Foods I've Been Digging

So, between diabetes with ever-increasing insulin resistance due to pregnancy and just typical pregnancy stuff, some things about my diet have changed.  Here are some things that I've really been digging and that seem to work well for me...

1. Strawberries.  Freaking yum!  These are also one of the lowest-carb fruits so, as long as my blood sugar is at good levels, I can pass through the kitchen, grab one, and nom it without thinking of insulin.  I couldn't do that with, say, a slice of apple.
2. Raw veggies.  Baby carrots have been really nice to snack on, even without any dip, though I do have to bolus a little for them if I'm having more than a couple.  Celery?  If I'm willing to take the time to cut it up, this is one of those no-insulin snacks for me.  Or if I want some peanut butter without a ton of carbs, this is a better option than crackers or toast.  And for our weekly RPG nights, I usually grab a bag of raw broccoli and cauliflower at the store and dump it in a bowl with a little side of ranch.  I do bolus a little for this, but it's mostly a good nosh-all-night kind of snack.
3. Those little single-serving snack packs, the kind that are usually marketed for being 100 calories.  If I want something junky, these keep me from going overboard.
4. The turkey burger from Carl's Jr.  No fries, just the burger.  For some reason, of all the fast food options I've tried when just desperate for fast food, this one has been the kindest to my blood sugar.  No spikes, and no fat-related rise later on.  Awesome.
5. Peanut butter.  This is a comfort food for me, it's not high carb, and it's about the right amount of fat (good fat!) and protein that it helps smooth out sugar rises without causing a fat-related rise later on.  I've been eating a lot of this stuff since getting pregnant.
6. Low fat milk instead of skim.  I love milk but, sadly, lactose is one of the faster-acting sugars out there.  But add a little fat to a meal and that helps chill things out.  I also made this switch early on because I kept being told I wasn't gaining enough weight.  This was an easy way to add some fat and calories.
7. Vanilla Soy Slender.  When I want milk but my blood sugar isn't doing so great, or if I just feel like drinking a big glass of milk without all the carbs, I'll drink this stuff.  It's only 4 carbs a cup, and it totally satisfies my milk cravings.
8. Diet Rite, especially the funky flavors.  In addition to being diet (and therefore carb free), it's also aspartame free and sodium free.  The cola is decent, but I love picking up their funkier varieties, like tangerine or cherry cola.

These have all been good choices for me.  Maybe they aren't all the best choices I could make (I could surely be better off without any fast food or junk), but they work.

Two things I'll soon be adding, with hope that they also "work for me," are prunes and watermelon.  Prunes are just to help keep things closer to normal now that I'm at a point where my digestive system is naturally running more slowly, and the watermelon is an experiment to see if it helps with swelling (something I was told and have read a couple places online).  I figure that, even if it does absolutely nothing for my swollen ankles, at least it's a good summer time fruit that's very low in carbs.

But honestly?  I can't wait to be able to eat real pizza again!!!

Diaversary: Celebrating the Best Bad News of My Life

Yesterday was my one-year diaversary, and how did I celebrate?  With cake!  Yummy, sugary, properly-bolused cake!

Chad was awesome.  I was feeling crumby from an earlier low BG and I tried extra hard to look all pathetic and tired and pregnant on the couch while I said I should eat cake for my diaversary.  So Chad went to the nearest market with a bakery and brought back both red velvet and carrot cake!

They're individual slices of cake, but still just huge!  I bolused (generously!), made marks in the icing to indicate how much I would eat so I wouldn't get carried away, and thoroughly enjoyed my treat.  Chad had some of what I didn't eat and we still had plenty of cake leftover.  That's how big these stupid (but tasty) slices of cake were!  Supposedly two servings, but really more like 4.

And this was a little celebration, as far as I'm concerned.  We weren't celebrating diabetes, we were celebrating the diagnosis and the fact that the disease is about as under control now as it could possibly be.  (But let's not fool ourselves. There's no such thing as 100% control when it comes the the big D.)  One year ago, I got the best bad news of my entire life.

My blood sugar behaved with the cake, and I went to bed feeling pretty much OK about life.  Yeah.  Life is pretty good.

What to Eat?

Since diagnosis, I've struggled with what I should eat in my overall diet. I don't believe anything is 100% banished from my kitchen, but I have struggled with whether or not I should limit carbs in general.

I already eat far fewer carbs than before I was diagnosed, but that's largely because:
a) I was so freaking hungry all the time!
and
b) You can't mindlessly snack on carbs as a diabetic. You have to be deliberate enough to measure and bolus. So no box of crackers next to me, thanks. I'll count out my portion and put them on a napkin.

And I'd probably have gained way more weight if I'd kept eating the way I used to... now that my body can use and store carbs.

Which brings me to one reason why I think a lower carb diet is a good one to consider...

Fewer carbs helps maintain (or lose) weight. Aside from a potential reduction in calories, and the theory that our bodies' metabolisms work "properly" when we consume fewer carbs, fewer carbs also means less insulin. I am skeptical of this next point, but I've read over and over that "insulin causes weight gain." I'm not so sure about that... It seems more likely, to me, that insulin allows us to gain weight from what we eat. After all, you take more insulin because you're either eating more carbs, or because your carbs aren't being properly absorbed with smaller doses. But still, it's a theory that worries me.

And the other significant reason for considering a lower-carb diet...

Smaller mistakes. If you're eating something high-carb, that calls for more insulin. So if you get the portion size wrong for something carb-dense, your dosage error could also be pretty significant. Take that piece of cake I had yesterday: I was guessing at the carbs, based on how many carbs are in other frosted cakes I've had before, and gave myself three units of insulin for the piece I ate... but I guessed wrong, my BG (blood glucose) dropped quick, and I struggled for the entire afternoon to keep my numbers up (which meant consuming a lot of unwanted calories, tying back to my first reason!!!). Let's compare that to if I'd eaten, say, a sugar free cup of yogurt. If the nutrition label was torn and I couldn't look up the brand, I'd remember that my usual sugar-free yogurt cups are about 7 carbs and (assuming this cup is the same size) given myself anywhere between .65 or .8 units of insulin (depending on my insulin-to-carb ratio for that time of day). My guess might be off, but I doubt it would be by more than .2 of a unit. As long as my BG was at a pretty safe number in the first place, an error of that size isn't going to hurt things much. Unlike the cake, for which I probably gave myself one whole extra unit (if not more).

I love carbs, and I believe everyone should be able to enjoy cake once in a while... but I know from experience that I can eat a generally lower-carb diet and feel satisfied. But that was a few years ago... If I can just get back into that mode!

Cake Will Make You Go... Low?

Today was my last day at work (I start a new job Tuesday!), and some coworkers were sweet enough to bring me a yummy red velvet cake. I admit I gave in to the "obligation" to eat a piece right then and there, but whatever, I can just bolus for it, right? No biggie.

Except I apparently suck at judging the carbs in cake. Like, really really suck. A lot.

I should have known sooner that my blood glucose was dropping, as I felt an odd anxiety creep in. But I knew by the time I was actually low (caught it at 68), and I downed a juice box... then ate my lower-carb lunch with no insulin... then drank a carrot-apple juice box... Then later, a couple random bites of cake again... then more cake yet again, with almonds for some staying-power. All without insulin. I'd get up to a reasonable number, then go right back down!

And it's not like I gave myself some amazingly huge bolus for that cake. I most certainly ate more than enough carbs afterword to account for that insulin. But they say that once you go low, you're more likely to go low again over the next few hours. Weird. Why can't it be simple? Take this much insulin, consume this many carbs, and all is fine. But no, it can't be that simple. And my last day rather sucked because of it.

Maybe this cake was made of anti-carbs. Like anti-matter. Only... not as deadly and destructive.

Smoothing Out the Seams

I think I’m beginning to incorporate diabetes treatment into my life more smoothly. Even with the pump being so new, and even with other new things (CGM) on the way, it’s all starting to blend in. All of the actions are inspiring less, “Let me stop my life for 5 minutes to test my blood sugar and take an injection,” and more, “I hope I don’t look too inattentive while I test my blood sugar and listen to this person talk at the same time.”

The most invasive daily activity at this point is counting carbs, even though the pump takes care of some of that for me. Even if the database were easier to browse, some foods are just always a mystery unless you make them yourself. There could be sugar in your sweet corn, flour in your omelet, or (on the flip side) far more fiber in that dinner roll than is typical. And what is the tuna-to-pasta ratio in that tuna casserole??? It helps, when dining out someplace without a nutritional guide, to stick to simple foods. I’ve been eating a lot of poultry and seafood with rice and veggies or salad lately... The meat has little to no carbs (as long as it's not battered, and depending on sauces and glazes!), I can pile rice or veggies into a mound and judge which of my measuring cups it would likely fill, and side-salads with creamy dressings (ranch or Caesar), a few croutons, and no fruit have pretty reliably acted like about 10 or 15 carbs (depending on size). I’ll probably branch out into more combination foods as I get a better feel for carb content, but simple and familiar foods make life a little easier when there are no hard numbers to rely on.

Making food at home is easy. Meals for just myself are usually packaged and frozen (I love Kashi meals for lunch!) or routine enough that I know exactly how many carbs are in the final product as I always make it (my usual PB&J sandwiches are 34 carbs). If it’s a more complex meal for my husband and I, I usually try to cook exactly enough for both of us. I jot down carbs on a scrap of paper as I choose ingredients, total it up, then divide by two to determine the carbs in my half of the meal. (Or, more likely, I take a look at the carbs for one serving of a frozen “meal for two” I’ve just sauteed!) I test my blood sugar while the food is in the last couple of minutes of cooking, then punch the carbs into my meter-remote for my bolus calculation as soon as we sit down to eat. I’m already eating the first bite before the pump has finished its bolus. (So much faster than taking a shot!)

So it’s all falling into a rhythm. I’ve had to make some adjustments to my routine to more seamlessly incorporate treatment (eating simple foods at restaurants without nutrition guides, taking a few extra minutes every third day to put insulin in my pump and insert an infusion site so I don’t have to take a shot 5+ times a day, buying a more organized purse to easily carry and find my gear, buying some 1-cup tupperware bowls so I know exactly how much cereal I’m eating without breaking out the measuring cup...), but the treatment itself is also becoming easier to adjust (the pump means less time and mess before meals, I can use my glucose monitoring kit more quickly and without taking every little thing out of the case now that I’m used to it, and I don’t have to do as much math to give myself insulin anymore).

I still have these surreal moments when I realize, “I’m diabetic. I have a chronic disease. I have to take medicine multiple times a day to stay healthy and alive.” This strikes me especially hard when I wrestle with the tube of my pump while changing clothes, but then the pump disappears quite effectively under the front of my bra, and I only occasionally talk to it for the rest of the day through what looks pretty much like a fat little PDA... and it talks back to me from beneath my shirt through the quietest whisper of a *click* when it gives me a basal dose of insulin, and through a rhythmic vibration that translates into, “Bolus insulin for 41 carbs coming right up!!!” And I can hear the quiet twist-and-deliver as I enjoy the first bite of my meal... and then I think about other things.

Every now and then, I’m amazed by the things I do automatically. The seams are smoothing out...

Food

I have a conflicted relationship with food now.  Wait, that's not right... I've always had a conflicted relationship with food.

I love food and I hate food.  I've been in good places with it, and I've been in bad.  I remember one night in college, back when I was unhealthily heavy and seemingly unable to change it, I was standing over my food drawer in my dorm room, eating Doritos and crying because I couldn't stop.  And then, by about a year after college, I was down to a normal weight and was eating mostly organic food that I loved...  Largely because I was a happier person and didn't have much of a need to eat emotionally.  I'd have my vegetarian lunches of a cheese and broccoli slaw sandwich on whole wheat (honestly so good!), light miso soup, and seriously tasty organic chips.  I was satisfied, eating in moderation, and avoiding most sweets because I just didn't crave them.

So to show you those two polar opposite pictures gives you a little background.  For the past couple of years, I've been more like the average person.  I ate a little too much and there was more junk food to be had when I was under periods of stress, but it was about what you'd expect from an average American working girl.  I gained enough that I wanted to get back to better habits and lose weight again, but most of those better habits never formed permanently.

But for the past year or so, I was more or less eating whatever I wanted without gaining weight.  Nothing insanely unhealthy, but I ate all the time because I was hungry all the time, and I either held steady or lost a little weight.  At one point, after a couple days of eating way too much junk and sugar, I got on the scale and thought, "Wow, I didn't gain!  I guess since most of what I eat is on the healthier side, I do OK with eating as much as I do and having the occasional sweet treat."

How bizarre, to think that I was maintaining what seemed like a "healthy" weight only because my body was anything but healthy... because it wasn't working properly... because my cells couldn't get the fuel they needed.

I didn't fix my eating habits the moment I discovered I was diabetic, but I did as soon as I started my extremely conservative insulin regimen a few days later.  At first, since I knew I was really only taking insulin for my existing blood sugar and not what I was about to put in my mouth, I began eating meals of no more than 30 carbs each.  Once I started calculating my insulin to account for my food a few days after that, the dietitian assured me that I could eat more carbs as long as I didn't go crazy.  45 to 60 carbs per meal is the realistic range.

But I still keep most of my meals around 30 carbs.  Sometimes 40, rarely up to 60.  I know there will be times when I eat more than that (damn it all to hell if I can't have a little piece of real cake on my own birthday!), but that's fine with me for now.

It's a combination of things.  First of all, I'm satisfied with that 30 to 40 range.  I mean... my hunger stops!  I may be consuming far fewer carbs than I used to, but my body is able to use so much more!  So my physical cues to "eat more fuel" aren't there.

Second, I currently don't like giving myself the larger amounts of insulin that go along with higher carb meals.  This is all still new to me, and I feel nervous every time I take a larger dose of insulin than I have before.

Third, I'm realizing that a lower carb diet will not only mean possible weight control now that my body is working normally, but also savings on medicine...  The fewer carbs I eat, the less insulin I need!  I'm not going to make decisions for my body based on financial issues, but it's something that's crossed my mind.  And is it somehow better to need/take less insulin, anyway?  I think the true answer is "stay healthy and take the insulin to support that health," but haven't fully adopted that attitude.  To be healthy on less medication is better than to be healthy on more medication, in my mind.

And I can't leave out the the fact that I worry I'll blow up like a balloon now that my body can use and store the fuel I give it.  I got the green light to do start doing some light exercise (should have started already, definitely will this coming week), but all of this has made me want to become a freaking athlete.  Diabetes puts you at risk of so much, including cardiovascular disease, that I want to reduce as many other risks as I possibly can.  That means losing and then maintaining my weight and getting fit in general... especially my heart.  I'm a 30 year old woman who is still menstruating, and that gives me a good window to get my heart up to speed before I become more at risk for heart attacks at menopause.  I'm going to take advantage of that window, damn it!  (This will have to be an entire post unto itself.  There are many layers of fear and frustration surrounding exercise, fitness, and risk for cardiovascular disease.)

Another thing I've considered, regarding food, is starting the Nutrisystem Diet again.  The prepackaged, perfectly portioned entrees would make it easy to know exactly how many carbs I'm putting in my body, and they have a low-glycemic version called "Nutrisystem D" that's designed to help Type 2 Diabetics gain control over their disease through food.  A low-glycemic diet could not control Type 1 Diabetes, but it would support the medical treatment.  I'm struggling with this decision though, because it's fairly expensive once you start adding in the grocery items.  And the last time I did Nutrisystem, I grew tired of the dinners and lunches fast.  (But man, do they have awesome breakfasts and snacks!)  That, and I actually suspect I may end up consuming slightly more carbs than I currently do.  Many of the meals would be 40 carbs once the salad and veggies are added.  Not bad, but maybe not what I want.

But I think it could be a really great choice for someone who's eating a few more carbs than I currently do.  Hell, it still may be a great choice for me, anyway.  (And, FYI, the first time I did Nutrisystem was awesome.  I loved the food while it was new to me, I was only tempted to do some very minor and rare "cheating," and I think I lost about 20 pounds!)