Blogger Round Table Session 4: All About Food

Moderated by Allison Blass

For some people with diabetes, food is a necessary evil. We need it to survive, but it is also one of the more unpredictable and confusing aspects of our management. Between balancing carbs with fat and protein, each meal can seem like a hurdle. With a bit of education and a whole lot of trial and error, our team of bloggers has developed some coping strategies for enjoying their food without sacrificing their health. Luckily, basic tenets of healthy eating benefit both people with and without diabetes, so applying these suggestions to your family’s meal plan can only lead to a healthier lifestyle for everyone.

What’s your food philosophy?

Kerri: My food philosophy is that a lower-carbohydrate, higher-protein diet is what works best to keep my blood sugars under control. I believe that eating healthy and taking the right amount of insulin to cover what I’m consuming is the key to getting a grip on my numbers. But aside from the insulin factor, my husband and I share a very similar diet, eating low-carb, high-protein, and plenty of vegetables. Our collective philosophy is that eating healthy is good for everyone, not just people with diabetes.

Allie: I don’t have a “diet” per se. I try to eat as natural as possible–vegetables, protein fruits, nuts, and grains in the most unrefined form. Processed foods, as tempting as they are, don’t really fit in with my goals. Even the things I used to crave, like sweets, don’t tempt me like they once did–funny how a big old red delicious can win your attention over a decadent brownie. I’ll keep telling myself that, anyway.

Bernard: In the last two years I’ve been eating more salads–at least once, and mostly twice, a day. I eat them before the rest of my meal which gives some time for insulin to kick into action. It also fills me up a bit so I tend to eat less carbs. I’ve been indulging in more fats and trying, desperately, to reduce my general carb cravings.

Scott J: My philosophy about food in relation to my diabetes is that it is the main source of trouble with my personal diabetes management. If I could avoid food altogether I would have stellar blood sugars almost all the time; unfortunately, that is impossible to do. I feel more than a little ignorant about nutrition, and am downright intimidated by the thought of digging in to learn more about it. I think I have some “food issues” that go much deeper than just diabetes management, though I feel that living with diabetes has contributed negatively to those issues. I love carbs and don’t eat meat, which feels like cruel punishment for someone living with type 1 diabetes.

Sandra: Our philosophy is simple: balance and moderation. Unfortunately, because our son is an active, rapidly growing adolescent, that philosophy doesn’t always translate into our reality (especially the moderation part).

Is there anything in particular you avoid? Why do you choose to skip that?

Scott J: Cold cereal makes my blood sugar spike higher and faster than anything I have ever experienced. While I may use that to my (temporary) advantage when treating a low blood sugar, I try to stay away from it other times. It is hard because I do enjoy it.

Scott S: The one food I usually avoid is corn. It’s always hard to measure the carb content, and I don’t really like the taste anyway; plus I was totally freaked out after seeing Ian Cheney and Curt Ellis’ documentary “King Corn”.

Kerri: Back in the days of NPH and regular insulin, I avoided foods like pasta sauce, pizza, and high-sugar items because insulin just couldn’t keep up with those kinds of carb demands. The absorptions and peaks of those insulins weren’t as predictable as today’s Humalog and Novolog, so my diet was more scheduled and strict than it is now. Today, using my insulin pump and a cartridge of Humalog insulin, I’m able to better-manage those “forbidden foods.”

Sandra: In general, we try to stay away from things like juice, popsicles, hard candy–anything that will hit his system so fast that whatever insulin he takes won’t have an effect until long after his blood sugar spikes. Of course, when he’s low, these things are ideal. Also, we try to avoid giving him Indian food for dinner–no matter what we do, it always sends his blood sugar sky high overnight.

Amy: I avoid high-carb dishes that spike your blood sugar: pizza, pasta, fruit and fruit juices, all kinds of baked goods, sweets and candies, etc. Anything that tops the charts on the Glycemic Index. If it’s a starch or sugar bomb, I pretty much consider it off-limits.

How often do you see a nutritionist?

Scott J: Probably five or six times in my entire life. I had a real promising relationship going with an awesome nutritionist, but experienced some nightmarish insurance issues that made it a lot of work to deal with. Because I struggle with food issues anyway, those insurance and payment issues were enough to make me abandon it (for now). Many nutritionists that I have seen in the past were not willing to work around my unusual eating habits, and made me feel bad about the way I eat.

Allie: A what?

Scott S: I saw a nutritionist when I wore an insulin pump, but frankly, nutritional science is not a rapidly-advancing subject, so I did not find tremendous value after I had learned the basics. It’s been about four years since I actually had a nutritionist appointment. I might reconsider if I were pursuing intensive sports activities, but most nutritionists are trained mainly on issues pertaining to type 2 diabetes and not specifically on sports-related matters, so people looking to pursue that should choose their nutritionists carefully.

Kerri: The last time I saw a nutritionist was at the Joslin Clinic four years ago, when I started pumping. But I have consulted with several nutritionists online, worked with many through dLife, and have also married a personal trainer, so I’ve had access to experts when questions arose. I’ll be seeing a nutritionist this August at Joslin, as I prepare for the pregnancy clinic.

Gina: I see my nutritionist at least once a year and talk to her at least once a month. She helps make great suggestions for food intake for meals and also for working out. Finding a good snack to help prevent lows has been a challenge though.

When you eat out, how do you figure out how many carbohydrates you’re eating?

Allie: That’s a hindsight moment. I take my shots in the a.m. and the p.m. as basal coverage. When I go out to eat, I’ll “flex” the dose according to food choice.

Scott S: Scientific, wild, crazy guess combined with a lot of after-meal testing!

Manny: I try to go for high-protein foods (chicken, fish, meat) and salads. Even then, I make mistakes figuring out carbs at times.

Kerri: I don’t generally eat a lot of carbs when I’m dining out, but if I’m going for broke and diving into a bowl of pasta, I try to picture the portion sizes in my head. dLife has a good resource online, talking about how size matters. Sometimes, when I’m cooking at home, I measure my food and take careful note of the serving size visual, which helps me when I’m out at a restaurant.

Sandra: Typically, we eyeball the meal for portion size, then consult “The Calorie King” (our carb-counting bible) and our logbook. If Joseph has eaten the meal before, we can see how much insulin he took for it, and how both food and insulin impacted his blood sugar.

Bernard: I estimate usually based on comparing what I’m eating to a slice of bread, since I know that’s 15g. I’m fairly sure I underestimate much of the time. But again I’ve moved to eating more vegetables and protein when I’m out and avoiding carbs.

Many people talk about “diabetic” foods like Glucerna bars or sugar-free candy or diet soda. Do you incorporate any of this into your diet? Why or why not?

Scott J: I do often use a Glucerna “Glucose Control” drink before I play basketball. Most of the time it helps me stay nice and steady when playing ball.

Manny: I LOVE Boost Glucose Control. I don’t drink it regularly because it can be expensive, but once in a while I pick up a package in the supermarket. I also like The Zone protein bars for snacks.

Kerri: I don’t generally incorporate many of the “diabetic” foods into my diet. I believe that making things “low-carb” and “low-fat” removes the carbs and fat but replaces them with chemical substances. I’d rather make more educated organic choices, if possible. I do use sugar substitutes (i.e., Splenda, Equal, Stevia, ZSweet), but I try to use them in moderation and I opt for the organic ones when I can.

Sandra: Actually, Joseph eats very few of these kinds of foods. We’re not big soda drinkers, never have been. Soda has always been something the kids might have at a party or as a treat if we’re out at a restaurant. In those instances, yes, Joseph has diet soda. As far as so-called “diabetic” candy and foods–with the exception of sugarless gum, he doesn’t eat these at all. We’ve heard too many horror stories about food additives that have been FDA approved, only to discover years later that they cause problems–sometimes devastating problems.

Bernard: No. I found that diet soda caused me to drink more of it and I was concerned about the long term effects of that much chemical sweetener. I’ve moved to water. I avoid sugar-free candies because they still have a lot of carbs and the laxative effects of the sugar alcohols are horrible.

What are your favorite snack foods or desserts?

Amy: Ugh, a pain point for us all, I’m sure. My “favorite” snack foods are fruit and tortilla chips, but I try not to eat those anymore. Now I eat veggies with dip and small portions of meat for snacks. Oh joy.

Manny: For snacks, I like protein bars, nuts, string cheese. For desserts, I LOVE smoothies: We typically prepare them with protein in them. I can fix a mean smoothie! Here is my “secret” recipe:

Kerri: I am ridiculously snacky, often found munching on fresh green beans, apples, almonds, walnuts, cheese sticks, and Greek yogurt. For dessert? Sugar-free Jell-O, angel food cake, or berries with cool whip. But sometimes a cup of coffee is a good stand-in for a dessert.

Bernard: Cookies, puddings–Jell-O is doing great sugar-free puddings that I can make in less than 10 minutes–and fresh fruit, especially blueberries or strawberries.

Allie: A half-pint of blueberries or a golden delicious apple satisfy the sweet tooth; or almonds or cashews if it’s a buttery craving.

Gina: I love anything with milk chocolate, cheese cake, and my favorite snack has to be noshing on almonds.

What’s your strategy for dealing with foods like pasta and pizza?

Scott J: Extended or Combination boluses. With my pump I am able to take some insulin immediately and then “stretch” some out over a period of time. I find that both of those help me avoid an after-meal low and later a high.

Allie: I’m afraid there’s not much of a strategy for overcoming those “necessary evils” of life. When your body calls for pizza or pasta, sometimes the only choice is to answer. Keep a watch on the aftermath for the next few hours and “duck and cover.”

Kerri: I eat high-carb foods like pasta and pizza on Saturdays (a strategy used by my husband and one that I follow). This helps me keep my carb indulgences to a minimum, knowing that I can satisfy my cravings on the weekend. And when I do find my face in a bowl of pasta (yum), I make use of the square-wave bolus on my Minimed pump.

Sandra: First, we take one big ol’ deep breath. Next, we decide when Joseph should bolus (i.e., if his blood sugar is falling rapidly, we’ll have him eat before taking insulin). We then determine the amount of his bolus, often changing his insulin-to-carb ratio from the usual 1:15 to 1:14 or 1:13–this is essential with pizza, as the higher fat content makes him less insulin-sensitive. And finally, we’ll give either 50 or 60 percent of his insulin up front, while extending the remainder of his bolus over four hours–since both pasta and pizza tend to cause a late hit hours after eating.

What do you find frustrating about food and what are your strategies for coping with it?

Scott J: Food is by far the most frustrating part of my life. I do think it goes beyond diabetes and branches into other psychological food issues. I’ve wondered if being diabetic, with food being interwoven into our every thought, plays a large role in the source of those issues? I’ve yet to find a successful method for dealing with it, and struggle with it almost all the time.

Scott S: The biggest pain is dining out because other than junk-food chains like McDonalds, most better restaurants seldom disclose the nutritional content of their dishes–or even the size of their dishes. My philosophy is to try and leave some portion of the dish behind, as they always give you too much anyway.

Manny: The most frustrating part about foods is when you are surprised with meals that contain sugar in them when they don’t need to. This can be pretty scary, because you can be in front of a dish that supposedly is only (or mainly) protein and perhaps some fat, and you get thrown a curve ball with sugars and carbs in it that make no sense and make life unnecessarily more complicated for those of us with diabetes.

Kerri: The most frustrating thing about food is that certain foods affect me one way on one day, then completely differently on another. It’s downright maddening. But it helps to have the management tools (i.e. glucose meter, fast-acting carbs, or insulin, and a CGM) to deal with these moments. It also helps to have friends and family who “get it.” And when all else fails, it’s good to just let out a nice, loud “AARGH!”

Sandra: Two things. First and foremost, helping our son make good food choices. Joseph often wants to eat the same kinds of foods his 12-year-old peers enjoy–burgers, fries, hot dogs, chips, cookies, and candy. And for the most part, we let him have all of the above–in moderation, and with some limits (i.e., if his blood sugar is 300, he’s not gonna have that double cheeseburger with fries or that piece of cake). Why let him eat this “junk” at all? Because by letting him have this stuff now, we’re teaching our son how to bolus for the kind of food he’d likely eat anyway when he becomes an older teen–food he might later eat with tremendous guilt (and with no idea how to cover with insulin) if we were to withhold it from him now. Bear in mind the second part of our coping strategy: We provide him with plenty of whole grains, vegetables, fruits, meals prepared with herbs and spices–thus exposing him to (and helping him cultivate a taste for) a variety of interesting, healthy food choices.

Our other food frustration is just figuring out how to bolus for the type–and sheer volume–of food consumed by a pre-teen boy. How do we deal with this? By recording everything–food, carbs, activity level, insulin doses, and blood sugars (and graphing those blood sugars) in a checkbook-sized logbook called the Smart Chart. I’m not sure how we’d manage if we didn’t have this historical information telling us what worked and what didn’t.

Gina: I think the most frustrating part of eating is bolusing for the same exact food every day, but the numbers a couple of hours later are never the same. I used to freak out about it but, I have learned that it’s just a number and highs and lows happen. You have to correct it and move on.