Shoot Up or Put Up

La fée verte

I was idly rummaging through my old notes, leaflets and booklets that I was given by the DSN when I was first diagnosed. I did because I wanted a) clear some space in my drawers; and b) remind myself how many bad habits I’ve picked up in the last five years.

One booklet in particular did leap out at me. And that was a useful guide produced by the Royal Infirmary which gave the carbohydrate contents of various meals one might encounter out on the high street. After flicking through it again, I was reminded that there are 83g of carbs in a McBigMac, 45g in a McMuffin and 99g in a KFC Family Bucket (whatever that might be).

However, this led me onto thinking that while somewhat useful, it doesn’t really help the posh diabetic. Those within the pancreatically-challenged masses who dine on fine food and eat in exclusive restaurants. So, dear reader, I’ve done some research and calculated the carb contents of some fabulous meals for poshos:

Pheasant & port

Like most right-minded Englishmen, I like to start each morning with a good, sturdy breakfast and like nothing better than a roasted pheasant, a large glass of port and a copy of the poems of Blake propped up against the tea pot. Sets you up for a day on the rugger pitch (in winter) or an afternoon in flannels listening to great, English sound of willow against leather (in summer). Ruddy marvelous!

Carb content: 15g (depending on amount of port)

Narwhal & absinthe

Of course, some of our readers will tend towards the more bohemian echelons of upper society; so I have included this classic dish of narwhal steak, washed down with a soupçon of la fée verte. Best enjoyed with close friends at a left-bank bacchanalian feast, you won’t even be able to even feel your legs after the first course, so taste is fairly academic.

Carb content: 22g

Ortolan

Finally, a particular favourite of mine – Ortolan. Illegal in most countries (even France, for heaven’s sake), an ortolan is a small bird which is drowned in brandy and then roasted whole. Pausing only to cover your head in a large, linen napkin (to hide your shame and gluttony from God) you consume the bird whole, biting through bones, beak and sinew. An added bonus is when said bones pierce your cheeks, mingling your own blood with the bird’s flavours. The best bit is, of course, when you bite through to the lungs and stomach, which burst and release the delicious brandy within. Best enjoyed with one of the better clarets. Yummy!

Carb content: 97g

So there you have it; please feel free to add your upper class eating favourites in the comments below. Bon appétit!

I recently discovered that if I spend long periods of time online looking at websites that contain images of carb heavy foods, my blood sugar rises. It seems that I need to take account of the carbs I’m exposed to online when calculating my insulin dosage.

Sorry, that’s complete garbage, it just sprung into my head when I wrote the title of the post and seemed a more interesting opening paragraph than “I’ve found a cool online carb counting course”.

That is what I actually wanted to say. I have found a cool (and free) e-learning course that will help you to work out how to count carbs and adjust insulin doses accordingly.  And if you’re a particularly interesting diabetic who thinks their life should include alcohol, exercise and eating out, there’s an advanced section which covers that too.

If you’ve heard peeople enthusing about DAFNE (Dose Adjusting for Normal Eating), BERTIE and various other amusingly named courses that help you to work out how to adjust your insulin according to what you eat and do, this is a very similar thing. Except it’s online rather than in a darkened room in a hospital basement.

Take a look - www.bdec-e-learning.com

Nectar of the gods!

By Samantha

The dreaded hypo’s are back. Uh-oh. Man the barricades. When I have bad hypos, I turn into something like the monster from the black lagoon, all growly, pale and nasty. And over the past week or so, I’ve been having some rather nasty ones in the vein of at least two a day whereupon my poor other half has to pour copious amounts of apple juice down my throat.

Yesterday, we decided to go shopping. And the supermarket we decided on was about a half hour walk away. Fifteen minutes down the road, I start noticing some weirdness going on with my eyes. Then the legs start shaking and the words start slurring.

“I dunt feel fery well…”

I’m trying to get my point across to my other half in the middle of a very busy street. Things are blurry and the world is spinning, and he laughs at me for a moment before making me sit on a wall and making me check my blood sugar.

“Oh dear…I think you need some sugar”

With eyes that seem to be making the world jump around and have a crazy party, I see the number on my meter. 1.6mmol/L. And silly little hypo me starts panicking and, with what must have been rather funny for any passers-by, I tip my handbag all over the pavement. My purse starts rolling away, my gloves flop uselessly on the pavement and various receipts start flying away. In my lack of sugar state, I’m trying to find myself some glucotabs. And I can’t. There is nothing in my handbag.

And then, to make matters just that tad more embarrassing. I start crying. My poor other half helps me put my things back in my handbag before helping me to my feet. Something is muttered about always making sure I have something on me, how come this time I don’t. So our next mission, should we choose to accept it, is to find me some juice. I’m muttering all the way to co-op about wanting juice.

“I want some juice. I need it. I’m soooooooooo hungrrryyyyyyyy”

It earns me yet more funny looks, but I stumble on with a grin. And then, I magically find some chocolate in my coat pocket. And it’s good chocolate, half a bar of Thorntons milk chocolate. It’s thrown in my mouth with the fervour of someone who hasn’t eaten in days. And then the hunger starts. My tummy rumbles so loud that my other half looks at me with raised eyebrows, “Hungry honey?”

I fall into Co-Op, and mutter something to the employee stood at the counter “I need juice. Where’s your juice?”

He points me in the right direction. And I see the biggest drinkable bottle of juice in history. It’s huge. And it’s shining at me, like gold. DRINK ME. DRIIINNNKKK MEEEE. So I grab it, and in the process end up knocking half of the other bottles over with a crash. But I don’t care; I rush over to the counter, drop a pound on the side and start chugging that sweet, sweet orange juice. The cashier is looking at me funny, and I grin at him.

“Diabetic” I say with a goofy grin, “Hypo diabetic. Not good. Need juice”

He just smiles and nods and I go back outside. The world is coming into focus by now; after all I’ve just polished off 500ml of orange juice. And that’s when I start feeling like a prat.

“Seriously…how much did I embarrass myself there?” I ask my other half.

He just looks at me with a grin and shrugs, no answer given. It’s probably best for him not to tell me I think, as we make our way around to the supermarket, where I still want to eat everything.

—————

Samantha is Type One and regularly blogs at http://www.talkingbloodglucose.com/

And lo! the scales fell from my eyes

During the summer last year we went round to some friends of ours for a dinner party. Yes, a dinner party – now that I have reached my thirties, I no longer have the desire to frequent sweaty nightclubs of a Saturday night, downing expensive, sticky drinks and being much, much too close to the dripping unwashed masses.

So being unrelenting and incurably middle class, I now spend Saturday nights with friends, supping fine wines and discussing the issues of the day (I say that, but this particular dinner party ended up being somewhat rowdy, with broken glasses and minor chaos – we eventually left our host in the early hours with an uncontrollable bout of booze-induced hiccups).

Anyway, I digress. I bring up the whole dinner-party thing because I noticed on that particular evening that our host had a rather fancy-pants set of scales which gave you the various nutritional values of whatever you happened to be weighing. I saw that it did carbohydrates and duly lodged this diabetic-friendly piece of information away in the recesses of my brain.

So it came to pass that when our crappy set of TESCO scales gave up the ghost (thanks TESCO – that was £12 well spent, I think not) I finally fulfilled my ambition and purchased a set of said fancy-pants scales.

As I think I’ve mentioned before, I religiously carb count. I mean religiously in that I strictly carb count about as frequently as I attend church (once on Christmas Eve and the occasional wedding). Most of the time I fly solo and make an educated guess for carb contents and insulin doses. But every once in a while I properly check and log everything for a week or so – sort of like a diabetes refresher course – to check I’m doing things well.

It’s therefore when I’m doing a periodic refresher that these scales really come into their own. Can’t be bothered to work out the carb content of your glass of breakfast orange juice? Easy – just bung the glass on the fancy scales, hit 878 (the code for orange juice), fill up with orange and hey presto! up comes the carb content for that exact amount of fruity juicy goodness. Yum!

Using the internal memory, you can quickly tot up the total carb content of your entire breakfast (which is usually, for me, a pint of heavy claret and a whole roast pheasant and trimmings) and log and inject accordingly.

So while not entirely world-shattering, my new fancy-pants scales are actually quite good with helping me to carb count. More importantly, they look really cool. So – in summary – they’re probably a worthwhile spend of £36. If you care, my Salter “Nutri-weigh Slim” electronic scale can be found on the John Lewis web site; if you don’t care, what technology-of-the-future do you use to help carb count?

Satsumas, a dangerous force

Satsumas are one of my favourite things about Christmas. I know it’s a shocker to hear that I prefer satsumas to traipsing round overcrowded shops and avoiding hysterical toddlers who’ve just had a traumatic encounter with a Type 2-in-waiting in a red coat with a bushy white beard but obviously I’m just strange.

Many moons ago when I was a child we didn’t have chocolate at Christmas, for obvious reasons. Instead we had satsumas and nuts that you crack. Any other time of the year I can happily let Tesco shell my almonds and brazils, but at Christmas I must do it myself.

This is where having diabetes at Christmas gets dangerous. If I simply bought a box of Quality Street and ate my bodyweight in sugar over Christmas life would be simple. Instead, I indulge in the perilous pleasure of satsumas and nuts.

Last night I nearly broke my poor husband’s nose whilst passing him a satsuma via the medium of a poorly aimed cricket throw. It appears that when a satsuma hits you in the face at speed it isn’t as soft as it looks. This wouldn’t happen if we just bought chocolate.

Then there are the nuts. There’s nothing nicer than a freshly cracked nut. Sadly when I do it we either end up with a hazelnut shattered into a million pieces all over the living room, or I do myself some form of mischief with the nutcrackers.

My inevitable conclusion to this deeply scientific study is that having diabetes at Christmas is a hazardous occupation for me and my family. Christmas pudding, chocolate and eggnog are inherently safer than the diabetic friendly satsumas and nuts. For the sake of my family I fear I must indulge.

Pretty sweet

For the last few days I’ve been suffering from a slightly sore back. Nothing so bad as to make me retreat to lie on a hard wooden floor or be tortured by a chiropractor; but enough to slightly annoy me.

You’ll no doubt be thrilled to discover that I soon traced the problem. Being pancreatically challenged (as you’re no doubt aware) I carry a funky man bag with me wherever I go to transport my diabetic-supplies and miscellaneous other guff I need to live on a daily basis. Needless to say, being a Good Diabetic, amongst this stuff I always have a small cache of sweets in case of an inopportune hypo.

Speaking of which, I wonder if it’s possible to get an opportune hypo? I suppose hypos could be feigned to get out of awkward situations – for example, blind dates where your expectations haven’t exactly been met; a smelly, fat guy coming to sit next to you on the bus; or arrest by angry armed thugs and countless other socially difficult circumstances. Thinking about it, I really should try it sometime.

Anyway, I’ve been pretty busy recently so every time I’ve been rushing out the house I’ve automatically picked up another handful of Fruit Pastilles and shoved them in my bag. Fortunately, my levels have been grand and I haven’t had need of everyone’s favourite hypo cure. This has had the results that I’ve now built up the world’s largest supply of Fruit Pastilles (pictured above) which I’ve consequently been lugging about for days and days and which must have caused my sore back – they do actually weigh a suprisingly large amount.

So this is yet another of the myriad hidden costs of diabetes – sore backs from carting hypo cures around. At least I don’t carry great bottles of Lucozade around like I used to; but still, I curse you God of the Pancreas! *shakes fist at heavens*

The thills and spills of formulae

In an idle moment and for a bit of fun – I use the term “fun” advisedly here – I decided to knock up a diabetes spreadsheet.

I thought it would be interesting (again the term “interesting” is relative here) to log my insulin doses, carbohydrate intake and resultant blood glucose. By comparing the carb to insulin ratio – over, say, a 14 day period – to the resulting BG target-range hit-rate, I could objectively calculate my ideal ratio at different times of day. From this data I could then create a personalised insulin calculator. I could type in the time of day, my proposed carb intake and from that calculate the correct dose of insulin to stick in – all based on the data I collected earlier.

I don’t need to tell you, it was a dull, rainy weekend.

I know that the minute I publish this, someone will say in the comments below “Ah yes, the ‘Carbotron-XP’ software can already do this for you”. However, despite that inevitability, it was an interesting exercise to work out the formulas, etc., by myself.

This was mainly because I quickly realised how insanely complex it is to note all the relevant factors and come up with objective calculations. Measuring and logging my BG, carb and insulin intake before and after meals is pretty straightforward (if incredibly, incredibly tedious) but then it gets more complex.

What if my BG is high before my breakfast banquet and I stick in a correcting dose – in addition to an amount to cover the roast pheasant and flagon of port I have each morning? If I simply divide the number of carbs by the amount of insulin I’ve put in then that screws up my carb:insulin ratio calculation, as it doesn’t take account of the correction. So corrections have to be recorded separately.

To keep things simple, I’ve also divided the day into eight separate blocks – that is before and after meals and two night-time blocks. But what if I have a mid-morning snack which I might cover with a unit or two? If that’s not recorded then, it too, will screw up my calculations. I’ve therefore had to cheat and lump my elevenses in with my breakfast. While this is probably near enough, it starts to add a margin of error into the equations.

More errors inevitably creep in as the spreadsheet doesn’t take account glycaemic index, exercise, stress, phase of the moon, tide times and everything else that affects my blood glucose.

And so, in the end, my highly objective exercise results in a rough guide to carb:insulin and requires quite a lot of finger-in-the-air guestimating to get it to work. If carefully recorded data and the massive computing power of Microsoft Excel can’t come up with a useful guide to diabetes, then it’s no wonder I manage to completely cock-up my doses from time to time. I suppose what is more interesting is that – apparently against the odds – I manage to get it right quite so often. Go me!

After a summer diet consisting pretty much exclusively of whisky and protein I now resemble the character Greed in gory chucklefest Se7en. There are now two alternatives for me – I can either be tortured to death by a particularly inventive serial killer named John Doe, or I can cut out the whisky and do a bit more exercise.

After giving it some thought, and consulting with my wife, I’m going to go for the latter option.

The main problem with this is that I’m really not much into working out. The main flaws are that it’s boring, sweaty and time-consuming. Also in Scotland it’s not very nice outside after mid-September. And exercise hurts. Oh, and did I mention it’s as boring as hell?

I’m not a team player type of person and so the chances of me joining some sort of exercise or keep-fit club are next to zero. After all, if I wanted to spend a lot of time in a small room with a bunch of sweating, hairy men I would go to a Turkish prison.

So to try and combat these problems I’ve taken the effort to clean out our garage and turn it into a sort of pseudo-gymnasium. The effort of doing this left me puffed out and sweating like stalker focusing his night-vision goggles on an unsuspecting neighbour. Anyway, it’s given me more than enough room to put my bike up on its roller-wheel thing and I’ve set up an old set of speakers so I can connect up my MP3 player to provide phat choons (as I believe the young people of today call the Hit Parade).

So that takes care of the legs, but what about the top-half? After a considerable amount of research on the Intermaweb (about three minutes in reality) I came across “Shovelglove – the Sledgehammer Workout“.

Essentially the Shovelglove exercise regime consists of making “useful” movements with a bloody great sledgehammer. These useful movements consist of things like churning butter, chopping a tree down or driving in fence posts. As the author points out these movements are silly; but no sillier than, say, riding a non-moving bike or climbing a set of imaginary stairs in a gym.

I also quite like the concept of doing only 14 minutes of the regime at a time. The reason for this is that no calendar, such as Outlook, has an appointment period of less than 15 minutes – therefore at 14 minutes the session is the equivalent of no time at all.

The most important thing, however, seems to be the naming of your sledgehammer. After a quick look on godchecker.com and I had settled on “Magni the Mighty“. Rrrraaaagh! Prepare yourselves for the new slimline Timmy!

Do I really believe that?

When I was a child my mother used to carry an uncooked baking potato in her handbag. She knew that potato contained 30g of carbs. When my meal arrived in the restaurant she’d get the raw potato out of her bag and compare it with the one on my plate. Ta-da, a very early version of carb guestimating technology.

Now, I will admit that it isn’t practical to carry in your bag a ready weighed version of all the food you intend to eat. I’m the woman who whinges about the amount of diabetes junk I have to take on holiday, a life size specimen of all foods I may encounter certainly isn’t going in my hand luggage.

Over the years lots of people (ok, more than 10, less than 100) have said to me that we should campaign for all restaurants to publish carb counts of their food. Sounds sensible.

However, I’m a big fan of self sufficiency. I don’t want to be dependent on someone else publishing carb counts when I go out. Surely it’s better to learn the skill of guestimating carbs with the help of a good book and some trial and error rather than rely slavishly on companies to publish the data? That way, you can go anywhere.

I’ve already recounted the Chinese dumpling banquet debacle. A label on each dumpling wouldn’t have helped, there’s no way I would have believed they contained so many carbs and I wouldn’t have been brave enough to put in the full bucket of insulin required.

McDonalds do publish carb counts and if I inject according to their carb count I’m on the floor within 2 hours begging for sugar. I’m sure it’s factually correct; it’s just that the fat content is so high it slows the absorption of the carbs. It doesn’t tell you that on the box.

I’m all for a bit of help to make life easier. However, I also like to pick my battles. Getting CGMS funded by the NHS? I’ll fight til I drop. Getting insulin pen needles on prescription when the Govt refused in the early 1990’s? Done it. Campaigning to ensure that all people with diabetes have access to decent patient education and support? Oh yes. Pushing water up hill to get all restaurants to publish carb counts? Nice to have but if I put my efforts into getting decent education and support for people with diabetes, this one almost becomes an irrelevance.

We’re back from our long weekend in Venice, it was all the things they tell you in the guide books – romantic, beautiful, lots of bridges, water, gondolas etc and one thing they don’t tell you – carb heavy.

I’ve thought for years that as well as eating low GI foods reducing the number of carbs I eat gives me better control. When I got my CGMS the data showed that I had much better readings when I ate fewer carbs. This is of course logical, if you’re trying to cope with a massive plate of pasta the margin for error in insulin dosing is far greater than if you’re eating a small green salad. This isn’t rocket science.

I do keep an eye on how many carbs I eat and reduce them wherever I can and overall I do ok. But it’s not easy. I like food that contains carbs. And I now think it is physically impossible to have a low carb weekend in Italy – all that fresh pasta, risotto, pizza, ice cream, tiramisu (yes I know they do delicious grilled fish and marvellous salads and I tried, believe me, but they really do specialise in scrumptious carbs!).

I find pizza in the UK to be the root of all diabetes evil so I rarely eat it. Its high carb and also high fat so it’s absorbed quite slowly into my system. I need buckets of insulin to deal with the carbs but not straight away because the fat slows down how quickly those carbs get in. Since I’ve got the pump, I’ve mastered the dual wave bolus which allows me to put some insulin in at the start of the meal and stagger the rest of it over the next few hours. Bingo, pizza without the immediate low or hours later high.

Thankfully proper Italian pizzas have an incredibly thin base so middle of the night highs following pizza for dinner weren’t a problem last weekend. The first one did catch me out though after I was a bit gung ho with the insulin guessing and it appears I needed half a bucket less than I’d thought. And that brings me to the final great thing about Italy – there’s a very tasty ice cream stall on every corner just waiting to help you deal with that low.