Type 1 Diabetes and my Feelings about Food

I absolutely love food.  I know everyone says they love food but it really is an interest/hobby of mine.  Going to a restaurant I’ve never tried before excites me; I love the challenge of testing out a new recipe; my holiday itineraries are based around places I want to eat; in book shops I love to browse through the cookbook section; baking a cake or a loaf of bread is a relaxing way to spend an afternoon for me and my favourite TV shows include Masterchef and GBBO.  I’m obsessed.

However, when you have type 1 diabetes, there are more things to consider than which takeaway to try out on a Saturday night or how much your dough has risen…
You need to think about exactly how many grams of carbohydrate are in what you are eating to calculate a precise amount of insulin to give yourself, to avoid high or low blood sugars.  But aside from the carb content itself, you also need to think about protein levels if you’re having little or no carbs, fat content which can make blood glucose rise more slowly; whether carbs are simple or complex or the glycemic index.  When you start to think about all these factors, it can take the enjoyment out of food and make it feel quite stressful.

I’m an all or nothing kinda gal, as in the type who goes to the gym every second day for a fortnight then I have to miss one class for an appointment or something, and I don’t go back for 3 months… Stupid, I know.  This is an attitude I really need to work on changing, any suggestions welcome!  But this means I’ll spend about a week putting 110% effort into my carb counting and insulin ratios, weighing out all my food, keeping a food diary, reviewing my blood sugars and trying to spot patterns and make adjustments.  This approach works (to a degree, at least – there will always be outlying factors e.g. stress caused by a traffic jam; unplanned exercise in the form of having to lug boxes up and down the stairs at work; or sweating on a hot day) but it’s exhausting and takes a lot of time and mental effort.  Then, when I get thrown off by a busy day in work or a birthday night out, or if I get discouraged by some unexpected highs or hypos, I give up.  I take it so personally, consider myself a failure and ditch the diary.
When I give up, I feel as though I can really enjoy my food again, not put too much thought into the nutritional make up of it and still take an injection that roughly covers the carbs at a glance and a guess.  However, this comes at a price.  The price is guilt and regret.  After every meal or snack, I feel that horrible knot in my stomach.  This does not help my anxiety and in a different, more indirect way, it takes the enjoyment away from eating, just as the intensive carb counting is.

The other thing I have little self control with, and therefore more guilt, is grazing.  I like to snack between meals.  I feel peckish when I get in from work and like to have a packet of crisps or a banana at 4, followed by a meal at 6 and then a cup of tea with some chocolate at 9.  If someone has brought a packet of sweets into work, I can’t see them lying on the desk without picking up a few.  When controlling blood sugar with insulin based on carb counting, you should really have 3-4 hours between food.  This constant grazing makes it very difficult to get a true blood sugar reading and means that your blood sugar will never properly settle between food, making it difficult to see if a correction dose is needed or not.  With this comes more food related guilt.

It is important to say that I have never had an eating disorder, or considered my diabetes monitoring, carb counting or eating practices to be unhealthily obsessive.  However, it is easy to see how people with diabetes commonly develop eating disorders, and how it is difficult to overcome this and still look after their diabetes in recovery from an eating disorder- particularly when insulin can also make you gain weight.  There are very little stats on how common eating disorders are in PWD but it is very serious due to the fact it can lead to complications such as blindness, kidney failure and neuropathy.

So how do we create a healthy balance?  A balance of monitoring blood sugars regularly, counting the carbohydrates we eat, as well as considering other contributing factors but also not letting this take over our lives, or beating ourselves up over one ‘bad’ blood sugar reading or one meal where we’ve taken a wild guess at the carb content?
My honest answer is, I don’t know, as I haven’t found that balance yet.  At the moment, I am trying to remember that, as Kerri Sparling says, in her book Balancing Diabetes, “life with diabetes is not a perfect science and perfect diabetes isn’t an achievable goal”.  As long as I’m testing my blood sugar when I should, I’m doing a good job and the sooner I realise no one is ‘perfect’, the sooner I’ll be able to cope with my day to day life.  I’m trying to use each blood sugar as information like Kerri suggests, information to work on and lead to a healthier me.  I hope that over time, I can learn to stop attaching emotions to my blood sugar readings and that with this I will find more peace around food, and less anxiety in general.  I feel I could go on and on here, but maybe emotions in relation to blood sugar readings, is one for a future blog post… 🙂

Burnout?

I haven’t written on here in 8 months!  And that pretty much sums up my diabetes attitude at the moment.  To be perfectly honest I haven’t really been testing enough or counting carbs at all.  I guess I’m sort of winging it.  I know I need to do something about it but have no motivation at all at the moment.  It’s sort of like eating healthily and exercising, except it’s to keep you alive.  You go through phases where you’re really motivated but then a few weeks or months later, you don’t see many results, you slip up, you don’t feel the motivation anymore, etc.

My aim over the next week is simply to test 4 times a day.

Short and boring post today but I’m going to get back into it!

Catchya

New clinic, new me?

Yesterday I went to my new clinic for the first time. I recently moved from the city centre to Partick and so, when I went to my new doctor’s surgery, the GP said I could move my diabetes care from Stobhill to Gartnavel and I jumped at the chance.
There was nothing bad about my old clinic, but they had so many doctors that it was common to have a different endo every time. This meant a feeling of starting again on every visit. My HbA1c has been too high for years – almost as long as I can remember, definitely since around 4th year of high school – and so I need support from the clinic but with each doctor comes a different approach. I also didn’t like the fact that none of them knew me, even if I had seen them before.
My second problem with it was that if I phoned to change an appointment, I wouldn’t get another for months.
Thirdly, I always had to wait for hourssssss. No exaggeration – it was at least a half day event.
Fourth, and finally, it’s a bit of a trek.

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So yesterday, I left the flat with a positive attitude and followed Google Maps on a nice wee walk to Gartnavel. Thankfully, I arrived quite early as I was in 3 different hospital buildings before finding the diabetes centre. Although I arrived feeling positive, diabetes waiting rooms can be quite a bleak place. This is probably not everyone’s experience, but I often feel like most of the patients look really ill and immobile which can be pretty soul destroying, as if it’s a glimpse into the future.
I got my weight and blood pressure checked (all fine) then got my bloods done before returning to the waiting room. A 20/30 minute wait later (much better than before!) I met my new endo, Dr Small. And what can I say? Great name, great doctor. My referral to him simply said, “Donna has moved address, please look after her.” which seemed to annoy him but for me it was a lovely clean slate. He asked about my job, uni etc and then a bit about my diabetes.

Your HbA1c represents your average blood sugars and a high result, aside from making you feel ill, exhausted etc on the short term, is what leads to long term complications associated with diabetes – kidney failure, loss of eye sight, neuropathy, loss of limbs etc. My HbA1c was 10.5% which is about 90 in the new measurement OR an average blood sugar of 14mmol. A person without diabetes’ HbA1c should be 4-5.9%. A person with diabetes should aim for around 6.5-7.5%. This was up since my last clinic but came as no surprise.

As he discussed the reasons behind this, how I controlled my BGs (blood glucose) and what approach I wanted to take, I struggled to hold back the tears. He said something that really rung true with me… He said that because he was a diabetes specialist with years of experience and more knowledge than most about diabetes, insulin, carbohydrates etc., that he could carb count excellently, figure out his dosage and insulin ratios perfectly and achieve perfect blood sugar (so he thinks, maybe not QUITE true since there are so so so many variables). But then he said that he could only do this for about 4 days before he got too frustrated with it. 🙌🙌🙌🙌 YESSS DR SMALL – nailed it! It’s so emotionally and mentally draining. That’s what’s truly the hardest part.

So next steps… He asked if I’d been on a DAFNE course (dose adjustment for normal eating) and I explained how I really wanted to do it but had been on the waiting list for years. He introduced me to a diabetes nurse and assigned me a dietician. I was then told I could go on course called DICE instead (diabetes – insulin and carbohydrate education). DAFNE is a 5 day course whereas DICE is two days. I am now signed up to a place on the DICE course in February!! Amazing, after being on a DAFNE waiting list for years!

My main step is strict carb counting using one of these…

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I’m weighing everything, recording it all in the diary, figuring out carbs with the use of My Fitness Pal, calculating correction doses, then testing two hours later to check if my insulin:carb ratios and correction units were correct. This will take a lot of analysing, effort and commitment but I’m feeling ready! Let’s do this!!

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