Postprandial Hyperglycemia Continues...

Much to my disappointment, I guess my endocrinologist had a point when she said high glycemic index food is out.   I'd initially hoped such a food restriction would be a fluke suggestion for my recent hyperglycemia, but it is unfortunately turning out to be something I actually need to consider.  Bummer.

As per our usual weekend morning tradition, yesterday before mass HB got up and made the family his famous pancake breakfast with a side of bacon and - hallelujah - coffee.  It's not often that I willingly hand over the reigns to my kitchen, but if he offers I always take him up on making this breakfast because it's just so darn good!  I think the special trick to his recipe is the 50-50 split of white flour to wheat flour and his inclusion of melted butter and cinnamon right in the batter... they are so amazing.

Anyway, after HB finished slaving away at his new griddle, he put the plate of gorgeous golden brown pancakes and our three maple syrup variants on the table and lead us in grace.  I set GW up with two pancakes and once they were cut into toddler sized pieces, I turned back to my own plate for calculation.  Taking three pancakes (20 g each), about 1/4 cup of sugar free maple syrup (10 g) and my coffee (20 g) into account, I bolused 5 units of insulin to cover the 100 grams of carbs in front of me (20 g carb per 1 unit insulin).   Back when I was first diagnosed, I remembered thinking that 100 grams sounded like an embarrassing amount of carbohydrates to eat in one sitting, but now that I have a better idea of the composition of food it really isn't difficult to rack up carbs quickly with a couple pancakes or a simple glass of juice.  So eating just barely more than my 3 year old, I finished breakfast and off we went to Sunday Mass.

Returning home an hour later, I checked my blood sugar at the two hour post breakfast mark: 202 mg/dL.  Requiring only 0.90 units for a correction, HB and I were thoroughly agitated to see I still had 3.4 active units in my system.  Sighing deeply, I waited another two hours before checking again and my glucose at that point was down to 71 mg/dL -- which as I have said before, is slightly on the low side but within the correct range of where I want it.

I'd peaked early, again.  I'd calculated my carbs correctly, I'd eaten what I intended to eat and my glucose was eventually were it ought to have been, but not without a cost.  Going up into the 200s isn't healthy and regardless of the temporary nature of it, I cannot afford to go high if I want my HgA1C to stay under tight control in a "normal" person range.  I need it to be normal -- and not just for me and my sanity, but for any unplanned children we may possibly have. I mean I trust God to be looking out for us and our current & future children, but that doesn't mean I should take his care for granted and disregard my responsibility and role in the process.

It's frustrating that after two years of a steep learning curve with diabetes management that things are changing all over again.  My body is responding entirely different to carbohydrates now at three months postpartum than it ever did before or during the pregnancy and, despite my irritation with the idea of the glycemic index, I capitulate that it is completely necessary.  And while my e-whining about cream of wheat and pancakes may indicate otherwise, I think the fact of the matter is that I am more emotionally attached to the luxury of choice than I am to the specific carbs I'm losing... my world is shrinking even further because of diabetes and the reality of my new condition and its limitations causes me great sadness.

Completely unintended.  You'd think it is smiling because it knows...
sick sense of humor pancake, just sick. 

Farewell, my beloved breakfast.

This past Saturday at just before 9:00 in the morning, two hours after my breakfast, my jaw hit the floor when my blood glucose meter read 312 mg/dL.  Having calculated the carbohydrates in my breakfast precisely and then failed to drink my coffee my blood sugar should have dropped low, but like so many early day meals lately my glucose was off the charts.  I'd adjusted my pump settings last week in an attempt to self-correct my post-breakfast hyperglycemia, but seeing my meter read a clearly unhealthy, wholly intolerable number in the three hundreds (THE THREE HUNDREDS!!) I placed a call to my endocrinologist on Monday morning for some much needed help.

Since my two hour postprandial numbers have been high, but my four hour postprandial numbers have been low/almost low she didn't recommend changing my morning bolus ratio and, because my breakfast isn't always at the same time, she said my basal rates shouldn't be the issue.  I inquired about whether I should go back on the symlin injections, but because I am breast feeding she insisted that I do not since there isn't any information about whether or not artificial amylin is transmitted in breast milk and, if it is, it'd create an unsafe situation for GV.

Removing all the "simple solutions" to the issue and still without a clear path forward, Dr. Rogacz inquired about what I usually eat for breakfast.  Telling her that my everyday (yes, the same thing, everyday) go to breakfast is a bowl of cream of wheat and a cup of coffee, she made an "ah ha" sound and proceeded to break my heart by saying "your problem is probably the cream of wheat."  Citing the high glycemic index of wheat, as we loving call it in this house, she instructed me to drop it and similar "dense" carbs out of my diet in order to keep my sugars under better control.

(Insert mopey, pouty face here)

So what is the glycemic index (GI)?  The GI is a measurement of how much each gram of carbohydrate in a certain type of food raises a person's blood glucose level once it is consumed.  Foods that breakdown quickly in digestion and rapidly release glucose into the bloodstream are "high" (over 70) on the GI scale, where as foods that break down more slowly will gradually release sugar into the bloodstream and therefore are considered to be "low" (under 55).   Here are some examples for you:

High:  Rice, plain white bread, potatoes, breakfast cereal and watermelon.

Medium: Sweet corn, bananas, raw pineapple, raisins, pita bread and regular ice cream.

Low:  Raw carrots, peanuts, raw apple, grapefruit, peas, skim milk, kidney beans and lentils.

Because a lower glycemic response usually means less insulin is required to maintain a healthy HgA1C, foods that are low on the GI tend to improve long-term blood sugar control and cause less spikes in sugar like I am currently seeing at my two hour postprandial.  So, you see, on top of needing to be carbohydrate conscious on the basic this is bread that is pork level, my body has decided for the first time since becoming diabetic that it cares what carbohydrates I am eating and is forcing me to forfeit the lusciously dense carbs I emotionally love.

I know my doctor is right in making this recommendation and I'm only just beginning my research on what this actually means as a lifestyle choice, but my first response is that I am thoroughly peeved.  I am annoyed with my diabetes for messing with me again and on something so indulgent as my favorite breakfast.  I mean at least the doc didn't tell me to give up coffee (Lord knows THAT would have been impossible) so I at least still have that, but what to have with it will take some time.  I expect after an adequate period of mourning that I'll come up with something else to whip together in half sleepy delirium, but for the time being, in a state of melodramatic protest I refuse to replace it with something sub-satisfactory.