Bolus Deserving Desserts

When choosing dessert, there are some sweet things that I consider to be bolus deserving and some that are not. Ice cream, especially when of the chocolate peanut butter type, is always deserving of an extra bolus. Flan is not. Carrot cake cupcakes with cream cheese frosting definitely get a yes vote from me, white cake with crunchy frosting, no  An oatmeal cookie with chocolate chips, yes. An oatmeal cookie with raisins, no. Cheesecake takes some serious consideration. Crust is important. Graham cracker is favorable. Flavor is also important. Mint can be passed up. Strawberry, maybe. Chocolate, bolus deserving.

There are also some desserts that I am reconsidering. Pie is an example. I have politely refused pie for many years now, so much so, that I had convinced myself that I didn't like pie. It was not a difficult refusal. Would you like some peach pie? No thanks. However, after riding my bicycle across the state of Iowa and being lured by roadside signs such as Grandma's Homemade Pies- 5 miles, I think I might love pie. Grandma Sue's homemade dutch apple. Mama's homemade peach. What was once not worthy of a bolus, has now become the dessert that makes my mouth water. Pies made by grandma-Bolus Deserving.

What's in a Number?

If you are a type 1 diabetic like myself, you know that Hemoglobin A1c is a measure of your average glucose over the past 2-3 months. It is presented to you multiple times a year in the form of a percentage. The higher your glucose levels, the higher the percentage and vice versa. If you happen to meet another T1 you might discuss HA1c, however you would never have the guts to ask. It's a taboo subject. It's synonymous with asking how much they weigh or how old they are. It's off limits. Because it is a way of comparison, a way of telling how well you are managing your disease compared to others. And since this number is controllable (for the most part) by you, it becomes a competition. How low can I go? How am I doing compared to others?

At one of our first meet ups for Young and Type 1, I was introduced to Jacob, a 21 year old male with T1. He sat down on the sofa with his coffee, introduced himself and proclaimed, to prove to all of you that I am diabetic, I'm going to measure my glucose right now. He then proceeded to whip his meter out of his backpack and take his blood sugar. Since you are all wondering what it is I'll show you. He then flipped around his meter and to reveal his result of 96. And thing is, we did want to know. Badly. We all wanted to know.
So what does Hemoglobin A1c really mean for us diabetics?

This is THE number that determines whether we are in control or out of control.  It is the primary tool we have to measure our success or failure. It is the number that every physician wants to know.  It is the number we measure ourselves by or try not to measure ourselves by. It is the number no one wants to reveal.  It is the number we feel self-conscious about and the number we strive to have lower and lower. It is the number we celebrate and the number that can cause tears.  If you want to become pregnant, like myself, it is the bane of your existence for months. It determines whether or not your womb is safe to be occupied. Everything weighs on this number. Which is why I am happy to report most recent result of  6.0% that I thought was impossible to achieve.

Yet, does everything really weigh on this number? My current targets are 70-100 before meals, 140 one hour post meal, 120 two hours post meal. That's a narrow range I have to keep. If I am able to maintain these targets consistently, my average would be 105 which is the equivalent of an HA1c of 5.3%. However if I maintain a range of 30-180, my average is also 105 or 5.3%. The latter is not necessarily a place I want to be in, yet would I be satisfied with a number of 5.3% even if I was bouncing from 30 to 180 each day? While I strive to have my number lower and lower and wait in anticipation for each result, I try to remember that this number is not flawless. It is simple math, an AVERAGE, which might not always tell the whole story. It is not the bane of my existence nor the sole measure of how well I am managing my diabetes. Nonetheless, with my number of 6.0%, I've been cleared to put a bun in the oven and it's not going to get burnt. I feel good about that.

Smoothie in a Blender

I love 'em. You can basically put anything you want into a blender and

call it a smoothie. Yogurt, frozen fruit, eggs, peanut butter, honey, bananas, cottage cheese, agave nectar, mint, tofu, peaches, the list goes on and on and I haven't even ventured into the vegetable side. The possibilities are endless! On a hot and humid summer morning when the temperature has surpassed 91 degrees by 7:00a.m. a smoothie is cool, refreshing and tasty.

My most recent favorite:

1c. plain yogurt (whatever fat content you like)

1/2 banana

1 tsp honey (from Katie's honey bee farm)

2Tbsp unsalted natural peanut butter (I prefer the Trader Joe's type)

Margarita + Beach Volleyball = Disaster

It all started out because of poor planning. My office mates and I had rescheduled our after work margarita night multiple times and had finally decided on last evening. I was also simultaneously scheduling an evening league with my beach volleyball partner. It all happened to coincide last night and I was faced with a decision. To margarita or to not margarita? I didn't want to force my office mates to reschedule yet again and I definitely did not want to miss volleyball. I love playing volleyball. So I decided to try both.

I should tell you that a margarita is not a normal drink for me, so I wasn't sure how to handle it. So I guessed. I bolused 1.5 units, probably a little on the low side, but a double-header on the beach was immediately to follow so I thought I would need the extra sugar. After 45 minutes and chips with guacamole the cacophony began. Beep. 185 and upwards. Crap. I hopped on my bike before I could be convinced of another margarita and rode to the beach. Beep. Vibrate. 256. The first game didn't go so well. Lucky for me, my partner had also consumed a glass of wine before game time, so we were both a little sluggish and slow on our feet. By the end of the match I had come down to 114 and felt much better. I drank some Gatorade and played another match. Beep. 139. I cycled 6 miles to my house. Vibrations. 67. I ate an ice cream sandwich and snuggled up in bed to read a book. By midnight, I was hearing that high-pitched shrilled, the last resort one, when you've missed all of the vibrations because you are SLEEPING. Beeeeeeeep(high-pitched and shrill-like) 59. ugh. I desperately wanted to go back to sleep, but decided against it and went to the kitchen for M&Ms. At 2am, beep. 56. To the kitchen I stumble! At 4am, vibrate. METER BG NOW. Are you kidding? 104. Sigh of relief. When 5am hit and I was 59 again I started to complain while half asleep. Why didn't I just bring the giant bag of M&M's with me to bed? After the third time of going to the kitchen last night, I was delirious and mumbling about having poor dental hygiene from all of the sugar consumed. My husband seemed concerned and all I could utter from my subconscious was, Typical Type 1 doesn't brush her teeth in the middle of the night.

Diabetic Housewives: A Fantasy

I'm going to visit my endocrinologist on Monday with the hope that she will tell me my womb is now safe to be occupied. I am optimistic that I have lowered my A1C over the last three months and that she will give me the green light. She is located across the hall from the maternal fetal high risk OB clinic where I will be transitioning to once I have a bun in the oven. They have "diabetic" Friday clinic days when all pregnant T1 diabetics show up for their battery of tests and adjustments.

I have this fantasy. I am pregnant, diabetic and visiting this clinic every other Friday to make sure that the growing fetus is not living in a toxic environment. I see myself in the small-ish waiting room. The walls are painted a sterile white and there are paintings with calming colors. On the tables, magazines are stacked with covers featuring healthy babies. A mother is holding her shapely child above her head and there is a lovely park in the background. She is happy with her healthy baby. There are only women in this waiting room. Pregnant women with little bumps and swelling bellies. Type 1 women with insulin pumps attached to their hips.  Because it is Diabetic Friday. I strike up a conversation with them and we find out that we have everything in common. We are all pregnant AND diabetic. We see each other every two weeks in this waiting room. Five of us become friends. We have fancy lunches in downtown Chicago when the drone of non-stress tests, ultrasounds and tweaking of basal rates are finished. We order our mid-day meal. Could I have 1 cup of a tasty low-sodium, vegetable soup with extra vegetables. Two ounces of lean protein. A slice of whole wheat bread, preferably with a low glycemic index.  And a non-alcoholic, sugar free margarita please.  We discuss our latest A1C's, how much our insulin requirements have increased, what doctor we saw that day and what he told me that was different from you. We discuss how often and when the fetus is kicking, how our husbands are talking to our bellies and whether or not we will return to work. We discuss the nurses we LOVE and the one's who drive us crazy. We lament about our challenges and celebrate our triumphs. 

D-Feast Friday with a Little Gravy on the Side

I've decided to join D-Feast celebrations on Fridays. The reasons for doing so are tri-fold. The first being that I love food!! Talking about it, reading about it, thinking about it, cooking it, eating it....  The original thought behind D-Feast Friday is to share diabetic-friendly recipes, but I'm going to add a little variation. I will feature recipes, but also dicussion, a link to an article I find interesting, some new food thingy (very open ended here), maybe a photo or whatever I fancy. The second is that food is so central to living with Type 1 that it becomes the center of my universe some days. I like to try and keep it fun and yummy and not obsess. And lastly, I'm jumping on to the D-Feast Friday to keep me on task and keep my blog updated regularly.

I have two rules 1) as long as it is related to food, it counts and 2) EVERY Friday-this is the hard one. Stay tuned...

Let the Sun Shine In

As many of you have recently seen, vitamin D seems to be making a star appearance in the diabetes world. The reason your endocrinologist is now ordering lab tests to measure vitamin D and recommending that you take it is probably a result of this study published in Diabetes Educator. The study states things such as "persons with diabetes are at significant risk for vitamin D insufficiency or deficiency. Reasons for this include diet, lack of sun exposure, obesity, renal impairment, and genetic predisposition." It claims that added vitamin D may reduce complications associated with diabetes such as cardiovascular disease. Also, it states that having adequate intake of vitamin D daily may delay the onset of diabetes. What is adequate, you ask? It has not been determined.  Do you all remember the blood sugar lowering capabilities of cinnamon? Sound familiar?

If you think I sound skeptical, I am. I was surprised when my endo started recommending that I take 1000mg of vitamin D daily and then followed up to make sure I was taking it. I was also surprised that she ordered labs to confirm.  The explanation for this unexpected inclusion into my daily routine was brief. There was this study. You should take vitamin D. It's good for you. You probably don't get enough sun.  What? We had never discussed my sun exposure while determining basal rates.

While I respect and trust my endocrinologist and appreciate that she is keeping current with science, I just don't think that vitamin D is really going to decrease the likelihood of complications or delay the onset of diabetes for those of you that don't have it. If I have an A1C of 13.1% and take vitamin D daily, will I decrease the chances of kidney failure? probably not. I don't mean to sound all pessimistic. I'm not saying that's its a BAD thing to take some extra Vitamin D with breakfast.  I like a more realistic approach, such as this.  I just think that this is a simple solution for such a complicated disease.

For the record: I'm taking vitamin D daily and I top off my oatmeal with cinnamon each morning.

Waterpark Hysteria

Who doesn't love water slides? The thrill of flying down a wet, slippery tube only to be dumped into a giant pool of chlorinated water. It doesn't get better than that. Last weekend, my friends and I just happened to find ourselves at a hotel with a waterpark. Bonus! So what did I do? I left my pump by my towel, suspended the sensor and pretended I was 8 years old for the afternoon and ran around in circles jumping up and down and giggling. I flew down the electric eel.  I then hurled myself into the twisted tornado, a large body bowl-like slide, followed by a dip in the discovery plunge.  Multiple times, I dropped myself down the vertical mighty mustang and raging panther only to find my suit lodged in odd places.

So it's no surprise that when I popped out of the howling hurricane my sensor was no longer attached to my body. The teenage lifeguard did not seem to care nor understand what I had lost. I suppose this was his summer job and he was more concerned with scanning the park for the "older" sexy girls to check out.  I had a hard time trying to explain this white, quarter shaped thing that was responsible for keeping me sane. And now it was lying on the bottom of the pool somewhere which happened to also be white! Apparently he didn't grasp the severity of the situation as I saw it, because he did not stop the kids from coming down the slide, nor help me look. Each time I bobbed up to the surface after meticulously scanning the depths of he pool,  a 6 year old in a pink and white bikini would be flying into my face. Luckily my husband came to the rescue, scored some goggles and managed to pick it up off of the bottom of the pool. My hero.

A word to all of you: remove sensor when going to the water park.

Giving the Dual Wave a Shot

My nurse recommended that I try a dual wave bolus with dinner, because I WILL be using the dual wave feature when I am pregnant she says.  A dual wave is a bolus given in two parts, one part immediately and one part given over X amount of hours. For example, she wanted me to try 50:50 over three hours, which meant that I would get 50% of my bolus initially and the other 50% over three hours. For some reason I was hesitant to try this. I had an irrational fear of it not working. I'm not sure what I was fearful of exactly, maybe it was the change.

The 50:50 did not work, so now we are trying 40:60 which seemed to work initially, except that for the past two evenings I have ended up with blood sugars in the 200's at 3 hours. I was even so enthusiastic about it being successful initially that I suggested trying the dual wave at breakfast and lunch as well to decrease post prandial spikes. This Tuesday I did 60:40 over 2 hours at breakfast and lunch and got spikes up to 180 at 2 hours post meal. Wednesday I did the same 60:40 over 2 hours at breakfast and lunch and no spike.  Today I got a spike at breakfast, none at lunch.

I am both discouraged and encouraged by the dual wave results that I am getting. When it works, I am thrilled. When it doesn't work, I am overwhelmed by the numerous options in which it might work. Which ratio should I choose for each meal? Let's try breakfast. 60% first or 60% over 2 hours? or should it be 3 hrs? Or should I try 40% first over 3 hrs? or maybe only 2 hours? Or should I just go back to 50:50 over 1 hour? Or is it the type of carbs I'm eating. Should I add more protein? And then there's lunch and dinner to think about and it starts all over again. There are so many options and I am so anxious to get it right that if I think about it all at once I want to give up. One can drive themself mad. I just need to find the balance as Kims says.

More on Ragbrai

Hamballs

For those of you that aren't familiar with Ragbrai, let me explain. The idea is to ride your road bike, tri-cycle, mountain bike, recumbent, uni-cycle(seriously, I saw one guy riding a unicycle), tandem or elliptical bike across the state of Iowa. It is spread out over 7 days with an overnight town every 60-80 miles. Each day there are small towns to ride through that have food every 10, 15, 20 miles until you reach your destination of the larger, overnight town. Tradition is that you dip your back tire in the Missouri river at the start or the week and your front tire in the Mississippi river at the end of the week.

I've been dying to let you know that for one week I got a break from this thing that we never get a break from.  I was able to eat sugar, lots of it, and not bolus or worry about it. During the days of bicycling, I was on a diet of sugar and protein and I was thrilled. My plan was to eat a little bit in each small town throughout the day instead of entire meals. I would eat a banana for breakfast, ride to small town in Iowa, eat a hamball that was 50% brown sugar, ride to next small town, eat a bratwurst and an ice cream cone, ride to next small town. Wait. Is that homemade peach pie on the side of the road? I have to have me some of that pie!

The crazy thing to me, is that this worked! I lowered my temp basal to 50% and ate small amounts of sugar and protein as needed to get me through the next hour or two until there was more food. I did not bolus all day and my cgms remained a flat line!

Camaraderie

There is something undeniably great about meeting another Type 1. There is an unsaid connection, a sense of understanding, relief and a camaraderie in the fight against this disease. I want to meet more of you Type 1's! I can count every Type 1 diabetic that I have met in the past 14 years of living with this disease, which is to say that there are very few.  I remember every detail of our encounters.

There was a girl in high school who I played basketball with, but we were teenagers and had adolescent insecurities to deal with, not diabetes. Then there was a girl in my dorm in college, whom I never really connected with and have since lost contact.  Last year, I met a guy in a cooking class my husband got for me, who I identified with in so many ways it was creepy. We had similar life paths, but he was leaving for Honduras in a week, so the friendship that could have ensued, ended before it began. Most recently there was the nurse in the ER who stitched my finger that I sliced while chopping squash. She had had two children successfully and my husband and talked to her for an unknown amount of time at the midnight hour while she neglected her other duties.  She lives in Ann Arbor, Michigan, we live in Chicago, IL. That sums it up. Four type 1's in 14 years. Which brings me to the point of this post. After the ER visit my husband initiated a support/social group for Type 1's in the Chicago area and it has gained a few members. We met up tonight and my spirits are high. It's comforting to know that there are others out there that are living life just like me.

If your in Chicago, come hang out with us on the first Wednesday of the month! We are Young & Type 1. We meet at the Dollop Cafe in Uptown. It is GOOD.

Success

I did it! I successfully rode my bicycle across Iowa! 433 miles in 7 days. No need for the glucagon injection that I carried with me.  I ate a steady stream of sugar and protein and my blood sugars remained stable with the exception of overnight lows. No sore butt or hamstrings. I am not tired, but full of energy and I would do it all over again. It was rewarding to see my home state in such a different light and so peaceful to spend my days in the sunlight riding through cornfields. More to come later!