Let's Watch The Labels

No, this is not a post to encourage you to check the labels on food you purchase or consume. This is about something that has been going through my mind for a while. It bothered me when I visited my doctor. In response to my improved blood sugar control he said, "You're still a diabetic". I think of it every time I craft a DM to a recent follower. And I think of it hundreds of time every year in our home care business as we help people living with various diseases or disabilities.

The inspiration to actually write this blog post came in the form of a tweet by Deepak Chopra this morning: To live without labels is ultimate freedom. Seven words of sublime common sense.

When we place a label on someone we automatically associate some preconceived notion of what that label means with that person. The effect is the same regardless of whether the label describes race, disability, disease, or preference. It suggests some form of prejudice, regardless of our intentions. We may mistrust, be curious, or even pity the subject of our automatic judgment. These assumptions are not fair. Not one of us would be happy to have them made about ourselves.

So the next time you meet someone who has to count her carbs, test her blood sugar, calculate a correct bolus dose (accounting for activity), and inject insulin multiple times each day; remember - she is not a "diabetic". She is a person living with diabetes, and she wants to live a full life and achieve all of her dreams. Just like you.

Happy Day - No More Insulin With Doc's Support

As mentioned in my last blog I had my quarterly date with my doctor and diabetic nurse this week. After five weeks on a slow carb diet I am successfully controlling my blood sugar without insulin injections. My blood work also showed a significant decrease in LDL, and my blood pressure had dropped by 20 points since my last appointment.
My questions going into the appointment were:

What would the reaction be to my change in diet and the resulting change in insulin requirements?

Would I be able to negotiate at least a reduced dosage on some of my oral medications?

It took my nurse a little time and a little coaxing as she looked through my log to get to the "no insulin" punch line. At first she was confused and wanted to know how it was possible. A short expanation of the 4 Hour Body program followed. "So you're not eating any starch?" "Well, except for on Saturdays ...", I told her. She marvelled at what I ate on Saturday, also without injections, and how my blood sugars stayed in check. I had a slight high Sunday morning then everything fell right back into line after my typical breakfast. In the end both she and my doctor were supportive of continuing without insulin if I can manage the type of control that I have been experiencing.

My other meds were a little more challenging to negotiate. My LDL had dropped from 2.21 to 1.52 and my blood pressure had dropped from 148/90 to 120/75. In the end my doctor agreed that I could cut the Crestor and Norvasc doses in half and we will review in three months. I had to promise to return to my previous Norvasc dose if my blood pressure goes back above 125/85.

Collaboration. I love it!

It may seem like a small victory, but the getting the vote of confidence to reduce my medications was a huge step for me as I work towards my ultimate goal of no medications to support my diabetes.

Looking forward to any comments either from medical professionals or from others with type 2 diabetes.

Start Your Day With a Fat Burning Breakfast

One of the keys for me to lose weight during the last few weeks has been having the discipline not to overeat. A key for controlling my blood sugar is to measure how many carbs I eat in a meal. For the last six weeks I have eaten the same thing for breakfast every morning. It's a breakfast that meets both of my goals. It keeps me satisfied until my next meal and gets my day off to a great start.

Here's how I make it:

1. Start with a medium skillet and add a bit of grapeseed oil. Heat the pan just until the oil flows.
2. Break one whole egg into the pan and add 1/4 cup of egg whites. Scramble them up with a little salt and pepper.
3. After the eggs are firm add one cup of cooked green lentils and stir all together until the lentils are warm.
4. Remove to a plate or bowl to eat. I like to add some hot sauce to the mix for flavour.

After I have finished eating the egg / lentil mixture I eat about three cups of spinach. I find it easier to eat if I shrink it down a little in the microwave, so I use the same bowl. It seems like a lot of spinach to eat raw, but not so daunting heated with a little vinegar.

I make the green lentils ahead of time in batches big enough to last a few days. Pour a 900 ml carton of low sodium stock into a pot and bring it to a boil. While the stock is heating measure 600 ml of dry green lentils and rinse them in a sieve. Add the lentils to the boiling stock, reduce heat to simmer and cover. It will take about 45 minutes for the lentils to be done. Stir about every 8 - 10 minutes.

Here's the nutritional information for the whole breakfast assuming a half tablespoon of oil:

Carb: 44.5 g
Fibre: 17.6 g
Protein: 31.2 g
Fat: 14.75 g (7 g from grapeseed oil)
Calories: 460

It's a big, low glycemic index breakfast that's high in fibre and protein. The meal is also very low in sodium if you cook your own lentils from dry in either water or low sodium broth. It's extremely easy to make and keeps me fueled for at least four hours until it's time for my next meal.

Time to Try Diabetes Without Insulin

Today is an exciting day for me! This morning I made the decision to discontinue insulin use for a trial period. This is the next big step towards my goal to manage my diabetes without medications.

This is not a snap decision on my part. Nearly six weeks ago I made a radical change in my diet by switching to a slow carb diet, a la Tim Ferriss' 4 Hour Body. Almost from the start I found the need to reduce my insulin dosage in order to avoid low sugar results. For the last two days I have been injecting 3 units of rapid insulin with breakfast only, and 5 units of long acting insulin at bedtime. This is a remarkable change when you compare it to my pre-May 15 daily averages of 30 units of rapid and 40 units of long lasting insulin.

It's time to try this.

This Tuesday I go see my doctor and diabetic nurse to discuss my progress over the last quarter and my lipids for the last year. My blood work was done four weeks after I changed the way I eat. Despite this short amount of influence I can tell you that my HgA1c is down by 0.4, my LDL is down significantly, my Chol/HDL ratio is down, and since May 15 my blood pressure is way down. Despite these changes, and the obvious shift in my body's need for external insulin, I expect some resistance to the notion of cutting medications.

I'll update you all on how this meeting went and let you know how my no-insulin trial is going in a blog next week.

A Diet Change Worth Exploring

If you read my last blog you know that I have been following a slow carb diet for about five weeks now. The great majority of my carbs are coming from beans, legumes, and lentils. Five weeks is certainly not long enough to be conclusive, but I feel great and I've had to significantly reduce my insulin use to avoid having lows.

Since I've started this program (prefer program over diet) I've lost ten pounds. More importantly I have lost 4.5 inches from my waist. I have to believe that this loss of belly fat is having a huge impact on my insulin sensitivity. My goal is to get off of all of my meds. That's only possible if I still have my own insulin on board. My hope is that the insulin I have been taking for the last four years has been necessary due to insensitivity, not because my body has run out. The last five weeks have encouraged me that this may be true.

Here are the top three reasons I think this change in my diet has been successful so far:

1. Slow Carbs Six Days Per Week:
Prior to making the change most of my carbs came from grains, starchy vegetables, and fruit. These relatively high glycemic index foods convert into sugar fairly quickly. As a diabetic using insulin I was trained to use enough insulin to have an acceptable blood glucose level 1 - 2 hours after eating. The problem is that even rapid insulin is still active for up to four hours after being injected. By changing to a low glycemic index carb source the conversion to sugar is slower and the spike is lower. Less insulin is required to keep blood sugar in an acceptable range.

2. Beans Have Lots of Fibre:
My current diet is extremely high in fibre. Meals are filling and satisfying and include lots of vegetables for variety. When combined with the benefits of lower insulin demand and slow release carbs this means that I never feel like I need a snack between meals. I have four meals every day at about four hour intervals and a light snack at bedtime. By not wanting to eat something to curb that empty, low feeling between lunch and dinner, or to have a huge supper, I'm less likely to yo yo. I only eat the food that I planned to eat in a day. My blood sugars are even and predictable.

3. I Eat Whatever I Want One Day Per Week:
Once a week I abandon the bean routine and eat whatever I feel like having that day. This kind of cranks up my metabolism so that when I return to the slow carb diet for the rest of the week I can lose some more weight. It helps stop the urge to cheat on the program.

This is not a program that someone sold me or that I am trying to sell to you. You do it yourself. The most recent and popular literature on this type of diet is the book The 4 Hour Body by Tim Ferriss, but this diet has been around for a long time. It's a balanced diet that has also been labelled as "Low GI". Whatever you call it, I have seen immediate benefits that have already improved the way I feel and changed the way I manage my diabetes.

Will a Slow Carb Diet Stop My Fight With Highs and Lows?

After being on insulin for over four years and experiencing all of the highs, lows, and eventual weight gain I have decided to make a change. Four weeks ago I started the Slow Carb Diet that Tim Ferriss promotes in his book, The 4-Hour Body. I'm not a big believer in diets. The trigger for the change was a realization that I was at my highest weight and poorest fitness level ever, and that my insulin use was continuing to rise.

My biggest surprise was how quickly things started to change. Early in the first week I experienced a low blood sugar just before dinner time after using my regular insulin / carb ratio from my experience with bread, potatoes, and rice. I immediately reduced my insulin dose and have continuously done so each week since. As of this week I have reduced my bolus insulin (Apidra) from a daily average of 32 units to 12 units. I have reduced my basal insulin (Lantus) from 40 units to 20 units.

My weight loss results to date have been encouraging, too. As of my Saturday morning weigh-in and measure up I have lost a total of nine lbs and four inches from my waist. Using the US Navy body fat calculations that translates into 20 lbs less body fat and 11 lbs more lean body mass.

Why is this happening? All of the carbs that I am now eating are slow release carbs from beans. This results in a more even change in blood sugar than I used to experience after my morning toast and oatmeal or my lunchtime sandwich. Since there is no spike (or at least a smaller spike) in my blood sugar I don't need as much insulin to deal with it. As a result I eat less and don't pack on fat from my food. As fat falls off, my body seems to be less resistant to insulin which means I can inject less.

My quarterly A1C annual cholesterol tests are due to be done in the next couple of weeks. I'll get the results when I see my doctor on June 28. These results will help tell me if I am on the right track. I'm looking forward to seeing good numbers and continuing to see the impact over time. So far so good. I'm encouraged.