OK, so to make a long explanation short:
* I have been Type 1 for more than 20 years; most friends never knew me before diabetes.
* As a kid, for years, I lived a REALLY restricted diabetes life (both in terms of what I ate and when I ate, this being two shots of R+NPH days).
* Then in the mid-2000s I started counting carbohydrates and could suddenly "eat whatever I wanted" as long as I bolused. And you bet I did—I tried things like brownies and milkshakes and countless other goodies I had literally never had before. My friends still find it unbelievable when we come across some common childhood candy that I've never had.
* I went on the pump five years ago. I'm very discreet and don't make a big deal out of counting carbohydrates or bolusing when eating out with friends, so many people meeting me don't even pick up on the fact I have diabetes until some comment comes up, and/or they "know" I'm diabetic but forget.
* I have a severe food allergy and this I DO make a big deal about double-checking ingredients and asking for no side dish, etc. Everyone knows about my allergy since it comes up often.
* Over the past six months I've made major changes to my way of thinking ... specifically, I'm starting to see food as an important aspect of diabetes (in addition to insulin and exercise), and when I'm at home I'm good at sticking to lower-carb stuff and weighing/measuring what I eat.
* I'm also good at not eating out as much and, when I do eat out at restaurants, sticking to generally health stuff (most of the time).
* However, what I am NOT good at are gatherings where the entire group decides to order a meal. Like when I go to a workshop and they order pizza for lunch. Or I'm with friends and everyone spontaneously wants to go for sushi. Or like tonight when I went to a gathering of friends and we ordered Chinese. This is the ONE area I will go ahead and eat the food ... and usually end up with high blood sugar for hours afterward, even though I do massive combo boluses. Tonight I got home to a blood sugar of 19.6 (353 mg/dl) a few hours after eating, and I'm sure that's going to take a many hours to sort out.
* My problem is, I don't know how to deal with this without either a) not eating, or b) making a huge, big deal about it. I know diabetes is common but for some reason at these types of things there are never any other diabetics. I have tried talking to my non-diabetic friends about it, to try and "break them in" to the idea that I would rather not eat that type of food, and their responses tend to be something like, "Oh well, how often do you eat that food? Not like a few hours of high blood sugar will kill you." Well, no, but that's easy for them to say when they aren't the ones having their cells slowly killed ... Part of the problem, too, is that I don't feel unwell or get sick when my blood sugar is high, so they don't get to see any change. Plus, it's not like my food allergy where I would NEVER eat or touch it, because there aren't really any "off-limits" foods with diabetes ... it's not as simple as that.
What do other long-term Type 1s who have changed their eating do? I realize this is something I just need to do myself, but it's hard when I'm with friends who have known me for years and when my diabetes has not really gotten worse, developed complications, or anything like that. I'm just really wanting to do everything I can to get tight control, because tight control is extremely hard for me under the best of circumstances so if I can avoid foods that I *know* will make me spike high for hours it would make sense to do so. But it's hard when, for years, I've told people I can "eat anything" as long as I bolus for it, and it's not like anything has changed diabetes-wise to change that philosophy other than my mindset. It's also hard because, no matter how much I try to explain it, most friends still do not understand the difference between carbohydrates and sugar nor how my blood sugar can still go super high even if I take insulin to cover something like Chinese food, or why " a few hours" of high blood sugar matters even though it won't kill me. My friends are absolutely NOT "food police" but a large part of that is because I've gone on and on in the past about how I can eat anything ... and now I'm suddenly trying to backtrack and contradict that at these types of events.
this is a really hard one. I haven't been at it as long as you by far.
I am pretty good at home and when left to my own meal planning devices, but fare very poorly when eating socially or when confronted by unplanned food, and tend not to say no, even though I should.
My person feeling is that the ideal would be to have some of the food, but a very small portion only. IN reality, after that first slice of pizza I may not say no any more and 1 slice leads to 2 etc.
I am now forced to be more strict becuase of the pregnancy and the 'risk' of a big baby. IF the food is really not suitable I just don't eat at events organised by others (like the burger, softdrink, and fries lunch provided at my meeting last Monday when I just made do with a glass of water - they did offer to order me something else in, but it was far too late for that and I just politely declined....). Or have a coffee or some other drink that I can hug. Where I have input on the food, I would try to make sure there is something that I can eat. Ie. Fried chicken (I can remove the batter and then it's mainly protein and fat) vs. pizza.
At friend's houses if I'm socialising I just hug a coffee or other drink and usually don't eat.
Once I start eating I find it hard to stop, so better not to start. Of course one also has to plan so one is not so hungry that again all discipline goes out the window.
As far as the friends go and them not understanding becuase in the past you have eaten what you want; can you explain to them that you are trying to get better control now than you have had in the past and you can't eat what you want any more. They'll get the idea eventually.
I really hate those "just have a little bits" because just a little bit easily becomes more than a little bit. Anyway, just what is a little bit!
I like your idea of telling people I want to get tighter control than I've had in the past. It's simple and also true!
I agree it's challenging at "those type of events" but I don't bother with "combo boluses" (do you mean square wave/ dual wave?) as I haven't found them that useful for "Big food" events, like Chinese food. I "cover" Chinese w/ extra basal, like just crank it to 200% for a couple of hours. I also just take small portions of stuff. Part of that is because I am a psycho about watching my weight and, if I eat as much as 275 lb acidrock ate, I'll gain a couple of pounds. Last night I went to my friend's house to watch zombie shows and he made pizza and has carbier beer than what i usually drink. I had one piece of pizza. It was good and I could have eaten 3 more pieces easily but I didn't. Beer was "limited" by having to drive so it was ok. At my in-laws, the either family or Korean, or maybe both, tradition is to to heap the food on so I just put the rice back in the rice cooker now. I'm certain it'd be worse manners not to clean my plate and, while they thought it odd at first, I just go with it.
There's a lot of reasons, besides diabetes and food allergies, that pigging out is not good for you and those are good ones to stress to yourself. If you've known people for a long time and they say "what, you used to eat 1/2 the pizza" you can cite numerous reasons to not want to eat pizza "my cardiologist would like me to eat 1/2 the pizza" or "[insert fashionable pants store] would like me to buy more pants" or whatever. I haven't encountered a lot of situations where people are paying that much attention to what I shovel onto my plate when we are sharing food.
The crazy part is that times like last night I AM eating small portions and am still ending up super high. My friends are not the type who push seconds and thirds on people if they say no, so that's not a problem. I took probably less than 1/2 the food that others took, partly because I can never get Chinese right and partly because it feels horrible eating so much that I feel too full afterward. So it's not like I go to these things and eat uncontrollably, I can just NEVER get Chinese food and other take-out stuff right if I eat more than a few bites, it seems.
I use a combo bolus but I don't do it like most people, I dial in the number and then make the split 100%/25% or something by increasing the dose more than that recommended. Not quite the same as putting a 200% basal rate, but then I never use a basal rate over like +25% so +200% would kind of scare me.
You should try again, take a picture of your plate and we can discuss it? Holger had included an app to take pics of your food w/ the Glucosurfer droid app and I think that it might be a useful idea? If you are guessing "80G of carbs" and are getting 120G of carbs one way or another, that would likely explain the variance, regardless of what sort of stylish basal or bolus tricks you are hitting. I still sometimes think of using the dualwave boluses but I can't think of too many times that they worked as well as just taking a big bolus and riding the storm out. Chinese is very hard as they toss a lot of cornstarch, which is milled very finely, making it denser than say big fluffy oatmeal or couscous or something and then the food has that slathered all over it. If General Tso's army makes an appearance, that's another ton of carbs in the crunchy stuff on the outside, honey sauce and/ or plum sauce, there's all kinds of carbs that pile on there. I do ok w/ Chinese if I stick to the stirfried undeepfried meat and a moderate pile of rice.
Last night I bolused for 100g of carbs and thought THAT was overestimating, but clearly it wasn't. I think you are right that there are a TON of extra carbs in there. I stayed away from the "obviously sugary" stuff but maybe I need to do some more research. It's like Starbucks and Boston Pizza, after actually looking at how many carbs most of their stuff has I've limited myself to one or two different things at each that I know aren't 80-100g of carbs. I wish Chinese places had nutritional information available, a lot of restaurants are starting to do that and it's really useful.
Panda Express, a chain place, has nutrition info for their food that's here: http://www.pandaexpress.com/menu/nutrition.aspx
Stuff like Hot & Sour Soup, one of my favorite things, that doesn't seem too carby has 12G! It may not translate exactly to whatever you had but it looks as if there's a ton of carbs strewn about the menu.
PF Chang's also has its nutritional info available.
I've avoided Chinese food since my diagnosis, but this might give me enough information to give it a try.
I eat moderate to even high amounts of carbs but I have never allowed myself to eat what I want. Yes, I can handle high loads of carbs if I know the food very well. But I would never eat something like that after 18:00.
a) it could mess up my sleep > risk of low BG at night due to corrections and miscalculations. The point is that this could happen. Most likely all will work as planned but I am not willing to take the small risk because I need my sleep.
b) it could mess up my mood > risk of high BG on the next morning due to late digestion of proteins.
Of course I will get social with friends but I will not eat anything different from my normal. My friends know that I am pretty knowledgeable about my diabetes management. Of course they would like to see me share the same experience of eatig as they are. At the same time they have respect for my decisions.
I also think that friends who think that you can eat what you want with the right amount of insulin have not understood the task of glucose management at all. You need to reeducate them. Show them that there is a high risk of failure involved. Show them that you are not willing to take these risks anymore. Make it clear that complications are the summary of little mistakes, misjudgements and randomess of life. The right choice of food will help you to reduce the likelyhood for these problems. You are on a marathon for your whole life and you need to pace oneself for all the years to come.
Your last paragraph is exactly right. I think they don't understand diabetes because they don't spend more than a few hours around me on any given day. So they see me testing but don't necessarily see me up half the night dealing with my blood sugar. And I really don't make a big deal about diabetes—half the time they don't even notice me testing/bolusing because I do it in the open but don't draw attention to the fact I'm doing it. I just don't know how to suddenly start mentioning I don't wan to eat this, don't want to eat that, because of diabetes when, up till now from what they've experienced I've had no problems eating that stuff. Someone above suggested I explain that I'm wanting to get tighter control than I've had in the past, and I think this is a good explanation because it's simple and accurate.
There's a spot in "The Kids are All Right" where a perky rock journalist asks Pete "there's been rumors about you and the band doing drugs, does this mean that you're 'blocked up' when you're onstage" to which Pete replies "No, it means we're 'blocked up' all the time..." which is very much the case w/ diabetes, even if you are where you are supposed to be, you sort of have to keep an eye on it and all that?
One strategy I have found works really well at shared meals is to help to serve - if you're in charge of the rice bowl it's much easier to have a tiny portion without causing comment.. This is actually the Best Manners if you eat Chinese. Otherwise, I never go out without something suitable to eat, and I use the phrase "I don't eat that" rather than "I would rather not eat that", as it brooks no further argument.. If you can say "no I'm allergic to x" then you can say it even if it's not true about a food whose effects on your blood sugars you can't tolerate..
Only one set of legs, eyes, and kidneys per person in this life...