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A few months ago I hit a maximum level of frustration with controlling (or not) my diabetes and decided to make some drastic changes. A friend made some clear, strong recommendations about diet changes that had yielded some impressive results with the control of his own type 1 diabetes. In a nutshell, he recommended cutting out as much carbohydrate as possible from my diet – kind of the nuclear option for blood sugar control.
When I got my first insulin pump, my doctors encouraged me to relax some of the relatively tight control control I had maintained over my diet. For my first 10 years with diabetes I had restricted my intake of sugary foods – or at least felt guilty about eating something sugary. The doctors let me know that, with an insulin pump attached to be 24 / 7, I could simply take a bolus if insulin to handle whatever food I ate (more or less, they were not entirely cavalier).
While this approach may work for some people, it has most certainly not worked for me. I’ve suffered from erratic blood sugars for most of the past 12 years. There was certainly not a single culprit; stress, diet, lack of consistent exercise, not monitoring my blood glucose often enough, and many other factors have been at work. My diet change has simply reduced one of the big culprits – carbohydrates. At the same time I am also testing my blood sugar more often, 5-6 times / day instead of 4 times a day.
Carbohydrates cause a diabetic’s blood sugar to increase (or spike). We control this by taking insulin, however insulin takes 15-20 minutes to start working after it enters the blood stream. Ideally one would take insulin to treat carbohydrate intake 15-20 minutes before eating – assuming you know exactly high much carbs you are eating. This is never been the case for me; I rarely take insulin before I start eating, nor do I generally know exactly what I’ll be eating until I have it in front of me. Especially if I’m having a snack. Furthermore, not all carbohydrates digest at the same rate or effect blood glucose in the same way. These complications make carbohydrates hard to deal with – the enemy.
Until November 2011, I had been vegetarian for the past 14 years. While I did get a good amount of protein from sea food and soy, my diet consisted primarily of carbohydrates like rice, potatoes, crappy snacks, etc. I’ve reduced my daily carb intake by about 50%, and abandoned being vegetarian entirely. I now eat meat at two meals a day, both to keep from being hungry and also to "reward" myself for avoiding carbs. Even with the reward of delicious food it is still a daily challenge, but the results are hugely motivational.
Mostly as a result of changing my diet, over the past 6 months I have significantly reduced spikes and unexpected high blood glucose levels. My blood sugar average has gone from about 170 mg/dl a year ago to 142 mg/dl (non-diabetic is around 100 mg/dl), and my HA1C has gone from just over 8 to less than 7.2 (non-diabetic is less than 6). The standard deviation of my blood glucose levels has decreased from 95 to 70 over the past year. I’ve reduced my daily insulin use by about 30% (from 45 units / day to about 32 units / day), too. I’ve lost about 12lbs (unintentionally), and now need to replace most of my clothing. Not that I’m entirely unhappy about that. Despite eating lots of animal protein, my cholesterol levels have remained constant (about 160 total, HDL and LDL totally healthy).
I can’t claim the my diet change is the silver bullet. Testing my blood sugar more often has also helped, I’m sure, helping me be more aware of my level and correct highs and lows more quickly. I still need to get more of my glucose readings into my target range, and reduce my standard deviation further. Overall, however, I have a few strong recommendations for any diabetic out there.
1. Being vegetarian is likely incompatible with being a type 1 diabetic. Certainly not impossible, but very difficult because of the heavier reliance of carbohydrates. I would prefer to be vegetarian for many reasons, but limiting my diet to low carb and vegetable protein is not something I could live with.
2. Freely eating carbohydrates and relying on large doses of insulin is not great. Carbohydrates always cause some sort of spike of glucose entering the system, meaning you must rely on precisely timing insulin intake to manage the spike. An error in timing or quantity of insulin causes a harmful spike, and then lasting erratic blood sugars over the next 24 hours (a stress response). Given that I’ve lost 12lbs without trying in the past 6 months, I feel pretty confident that substantially reducing carbs would be a good idea for just about anyone.
3. Frequent blood glucose tests really are essential. Although my blood sugars are much easier to manage than before, with far fewer unexpected results, testing even once or twice more during the day might reduce a high blood sugar from a 6 hour even to 3 hours. That has a real impact on HA1C levels. Testing 5-6 times / day has dramatically increased my control even versus 4 times / day.