Wednesday, September 12, 2012

How I Manage Diabetes While on the Primal Diet


***NOTE:  This post and blog are not intended to diagnose, treat, advise, or advocate any particular medical decision, choice, treatment, or program.  Any and all information in this blog post and all others are solely intended to communicate my personal and particular situation and choices.  I do, however, believe that if it can work for me, anyone dealing with diabetes can also approach their situation with similar resources as presented in this blog post and all others and make particular choices related to their situation to have similiar results, depending on his or her current health situation.***
 
Managing diabetes while on either the Paleo or Primal diet has been one significant way I have been able to live well with diabetes.  By “living well with diabetes,” I mean I have been able to regulate my blood sugars within a range relatively unheard of for diabetics.  And this has all happened within three months of “going Paleo” (although technically, I have gone Primal, meaning I am eating certain dairy products).

I owe it to my friend Sharon, a fellow Primal Blueprint follower, for bringing the Primal/Paleo idea back up to me, in the hospital after my diagnosis, no less.  So as I sat there with insulin and fluid bags hanging from both arms, I really didn’t see any other option.  It was either be bound by the carb-insulin train, or try really hard at my last effort to have some semblance of a normal life.  (I have had several diabetics shake their fingers in my face since then, telling me I can eat whatever I want.  Unfortunately, what I have known about these certain diabetics is that they all have had health problems of some kind connected to their diabetes.  So, having “whatever you want to eat” is really synonymous with slowly dying every time you take a bite.  That is NOT how I choose to live.

As I embarked on my Primal journey upon two weeks of leaving the hospital, I did so enthusiastically and joyfully.  I was optimistic that this new way of eating would allow me to have a relatively normal life.  I spoke with a friend during this period of time that relayed to me that she did not think that diabetes was God’s will for my life.  Though I knew the numbers didn’t lie, I believed her and agreed with her in prayer.  And though I now still know my numbers prove out that I deal with diabetes, I am thankful and proud to report that my numbers, three months after my diagnosis, show that I have blood sugar levels that are relatively normal, like that of a non-diabetic!

So, What Do I Do?

Primal Lifestyle

I follow the Primal Lifestyle as found here.  I tweak diet as you can see below, based on needing to regulate my blood sugar.

Target Blood Sugar Levels

I use Dr. Richard Bernstein’s Diabetes Solution and Diabetes Diet as the definitive resource to understand and manage my diabetes.  From these great books, I’ve tweaked the Primal Diet staples to include tips from Dr. Bernstein as he has used his methodology to manage his own Type 1 Diabetes.

As he recommends, I strive to stay within a very narrow, low range for blood glucose measurements.  Because I adopt a low-carb Primal diet, I am able to easily predict the impact of the natural carbohydrates I eat on my blood glucose level.  And because I have gone grain-free and refined sugar free, as recommended by Diane Sanfilippo here.  Please note, however, that she is not providing medical advice (nor am I, and I cannot claim to have diagnosed or treated anyone or take responsibility for anyone else’s health but my own, not even my husband’s.)

So, going grain and refined sugar-free, as well as very low carb, I can say that backing that up against a Primal lifestyle has allowed me incredible control of my blood glucose.  I strive to keep it between 70-90.

Insulin Regime

Dr. Bernstein has advice related to how to determine the optimal long-term insulin dosage for a Type 1 Diabetic, which I am.  I have followed his advice and adopted an appropriate Lantus dosage for myself.  Again, my dose will not necessarily work for someone else, who needs to determine his or her optimal Lantus dose with doctor supervision and input.

I, personally, take two doses of Lantus, 6 units around 9 am and another 6 units right before I go to bed, around 9:45 pm.  This allows optimal impact on my blood sugar during times when I need to take Lantus impact into consideration.

Dr. Bernstein has reasoning dependent on the performance of Lantus and other basal insulin products, so please consult his book for that reasoning and the way to determine the right dosage for any particular individual who is Type 1.

Diet

Here’s where I really seem weird.  However, remembering that I can’t necessarily eat carbs without expecting an impact on my blood glucose level, the reasons I eat as I do should start to become apparent.  This section requires some knowledge of how diabetes manifests in a person who is Type 1.

Normally, a person who is Type 1 Diabetic will experience a slight rise in blood glucose upon awaking.  This is typically known as the Dawn Phenomenon.  Because of this rise in blood glucose, Dr. Bernstein recommends that a Type 1 eat less carbs at breakfast than at any other meal.

Dr. Bernstein also recommends that diabetics eat three meals a day, NO SNACKING.  This is really critical, as I believe that someone who is diabetic should know what his or her blood glucose level is before putting ANYTHING in his or her mouth, and I follow Dr. Bernstein’s advice not to inject more fast-acting (or mealtime) insulin until at least five hours after injecting the previous dosage of fast-acting insulin.  It would stand to reason, then, that mealtimes such as 7:30 – 12:30 – 5:30 would be suitable, or in my case, closer to 8:30 – 1:30 – 6:30.

Then, it would also stand to reason, it’s too late to snack before bed.

On the Primal diet, I’ve been so satisfied I am sometimes not hungry at a typical meal, so I will skip it and not suffer any ill effects.

A typical daytime meal plan will look something like this.

BREAKFAST:  Eggs and either sausage or bacon, with sautéed vegetables.  Often I clean out my fridge the night before, chop away, and sauté in bacon grease.  Before you look at me funny, read this article.  If you are going to eat less carbs, you are going to need to be ok with eating more protein and fat.  And believe me, my cholesterol is VERY healthy!  Back to a low-carb breakfast, I achieve it by going for a savory one.  Gone are the pancake, biscuit, or French toast days.  However, if you really miss it, you can find a Paleo or Primal recipe for anything.  I very rarely partake, and only as long as my fasting BG was around 70, with fast-acting insulin to cover it.  I aim to have this kind of breakfast only once a week, and twice very, very rarely.

Also acceptable is to have leftover meat with vegetables for breakfast.  Whole30 co-creators Dallas and Melissa Hartwig call breakfast “Meal 1.”  It doesn’t have to look like the all-American breakfast, especially if you are going for consistent blood glucose levels throughout the day!  Read on to find out how I satisfy my desire for something sweet.

Before I move on, I relish the fact that one Paleo/Primal given is the copious enjoyment of coffee, and not even Swiss Water Decaf!  Leaded, fully-caffeinated coffee  - espresso is even better.  I enjoy mine in the morning with a tablespoon of heavy cream (not whipped cream, but whipping cream you buy in the milk cartons at Costco.  Forget the small pint-size!) and several drops of stevia.

For lunch, I would have a salad topped with meat strips.  I use a homemade dressing shown here, or simply olive oil and vinegar of choice.  Or, I will empty the fridge of leftovers.  If my BG is low enough, I’ll enjoy an avocado with lunch or berries and nuts for dessert.

Now, here’s where I have my froo-froo coffee drink, if I am at home, or a half a Lara bar.  I have been working on a frappuccino drink that uses minimal carbs.  My body reacts to heavy cream as if it were a carb, so I will take one for the team and choose to cover this drink with a unit of fast-acting insulin.  I can publish it later, and link here as well.  It’s a good excuse to update my blog, and work on traffic!

I will often have dinner after my family.  I know this goes against convention, but I sit with my family during lunch, I just don’t choose to eat until at least 6:30 so I don’t get hungry or tempted right before bed.  Dinner will be a more traditional meal, but again, will not contain more tham 20 g carbohydrates.  Often, it only contains 15g from the vegetables.  I do a meat and two vegetables. 

We are all full after dinner, though my (young) kids are often in the mood for a dessert before they go to bed.  I can often get them to have yogurt and fruit with nuts (like a parfait) and I make my own yogurt with no added sugar.  It is fantastic.

In a day, I aim to eat between 50-80g carbs.  As you can imagine, it is very hard to keep this number below 80g.  I count any and all carbs I eat, not considering creamer or supplements or drink packets as “free.”  I count EVERY carb, even if it comes from vegetables.  The reason for this is because my carbohydrate intake is so low, and because I want to keep my BG within that range of 70-90.

Specifics about what I eat and don’t eat

I eat whole, clean foods.  I have for the most part been able to eliminate processed foods except for those allowable on the Primal diet.  I am still eating Xylitol (and am trying to figure out how I feel about it), as well as powdered zero-calorie drink mixes.  I am also eating cheese, heavy cream, full-fat no-sugar-added yogurt, and butter.  I eat almond flour and coconut flour.  Almost everything else I eat is raw or minimally processed.  I am the one who processes most of my food, and if I eat something made by someone else and don’t have a chance to ask what is in it, I literally add at least one unit of fast-acting insulin, and often two.  The reason is that most sauces contain enough sugar to cause a significant spike in my blood glucose.

As for eggs, I consume many of them.  Most of the recommended substitutes contain carbs, so I don’t substitute.  I will sometimes do that, but only within reason and if the recipe makes sense with the substituted carbs.

I also consume large amounts of fat.  I love bacon grease and have been known to eat a tiny bit on a spoon when I want a treat.  The bacon flavor is very satisfying.  Once you can’t consume carbohydrates without punishment, you look at consumption of fats differently.  More socially acceptable is to savor a small amount of heavy cream on a teaspoon with a sprinkle of cinnamon.

Speaking of cinnamon, raw stevia (either the leaves or the drops) and cinnamon are considered blood glucose stabilizers, so I consume some of each in moderation.  I have stevia drops every day in my coffee, even though most Paleo educators advocate weaning yourself off of sweets using stevia, and eventually dropping even the stevia.

Exercise

I follow Mark’s Daily Apple’s exercise advice.  I get outside every day it’s nice for as long as I can either stand it or my schedule will allow.  I rotate my schedule between: circuits, intervals, yoga, playtime, rest, and Oxycise on the days I can’t do any of the above.  I know Oxycise sounds crazy, but since it works, I do it when I can’t do something else.

Daily Schedule

Because of rises in cortisol levels, I often wake early.  My kids do too, because they’re on the Primal meal plan too.  If they don’t, I can get some things done before everyone wakes.  I often turn into bed, tired, before 10pm, and often I’m asleep soon after that.

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