June 2017, Sugar Versus Treadmill

I spent years after my initial diagnosis of Type 1.5 diabetes striving to limit my blood sugar for the purpose of not using insulin. That is a nuanced objective that tripped me up for a while after my exogenous insulin production finally dropped (after 8-9 years) to the point that using insulin became a requirement. I had to make the psychological shift from striving to “not use insulin” even if my short term numbers might rise higher than I would like, to keep my overall blood sugar low.

I wouldn’t have expected that this slight shift in objectives would have a massive impact on my behavior, but it did. I’ll dive into the specifics of that impact in other posts. For the moment, I wanted to point out simply what the impact is of NOT practicing portion control.

For those of us who come to using insulin later in life, it can mean many things. As I allude to above, one thing it meant for me was self criticism. (“I’ve failed! Now I must use insulin! Drat!”) Once I got over that, it became a liberation. “Yippee! Now I can eat what I want! All I need to do is bolus enough insulin to compensate!” Well…it’s not so simple.

I’m a father, and last Sunday was Father’s Day. The extended family gathered for a meal, and the dads were allowed to be lazy. We could eat and drink without reprimand. Good thing? Bad thing? It’s a mixed bag.

Yes, I loved the indulgence, but let’s look at what behavior that invited.

Impact of eating too much — I knew I was going to indulge, so I bolused in anticipation, then I bolused more to keep up with my indulgence, then I crashed (almost), then I climbed right back up to where I had been.

This is a readout of the prior 12 hours, with insulin boluses indicated by squares on the line plot. We arrived at my in-laws around 4:30 pm (16:30 military time). [As an aside, I keep my watches/phones running on military time, hence the double digits.] the eating began around 5:30 pm (17:30). I knew there was a bunch of delicious goodies to sample, so I bolused 4 units of Humalog – fast acting insulin.

The packaging for Humalog says that it acts over a four hour time period. I find that it takes about a half hour to kick in, and then it runs for only 3 hours for me. Everyone should gauge this for themselves because your milage may/will vary. You should also watch it in real time, because other factors like sleep, stress, illness will all impact that performance.

Within about an hour and a half, it was clear I had overdone it. Even with 4 units, I was already hitting my upper limit of 190. So I did what I rarely do, and bolused an additional 3 units!! (Don’t try this at home! That’s too much! 7 units all at once when I never have more than 4 is risky business. I must have thought I had really overdone it with the gluttony.) Despite that user warning, my numbers started to drop. You can see clearly in the graph that from my second bolus at 7 pm (19:00), the levels drop, and continue to drop almost exactly 3 hours.

The drop so successfully that I start to approach the lower limit. Happily I didn’t go any lower than I did. But then, at the three hour mark, they start to climb again. From 10:30 pm (22:30) on, I am still digesting the food and drink from the evening’s splurge. The levels rise again, climbing steadily to 4 am (04:00) when they cross back over the high alarm limit. My CGM sounds the alarm. I wake up. (So does my wife! She was on pins and needles as I flopped into bed at 10:30 pm (22:30) because I had drunk too much as well. She wasn’t sure what was going on, but hoped that my CGM would alert her if I went seriously sideways.) I go into the kitchen. I bolus another 3 or 4 units (I can’t recall), and go back to bed.

Father’s day had been super hot. I worked out in the yard before meeting with the extended family for our evening feed-fest, and I suspect I had not drunk enough water during the day either. The night was hot. I had fitful sleep. My FitBit told me my heart rate was much higher than normal overnight. I was a bit of a mess. But all’s well that ends well. By morning, I was a bit hung over, but blood glucose levels were normal again and I was on the mend.

The moral of this silly story is PORTION CONTROL. If I eat too much, and it can be too much of very low glycemic index foods like vegetables or cheese, it overloads my system somehow and taxes my blood sugar levels hours after eating.

This is an area where I need to develop greater personal discipline. I’m usually pretty good, but I still have my weak moments. What have you found helps you control your impulse to mow down the entire buffet? What do you think contributes to your having more self-control on some days, and less self-control on others?

For Type 1.5’s like me, for years I managed to avoid medication and insulin because I still had some insulin production. So long as I didn’t overrun my system with carbohydrates, my blood sugars would not spike. A common go-to snack was nuts or cheese. Neither seemed to move my blood sugar numbers by much. My feeble insulin production was enough to manage that.

That said, I quickly bored of nuts and cheese. Early on, I remember howling to the cosmos that, “I was sick and tired of nuts and cheese!!!”

Even though I do use insulin now, 10 years after my original diagnosis, I still have the inclination to eat the rough equivalent of a South Beach Diet that is generally pretty low carb. I do very well with a cup of tea and a couple spoonfuls of peanut butter.

But how good can that be for me? While sufficiently filling, I’ve begun to wonder whether or not the same thing day and out is bound to leave some nutritional holes that might cause problems over the long term. So I was susceptible to a prime product placement close to the Whole Foods check out line: Garden of Life’s whole food and certified organic Shake and Meal Replacement!

On the face of it, this option seems ideal. The ingredients purport to be raw and organic, so there seems nothing to cause any concern. It has all sorts of ingredients listed, so there seems little chance that I would create an inadvertent nutritional hole.

Garden of Life Raw Organic Meal Replacement — This label seems too good to be true: raw, organic, non-GMO, etc.

The best part of this option is that a single serving appears to have less than a gram of sugar. The rest of these carbohydrates are fiber, which are low glycemic and typically won’t kick up my blood sugar.

This carbohydrate breakdown suggests less than a 1 gram of sugar per serving.

What I found was that even with insulin on board, my sugars spiked faster than how they normally rise on a relatively low-carb diet.

Illustration of rapid blood sugar spike after drinking a meal replacement shake. — Anticipating my blood glucose would rise, I bolused 3 units ahead of time.

Notable to me is the rapid rise after the shake, and then the equally rapid drop after the insulin kicks in.

That behavior seems logical for something with more sugar than the ingredients suggest are in the single serving of this meal replacement.

As I thought about it more, I had a short night of sleep the night of June 13th, so I repeated the experiment the next day after a better night’s sleep.

BS response when better rested. — This reaction was much less sever than the day before, but so too had I slept better the night before.

The 3 units of Homalog insulin kept the peak lower, but the following blood sugar drop is also more abrupt.

So this was a promising result, I kept up the meal-shake-as-breakfast routine for several more days. In the end, my muscle and joints became creaky during the same period as when I taking the powder, so I need to do some more investigations to see if there’s a connection.

Does anyone have a recommendation for a nutritious and well-balanced snack that can double as a meal?

Conquering LADA Type 1.5 Diabetes

Gluttony – the blood sugar impact of eating and drinking too much, even with insulin

Looking for new snack options – meal replacement shakes