Why I follow a low-carbohydrate meal plan

I would like to start off this post by explicitly stating that a low-carbohydrate diet has worked extremely well to help *me manage my blood sugar. However, this does not mean that I am going to try to convince *you to do anything. I am after all a libertarian – freedom of choice to do whatever you want is important to me, and I am not here to preach or to convince you to do one way or the other – simply relaying my experiences with different food choices. Nor am I going to partake in the stupid divide I have witnessed in the #doc when people have different opinions and can’t seem to accept that “to each their own” ;)

Now that I have gotten that out of the way, I must also point out that the dietary guidelines recommended for the general population as well as for PWDs are unfortunately not the best. Better than the food pyramid? Sure. However, still way outdated and not supported by research (saturated fat, anyone?) As a scientist I read primary literature. All. The. Time. Be it developmental biology (my current area of expertise), immunology and cancer (my graduate work), or simply for fun (read: nutrition). As a result of my background and constant need to read papers, I have realized that a low carbohydrate diet can be both “safe” and very sustainable. If you have specific questions, please feel free to contact me :)

Now, I realized many years ago that eating less carbs per meal helped me avoid post-prandial blood glucose spikes. However, at the time, I was not well-educated about fat consumption, and as a result of adhering to the low-fat advice, couldn’t maintain my weight, and thought to myself – hmm, I guess this is unsustainable and I need to eat more carbs. Fast forward to today, and I have learned a lot more about both metabolism, and also the terrible studies that produced the low-fat guidelines/craze (luckily, things are slowly starting to change – even the 2015 dietary guidelines have finally removed dietary cholesterol and saturated fats from the “nutrients of concern” list.) In any case, once I realized that fat (good fat!) is not the enemy, and also that there is absolutely no evidence that eating more protein causes kidney damage, I once again began my journey of diet experimentation in an effort to normalize my blood sugar. 

Here’s the caveat  - a majority of health professionals are not up-to-date on their continuing education and as a result are prone to continuing to misinform the public. Don’t get me wrong – I think the vast majority of physicians have the patient’s best interests in mind (after all, why wouldn’t they?) However, about 50% of what doctors learn in medical school is unfortunately wrong (we just don’t know which half). I whole-heartedly applaud those doctors (such as my paleo-eating endocrinologist, who holds both a D.O and a M.D., and has actually conducted research) who stay up-to-date and don’t just spend decades regurgitating information they memorized years ago. One of the reasons I never became a medical doctor was because I really didn’t want to deal with the ridiculous hours (residency and beyond), and also because I don’t really want to deal with the stress of getting sued. But – if you are a doctor reading this – I applaud you – and I hope that you are finding time in your busy schedule to attend conferences and read studies yourself. (My endocrinologist is appalled at how many docs are getting their CE from pharmaceutical reps. He is also appalled at how new drugs are pushed out today with pretty much no safety profile). But, I digress – that will have to be another post.

Anyway, back to my low-carb (moderate fat/ unlimited protein) diet. PROS: Amazing BGs. Fewer lows. More stability. As a result – improved mood. CONS: Learning to bolus for protein (this was the hardest for me), and spending a lot of time in my kitchen (some may consider this a con, but I personally do not :).  As an example, I am posting some CGM graphs from my “standard diet” days vs. today’s low-carb. The first set of graphs illustrate the difference (for me anyway) between eating a bagel vs. low-carb waffle + egg. The 24-hr. ones are representative of overall stability throughout the day (I am still working out all the kinks). Importantly, these graphs are not representative of effort (I tried really hard to have stable blood sugars on a “regular” diet just as much as I try to do it now), these graphs are reflective of diet. 

Now, I personally eat a lot more carbs than most people adhering to a low carbohydrate diet (e.g. Bernstein plan). I eat about 60g per day (on average), and I don’t actually have any foods that are “off limits”. If I feel like eating it, I will eat it. However, most of the time, I tend to prefer feeling good instead of “indulging”. What does indulging look like to me? These days, this would be a serving of popcorn and an ice-cream (together, at once). I had some last week, spiked to 150 mg/dL. Did I regret it? Not necessarily, but looking back, I wish that I had split up these “treats” into two occasions. What does a typical day look like? For breakfast, I have a two egg/ cheese (sometimes meat too) “sandwich” on a low-carb wrap. An alternate breakfast is a low-carb waffle (made with almond flour, plain yogurt, a bit of milk, and eggs, with Stevia) with a teaspoon of jam and 1 fried egg with a sprinkling of cheese. Another alternative is plain yogurt with berries. And coffee. ALWAYS coffee :) My favorite lunch is hands down a loaded Greek salad – lettuce, tomato, cucumber, olives, feta, green onion, with added avocado, or chicken, or tuna. I make my own dressing (1:1 EVOO/red wine vinegar with s/p, oregano, and garlic powder – so good). Alternately, I bring my leftovers from yesterday’s dinner – usually this is a protein source and lots of vegetables. For instance, last night I had cheeseburger casserole and bacon-fried French green beans. It is also my lunch today. This particular meal is quite high in protein and fat (and illustrates one of my lowest-carb meals), but not all my dinners are. I also enjoy blackened tilapia, ramen using shirataki noodles, Parmesan-crusted chicken (with a tiny bit of bread crumbs) with steamed spinach or broccoli, etc. I could go on and on and on (I will have to make a separate recipes-only post ;) And I am not afraid to throw some refined carb in there – be it about 1/3 – 1/2 serving or rice or French fries or whatever if I feel like it. My favorite “carby” thing to eat remains the occasional small serving of multi-grain bread from Costco with artichoke spread or smoked salmon and cream cheese. Alternately, I really like crackers and cheese J Oh and I loooove Kind+ bars as an on-the-go snack. I also love berry/plain yogurt smoothies.

Here is the fun part – since I now bolus for protein, I don’t have to wait 15-30 minutes after bolusing to eat my meal to achieve flat lines. So I bolus for my carbs and 30% of the protein up front and eat! 

And this is why I choose to eat low-carb. Here is this morning :)

A Discourse on Diabetes Technology

Hi there! Still here, still have diabetes :)

Today I am talking about diabetes technology. In today’s diabetes world this can mean many things – blood glucose meters, insulin pumps which can deliver very tiny and precise amounts of insulin (some of which are integrated with continuous glucose monitors, automatic insulin suspension and other safety features, etc.), continuous glucose monitors (CGMs), which deliver (*almost) real-time blood glucose results to a receiver or even your cell phone (by measuring interstitial glucose and correlating that to BG values via calibration with a meter), a multitude of sharing features that allows PWDs and their loved ones to have more peace of mind, and of course, the several ongoing AP (“artificial pancreas”) projects (definitely a misnomer), which aim to integrate CGMs with pumps (either insulin-only or a combination of insulin and glucagon), with the end goal of automatic delivery based on the individual inputs in order to keep BG as close to normal as possible at all times (Whew! Hopefully I covered most of that without too many mistakes or omissions :)

I catch myself often thinking about the “Diabetes Dark Ages” – check out Kelly Kunik’s blog for example - http://diabetesaliciousness.blogspot.com/ - to learn more about the “Diabetes Dark Ages" – the times of testing your urine (qualitatively) – a very drawn out process, guillotine-type lancets, enormous (and slow) blood glucose meters requiring a “hanging drop of blood”, backpack-sized insulin pumps, and needle sterilization via boiling, etc. Wow – what a pain in the ass! That’s when I remind myself how lucky I am to be living in the 21^st century, and currently have a job with health insurance that will cover 80% of all my supplies with a minimum deductible and a max out-of-pocket of only $2k annually. I am thankful to have a good plan through the university I work at this time; over the last couple of years of graduate school, I was much more broke, had crappier health insurance, and although I did manage (with my mom’s help – thanks mom!) to get my hands on the original Dexcom 7+ CGM system, I couldn’t really afford the sensors on a regular basis (shout-out to the #doc folks who sent me their expired ones!)

Although I never tried one, I never felt like an insulin pump would be a good choice for me, personally (that is not to say I would never try one). The reason I feel this way is a combination of the troubleshooting that comes with kinked pump cannulas, occlusion sites, scar tissue, delivery failures (for various reasons, which unfortunately can be very dangerous, as all insulin delivery – basal and bolus occurs via the site, so if anything fails, the threat of DKA becomes very real very fast), battery issues, and a cohort of other potential problems that I have read about on many pumpers’ blogs. Couple those potential issues with my vanity  let’s call it self-consciousness (I don’t really want to have a device attached to me at all times – tubing or not - on the beach, during sex, etc.), along with the high financial cost of pumping insulin, and that  pretty much explains why I am not a pumper. Don’t get me wrong – it works out fantastically for so many people, and I can totally see the benefits of pumping, especially for those who have needle phobias, or are very active and benefit from the easiness of basal dose adjustment/ suspension. 

Moving on to CGMs. As I mentioned, I had the original Dexcom 7+ system a few years ago). It was the most profound piece of technology as far as improving my diabetes management. It allowed me to assess my overnight control, providing a safety net (via low BG alarms) to allow me to run tighter BG control, especially overnight, gave me great insight into postprandial BG values, allowing me to better time my meal-time insulin to avoid post-meal BG spikes, and it also acted as a constant accountability buddy, which was very useful to me. This is why I am super-thrilled to be getting hooked up with the Dexcom G4 system this week!!! I am excited for the slim transmitter (at least slimmer than the original G4 transmitter as of 2014), the sleek (not egg-shaped, eye roll emoji) receiver, the increased range of signal, and hopefully better accuracy and sensor life. I should mention there is a G5 on the market as well – I personally chose the G4 for a couple of reasons, such as the slightly smaller transmitter and the longer transmitter life. I can’t wait, and will have to post some pics and graphs once I get everything delivered (hopefully later today)! Here are some pics of the original Dexcom 7+ system (along with its giant egg-shaped receiver – like really – who thought of that!?) from a few years back. But even this original system changed profoundly my approach to diabetes technology and management alike. 

And even though I don’t like a device attached to me – as Kerri Sparling of http://sixuntilme.com/wp/ points out “healthy is sexy” – thanks Kerri ;) That, and (as with an insulin pump or any other kind of Diabetes technology) we have a choice! We are lucky to have a choice to remove it whenever we want, go back to the more old-school ways of management – we can chose to do what works for us and when and that is awesome! I dream of a world where every PWD across the globe has easy access to insulin and BG monitoring supplies, and I recognize just how fortunate I am. 

Now, I promise not to be a stranger as much as I have been. I miss this place, because it’s like a break from work (while I am at work currently, hehe). Also, because I really benefit from writing about diabetes from a mental-health standpoint, and by connecting with all of you! In addition to writing about diabetes and technology, I soon hope to write more about my low-carbohydrate diet approach, as well as more about travel, stress, and many other things ;) (I am posting it, so I will have to come back soon and write more!)

Peace out. 

<3 MM

Improvements!

I had an appointment with my endocrinologist yesterday and just got all my labs back. I am pleased to say, that although I am still not 100% satisfied with my A1C, I was able to reduce it by 1.3% since my last visit and all my other labs are normal! I am happy to see the improvement to say the least J I wish I had time to write more, but life.

Love you all!

Update :)

It has been forever since I blogged, so look at me - two in one day! ;)

I just wanted to acknowledge that my 3-year blogaversary was 12/12/15, and I missed it again this year! I have been busy in the best possible ways, visiting family, which included our nephew's first birthday party (which was the cutest), and (of course) working! I cannot express in words (although I will try) how much peace writing about life with diabetes has brought me over the last 3 years. It has brought me acceptance, and put me into a position to take the best care of myself possible, diligently, and with peace of mind. A lot of the changes in my attitude and concrete habits of D management over the last three years came about as a result of writing (you can probably tell this is kind of my journal). Also, however, my mind and heart have been changed by reading everyone else's blogs - be it dx stories, pregnancy adventures, travel blogs, or diabetes burnout - we all share this unique bond that noone else can understand - I love you all!

I want to wish everyone a very happy and healthy holiday season and the best of wishes in 2016!

<3

Check, check, check

Every time I have issues with blood sugar than span more than one day, I pretty much know I have to start logging to help me tease out all the variables.


-Did my fast-acting go bad? No.

-How about my long-acting? No.

-Am I eating too much fat and causing IR? Maybe.

-Am I waiting enough between meals, or am I snacking too much (Totally guilty of snacking too much) [Note to self: stop eating so many almonds without bolusing]

- Have I gained weight? (Yes - 5 lbs).

-So my long-acting isn't holding me steady anymore since I gained 5 lbs? (Bingo!) [Note to self - lose 5 lbs. stat]

-Am I drinking too much coffee? (Always)

-Am I stressed? (Most of the time, but I am working on it!)


So. Many. Variables.


It has come to my attention that a lot is expected of us diabetics on a daily basis:


Wake up - test your blood sugar. Check.
Correct or bolus for DP, or pre-bolus for breakfast. Check.
Test again before driving. Check.
Get to work. Test. Correct/ bolus for more coffee. Check.
Do work. Don't forget to check! Check.
Drink water. Check.
Check BG. Check.
Lunch-time check. Bolus, wait, eat. Check.
Check in a couple of hours, correct if needed. Check.
Test before driving home, correct if needed. Check.
Check BG, pack snacks. water, take dogs for a walk. Check, check, check.
Make dinner. Check.
Check BG, bolus, wait, eat. Check.
2 hr. pp reading? Check. Correct for extra fat/protein? Check.
Clean kitchen, make lunch for next day. Check.
Bedtime BG? Check.
Wake up in the middle of the night? Check BG. Check.

That was at least 13 checks and adjustments in a "regular" day.

Next morning - do it all over again. Every day.

That's what my days looks like - and that's just a regular day - one that is not hindered by stubborn highs or nasty lows or any additional stresses. The good news is that if my control is good, so is my mood, and the rest of the things in the day tend to be done with ease, maybe even motivated passion (at least the walking of the dogs ;)

(time to face the strange) ch-ch-changes....

Change – we all experience it. Whether it’s by choice or whether it’s forced on us by this thing called life we are all a part of.

In my life the last year or so has been difficult as far as diabetes management. My (roundtrip) commute clocks in at just over 2 hours (which is not only sedentary but can be stressful too). The stress of living life “in the real world” outside of grad school, the stress of grant-writing and publishing pressures, coupled with the stress of not knowing what lays ahead for me and my husband (next year) has (to say the least) made for an unsettling trend in my blood sugar and A1C this year.

Knowing full-well that stress is unlikely to just dissipate, and not wanting to continue on the roller-coaster high-low in my struggle to chase sugars in either direction, I tried to focus on specific concrete changes I could make to improve the state of things. I settled on changing my food intake, slowly shifting towards (what I now estimate to be) 90% grain-free low-carb home-prepared choices. II set out in this simply experimenting, but over time I must say that I am happy with my success. What is success? How do you measure success? I measure success by how I feel (not necessarily by the numbers). The stress that Diabetes used to impose (daily and nightly) has faded, and (in addition to improved glycemic control) this is the biggest measure of accomplishment for me. I don’t worry about low blood sugar anymore, because I never take more than 2U of short-acting insulin at a time. I don’t eat after 6 PM, most days, and thus am able to achieve great stability overnight. In addition, the focus of high-quality proteins and fats in my diet has seemingly smoothened exercise-induced dips (e.g. these days I can hike on a handful of nuts and maybe 1 lifesaver if needed, as opposed to pre-gaming with granola bars or even juice in anticipation of a crash…) These are changes that I have chosen to make in order to improve my health and quality of life. In a way, sometimes I feel like I HAD TO make these changes (or some changes) that would make a difference, because I was really starting to get depressed and angry that I had to work so hard just to be chasing bgs in every direction on an almost daily basis (not to mention the averages on my meter, which had the potential to make me cry some weeks). I have mentioned that I don’t really miss high carb foods, and if I do I (wait for it) I EAT THEM! Usually, I regret it, but I am not one of those people who has to be extreme or perfect about my diet in order to gain what I need from it. This way of eating and dosing insulin in much smaller quantities has greatly improved my stress and anxiety levels. It has made a permanent dent in my bg trends (as an example, I used to have spikes into the 200s almost daily, but now anything like that gets a weird raised eyebrow, because that just doesn’t happen most days anymore.. AND I have had exactly ZERO LOWS. Sure, I was always vigilant about not having serious lows, but with this way of eating I am much more comfortable running in the GASP! Normal range!) Anyway, this isn’t to brag about my sudden morph into some diabetes dominatrix. I still have work to do – there is ALWAYS more work to do with Diabetes! J

This change in eating habits has been coupled with another lifestyle change – my ethanol consumption has gone down dramatically. When I found myself using alcohol to help deal with stress, I recognized right away that it wasn’t a very healthy outlet for stress, simply because it’s bad for your health and (for me) provides an excuse to run higher BGs in anticipation of the over-night crash after drinking. I am happy to say that I am much more comfortable right now with my alcohol consumption, and that I have been actively using other means of stress relief more times than not (such as putting my work away and training my dogs or sewing.) Sewing has been something that I didn’t expect to fall in love with but did, much to my (sewing) grandmother’s delight. There is something about sewing that earnestly teaches me the patience I lack and Diabetes has failed to teach me. When the thread catches or (worse) when the needle breaks (Arghh!!) all you can do is stop and fix it. Kind of like with blood sugar. Or life.

My mom always said – life is like a sine graph. We do the best we can, and we ride the waves. There are things we can control. There are things that are out of our control. Important to remember (for me anyway).

As life doesn’t slow down, and with even more changes on the near horizon in my professional and personal life, today I am stopping for a moment to acknowledge how far I have come. Also, to acknowledge how excited I am for my future.

<3 You DOC J Peace out.

The shit my doctors say

I love me a good doctor – a doctor who is knowledgeable, respectful, and listens (but emphasis is on the knowledgeable part for me). Unfortunately, *some doctors are just total ass-hats, who either 1. Don’t care; 2. Are too terrified of getting sued to REALLY try to help the patient; 3. Are really not knowledgeable at all (read: they get any if at all CE from rx reps).

In no particular order, here’s some shit my doctors have said:

1.       “Oh, you have diabetes. Just don’t eat any white foods. Cheese, butter – those are all bad for diabetics…” (UMMMM…. I didn’t have a reply for this one. I was simply stunned.)

2.       “Oh well, I don’t want to write you a prescription for lorazepam because that can be addictive. Let me give you an SSRI instead – it works in the same way for anxiety.” (Cue my rant about SSRI mechanisms of action vs. benzodiazepines, concluding with the fact that SSRI “discontinuation” typically has pretty significant withdrawal symptoms. As I proceed with my rant about not wanting to take a pill every day [with a number of side-effects], when I may use the lorazepam on a prn basis once or twice a month maybe [if even that frequently], she concurs that the two drugs are in fact very different and that there are withdrawal symptoms from anti-depressants, although she prefers to call them “discontinuation”. In the end, I went a floor down at the University health clinic to get the rx I needed from a much more knowledgeable NP). I haven’t had a lorazepam in about two years – the three remaining pills sit in my cabinet still.

3.       (from staff at dentist’s office in a sarcastic/derogatory tone) “Oh wow – a risk of “zero” – you must never eat anything or drink anything at all, which may be good for your teeth but not so good for the rest of your body.” (Did this woman just skinny-shame me? She definitely did! I roll my eyes…)

4.       “Oh, well if you continue on this way, you will be on dialysis by the time you are 30!” (He was probably right. These words were spoken when I was in DKA and refusing to treat my T1D due to severe denial that I in fact had diabetes. BUT – trust me when I say saying that kind of thing to a patient is not motivational – just devastating.)

5.       (eye doctor after hearing my A1C) “Oh- so you are an UNCONTROLLED diabetic!!! *Scoffs and turns to me and says in an accusatory tone – “Did you know that Diabetes is the #1 leading cause of blindness? Here is a pamphlet of what you vision will look like soon if you remain UNCONTROLLED.” (This eye doctor did get confronted, and ended up apologizing. No need to treat patients like shit – no really. This especially ticked me off because my A1C was in the 7s at the time, and honestly – I know that’s not ideal, but also I can only imagine how she would treat someone with an even higher A1C.)

6.       Her: Do you have any eye disease? Me: Not yet J Her: Oh, don’t be so pessimistic - glass half-full right? (After a while I realize that she has not a clue that I have diabetes…) Me: You know I have type 1 diabetes, right? It’s right there in my chart – along with my most recent A1C – I was assuming you’d want it… Her; Oh, WOW! I had NO IDEA……

Well, doc, since I went on this rant about medical professionals, let me let you in also on a few heart-warming moments with them:

1.       Nurse Erin at MGH. OMG. I love her still – to this day. She took care of me when I started treating and she was so upbeat and helpful! She brought me literature about diabetes management, magazines, and told me all about her T1D auntie who lives a great awesome life, and diabetes is just part of it. THAT. THAT IS what I needed to hear (she also stood by my side as I performed/ butchered my first injection, together with my mom, and was reassuring and when I did it she said – great job, see – nothing to it!)

2.       My old endo. I loved him so and was slightly devastated when he moved his practice back to Cali last year. He was THE MOST knowledgeable endo I could imagine. He did research. He actually read studies. He actually took the time and listened to patients. He was reassuring. He was helpful. He was in no way ever an ass-hat.

Unfortunately, it seems that I can think of more ass-hat than heart-warming moments. SO – if you are a medical professional, please (pretty please):

1.       Do your own research (at least read the studies yourself before giving advice about meds)

2.       Don’t expect your patient to not know more than you about some things – you never know who you are getting (and I’m pretty sure some of these doctors thought I was a difficult ass-hat – but hey – it’s MY health, MY life, and I deserve the best care I can get – and so do you!)

3.       Don’t be rude. Don’t be fear-mongering. It’s one thing to make sure your patient understands the possible consequences of their condition, but shaming or accusing in NOT ACCEPTABLE.

Cheers J