment approach from the days of older insulins where snacks were integral or even essential preventing lows. I see a fair share of posts where CDE's/Endo's/Dieticians are still adhere to this mindset and are recommending snacks to their patients.
- A byproduct of the typical American high-glycemic diet for non-diabetics is the mid-meal hunger caused by rapidly plummeting glucose levels due to the high amounts of endogenous insulin produced in response to high-glycemic meals. This can create a habit that is hard to break post diagnosis for some, especially if they maintain a high glycemic diet post diagnosis.
- Many T1's battle a pervasive feeling of hunger due to their lack of endogenous amylin production, which as you probably know is the hormone that is a byproduct of insulin production that delays stomach emptying and creates the feeling of satiety
Like you, Zoe, I'm usually pretty good with three good meals a day, especially if I have a full schedule. However, I know that when I'm not busy or distracted and have time to kill there is a subtle, persistent background hunger driven by my own lack of Amylin. I can usually address this with a small snack - something like almonds, avocado, boiled eggs or unflavored full-fat yoghurt.
Interesting question, Zoe. While I am a T2, a decade before my D diagnosis, I was diagnosed with fibromyalgia. While pain is the symptom most folks know about, another manifestation is reactive hypoglycemia. So if I am not careful about regular eating, I have all the troubles that an insulin-dependent diabetic has---cognitive difficulties, shakiness, etc.
But I had to train myself to eat more regularly. For all my dancing years, I would sometime eat only once/day---who wants to dance on a full stomach?! Anyway, that's the point at which I had to learn to eat snacks. To this day, if my schedule is unpredictable when I head out, I carry things like string cheese and nuts because if I get to the "shakeys" point, I will vomit the first thing I eat, and I Hate to vomit! If I am at home all day, though, I don't usually need to snack.....
While I lived in a constant state of rage for most of the first year after my D dx, it had taken me years to figure out how to have any kind of life with fibromyalgia.....Blessings all
Yes, I know what Amylin is. While your description of its role makes perfect sense I don't experience this feeling of increased appetite since my diagnosis. I don't even have the symptom of increased hunger when I'm low. On the other hand my D diagnosis was concurrent with my aging and I think it is normal at age 65 to have a reduced appetite. But I agree with you about the high carb foods increasing hunger and reducing feelings of satiety. I do believe that is equal parts biological and emotional/psychological, though, but that is my own bias as both a Psychology instructor and someone with long term recovery from an eating disorder. For me as a Type 1 I haven't found any significant difference in high glycemic vs low...a carb is a carb in terms of my BG response. (though whole grains are certainly healthier). YMMV.
Thanks for sharing about this, Judith; you are right, I was completely unaware of the other sx of fibromyalgia you mention. So are you talking basically about low blood sugars if you don't eat on a regular basis? And do low carb snacks help with low blood sugar for you? That YMMV thing again!
Zoe--Once or twice after my D dx, I reached the "shakeys" point. So, out of curiosity, I grabbed my meter to see what my number was. Well, it was a perfectly good-for-me 86. That's why we say that it Mimics hypoglycemic symptoms.
And unlike a diabetic low, what I need at those moments is protein---cottage cheese, for instance, is perfect if I am at home, a couple string cheeses if I am out and about. We call it a FibroFog. The cognitive fog is scary as hell, but seldom as potentially life-threatening as it is for a diabetic. I'll just shovel in too much cottage cheese too fast and vomit before I can settle in with a reasonable meal after which I will be fine.
I remember one time, for example, that I had a length of dental floss in my hands and just stood there staring at it because suddenly, I didn't know how to use it!.....Oh, and when I went lo-carb for my diabetes, it also helped settle my fibromyalgia!.....
You're absolutely right Zoe. There is also a psychological component to be considered, running the spectrum from "comfort food" to eating disorder.
Raw nuts are a really good portable snack- cheese is also. This disease is a big burden. Be sure to manage your psychological needs also because you can burn out very quickly especially if you have Bg that swings around and then can stay high for hours when it spikes like I do. It is NOT easy and it’s has an impact on everything I do. You’re one of the lucky ones who have been diagnosed before you reached a real crisis. I was in DKA and had complications. I do have neuropathy symptoms now and other things going on maybe. There is no break from this it is every second of the day. There are times when I haven’t eaten all day due to high bg, insulin doesn’t bring it down and then I just have to eat because I’m starving by that point- it went higher for hours and then crashed. Insulin is dangerous even when you manage it properly and when you’re exhausted from managing the 24/7 disease it is easy to make mistakes too. There are days when I just say. Ok Bg you do whatever because I know nothing is going to work and it’s better to stay high than have a bad low IMO. Until you’ve had a bad low dropping fastor not responding for two hours, until you’ve been in an icu unit etc you have no idea how bad D can actually be and I’m hoping you never will. Pwd who are lucky are the ones who can safely manage their Bg and still stay pretty stable. I don’t think my bg swings are even that bad compared to many but they’re bad enough.
Oh, now I understand better, that it "mimics" hypoglycemia and the solution is protein, not carbs. I've heard of fibro fog, and other conditions that have cognitive issues, like CFS which my good friend died of and HepC as well. I hope it is not frequent. I hate the cognitive aspects of a low. I've always been good in emergencies...very focused and calm. Hard to be focused when you forget what dental floss does! (Let alone how to open a glucose tab bottle!)
Since I use public transit, when I leave the house for work or some other event I'm usually leaving for hours at a time. For example, when I go to work I am out of the house from 7:00 AM until 6:00 PM at a minimum. So I have to take my lunch and whatever else I need or want to eat with me. I usually bring a lunch plus a snack, because depending on how busy my day is, some days I am starving or have a low blood sugar in the middle of the afternoon.
I did spend a majority of my life snacking, and it's a very hard habit to break. Before I was diagnosed I was a kid, so of course I snacked. Then after my diagnosis I was on NPH up until the age of 23 or so, which caused me to snack far longer than most people ... When I started MDI with Lantus I then went on to student teaching where I almost always had a snack at recess (classroom teaching makes me really hungry, even with recess snack and lunch I was always starving by 4:00!). Now I am trying to break the habit, but at age 32 it's really hard! Especially most recently when I tend to bring snacks just to be on the safe side - since it's rare that I can eat anything bought these days. Never know when someone will want to go out for coffee and it's nice to have something to munch on if they order something ...
I also wonder a lot about the amylin thing because I often feel hungry when I shouldn't. It's quite annoying, and I think it's partly what makes trying to snack less even harder than it would usually be if I didn't have diabetes.
These are all excellent points/observations/tips. I will be reading about amylin and endogenous amylin http://books.google.com/books?id=25NS2UArEoQC&pg=PA230&lpg=PA230&dq=endogenous+amylin+production&source=bl&ots=_jMu7blFWZ&sig=duv5s7B1x2FIWQ50aeDBhDFwDFw&hl=en&sa=X&ei=Aa0UVIbUB9P7yATa-YLgCQ&ved=0CEMQ6AEwAg#v=onepage&q=endogenous%20amylin%20production&f=false. Like Judith in Portland, hunger is not necessarily an indicator for me as to high or low BG. I could be hungry with BG's around 100, or 190. I've gathered (for me) that the jittery, shakey feeling is more likely a result of the delta or the change of the BG. The jittery feeling occurs often when the BG drops from highs like 180's to 100. But then again, this past week, my post breakfast, before exercise BG was 154 and after exercise BG 64. I felt fine with BG 64 - took one Dex4; recovered to 88. The variability, the range is the problem. When I manage the BG within a tighter range, there is so much less feelings of irritability, shakiness...etc. It's odd that when I bring up the subject of tighter BG control the endo and CDE both tell me that they don't want me to go low. Go figure.
The reason they're telling you that is because lows are very dangerous and over time you can lose hypo sensitivity, lows can kill you. No matter what anyone here says about how it is safe to do tight control, it can also be very dangerous for a lot of people on insulin, especially pwd who swing around more and who tend to have night time hypos. Some people can safely do tighter control and not have bad lows.
I'm not one of them unfortunately- I found it quite stressful because it drove me nutso and I didn't feel physically well, I was constantly worrying if I was in the 80-100 range all the time and trying to keep myself there.. it is just not possible for me due to the way my bg swings around even on 30g per day which felt like starvation to me. If you eat tiny meals with very low carb, and you can manage it with very low doses of insulin you may have an easier time, I had to take larger and larger doses even for very low carb, small meals due to fat and protein and progression of the disease. For most people this disease will progress over time no matter how good a job you do of managing things unfortunately. A pump is usually the best way to stay more stable but not for everyone and there are some safety issues.
If you can do tight control safely that is great, you are in the early stages and you will figure out what works best for you, but always keep in mind to have a very healthy respect for insulin, you never really know for sure what will happen with your body and injected insulin and each day is different as is each year and so on.
The most helpful CDE, whom I just met less than a month ago, who is quitting ( because office/organizational politics)at the end of September, told me "you have to be your own doctor". She is absolutely correct in that each one of us live with this 24/7. Whereas, the doctors (unless they too, are diabetics) do not. I find their "general" attitude (sorry for stereotyping) to be somewhat cavalier. I once heard it said that doctors have to detach themselves from the patient. That is the reason for covering them up during surgery (the only exposed part is the area being worked on) All patients are interchangeable, "one size fits all diabetics" treatment and regiments, protocol. Sorry for the venting. Richard Bernstein makes some really key points. I just find some of his food recipes to be not very appealing. With time, the food thing will work out.
I think it is completely true we are the ones managing the disease and it is very different for each of us- what works for me won't work for everyone else and so on and that applies to advice from other pwd or doctors/cdes.
I wouldn't discount the advice of doctors and cdes and completely lump them all together because some may have some helpful advice even if it is just one thing and one point in your management, as the one you're losing did, but you're right that there is often a one size fits all approach and no one who doesn't actually have diabetes themselves can understand the amount of work that goes into this and what it's like to live with it.
In terms of the surgeries I get your point but I think they do that for sanitary reasons. I totally agree about Dr. B's food recommendations but if you want to follow a really low carb diet you will figure out a way to do it and hopefully eat foods that you like and that work to manage your bg well.
The advice that truly annoyed me was the one where my BG was 70, which was lower than what I was accustomed to at the time and I drank half a cup of sweetened vanilla soy milk - 5g, which brought my BG up to 95. The previous CDE pretty much scolded me about the rule of 15, 15 carbs, 15 minutes later, use juice, honey...etc. . 15 carbs would cause me to be 75+ points higher and put me on a roller coaster ride. When I eat more carbs, the BG rise is less predictable than smaller quantities of carbs. With milk, soy milk, there is at least protein for staying power, in addition to lactose, and added sugar. I won't be seeing this CDE anytime soon. There seems to be two philosophies out there about correction. When my BG was 60, I took Dex4. At 70, I don't "need" to overreact and overcorrect. More recently my numbers have been generally lower so I play it conservatively at/before bedtime; but if 80's during daytime, I take a 5 g carb snack and check later.
This is a very individual thing because everyone reacts so differently. If you find the 5g soy milk works best just do that, don't take more sugar than you need for a mild low for sure. The 15 grams and then check in 15 minutes is the typical advice and then keep doing it until you are back to normal range.
What you may find though, which I mentioned above, is that at some point you are going to need over treat a low( a lot more than 15 g) if it is dropping really fast, you will know from your symptoms if it happens. For this I find juice or glucose drinks work the best.
The only thing you need to care about then is to get your bg back up as quickly as possible, even if it spikes a lot. You can always bring down a high later, but a bad low can kill you.
When I feel a fast dropping low or even sometimes a normal one I often don't even test- I treat it and test later. For a really bad low you need to test sooner than 15 minutes sometimes to make sure you're not dropping even more.
As for the night since you have a dexcom I would watch what is going on at night and if you tend to drop a lot at 3 am- when insulin needs are lowest, and you don't have dp, I would probably go to bed with a higher than 80 bg.
Again it is variable. I'm not sure if you meant by more conservative you are staying higher at night. There are so many things that affect lows at night, if you have a really active day, and you ate a little less, bolused more etc. or whatever, you're on mdi and can't reduce basal etc., hours later, while you sleep you can drop a lot because your muscles try to replenish themselves while you sleep and need more glucose.
Thank you for letting me know. At/before bedtime, I try to be around 100+. The one weird nighttime incident occurred after injecting Lantus, I went to 60 (maybe bad lantus, or I failed to inject subcutaneously - I did notice 1 drop of blood) That was worrisome, basically did have to stay up until about 4 am; correcting twice and yes, the second time, I overcorrected to 198 so that I could at least try to get some rest. Woke up 3 hours later to 70. The only IOB, if any, insulin ought to be Lantus. There could not have been any bolus remaining from dinner from the previous night.
We are indeed all different, th378. I would only use 15 carbs if my blood sugar continued dropping or wouldn't come up. I take 2 glucose tablets (8 grams) for a moderate low (50s or 60s) and 3 for anything below that (12 grams). I find 15 minutes is too soon to check and re-dose. I check at 1/2 hour. It usually does the trick. Lows are important to take seriously but over-reacting and over-treating causes roller-coasters which can be worse for us than an actual low. I wouldn't have any reason to treat 80s during the day (but I don't use a cgm so wouldn't know if it was dropping quickly) and I don't treat 80s at night either as I am on a pump and my blood sugar stays fairly stable overnight. Lows are important to take seriously but doctors are notoriously paranoid about lows. Anyone who has an A1C in the 5's or even low 6's has had a doctor tell them this is not good as it's achieved at the cost of too many lows. This is not often the case. I had two 5.6's in a row once; the first one was too many highs and too many highs averaging out, the second one was nice and steady (relatively). We are all different and you are doing a great job at knowing what is true for your body.