Saturday, August 8, 2015

Confessions of a Guilty Diabetic Part 2

Okay I will add another, bonus confession to this one: this is not actually a new post. I wrote it at the same time as the last one, as a part of the same entry, but I thought things were getting a bit long so I split it. SO SUE ME. Okay, actually, given the way the world works these days, I feel like I should add: PLEASE DON'T SUE ME. It would be a waste of your time, anyway. My pump is the most valuable thing I own. Whoops! Another bonus confession....lucky you! I should probably just quit this intro paragraph now before I tell you my social security number. So here goes, confession number....whatever:

I don't carb count. Okay, new diabetics, don't throw away your hospital-issue "Calorie King" bible quite yet. I do carb count, in the sense that, over the past year I have strived (strove? striven?) to understand/memorize the carbs involved in most of my go-to foods and indulgences. And I do use that knowledge to help me make informed bolus decisions. But here's the thing, peeps. There is so much more to bolusing than just carbs. There's things you can see and calculate with, like IOB, and fat grams, sugar, and fiber. But there's also, EOB (my term for Exercise on Board, aka a workout you just did [metabolism running faster] or have planned), stress, fatigue, unexpected bus system crashes leaving you to walk home, etc. There is no perfect bolus. So in a way, I have given up. I'll admit it! I mostly look at my meals as sort of Large, Medium, and Small in terms of bolusing. Large being, high-fat, high carb bombs, for example a grilled cheese with tomato soup and/or french fries. Anything where you have dessert. Medium is more like, pretty high carb, moderate fat, some protein to calm things down. You've indulged but nothing crazy. Maybe a bit of pasta salad, or fruit salad, or a sandwich. Small (which is where I generally try to stay) is exactly what you'd guess. Lots of veggies, carbs mostly from legumes and/or fruit, protein-heavy and moderate fat. An example would be veggie chili and a salad or something of that nature.

But here's the thing that really helps me with any meal size, and that is pre-bolusing. Many times, I don't know exactly what I'm going to eat for lunch or dinner. But regardless of whatever ends up happening, about an hour beforehand, I use the advice I gleaned from this wonderful blog post by these wonderful people about carbohydrate absorption rates in order to do what I consider to be a pre-bolus. Most people do this about 15 minutes beforehand; however, I found that I was still experiencing considerable post-prandial spikes with that timeline. Upon googling around, I found the #DIYPS blog and it really answered a lot of my questions about that. So I set about testing pre-bolus times/amounts and recording the data and eventually settled on a routine that works for me. Yes it required a lot of eating the same meals at the same time and googledocs. But yes it was worth it. You should definitely try it if you plan on being a diabetic for a while.

So back to my not-carb-counting. Based on my earlier experiments, I give myself my standard "Hey I'm going to eat soon" pre-bolus (Note: I do not use this exact method when I'm experiencing out-of-range blood sugars) an hour or so before I eat. Then, when it's time to eat, I give myself a general bolus based on my meal size and contents. I generally call Large meals 60 grams, Medium meals 45 grams, and Small meals 30 grams. Then I eat. And that's really it.

I keep an eye on things via my Dexcom, and sometimes I need to give myself more insulin, or eat some fruit/juice/glucose tabs to keep things copacetic. But you know what? Even when I was religiously entering everything I ate into MyFitnessPal and sweating out all the details of exactly how many peanuts I was consuming, I still had to do that. I rarely got it exactly right, and now that I've relaxed, guess what? I still rarely get it exactly right.

Relaxing on my carb counting was right for me, because it allowed me to relax myself in general. Although I feel guilty admitting it, I felt way more guilty every time I blamed myself and my addition skills for falling down on the job. But you know what? You know who really fell down on the job? My pancreas. And my immune system. They're the ones who have the capacity to get this perfect. Not me.

Coming up soon: A follow up on this & how Afrezza can help/interact with this system


  1. Whatever works is the right way to do it, in my opinion. It's your pancreas' fault, and all you can do is deal with it. It's not an exact science. The stress of trying to do it "perfect" probably causes more issues than it fixes. JMHO, YMMV

  2. Whatever works is the right way to do it, in my opinion. It's your pancreas' fault, and all you can do is deal with it. It's not an exact science. The stress of trying to do it "perfect" probably causes more issues than it fixes. JMHO, YMMV