Wednesday, August 15, 2007

Diet and Type ONE Diabetes

I don't think I'm alone, as a diabetic on insulin, in getting upset when people try to tell me what I can eat or assume that I'm on a diabetes diet. I'm not. But there are a lot of diabetics who are. I think every adult diabetes forum has at least one Dr. Bernstein fanatic.

Two weeks ago, I got a cold. It made me insulin resistant, and I ran 200-400 a LOT. My meter's 7 day average hit a six month high of 148. Then I stopped eating. I said hey, I hit the 300s after supper the last three days, I'm going to skip supper tonight. Well, I went from 110 to 240 at suppertime anyways. Oops. Opened a new bottle of Lantus and upped my dosage dramatically, ate an average of about 1000 calories for the following week. Guess what? My new 7 day average is at an all time low of 101 (including one test of a nondiabetic friend who was at 142), and there's not been a single number under 50 in there. Yee ha! Only one number over 200.

Days on which I don't eat are almost always good blood sugar days. They run low but not terribly so- rarely does fasting make my blood sugar go below 50. Eating low carb doesn't really give me the same effect- almonds and chumus can still make me soar. Skipping supper tends to make my overnight numbers remarkably stable. I think that there is something to be said for the ability of dieting to control blood sugar. OK, nothing new here, every single person you've encountered on your diabetes journey has said that.

But their message has always been this: carbs are bad for you. Don't eat sweets. Diabetes? oh you must have such a sweet tooth! Is that on your diet?
Their message is: diabetes HAS to be controlled by diet. You can't be healthy if you eat the same junk I eat.

There are major drawbacks to low carb diets. I'd rather avoid malnutrition and ketosis. Dr. Bernstein's willingness to do intravenous injections also turn me off. Sorry, but I want healhty veins to last me for decades to come. Going low calorie makes me function worse, mentally and physically, and I have a distressing tendency to get underweight. I do not want to encourage any latent tendencies towards eating disorders. Low carb is especially difficult if you happen to be a picky vegan (like me).

And while low carb's proponents claim that it's the only way to go, much in the way many pumpers tell me its the best way, the fact is that what I'm doing works for me. I'm having a blood draw for an A1c next week, and I expect it'll be around 6% plusminus .3. I haven't gotten ketotic, excursions above 200 are about a weekly occurance unless I have a cold, and Dr.Bernstein himself has more lows than I do.
Even in the last week, while not eating much, much of what I have eaten has been carbs and those have largely been juice and pedialyte, with some bread and rice cake. Not low carb foods.

My endo is a big proponent of diet, sort of. He is of the belief that it doesn't particularly matter how many carbs I eat, so long as it's about the same number, at about the same times, every day. I tell him I'm a college student with a hectic schedule and I can't do that. Sorry, man. He doesn't get upset about it, although I have the feeling he might if my craziness didn't result in A1cs below 7, because low A1cs are his other big thing.

Anyway, the cold is mostly better, probably will be all gone by my doctor visit. I'm going to be drawing charts and stuff because I like to, even though they confuse the endo. I think I've lost a few pounds since my last visit, and I'll find out if they're enough pounds to cause alarm. I have an unhappy suspicion that they will be. I'm going to tell him about my memory problems and ask for a recommendation to a neurologist, which I will use if the thiamine supplements don't do the trick. I'll have my blood drawn (he draws it himself, my endo) and call in a day or two later to find out what the A1c is. I think I'm going to ask him to run a c-peptide as well. We'll be checking to see how my meter's doing.
At the visit after this one, in November, it'll be time to renew scrips, and I think I'll be asking for a different brand of meter. I've heard good things about Jazz. It and the accu-chek are the only meters bragging about accuracy, and at least one of my three Avivas has been woefully inaccurate (see my posts from May).

2 comments:

Marina said...

I completely relate to most of your post. I am also a Type 1 and a picky vegan!

What I finally ended up doing was discovering a free nutrition-tracking program called Cron-O-Meter (at http://www.spaz.ca). I pick a bunch of my favorite foods, and make sure this meal plan adds up to 1300 calories and as close to 100% as I can to my recommended daily nutrients. Because I have such a crazy schedule, I grocery shop twice a week, and print off an index card with this list of food each day and keep as much of it as accessible as possible (backpack, work fridge, purse, home, car). Then I check off each food item as I eat it throughout the day.

I have actually found that the higher the amount of fat in my diet, the higher my insulin needs are. I fell off the vegan bandwagon for a very short while and meat, which has no carbs, literally doubled my basals AND my carb ratios. I had read about this theory in Dr. Neil Barnard’s “Reversing Diabetes” book (it was recommended by Bob and Jenna of VeganFreak Radio) but I didn’t take it to heart until I saw it firsthand. To protect my kidneys, I stick to 0.8g protein per kg of body weight, which ends up making my daily breakdown 15% protein, 15% fat, and 70% carb – and that’s when I use the lowest amount of insulin and feel best overall.

The biggest thing in terms of my BG numbers is planning ahead and blousing 20 minutes before eating. That’s when my hectic schedule can leave me only 10 minutes total to eat when I hadn’t even thought about eating yet. I’m trying to get better about this by putting an alarm on my phone for every three hours to eat something small, so I’m not left at any point being starving and in a jam.

Sorry for the long comment. Hope it was helpful!

manny hernandez said...

You are not alone, Jonah.

As a matter of fact, there's a community I want to invite you to:
http://TuDiabetes.com, a community for people touched by diabetes.