Peanut Butter

I don't know who I dislike more at the moment - Mr. Diabetes or Mr. Pregnancy. Those two (grumble, grumble, grumble) have a sick, sick, sick sense of humor and while you'd think that they'd be sworn enemies, oh no! THEY have to get together and play the not-so-funny-haha game of jokey-joke on me...

So get this: one of my favorite foods of all time has always been peanut butter. The smooth kind, none of that chunky boohockey.  I've grown up with it on everything - pb&j, pb and honey, pb and banana (thank you Elvis) and even pb on an otherwise classic blt.  Last week even, while waiting for HB's waffle breakfast to be ready I grabbed a spoon and the jar (okay fine, I have three jars in the pantry) of Skippy from the shelf.  He looks at me and asks what I'm going to put the pb on and I think my eyes must have doubled in size and my jaw must have hit the floor because, really, what kind of question is that?! 

Um... the spoon.  Hello.

Despite my efforts to convert him otherwise, HB is one of those on the fence kind of people who likes peanut butter as a sandwich option on a regular, but disbursed kind of basis.  You know, a freelance peanut butter-er, a non-connoisseur.  After three years of marriage you'd think I'd have made more progress, but alas he still asks the "cooking" questions with the obvious answers.  Maybe he'll get it next year?

Now I'm sure there are those of you out there that think that is crazy (don't knock the pb-blt until you've tried it!) or that peanut butter is "icky," but to you all I have to say is THANK GOD, MORE FOR ME.  If you don't grab the last jar from the shelf at the grocery store then I have a shot of getting it - and by God, I'm not going to let go of that sucker!!

Well... now that I've firmly established that I'm a bit of a freak when it comes to spreadable nut-paste, enter the excessively disturbing, horrifically mean world of diabetes and pregnancy:

So Mr. Diabetes and Mr. Pregnancy walk into the kitchen and take a seat at the breakfast bar.  They look around for the house head chef (aka ME) and, knowing the coast is clear, begin their clandestine rendezvous:

Mr. Pregnancy looks at Mr. Diabetes and says, "so, uh, you got the intel I asked for?"

Mr. Diabetes: "Yeah, I got it.  It's good stuff too... but if I'm gonna do this, I need more than basic tactical support to make it worth my while..."

Looking strategically ambivalent Mr. Pregnancy responds: "So what's the job?"

Mr. Diabetes:  "Get this, the target is totally digging peanut butter... and I've pulled some strings and managed to override her blood sugar to be non-responsive to it."

Mr. Pregnancy, looking very pleased: "Dang, that is good work... How about I have peanut butter make her neauseus?"

Mr. Diabetes:  "Perfect. Couldn't have planned that better on my own."

Mr. Pregnancy: "I know."

...

Thought you were going to read a joke, huh?  I wish.  Not so friggin funny in the end - peanut butter being a diabetes-friendly carb-filled food and totally not third trimester pregnancy kosher! UG!  I mean when I went off of kale after my morning sickness in GW's pregnancy I didn't feel like I was loosing anything... I mean it is kale for crying out loud! Just use chard or something, but PEANUT BUTTER?! Are you kidding me?! 

So.  Not.  Funny.

Carb-free cookies

I don't think I have mentioned this before, but I am currently going through the RCIA (Rite of Christian Initiation for Adults) program with the catholic parish that HB and I go to.  Having never been baptized or even remotely religious before, I've slowly but surely gotten my feet wet with the concept of faith and I'm actually really enjoying myself in the deep end of spirituality.  But that's neither here nor there for this post, just background mumbo jumbo.

Any way, over the past year or so that we've been attending mass weekly I've started to wonder: just how many carbs are in the Eucharist? While I am sure that my parish priest would be mortified that I'm asking that question (the vicar I'm sure would find it a bit more entertaining), I feel like it's at least relevant to point out that all bread - Holy or not - by definition contains carbohydrates and therefore is something that a diabetic ought to care about.  Right?  Right.

So I started doing some online research (you know, searching the hard hitting facts people reliably put in random forums) and have quickly come to realize that the consensus among catholic low-carb dieters is that - and I quote - "if you're Catholic, the carbs in the Eucharist don't count."

SWEET! (Do you hear the angels singing rounds of hallelujahs right now too?)

While I'd like to take this online wisdom as ordained fact, I have to rationally estimate that the Body of Christ has about 1 - 5 grams of carbs per serving.  Now, these forum-floating-sages may be right and maybe receiving Communion will do absolutely nothing to my non-pregnant blood sugars due to their limited number of carbohydrates and therefore can be treated as a "freebie" but I have to wait until next Easter to figure that one out for sure...

Until then, I'm going to pretend that the cookie plates the RCIA people put out each week are also ordained by God and covered under the auspices of the non-carb-carbohydrate policy of the google-gospel for the faithful... one can dream, right?

Ridiculous!

What you hear me say out loud: "Huh."

What you'd hear if you were in my head:  "What the bleep do you bleeping mean you bleeping stupid meter! Why the bleep is my bleeping blood sugar so bleepity-bleep-bleep-bleep-bleeping high?!"

The past three days have been absolute blood sugar hell.  I haven't been on track with my blood sugars nearly as often as my mental commentary has been inappropriately explicit in my opinion of them.  The last two nights in a row I've shot up into the 260s and even with active insulin in my system my body isn't responding to the "excess insulin" I'm rage bolusing to cover down on it.

Take last night as an example, I made this amazing poulet au porto rissoto a la Julia Child (yum) and I measured out my serving so as to bolus appropriately. Two hours later as my pump is reminding me to check my sugars, I see the numbers 186 mg/dl come on the screen of my meter.  Knowing that is high but will typically come down with the remaining active insulin, I let the high slide and decided to check again an hour later to make sure things were headed in the right direction.  So an hour later my meter reads 262 mg/dl and my jaw just hits the floor (probably making room for the commentary in my head to fall out my mouth).  The active insulin did nothing to fight off that high! So I rage bolused an additional 2.0 units of insulin to force my sugars lower sooner rather than later and set my alarm clock to wake me up in another hour to check on the progress... So off goes my alarm clock and I check my sugars again and they've barely moved down to 216 mg/dl. Frustrated beyond belief I bolus an additional 1.0 unit and set my alarm clock again, which I admittedly slept through until morning.  But when I woke up, my sugars were still above 100 mg/dl and my morning target numbers are between 60 and 90 mg/dl...

BOO HISS!!

As I've discussed before, such numbers are either indicative of carb miscalculations or insulin resistance as a result of pregnancy.  I've been really careful about my carb counting, so that means that the insulin resistance I've been expecting is off to an aggressive start... to fix this, I've decreased my carb ratios for almost all of my meals.  Pre-pregnancy my bolus ratios were roughly 22 grams of carbs per 1 unit of insulin, but now I'm down to 12 grams of carbs per 1 unit of insulin.  I've also increased my all of basal rates (the body doesn't need the same amount of basal insulin all the time for various reasons such as the dawn phenomenon) by several many tenths of a unit which has added up.  Pre-pregnancy my basal rates amounted to a daily total of 8 units of insulin and now I'm up to 11 units of insulin.

For those of you who aren't diabetic and aren't hypersensitive to the daily statistics of your life, such increases in insulin dependence are overwhelming (insulin:diabetics :: gold:pan miners).  The scary part is that I have somewhere between 8 and 12 more weeks of insulin resistance to work through, so these abnormally high glucose readings will persist and my increasing usage of insulin will continue until the placenta is delivered. 

Again, say it with me now: BOO HISS!!

The good news is that as of the appointment I had earlier in the week, I've been cleared to "exercise" again and that is another tool I can use to combat high glucose readings.  By hopping on the stair stepper and creeping along at a slow enough rate to keep my pulse at 140 beats per minute or lower, I can slowly but surely drop my blood glucose over the course of a half an hour from "exertion."  Unfortunately, with such high readings as the 260s, the risk is that I am spilling ketones and at that point exercise will only make my sugars go higher rather than helping me to correct.  So this additional solution is only helpful if I am at a lower high than the excessive numbers I've seen lately...

I am extremely relieved that I have another endocrinology appointment this next week to get some professional help to fix these issues.  From my understanding, I can pretty much expect my insulin requirements and bg numbers to be changing on a daily (or even hourly) basis, so at least one day this week I'll have exactly-exactly what the doctor prescribes. 

Carb Counting Challenge Results

So, to make things standard and therefore fair for everyone, I only used the CalorieKing.com website to gather the numbers.  Here's the final break down:

Thomas brand cinnamon raisin bagel - 58 grams carbs
3 oz cream cheese - 2.3 g
Starbucks blueberry scone - 61 g
Grande coffee with milk - 24 g
Two sugar packets - 8 g
Two medium slices bacon - 0.2 g
Two scrambled eggs - 1.5 g
Two slices white bread toast - 23.9 g
1 cup home-made hash browns - 54.8 g
One medium banana - 27 g
1 cup 2% milk - 12.4 g
1 cup multi-grain Cheerios - 24 g
Seven 4" home made buttermilk pancakes - 76.3 g
1/2 cup real maple syrup - 108 g
1 Tbsp butter:  > 0.1 g (not added to total)
12 oz fresh orange juice - 37 g

Total:  518.4 grams carbs

Pizza protest.

And so it starts.   I am officially facing irrational insulin resistance for the first time.  Dum dum dum! 

I've read about this part of pregnancy countless times and I knew this was coming, but it's still disappointing to have it begin.  One woman I read about would bolus for a full serving of oatmeal (roughly 25 g carbs for a cup) but would eat only a tablespoon of it and her blood sugar would surge so high that the rational carb:insulin ratio for everything else would be completely irrelevant and impossible to calculate for that particular food.  Scary....

Well, I've been on a serious Greek olive kick for the past couple months (I hated them previously, gotta love pregnancy cravings) and so HB and I regularly pick up this Greek pizza from a local pizzeria that scratches the olive itch and satisfies the quick easy meal when I am slacking and don't feel like cooking (Julia Child, please pardon me for this).  According to the pizzeria's nutrition information, each slice of this Greek pizza has 17 grams of carbs and, starting yesterday, no matter how much I bolus per slice - whether I double or even triple the amount of carbs per piece - I unavoidably shoot up into the 200s.  Dang.

Even with the cravings and ease of it all, such unpredictability isn't worth it and I'm bummed that this means pizza is out...

Back when I was pregnant with GW, I had pizza pretty much every day because it was just about the only food that didn't make me feel sick and we conveniently lived next to a fantastic Italian restaurant on Pentagon Row in Arlington, VA.  All I had to do was show up and sit down and this wonderful waitress named Monica would deliver to our table these amazing (pasteurized) goat cheese and spinach salads and one of these individual size pizzas with homemade sauce and ridiculously fresh toppings... yes, I was that predictable; yes, I was there that often; yes, HB was that supportive.

I guess I can say thank God that I live an hour south of that restaurant now and that pizza isn't my only source of sustenance this go around, but none the less it's frustrating to be diabetic, it is frustrating to be a pregnant diabetic and this irrational carb juggling simply sucks.  If it wasn't hard enough already, here's a new curve ball for ya! Boo hiss!

I hope someone out there - whoever you are - orders a pizza tonight and thoroughly enjoys it in absolute protest of my pancreas' tyrannical dictatorship and its cruel and unusual rejection of what ever it so capriciously whims!

Bon Appetit!

Carb counting challenge reminder :)

Don't forget to post your carb counting challenge answers!  Only have a couple guesses so far, but nothing correct as of yet... the prize is still up for grabs, so take the challenge and it could be yours!

:)

Carb Counting

Thanks to Cousin Lisa, I have yet another awesome topic to write about that I wouldn't have otherwise thought to cover if she hadn't asked a great question:  how do I know how many carbs are in everything I eat?  Yeah, a completely integral part of being a diabetic, but something I haven't necessarily thought conscientiously about in ages...  great question!

Breaking things down to the absolute basics for those unfamiliar with nutritional components: the food we eat is primarily divided into three categories - protein, fat and carbs.  Protein comes from things like meats, seafood and eggs. Fats come from things like nuts, ice cream and non-lean meats.  Carbohydrates are in foods that contain fruits, vegetables, grains and sugars.   It is important to note here that these categories are not mutually exclusive and that they often blend together in each of the meals we eat every day...  taking a cheeseburger as an example you've got protein, fat and carbs in several combinations like so:

So when "carb counting" you are looking to identify how many grams of foods from this third category are in whatever food you eat and, based on the hamburger example above, you can see that carbs come from more than just bread.  As a diabetic, I have to sit down at every meal and put a number to the plate of food in front of me... does it have rice? does it have potatoes? what hidden carbs are there? what kind of bread is used? is there milk in it? is the protein breaded? what is in the sauce?  And don't forget about drinks! I've found that most drinks have more carbohydrates than one might imagine...  1 cup of milk has 13 grams of carbs; a cup of coffee only has carbs if you add sugar and milk, but you have to account for the effect caffeine may take on BG; soda - don't even get me started; and juice, talk about straight sugar in a glass!

When I first was diagnosed and had to meet with a dietary nutritionalist to learn how to carb count, I was completely overwhelmed by the prospect of knowing what was in everything.  Fortunately I was previously acquainted with reading nutrition labels and that made things much, much easier - all I had to do was grab a measuring cup and do some basic math.  But when I don't have access to nutrition labels (like at restaurants, when other people cook for me or when making things from scratch) it got much more difficult.

I remember a conversation I had with a long time family friend back in Colorado who is also T1 about how he knows what carbs are in what.  Having been diabetic since he was just a kid his response was simply that "at some point, you just know."  Now a year and a half in, I get what he means and I "sight read" my food, but it has taken much practice and research to get to this point.

So what resources did/do I use?

Not being a terribly big fan of technology (face it, I'm anti-facebook and twitter), my absolute favorite go to nutrition guide of choice is the Prevention Magazine Nutrition Adviser book (ISBN-10: 0875962254).  It breaks down most foods (not complete meals, but specific components of meals) into a standard nutrition label - so for foods that might not have a label (ie apples and bananas) it is a great way to learn the necessary stats.    I'd definitely recommend this book!

If you're an internet searching type, the website of choice that I use most often is calorieking.com (I believe it is also in the form of an iPhone app).  It is a gigantic online database that you can sift through for basic ingredients or for comprehensive meal choices at specific restaurants.   It mainly covers chain restaurant, fast food or ready-made grocery store meals, so it does leave a gap of information for local Mom-Pop type places, but it can give you an estimate of what the stats are of a certain dish to guess off of.  So for example, the lasagna bolognese at the Macaroni Grill has 720 calories, 41.3 grams of fat, 46 grams of carbs and 41 grams of protein.  Assuming that the lasagna you make at home contains similar ingredients and is a comparable portion size, it like has 40-50 grams of carbs as well.

Another phone app resource that some of my diabetic friends use is called "Track3". From what I understand it is a comprehensive diabetes app that provides nutrition information and an exercise/meal/BG journal.  I don't personally use this so I cannot speak to it from experience, but from what others have said it is a great resource for carb content searches and data collection.  It seems to be geared toward diabetics, but I'm sure there is a way to make it work for non-diabetics as well if interested.

At the end of the day, carb counting is about being as close as possible to the right number of carbs (within 5-10 grams is usually okay), but mistakes are inevitable.  You can miscount and under bolus sending sugars sky rocketing or you can over count/under eat and send sugars into hypoglycemic ranges. Obviously it is ideal to know what you're getting exactly and to avoid such miscalculations, so understanding how to read nutrition labels and researching restaurant nutrition information is a great first line of defense.  But once you know some basics by memory - like most rice and pasta is about 40 grams per cup, an apple is 20 grams give or take a few and bread is typically between 15-20 grams a slice - it gets easier to eyeball meals you can't measure exactly and roll on with life.

I will admit that I still struggle with foods I am unfamiliar with and I do find myself in situations that are outside of my carb counting comfort zone.  Like when going to ethnic restaurants that use ingredients that I can't pronounce, let alone identify or when someone else cooks something I've never eaten before, I'm often left to take a wild guess or to ask the awkward question of "um, what is this?"  So heads up, when serving dinner to me or any other diabetic, you might be asked to show the recipe card  for the dish or the cans/boxes your ingredients came from just so a better, more accurate guesstimate can be made. Ultimately it's the responsibility of the diabetic to read what is in front of them, but don't be surprised or offended if they ask for more information or opt out of a certain dish for health reasons.

Well I hope that this post begins to answer your question to at least some degree, Lisa!  There are other ways to watch what you eat as a diabetic - such as no-carb/low carb diets or using the glycemic index - but I'll skip that for now since they're a bit more complicated than carb counting.  If any reader would like more info on those options/what they mean, I'd be happy to go into more detail about them in a future post - just let me know.

Until then, I have two challenges for all of you:

1) Check out the nutrition labels on your food and to track how many carbs you eat during the day.  Measure your food, conscientiously note when you snack and what is in your drinks.  It's a very different perspective of your plate than you might be used to, so please feel free to share your experience in a comment :)

2) Take a look at the following pictures and descriptions of common breakfast meals.  Whoever can give me the total number of carbs (including decimals... silly engineers) in a post comment first will get a prize! (And it is a sweeeeeeeeeeet prize!)

1) Thomas' brand Cinnamon raisin bagel with 3 oz regular cream cheese.  2) A Starbucks blueberry scone and grande iced coffee with milk and two sugar packets.  3) Two scrambled eggs, two medium slices of bacon, two pieces of white-bread toast and 1 cup of home-made hash browns.  4)  1 cup multi-grain Cheerios with one medium banana and 1 cup 2% milk.  5)  Seven 4" homemade buttermilk pancakes with 1/2 cup real maple syrup and 1 Tbsp of butter.  6) 12 oz fresh orange juice. 

As soon as someone guesses correctly, I'll post the answer for all to see :)

Good luck!

3:04 AM

I don't know if it is because of my growing baby bump that my back is bothering me as much as it is or if it is the manifestation of my stress knotting itself into reasons to lay awake tonight, but it's 3 o'clock in the morning and I've been wide awake for almost an hour.  The power light of our macbook was flashing like light house beckoning me safely home in the turbulence of my thoughts, so we'll see what this pitch-dark post makes itself out to be...

I almost dropped my pump again today when it got caught on GW's foot as I helped him step out of the truck.  Fortunately I had a free hand and was able to grab the cord before it fell too far from my infusion site and rip itself from my skin.  We were in a pretty remote part of VT at the time away from our rental place, so I didn't have a solution ready at hand were that to have happened.  I typically have an emergency SureT set up in the center console for times like this, but this wasn't my car and I don't carry around the necessary equipment to handle more than a hypoglycemic episode.  Before being a diabetic I didn't even carry a purse, I just threw my phone and wallet in the back pockets of my jeans and rolled out.  But now that I am out of college, need to carry glucagon and a requested matchbox truck or two for my son, I have no interest whatsoever in further conceding defeat by needing a full on diaper-bag, over-sized purse to replace the one I already lug around along with my book bag.

While I was surprisingly coordinated today in my pump saving reflexes, I unfortunately haven't been quite so quick or quite so lucky at other times.  One time, I turned around to reach for GW in his car seat and the infusion site I had placed on my oblique caught on the seat belt buckle and tore out... Another time, walking down the hallway of our home while carrying a bin of clean laundry I failed to notice my pump tubing loop the door nob to the bedroom and riiiiiiiiip there it went... While lying on the floor playing with one of our dogs, Gracie, she snagged a loose end of cable with her nails and spastically tugged it out in a playful bounce.  And there was this other time when snuggly-sleeping with HB that the cord somehow got wrapped around his arm and my site went with him when he rolled to his other side.  Let me tell you... between the shock of having a cannula pulled out of you unexpectedly and the pain of the tape detaching itself from your skin, it is not a fun experience to go through!!

I don't know if any of you have had an IV administered to you before, but for those of you who have, do you remember the extra caution that went into your every movement so as to prevent the tubing from becoming snagged on anything that might require the nurse to reinsert the IV?  Perhaps I simply have a more innate distrust of that tape stuff they use than other people do, but each time I've have an IV my motions are far fewer in number and much more deliberate in purpose than they are normally.  Well, wearing an infusion set is to one degree or another similar to this - but because it is always there, it's easy to forget about it or to not notice when the tubbing is hanging out farther than it really ought to.    So while I am extremely attentive to the perceived inability to flex my elbow while wearing an IV, I am sometimes blissfully unaware of my diabetes to my own detriment... blissful ignorance replaced with an instantaneous reminder of reality. Oh joy.

That reminds me of those random moments when sitting down to a meal that I absentmindedly go to pick up my sandwich and enjoy the food in front of me without remembering the loaded sentence "I'm a diabetic" first.  It's absolutely wonderful to take that bite and enjoy the quality bread and other ingredients without concern, but when the thought hits that I am savoring unaccounted for carbs, I have to put my contentment in normalcy aside, lay down my food and be the disease again.  In a lot of ways I am envious of the other type 1s who were diagnosed as kids and don't remember what it was like to not be diabetic... I spent 24 years becoming accustomed to life and eating as a healthy person and it's sometimes very surreal to realize my life has been divided into a before and after shot.

So while you're sitting there enjoying your bowl of Cheerios tomorrow morning (that is 20 grams per cup of regular - non-honey nut - Cheerios and 13 grams per 8 oz of milk), take a moment to realize how nice it is to be healthy... I didn't appreciate it enough before I got sick and hind sight being what it is, it would have been nice to make the connection of how good I had it before sugar became a problem.