Conventional food habits vs flexibility on basal-bolus insulin

Hi,
I just visited a diabetologist (not my regular doctor who is in another city) today and my HbA1c stands at 8.3% (which though still far off the ideal < 7%) is a big improvement from my previous level of 9.7%. Probably I could have edged closer to 7% if not for my hospitalization (for diabetic ketoacidosis, which was till now undiagnosed because the doctor who treated me during hospitalization didn't suspect or treat it :(, but the diabetologist immediately made sense when he told about diabetic ketoacidosis).

He was so adamant about me getting to the 7% mark to avoid complications as I am just 23 years old as of now and have a long life ahead to live.

I currently use a flexible food routine with my NovoRapid-Levemir regimen. Whatever I eat, I count the carbs and then take the bolus. I adjust the basal if and whenever needed. By flexible, I don't take sweets, bulbous/root vegetables and other things that any diabetic shouldn't take. But I take other food items that are higher in carbs than the very safe, but I scale my insulin to that level.

But this doctor and dietician advocated a food regimen that involves spreading my eating over 6 times (which imho is a good idea) and restricted the eatable things to include only the fully safe foods in very restricted quantities. (In fact almost all the doctors in India including my regular doctor do the same). This is a new, difficult change for me to try and get used to. I can understand that this will surely help better control, but I fear that I am losing the flexibility that is possible with the basal-bolus regimen.

The doctors approach sounds very orthodox, conventional and inflexible. My heart wants me to make full use of the flexibility without compromising control. But I am scared about the control that I'd actually end up achieving.

What could be the best position to draw the line between the 2 extreme approaches?

Tags: basal-bolus, flexibility, food, habits, orthodox

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Hi Gerri, the variations that I quoted were from the same pre-food bg levels. I am gradually understanding that lesser the carbs, lesser the complexity in bg levels and insulin shots. So I am gonna try to restrict my carbs to 180g per day and see how that works for me :)

Please let us know how it goes at 180g per day. Wishing you success!

I wanted to add to what I said above (about the 2 hours and 4 hours which is even more true when I see your target is <160!). Btw research shows that damage begins to form with consistent time spent above 140; 160 is a pretty lax goal, though the ADA here still says <180 most of us think that's absurd!
That smiling politely face I mentioned? You might have to use it on your parents too. If you stick with the 6 times a day regime there is no reason it can't start an hour later. If you don't, well I have no advice for how to tell parents you know what you're doing when you're 20 and live in their house. My own solution to that problem was to leave home at 17.

Lots of great suggestions here. Perhaps you can manage the strict schedule temporarily while you get your A1C to where you want it, then re-introduce flexibility and other foods gradually, one thing at a time, with lots of testing to see what it does to your BG.

We are all different, so you'll have to do lots of experiments on yourself. Please keep us posted.

Congratulations on getting your A1C down!

Thanks for the motivating words. You exactly said what I am trying to achieve now. Achieve target A1c levels with extremely conservative food habits and then introduce flexibility once the target control can be achieved with regularity.

Zoe, lol about nodding with a polite smile thing. I already do it often and there is this slight hesitation in me that says "even though it is my body that I know best, what if occasionally i am wrong and they arent?" I need to understand my body and its semantics much better to gain confidence and overcome the hesitation.
:-)

Guruprasad, I wish I could do more to help you, but you are dealing with things that I don't really understand. I have been thinking a lot about how to balance your cultural and dietary situation with your diabetes and...I just don't know.

I come from a rice-eating culture (people from South Louisiana eat more rice per capita than any other peoples outside of East Asia) and I haven't had rice in so long that I can't even remember when the last time was. I used to be a vegan and there is no way I could do that now and keep my blood sugars under control -- not unless I cut back my daily consumption to near-starvation levels. Just one cup of cooked rice has more carbs than Dr. Bernstein recommends in an entire day -- and that's less rice than I used to eat in one meal.

Diabetes is so hard for me to control, that I had to completely change my diet...and I'm still not there yet. I rely heavily on poultry, meat and eggs -- plus lots of low-carb veggies like mushrooms, asparagus, broccoli, greens, etc. But without the poultry, other meat and eggs, I'd feel like I was starving.

I do also eat Greek-style yogurt (strained to remove a lot of the moisture) and occasionally drink milk (at 13 gm carbs per cup, milk has to be limited) but I use up the majority of my daily carbs on organic vegetables.

I also cook almost all (98%) of my meals for myself at home -- no one else has to adjust or change their cooking/eating for me because I do it all for myself.

You have a challenging situation! Learning what's in your food by watching your mother cook (learning how to cook?), weighing/measuring what you eat, trying to figure out the carb content, testing your blood glucose and noting your results will be a trial-and-error process that will take time and good record-keeping.

Hi Jean, rice and wheat are the staple food for the Indians. And there is no way I can eat non-vegetarian food :( I have to find out the minimum quantity of carbs required for body metabolism and normal functioning and try to stay as close to that as possible. But I guess if I do that, I will end up feeling that I am starving or I won't feel full. Anyway this is a process that takes time and effort to gain some idea about.

Well, as a vegetarian, most of your food will contain carbs. The only things you eat that do not contain carbs (or very little) would be nuts/seeds and oils. All grains (rice/rava/etc.) vegetables, beans/legumes/dhal, fruits and dairy products contain carbs (ghee has very little, depending on how well it is clarified.)

In order to maintain your body (not get too thin) and have the nutrients you need to live, if you are vegetarian, you will be eating quite a few carbs. There's no way around that.

You'll need to figure out the carbs in the food you eat, and make substitutions that will keep you in energy balance.

For example, if you normally eat two cups of rice, eat one cup of rice and add 30 dry-roasted almonds to keep your calories the same while cutting carbs by a considerable amount (45 grams less.) Instead of a sweet rice dish, eat a bowl of dhal stew with no rice (more protein, fewer carbs.) Instead of a big serving of rava/upuma, have a small serving and add some vegetables sauteed in a little ghee to keep the calories the same.

You could start by cutting out the obvious: let go of sugar in tea, soft drinks, sticky desserts, canned fruit in heavy syrup, etc. Most tropical fruits are high in carbs. You'll need to do some research to see what you can have without spiking your blood glucose too high, but the first step is staying away from dried fruits (concentrated sugar) -- especially if they have been dipped in sugar-syrup -- also fruit juices/purees and canned fruit in syrup. Plain, natural, lower-carb whole fruits in small quantities will keep your carb-count down. For example a cup of canned fruit has 35 gm of carbs, while a medium kiwi has only 10 gm of carbs. Three ounces of banana chips have 45 gm of carbs, while three ounces of avocado has only 2-3 gm of carbs.

Most vegetables, with the exception of starchy root vegetables, have few carbs. Problem is getting sufficient protein without eating high carb beans, lentils, etc. You can make your own Greek style yogurt easily by straining regular yogurt. Higher protein, less carbs & very delicious & rich. Unsweetened coconut is healthy, low carb & high fiber. Nut butter would be a good choice for protein.

Paneer is low carb & high protein. Ghee has no carbs. Neither does butter.

Are you taking B12 vitamins? Only source of B12 is from animal sources & it's a necessary vitamin. When I vegetarian I ate a lot of fermented foods & also took B12.

A lot of these foods have high fat content and my doctor has asked me to avoid them as my bad cholesterol levels are marginal and I have started mild medication for the same :(

There's a lot of progressive research showing that dietary fat doesn't impact serum lipids providing the fats aren't vegetable oils & transfats. Saturated fat is not the enemy, nor are the good fats in nuts & seeds, & is necessary for nerves, hormones & general health. You can Google to find lots of info on the dangers of low fat diets & the fat myth. High carb diets cause unhealthy lipid profiles & high BG contributes as well. Once you get your BG down (which you will), your cholesterol will greatly improve.

What medication did he prescribe?

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