DAM: Diabetes & What Can You Eat?

1253971_48155847Nine times out of ten, after someone learns that you have diabetes, questions will be asked. Some are not pleasant and downright rude. Others are kinder and seek to understand more about this often misunderstood chronic illness. One question that can be interpreted as either rude or kind is this one:

“What can you eat?”

Here’s my simple answer:

“Anything.”

It’s obviously more complicated than that, but as a person with Type 1 diabetes, there is not a food on this planet that I am not permitted to consume. (There are many that you couldn’t pay me to try.) It’s a common misconception that we must never allow a doughnut to touch our lips or eat anything sweet, perpetuated by misguided self-promoting diet gurus and the manufacturers of sugar-free candy. I believe those manufacturers secretly work to undermine the laxative industry. Don’t eat a lot of sugar-free candy in one sitting. Trust me on this.

Diabetic Exchange Diet

When I was diagnosed in 1983, it was the Diabetic Exchange Diet that was thrust upon us and one that was adhered to diligently until I went away to boarding school a year and a half later. It was based on a calculation of calories broken down into neat categories: Meat, Bread, Fat, Fruit, Vegetable, Milk, and Free. (To this day, I subconsciously think to myself as I drink a glass of milk: “I could have traded this for a Meat and a Bread.”) We weighed and measured meticulously and I injected the same amount of insulin every day. It’s still used by some people with diabetes, but I have never been a fan.

I hated it. That “diet plan” got chucked quickly to the curb when I was on my own at school making my own food choices. (Let’s just leave it at… I was in a rebellious phase.) My relationship with food has always been a rocky one, but I will tell you that now, it’s better.  Thanks to carbohydrate counting and the ability to dose insulin based on my blood sugar levels and the number of carbs I ingest at a snack or meal, I eat what I want and when I want.

Carbohydrate Counting

My life changed shortly before I began insulin pump therapy. (“So, insulin pump… tell me about your mother.”) I began to use a sliding scale when injecting multiple daily doses of insulin to keep my blood sugars in range. I sat with a dietician who rocked my world with the revelation that as long as you understand the carb count (and the intricacies of carb counting, which while simple in theory, is not in practice), you can accurately match your insulin intake to your carbohydrate intake. Once my insulin pump and I were joined at the hip (sometimes literally), eating was no longer looked upon as a choice between “eat what your diet plan says you can eat and feel good about yourself” versus “eat what you want and feel guilty”.

Before you go all willy nilly bellying up to the buffet bar, know that you still need to know how many calories you should be ingesting and other tidbits that a registered dietitian works magic with your food. Here’s an nifty article on carb counting from Joslin Diabetes Clinic. 

Glycemic Index

Then, there’s the glycemic index. Hat tip to wikipedia, for defining it simply:

The glycemic index, or glycaemic index, (GI) provides a measure of how quickly blood sugar levels (i.e., levels of glucose in the blood) rise after eating a particular type of food. The effects that different foods have on blood sugar levels vary considerably.

Foods can be defined as low-, medium-, or high-GI. Low-GI foods will raise your blood glucose levels more slowly and steadily than high-GI. When you make food choices, the type of “GI” category can make a difference in insulin dosing and blood sugar excursions.

If you are interesting in learning more about the Glycemic Index and how to factor it in to your existing food choices, my first choice of website has always been this one by the University of Sydney. (There are a ton of books out there, but I can’t recommend one…) While not everything I ingest is low-GI, I do make small efforts – sourdough over white bread, brown rice over white, etc.

You Said That You Can Eat Everything. Explain That!

I can eat everything. If I want to have ice cream, I have some. I try to get the carb count and dose appropriately and enjoy a little bit. I do not eat two pints of Ben & Jerry’s Red Velvet Cake in one sitting. Cheesecake? Sure. A small slice, not the whole round. Chocolate must be the good “high end” stuff and not sugar-free. (Again. They are laxatives in disguise and they taste just as appetizing as Ex-Lax.)

Everything in moderation is the motto I try to live by when it comes to food. I know that some foods will send my blood glucose on a five-ticket roller coaster ride for hours, but I still eat them occasionally. Why? Because I can. (Does that sound like a cranky toddler? Probably, but I’m an adult and I still hate being told what I can and can’t do.)

I avoid daily consumptions of foods that I know will not help me in the long run. I prefer chicken to huge hunks of fatty meat (bacon is in another category…) and yogurt and I love each other very much. Do I indulge in a juicy steak on occasion? Yep. But like I said, everything in moderation. Peanut butter cups and crème brûlée every day isn’t healthy for anyone.

To Each His Own

I’m one person with diabetes. I have met individuals who are happy following a food plan to the letter. I have met individuals who live with celiac disease and deal with extra restrictions but still enjoy food choices.

So, as you are sitting down to eat a cupcake to celebrate something important (Like, “It’s Tuesday!”), after checking your blood glucose and dosing appropriately, and someone asks you: “Can you eat that?”, smile and say:

“I am person with diabetes. I can eat anything.”

 

Are you following me on Twitter?

I’m hilarious.

@ThePerfectDblog

The DAM series is part of Diabetes Awareness Month, because despite what you think you know, you don’t know everything. Neither do I. Let’s learn together. 

 

A Virgin What?

I got an email today from a relative that had my eyes rolling so far back into my head that I saw my brain. (It was decked out in a boa and bowler hat.)

VirginI’ve started a new diet called The Virgin Diet and I’m feeling super! I’m drinking nutritious shakes and hope to lose weight and find out whether I have a food intolerance…cut out all dairy and gluten and some other foods…

She has struggled with her weight for most of her life, but doesn’t quite seem to ever keep it off for long. I’ve watched the yo-yo pattern and it frustrates me, but I’m past trying to give information that falls on deaf ears. I’ve done “diets” and they don’t work.

They don’t.

When someone says they are going on a diet, I equate it to going on a vacation. She get a guidebook (the latest diet book), watches a couple of travel shows (Oprah, Dr. Oz, some “expert” on the morning news), packs her bags (in this case, her grocery carts), and sets off full of vim and vigor. Bon voyage! This vacation (diet) going to fulfill every dream they desire.

But vacations don’t last forever. Neither do diets.

Ten or twenty pounds (or even less) into the diet, she starts to feel like something’s missing. The newness wears off. She plateaus. She sees a comfort food that isn’t on the list of “don’t eat this” and thinks: “Ok, just once.” Then the guilt seeps into her pores and the diet willpower collapses. And the next thing you know…. the diet is abandoned and any weight taken off arrives like the lost luggage on a later flight.  And you’re now suffering from the post-vacation doldrums. (Been there. Done that. Have the T-shirt.)

The term “diet” itself is part of the problem. Merriam-Webster’s dictionary defines it as:  “a regimen of eating and drinking sparingly so as to reduce one’s weight”. It says nothing of what happens after one reduces it. For most people, a diet has a starting and a stopping point. “I’m going to diet and lose 20 pounds.” There’s nothing long-term about it. It’s all instant gratification. As a society, we’re totally into that.

Diets don’t work. Lifestyles do. What’s the difference? A lifestyle change is:

  • Making a conscious choice to eat the proper amounts for what you are trying to achieve (lose, maintain, or even gain) and not looking for the quick fix.
  • Making a decision to exercise to help with those proper amounts of nutritious sustenance. Hint: Exercise calories > intake calories. I know. Brilliant. And it’s math I can actually do!
  • Recognizing that sometimes it’s OK to eat something outside of what you’d consider to be proper and knowing that it doesn’t mean the end of your work.
  • Understanding that cutting out all dairy and gluten and potatoes and processed sugars and the like is not a sustainable way of life for most people. (Yes, I know that it can be done and that people have done it. Ever been to a restaurant or gone to a friend’s house and try to follow all those rules of a “forbidden foods list”? If there isn’t a medical reason for not eating them, you come off as a griping whiner. “I can’t eat that because I’m on a diiiiieeetttt….”. Smart hosts hand them a celery stick and a glass of water.)

Why do I feel this way? After my diagnosis, I was on a Diabetic Exchange Diet. It drove me crazy. Based on a caloric intake and slotting those calories into “meat”, “dairy”, “fruit”, “vegetables”, “bread”, and “fat” categories made mealtime not a lot of fun for anyone who followed it. (And calling it a diet made the whole thing worse in my head.) On birthdays or special occasions, I got to eat a whole 1/2 cup of vanilla ice cream. Vanilla. Go crazy, kid.

Restricting something or forbidding something is a sure way to make it almost impossible to resist. It’s no wonder I chucked that whole “diet” out the window whenever I could as a teenager.

What changed? Carbohydrate counting as an adult. Part of the diabulimia issue for me was that “forbidden” food guilt. Carbohydrate counting made that a non-issue. Did I want a piece of cheesecake? Yes. Can I have it? Yes. I just needed to count the carbs and take the appropriate amount of insulin to cover it.

I’m no expert at carb counting. I used to carry a book in my purse and will occasionally pull out an app on my iPhone to check carbs in a fast food meal (which is sobering when you realize just how many carbs you are eating in a Big Mac… which I won’t eat anymore.). I read labels. I still screw up sometimes. I am human. So are you. (Unless you’re a robot.)

The Glycemic Index is also something that I’ve used when trying to not spike after a meal. I know that I react differently to white rice versus brown rice, even though I can create an equal amount of carbs for my insulin intake. Complex carbs are the way to go for me.

And there are times I overeat. Sure. Just not at every meal. And not an entire cheesecake. I’m a firm believer in “everything in moderation” (except for Diet Coke for which I need a 12 step program), and I’ve found that moderation is the key to my lifestyle. Not some “lose 7 pounds in 7 days!” diet, because… what happens after seven days?

There are some who have successfully maintained their weight loss through Weight Watchers. That for me, is not a diet, but an overall lifestyle program. I’m just knocking any “diet” that forces you to drink shakes for at least two meals a day or eat packaged meals that you have to buy. That’s not just a diet, it’s a diet that makes someone a whole lot of money on people who are looking for someone else to control their eating habits by restricting their food choices. And you know how I feel about that.

So, it won’t come as a surprise to me when I hear about a new diet she’s going to try after this one fails. Because… it’s a diet, not a lifestyle.

Do you agree with me? I’m curious how other diabetics feel about the “diet” concept?