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/

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.

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.

This post is an extract (actually an entire copy to be honest) of an article from the About Diabetes page over to the right there. Feel free to add your comments, criticism and general bile at the bottom under the comments.

Anyway, there’s a lot of nonsense talked about what you can and can’t eat as a diabetic. This blog focuses on Type One diabetes and those lucky enough to have Type Two might find their experience differs. But probably not much.

When I was first diagnosed with Type One a few years ago, part of my crash course in diabetes was a session or two (easy there!) with a lovely dietician called Debbie.

By the way, it’s worth noting at this point that “dietician” is a protected term in the UK – much like “solicitor” or “architect”. You can’t call yourself a dietician (or a solicitor or architect) unless you are suitably qualified. However, the same is not true for the term “nutritionist” in the UK (it’s different in other countries though).

Essentially any old snake-oil merchant, quack or loony can call themselves a nutritionist in the UK. This is why pretty much anything written or sold by a “nutritionist” in the UK can almost exclusively be discounted as complete rubbish.

Anyway, that aside, Debbie and I had a lovely time and mainly chatted about my homemade Baileys ice cream and spoke about carbohydrate counting and a diet made up of foods with a low glycaemic index. I’ll talk about carb. counting in another post so ignore that for now, but the glycaemic index thing is worthy of mention as I think it’s possibly the most relevant part of the Type One diet.

Glycaemic index

As you probably know when you eat your deep fried mars bar or delicately sautéed fois gras your digestive system breaks down the foody-goo and releases its various constituent parts. Of interest to us diabetics are the carbohydrates or sugars which are released into our blood stream.

All foods are not equal in terms of the rates at which your body can process them and release them into your ruby-red blood. Essentially, and very broadly, the more pre-processed the food the less your body has to do and therefore the quicker it will be broken down and released in to your bloodstream (and so this food is said to have a high glycaemic index). The less processed it is, the longer it will take to be broken down and released (a low glycaemic index).

So why do we diabetics care about this? While it’s not entirely vital to your well-being, the theory is that low GI food makes managing your food / insulin balance easier. Rapid acting manufactured insulin, like humalog, kicks in pretty quickly – but not as quickly as your own stuff. Therefore if you iron out the peaks and troughs life will be easier.

This wonderful diagram shows the sharp Matterhorn-peak of high GI in red and the low rolling hills of low GI in blue.

There are number of GI-related books and web sites which give you the relative GI values of various foods. But a general and quite useful rule-of-thumb is the colourfulness of foods. The more colourful the better (by better I mean lower) in terms of GI. Though this rules does break down when we get into extremes of lime green and violent orange.

For example, wholemeal pasta (generally nice and brown with bits through it) is lower GI than boring, white pasta. A nice green apple is better than processed, clear apple juice.

Okay, the rule isn’t perfect – but you get the idea.

Eating every day

For the purposes of this article I’m going to assume that you too are not some sort of half-wit who doesn’t know how to boil an egg and lives off deep fried pizzas, so I won’t chat about the basics.

Because my wife and I like cooking we’ve got a load of cookbooks – both general cookbooks and those specifically for diabetics. Having cooked from both, I don’t really notice any significant difference in content between the “diabetic” books and the non-diabetic books, so there’s no point in specifically splashing out them.

Books by people like Nigel Slater or Nigella Lawson are great if you want to show off and Madhur Jaffrey is bloomin’ marvellous if you want to cook for large groups in style.

But we’re more interested in every day normal cooking and I like the following because they have quick and easy recipes for the busy young professional and you can knock ‘em up in twenty minutes or so while swilling back a glass of wine and chatting the day over with your loved one:

* Cool Eating by Louise Pickford
* Good Housekeeping – 1001 Recipes
* BBC Good Food – 101 Meals for Two
* BBC Good Food – Low Fat Feasts

Interestingly enough, as the wife and I are both control and organisation freaks, we organise our food by sitting down on a Sunday evening and working out a menu for the week ahead. This is actually quite fun. No, honestly, it is one of the less-onerous household chores.

What it does mean is that throughout the week every night you know you have something healthy and tasty in the cupboard or fridge and you won’t be tempted to pop down to the chippy for another deep-fried pizza, which can only be a good thing.

Anyway, use and abuse the comments section to tell the world about your favourite cookbooks and your slightly-anal domestic arrangements.

http://en.wikipedia.org/wiki/Nutritionist

http://en.wikipedia.org/wiki/Glycemic