External Factors, Food choices and Diabetes management

March 25, 2015By 5 Comments

FridgeWhen you make a decision to open the refrigerator and stare longingly at the shelves filled with food…or possibly empty with only a few options to choose from, and not all of them healthy, do you think with your mind, your stomach, or your blood glucose meter?

Let’s pretend for a moment that the refrigerator has a giant pad lock on it.  The key to unlock that deadbolt is insulin.  When insulin (and enough of it) is present, the door becomes unlocked and food can be placed in the fridge to be used later for energy.  Now if that insulin key is not available, or in not enough of a quantity, it becomes more and more difficult to fit the food in the fridge and the fridge becomes empty and in turn starts growling at you.

Luckily, this is just an analogy and our refrigerators do not have locks or growl at us (although that is a good weight loss idea that I should patent).   Remember, insulin is in fact a growth hormone (well, in essence, without going into too much scientific detail, insulin is related to growth factors).  What this means is that insulin helps to not only regulate blood sugars, but also to regulate the way that the energy from our food is metabolized.  If you have an insufficient amount of insulin and your cells are starved for energy because there is not enough insulin to let the food-energy in, then you actually become hungrier.  If you don’t eat your body will start to burn protein and fat for energy (this can sometimes be very bad as it could lead to ketones).  If you continue to eat without enough insulin to compensate for it, then you basically are starting a very difficult cycle to break: Hunger…food intake…not enough insulin on board…high blood sugars… need more insulin to compensate for the high’s caused by the food = MORE hunger.  Whenever someone asks me, “are you hungry?”  My response is, “I am always hungry”.

Because people with diabetes are constantly chasing a high or low blood sugar with insulin and food, trying to control weight and mood fluctuations is a daily battle that most people cannot see or even imagine when we are just going about our day.  Stress, illness, hormones, and exercise play vital roles in the decisions we make about what to eat and how to adjust our insulin for it.  Many of these things cannot be predicted and we often just have to role with the punches.  Here are some tips on how you can attempt to make the constant shadow of hunger fade a little in order to help with your diabetes management and weight goals:

SatietySatiety is the feeling of fullness after eating that suppresses the urge to eat for a period of time after a meal. Such feelings of fullness can play an important role in controlling how much we eat. It takes, on average, 15-20 min. for the food we first eat at a meal to reach the satiety signals in the brain.  A lot of over-eating can be done in that time.  Some ideas to help wait for your brain to catch up with your stomach are to try and consume foods higher in protein and fiber, as they make us feel fuller longer.  Also, try to drink a full glass of water during your meal.  Trying to reduce or eliminate alcohol at meal times can also help, as alcohol is an appetite stimulant.  Waiting is difficult, especially if you sit down at a restaurant after a long day of work and maybe even a skipped lunch.  Try your best to eat high protein/high fiber snacks throughout the day, especially if you know you will be indulging in a large meal later on.  Avoid appetizers and bread!  I know you’re hungry, but most appetizers are a meal themselves.  Pay close attention to your blood sugars and if you are dropping because you haven’t eaten, take fast-acting glucose in the form of glucose tabs or gel which won’t make you feel as full as a glass of juice and cookies, so that you can indulge a little in the meal.

BoredomIf you snack a lot at night while in front of the TV, try to do something else to distract yourself from automatically eating the entire bag of pita chips.  Do your nails, flip through a magazine during commercials, stretch, check facebook…just find something else to do besides consume more calories.

Rule of 15Don’t forget about this old rule of thumb.  Some of you may have never heard of this term, while others may follow it diligently.  The rule of 15 is a guideline on how to treat hypoglycemia.  It encourages a person who is having a hypoglycemic reaction (pending any severe lows or emergencies) to consume 15 grams of fast-acting carbohydrate and to wait 15 minutes and check their blood sugar again to make sure it is going up.  If it isn’t, then repeat with 15 more grams.   What happens to so many of us, is we often use a low blood sugar as an excuse to binge eat; it may be because we have been eyeing that left over cheesecake since yesterday and have been waiting for the perfect time to devour it; or it may be because we just like to continue eating/drinking until the awful feeling of the low blood sugar goes away.   Being low can really put a damper on your sleep, your enjoyment, your job or your workout… being patient to wait for the blood sugar to rise after treating it can be difficult too.  But what’s worse?  Waiting 15 minutes, or realizing you over-treated an hour later when you shoot up to 250 and now you feel even worse?  Also, the added carbs you consume while low can start to add up around the waistline.  Choose fast acting sugars; glucose tabs, 4oz of juice, some skittles (or for me personally Mike and Ikes), and if it is during bedtime, follow up with a little protein from a small glass of milk and peanut butter to help you coast through the night.

Decrease Rollercoaster Blood Glucose FluctuationsAs mentioned above, often over treating with food, or giving to much insulin to compensate for food or a high can cause a series of rollercoaster blood sugars.  So many of us trying to manage diabetes get stuck in this rut at least a few times a week.  All that up and down (whether it’s from 90-175 if you’re well controlled, or from 60-300 if you’re not so well-controlled) can affect the way we function both cognitively and physically.  Do your best to choose foods based on the glycemic index.  Foods higher in fiber and lower on the glycemic index scale will help to curb the quick spikes in blood glucose that other complex carbs can have.  Also, ALWAYS check your blood sugar before taking insulin.  Guess-timating both blood sugar and carb content is a recipe for a rollercoaster day.

Stress, Illness, and Exercise–  It is difficult to give solid advice when it pertains to managing food and blood sugars while under stress, illness or during exercise.  All of us with diabetes can have very different outcomes with our blood sugars under different circumstances.  The best thing to do it to make sure your checking your blood sugars more frequently, avoid the rollercoaster blood sugars as mentioned above, and try to put yourself first as difficult as that is.  If you are able to exercise, even light exercise or meditate it will automatically slow your heart rate and so that stress can be relieved.  Seeing a doctor specifically for stress reduction can also positively affect your diabetes management.

Illness can get tricky depending on what type of illness you have.  Make sure to have a plan in place with your Endocrinologist or diabetes educator as to what to do when sick.  Exercise is a crap-shoot and often needs a lot of trial and error to adjust for food and blood sugars.  Keep a journal and record times of day you exercise, what foods were eaten beforehand and what your blood sugars are so that you can make adjustments to your insulin or food intake.

There are unfortunately a million decisions to make everyday to help maintain good blood glucose control.  Don’t try to adjust too much at once.  Focus on one issue at a time, keep records and reach out for support and help from your medical team and support groups (both in person and online).  Once you can slowly start to fix some of the issues that may cause over-eating or misjudging carb counting, all the other things will fall into place, your metabolism will settle into a more consistent grove and so will your blood sugars.

 

Filed in: NutritionReal LifeTips and Tricks

Comments (5)

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  1. Jordan says:

    Hi Regina,

    What is your typical day of eating like? Thanks 🙂

    • Regina says:

      That is always a great question! While I don’t claim to be the perfect diabetic-dietitian…I do try to follow some of my own advice. I make sure to always spread my meals/snacks out throughout the day and to not put a huge carb load in my system all at once (I stick to between 10-30 grams per meal/snack). I also ALWAYS make sure I eat something for breakfast, even if it’s my daughters left over eggs and yogurt! I try to fix my fluctuating blood sugar patterns whenever and wherever I can pin point them as this greatly helps to reduce my cravings. I eat a lot of quick healthy snacks when I’m super busy (like an egg white flatbread from Panera, maybe leftover chicken and pasta for lunch, and dinner usually consists of a meat and a veggie with room for something slightly sweet instead of always a heavy carb. However, I LOVE potatoes and when eaten in moderation and not loaded with too much butter and cheese, the skin is so good for you! I also try to bake/broil/grill my meats whenever possible. Everything you will find in my fridge and pantry is the low-sodium version (even without high blood pressure, it’s amazing how much sodium you can cut out without noticing a difference in taste!). I don’t necessarily aim for low fat or low sugar, as those foods often are higher in carbs and preservatives/additives to add flavor back. I just eat the REAL stuff in moderation. It’s better for you! As far as cravings and indulgences go… I am a sucker for anything chocolate, so I usually try to keep NOTHING sweet in my house and indulge in my cravings when I’m out at dinner, or I eat some of my daughters chocolate graham cracker bunnies…I also like to keep some skinny cow chocolate ice cream bars in the freezer, and Kozy Shack chocolate pudding in the fridge for lows. You WILL eat what you keep in your house…so be better at restraining yourself at the grocery store, it’s better for the entire family! I am also very careful to not overtreat my lows as this always does more damage then good. I try to eat lots of fiber (in the form of veggies and Arnold’s bread). I really believe the key to making it all work for blood sugar control and diet is EXERCISE!! I run at least 3 times per week and do strength training 1-2x per week…sometimes only for 20 minutes if that’s all I have time for. Or I will have a dance off with my daughter after dinner…this keeps my fitbit in check for the day! I hope this info is helpful. Not every day ends up being perfect, but it’s all about how you eat for the WEEK not in a day. Keep it balanced the best you can!

      • Jordan says:

        Thanks for the response! I’m currently working on lowering my A1C of 6.8 so my husband and I can start trying to have a baby. I know you mentioned your dinners consist of meat, veggies and then “something slightly sweet”–can you give me some ideas as to what this is because I’ve been trying to cut down on heavy carbs at dinner and at the same time I have a wicked sweet tooth so trying to find ways to tame that too…I am getting to the point of burnout and searching for ways or ideas to lower my A1C-it’s so frustrating!

        • Regina says:

          For me personally, I love chocolate, and I only need a little bit to satisfy my sweet tooth. So often times, I will literally just eat one piece of dark chocolate (I usually ask my husband to hide it on me and then give me some because I have limited self control!) I also sometimes spread some Nutella (chocolate hazelnut spread) on a graham cracker. Another sweet snack I found recently was the Stacey’s Cinnamon and Sugar Pita chips. They are super tasty and you really only need to eat a few to be satisfied.

  2. Elizabeth says:

    I like your words of advice around satiety….
    Thanks for the insight!

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