Blogger Round Table Session 8: The Holidays

Moderated by Allison Blass

The holidays are filled with fun, food and family and friends – but they’re also filled with carbohydrate-laden dinners, sugary cookies, cakes and pies, long days of travel and unpredictable blood sugars. Luckily, new technology is helping to make holiday festivities a little bit easier. Our blogger round table shares some of their tips and tricks for handling the crazy holiday season.

Do you notice a major change in your blood sugars during the holidays? What do you think affects it the most (the food, the travel, the change in schedule) and how do you cope with it?

Scott J: Yes, I do run higher during the holidays. It is all about the food, the quantity of the food, and the often unknown carb values of the foods. I cope with it by just doing the best I can, testing and correcting often. I’m a little hesitant to pull the trigger on a huge bolus to counter the high carb intake because there are so many unknown variables (Will I like what I’m taking? Will it digest slower than I think it will?).

Kerri: On the holidays, my husband and I travel home to Rhode Island (where we’re from) and we stay with family and friends. Something about not having a reliable schedule (sleeping, eating, etc.) and the trouble getting a solid workout in makes my numbers tumble all over the place. During the holidays, I’m quick to test my blood sugar and I try to eat throughout the day, instead of just dining at the “big holiday meal.” A protein bar in the morning goes a long way, even if I slept until noon.

Amy: Definitely, it’s the food. I indulge in more carbs than usual, no doubt about it. I call myself “the correction queen” at this time of year, since I just have to keep “chasing the highs” by adding more insulin to the mix.

Bernard: Yes. My blood sugar tends to be higher during major holidays (Thanksgiving and Christmas), I also see post prandial highs that take longer to come down. Those carbs are a constant temptation for me, so I try to avoid them where possible. I also find that the later nights with family and friends mean that I don’t always have as much energy for exercising, which makes the problem worse. If there’s snow on the ground, that improves things because pulling sleds around or throwing snowballs can really drive down my blood sugars. I wear an insulin pump and can sometimes deal with the meals by using a super bolus technique that moves some of my basal insulin forward in time. Otherwise, eating salads and fattier foods before carbohydrates means that I’m less likely to eat those wonderful carbs.

What are some of your tips and tricks for handling the notoriously big meals during the holidays?

Scott J: Enjoy it!!! Really–I let the reins out a bit more than usual during the holidays. It is hard to find the balance between enjoying the holidays and satisfactory diabetes management. I’ll be the first to tell you I often err on the side of enjoying the holidays!

Kerri: I lean heavily on technology when it comes to those big meals. I test pretty often and I use my insulin pump to administer boluses throughout the day–anything to keep me from hitting those +200 mg/dL numbers that I have so much trouble coming down from. Unfortunately, this proactive method sometimes leaves my numbers in the trenches, bringing about some serious low blood sugars. This year was different–I had my Dexcom handy for this holiday and I was able to manage numbers more precisely. I was able to bolus more conservatively because I had advance warning of a creeping high. All this technology was a lot to physically juggle, but it made things easier on the diabetes front.

Sandra: One thing we find really helpful is running a higher basal rate. During a big holiday meal, there’s not much moving around–unless you count getting up for seconds. So it’s never a surprise that Joseph tends to be a lot less insulin sensitive during these events. If we kick up his basal rate 20 to 30 percent we’ll often avoid (or lessen the severity of) some of those highs. Also, we give more insulin per carb than we normally would, because most holiday meals are not just bigger, but richer and higher in fat than what we typically eat. Again, we need to compensate for that difference.

Scott S: Maybe I’m unusual, but I tend to stop eating when I’m full, so it really doesn’t matter whether the meal is bigger than usual because I just can’t eat anymore! Besides, for me, the holidays have never been about the food (I guess when you grow up with diabetes since you’re only a few years old and also have a sister with type 1, that helps!), but getting together with friends and/or family.

When people bring in cookies, candy and other treats to work or school, what’s your tactic?

Kerri: I do my best to avoid grazing, so if there are treats available and I want to indulge, I take that piece of candy or slice of pie and then move away from the rest of the dessert. That way, once I’ve had my fix, I’m not as tempted to go back for another handful. I also work for a diabetes company, so people are less apt to pull the whole “Go on, have a slice,” routine. Will power is tough sometimes, with all those tasty options, but saying no gets easier every time. Chewing gum helps, too.

Sandra: Moderation. That means one cookie (especially when they’re super big), not six. I won’t lie, though, there have been times when Joseph interpreted the “one” cookie to mean “one of each.”

Amy: Look the other way! Really, I’m not kidding. It sort of *helps* that I am allergic to wheat; I can’t eat most of this stuff anyway without breaking out in hellish hives. But if it’s chocolate or something I could eat, then I really try to make sure that the dish or bowl is out of sight for me most of the day.

Bernard: Generally these are left in the kitchen at the office, so I try not to go there especially at holidays. If that doesn’t work I limit what I take to a smaller amount of carbs. Sometimes I use the stairwells or fast walking between buildings to get in some quick exercise.

What do you say when a friend or family member starts acting like the Diabetes Police?

Sandra: I tell them that Joseph can indeed eat sugar (which is usually what the “Diabetes Cop” takes issue with). A conversation about the differences between type 1 and type 2 diabetes usually follows.

Scott S: Truthfully, none of my family or friends act as the Diabetes Police (they know better!), so it’s usually only an issue for individuals (co-workers, and more casual acquaintances) who feel entitled to share their unsolicited (and usually factually inaccurate) advice on how I should be taking care of myself. Usually, their comments revolve around food, in which case I will often say something like, “Actually, I HAVE to eat this now; I’m having a hypo,” which promptly shuts people up, but sometimes it’s a hassle to even respond!

Amy: It doesn’t happen to me often, but I’ll admit, sometimes I lose my patience. If you’re in the right mood, you can educate people about carb-counting and insulin dosing. If you’re not, you’re better off just saying, “I’m pretty good at managing my diabetes. I’ve got it covered–thanks!”

Bernard: Up to this year I’ve just ignored remarks about what I’m eating or whether my blood sugar levels are OK. Recently I’ve started giving people copies of the diabetes etiquette handout and trying to explain why they don’t need to watch over me so much.

Do you have a favorite recipe or traditional item that you always keep on your plate, no matter what?

Scott J: I’m all about any sort of cheesy potatoes. It’s a side item that is almost always present, and I love them! That’s all about the enjoyment again, rather than for diabetes management reasons.

Scott S: For me, the key has always been moderation in serving sizes rather than skipping items altogether, so I seldom skip any particular foods (unless I don’t like them–cranberries are one food I’m not crazy about so I have no problem skipping them altogether), just limit the portion size. One trick is to use a teaspoon rather than a traditional sized serving spoon (especially for items like stuffing and potatoes!). Plus, the added benefit is that I don’t have to deny myself anything, and I also don’t leave the table feeling quite so stuffed!

Amy: This year I tried a no-crust pumpkin pie made with Splenda. I ate it with Light Cool Whip and it was wonderful! It gave me the great taste and sensation of indulging in goodies, but was still pretty carb-safe. This was much better than having to say “no, thank you” to ALL the fun treats.

The holiday season is all about being thankful for what we have and looking forward to a new year, so what are some things you’re grateful for this year?

Scott J: I am very grateful for all of the wonderful tools we have compared to years past. I feel like we are on the cusp of some really big things changing for how diabetes is managed (CGMs and insurance coverage for example), and am excited to be a part of it. Our treatment is still very primitive relative to how the non-diabetic body works, and that frustrates me. But things are slowly changing for us, and that excites me.

Kerri: It’s been a remarkable year: I’m thankful to be celebrating my first holiday season as a loving wife. I’m thankful for my growing group of good friends. I’m thankful for the love and support of my wonderful family. I’m thankful for my job and my awesome coworkers. I’m thankful for my health. And I’m thankful for the diabetes community and everything I learn from you all, every day. It’s quite a crew, and one that has made such a difference in my life. So thank YOU.

Sandra: I’m thankful for my family and friends, our good health and happiness, and as always, for the many people working hard to find a cure for diabetes.

Scott S: Many people say they’re thankful for new technology or researchers, and while I certainly appreciate the efforts being made, I cannot honestly say any of these things have vastly improved my life with diabetes since I was diagnosed at age 7 in 1976; rather the improvements have been incremental at best. However, the one element that I think I’m most thankful for is people with a sense of humor! Living with a chronic disease is demanding, and people who bring humor to the situation make it much more bearable!

Amy: As noted on my blog, I am very thankful for MANY things, in particular: three healthy children and a partner I adore, extended family, good friends, a pretty comfortable life, a job that I love, relative good health, even with a chronic illness, and a whole lot of wonderful people online to share it with.

Bernard: I’m grateful for the insulin pump and continuous glucose monitor that help me better control my blood sugars. I’m extremely thankful for health insurance that covers much of the costs for my diabetes equipment and supplies. I’m especially thankful for my d-friends in communities like TuDiabetes.com and in many, many blogs for the advice and insight that they’ve given me. I’m also happy that I’ve only had two bad lows this year.