I have found that some vegetables are very helpful to me in my effort to control blood sugar after meals. Conversely, there are some that are very harmful.
The list of harmful vegetables is not that long. The main culprit is potato. And I used to love potatoes. French fries, baked potatoes,mashed potatoes with gravy. All are absolutely delicious. But I don't eat them anymore. I remember reading an interesting quote from someone that eating steak and potatoes can kill you but, contrary to popular opinion, it is not the steak that kills, its the potato.
Green peas and tomatoes should also be eaten in moderation. A little bit of either vegetable will not hurt the sugar readings.
All green leafy vegetables are excellent. Cauliflower and broccoli top the category of nutrient-rich and glucose-neutral veggies. Lettuce of any kind works well too but I personally prefer Romaine lettuce.
The only vegetable known to actually cut down blood sugar level is bitter melon. It is common in the Indian sub-continent. But not elsewhere. I try to eat it regularly. In spite of its bitter taste. I slice the bitter melon into thin strips and saute them in olive oil with salt and pepper. And down it like I am taking medicine. Which is what it is. It sure beats taking bitter melon supplement pills.
Wednesday, March 18, 2009
Tuesday, March 17, 2009
What to do when one strays from the strict plan for controlling blood sugars.
When controlling blood sugar with diet and exercise, willpower plays a strong part. And the willpower has to be applied not just on one day or for a specific period of time. It has to become permanent. One is not on a "diet" plan when trying to manage Type 2 diabetes without medication. One is on a "lifelong" course.
For me, use of willpower to do my daily exercise is much more manageable than applying willpower to resist eating desserts or food items that are not allowed.
I can do my workouts anywhere anytime. Whether I am traveling on business or enjoying a vacation in a tropical paradise, I will find time and create the opportunity to get in some walking time, tread milling and lifting weights. It does not appear like it is a chore to me. So I have that base covered.
Ever since I have had my glucose readings and my A1C in the normal range I have felt good. But over time, I have become a little more relaxed in my restrictions related to sweet dishes and how much of a particular dessert I consume at one time.
This can be dangerous. Fortunately, I have been through these types of situations enough times that now I have a pretty set way of dealing with the deviation. In other words, i have a system for getting back to good control when I have fallen off the wagon.
Luckily, this happens generally for no more than 1 or 2 meals. And that also around the holiday time. Here's my process for course correction.
First, after every meal in which I know I have eaten more carbs or higher glycemic index food, I always check my blood sugar multiple times until the "clearing" takes place. If the peak is high, like 147 for example, I get concerned. So first step is to get a wee bit scared. And the fear comes from looking at a high reading. And that happens from an established habit of checking blood sugar frequently. I am quite data-driven so that also helps.
Second step is a follow-on from the first one. Fear from the high reading puts me in a fighting mood. Combat status to quell the rising glucose blood sugar number and get back to normal as quickly as possible. I take action the next day right from breakfast. I watch what I eat and do my exercise attentively. And I test. Blood sugar returns to my usual levels. Leads to relief and satisfaction. Good feelings to have.
For me, use of willpower to do my daily exercise is much more manageable than applying willpower to resist eating desserts or food items that are not allowed.
I can do my workouts anywhere anytime. Whether I am traveling on business or enjoying a vacation in a tropical paradise, I will find time and create the opportunity to get in some walking time, tread milling and lifting weights. It does not appear like it is a chore to me. So I have that base covered.
Ever since I have had my glucose readings and my A1C in the normal range I have felt good. But over time, I have become a little more relaxed in my restrictions related to sweet dishes and how much of a particular dessert I consume at one time.
This can be dangerous. Fortunately, I have been through these types of situations enough times that now I have a pretty set way of dealing with the deviation. In other words, i have a system for getting back to good control when I have fallen off the wagon.
Luckily, this happens generally for no more than 1 or 2 meals. And that also around the holiday time. Here's my process for course correction.
First, after every meal in which I know I have eaten more carbs or higher glycemic index food, I always check my blood sugar multiple times until the "clearing" takes place. If the peak is high, like 147 for example, I get concerned. So first step is to get a wee bit scared. And the fear comes from looking at a high reading. And that happens from an established habit of checking blood sugar frequently. I am quite data-driven so that also helps.
Second step is a follow-on from the first one. Fear from the high reading puts me in a fighting mood. Combat status to quell the rising glucose blood sugar number and get back to normal as quickly as possible. I take action the next day right from breakfast. I watch what I eat and do my exercise attentively. And I test. Blood sugar returns to my usual levels. Leads to relief and satisfaction. Good feelings to have.
Monday, March 16, 2009
Blood sugar after exercise ............reply to reader's comment.
Adnan's second question was about blood sugar after exercise. Some people say that their blood sugar rises immediately after exercise. And then there are others who claim that their glucose level actually drops after exercise.
In my own case, I have experienced both. Let me explain.
When I go for a walk for 30 minutes - the brisk, arm moving, spring in the step kind of walk - and come back and check my blood sugar, it invariably is in the 90s. I have not tested the effect of shorter walks because in my opinion, those walks do not provide much exercise.
After a vigorous 30 minute treadmill workout, my blood sugar tends to also be in the 90s. And then it may slip back to the high 80s.
The only time I have seen an increase is after lifting weights. There is definitely something about a workout involving muscle action that stresses specific muscles to the point of no return. Meaning I just could not do one more rep if my life depended on it. Which is how muscle building exercises tend to be....they work you to exhaustion. The glucose meter definitely shows an increase after such a workout for me. But not by much and not for long. Maybe in the low 100s and then within half an hour, it comes back to the 80-90 mark.
I am sure everyone sees a glucose response to exercise that is unique unto themselves.
In my own case, I have experienced both. Let me explain.
When I go for a walk for 30 minutes - the brisk, arm moving, spring in the step kind of walk - and come back and check my blood sugar, it invariably is in the 90s. I have not tested the effect of shorter walks because in my opinion, those walks do not provide much exercise.
After a vigorous 30 minute treadmill workout, my blood sugar tends to also be in the 90s. And then it may slip back to the high 80s.
The only time I have seen an increase is after lifting weights. There is definitely something about a workout involving muscle action that stresses specific muscles to the point of no return. Meaning I just could not do one more rep if my life depended on it. Which is how muscle building exercises tend to be....they work you to exhaustion. The glucose meter definitely shows an increase after such a workout for me. But not by much and not for long. Maybe in the low 100s and then within half an hour, it comes back to the 80-90 mark.
I am sure everyone sees a glucose response to exercise that is unique unto themselves.
Sunday, March 15, 2009
Blood sugar upon awakening ......reply to reader's comment
Adnan from Phoenix raised a great question.
About testing blood sugar first thing in the morning. And the answer is yes, absolutely. No matter where I am, I make it a point to do so. In fact, I can't recall even one single day since diagnosis when I might have missed testing my fasting blood glucose.
I have done it both ways. I test the blood sugar after waking up and then after I get ready just before breakfast. Most days the time lapse between these two readings is about an hour. Both readings are fasting sugar numbers. I have not found any significant pattern between the two readings. In other words, the second reading is not consistently higher or lower than the first reading. Actually, most of the time, they are pretty close, within plus or minus 10 mg/dl.
Sometimes I double-check my readings with a second meter. This morning my blood glucose was 74 taken at 10 AM. It was a late night last night. I was watching a movie, Linewatch on Bluray disc. Good movie.
In Adnan's case, a reading consistently between 102 and 110 is interesting in that there is so little variability from day to day. Each reading can vary by at leas 5 per cent on the basis of differences in strips and because of the inherent tolerance in the accuracy of the meter itself.
There is also this thing called the "dawn phenomenon" which increases the fasting glucose number in some people to 30-40 mg/dl more than the bedtime reading in spite of the fact that these people may not have had anything to eat after going to bed. Apparently it is caused by an overactive liver that dumps a lot of glucose into the bloodstream in the morning to prepare body for the day's activities.
And then there is the matter of late night snack. I always have something at about 10 30 PM. The snack definitely contributes to the fasting reading but here again, the effect differs widely. Some can control the snack related increase by having a protein-based snack whereas in other people, it doesn't matter what kind of snack they have - it always raises the reading.
So far I have been lucky in not having a noticeable "dawn effect" and being able to snack without causing a big increase in my morning blood glucose. I am keeping my fingers crossed.
About testing blood sugar first thing in the morning. And the answer is yes, absolutely. No matter where I am, I make it a point to do so. In fact, I can't recall even one single day since diagnosis when I might have missed testing my fasting blood glucose.
I have done it both ways. I test the blood sugar after waking up and then after I get ready just before breakfast. Most days the time lapse between these two readings is about an hour. Both readings are fasting sugar numbers. I have not found any significant pattern between the two readings. In other words, the second reading is not consistently higher or lower than the first reading. Actually, most of the time, they are pretty close, within plus or minus 10 mg/dl.
Sometimes I double-check my readings with a second meter. This morning my blood glucose was 74 taken at 10 AM. It was a late night last night. I was watching a movie, Linewatch on Bluray disc. Good movie.
In Adnan's case, a reading consistently between 102 and 110 is interesting in that there is so little variability from day to day. Each reading can vary by at leas 5 per cent on the basis of differences in strips and because of the inherent tolerance in the accuracy of the meter itself.
There is also this thing called the "dawn phenomenon" which increases the fasting glucose number in some people to 30-40 mg/dl more than the bedtime reading in spite of the fact that these people may not have had anything to eat after going to bed. Apparently it is caused by an overactive liver that dumps a lot of glucose into the bloodstream in the morning to prepare body for the day's activities.
And then there is the matter of late night snack. I always have something at about 10 30 PM. The snack definitely contributes to the fasting reading but here again, the effect differs widely. Some can control the snack related increase by having a protein-based snack whereas in other people, it doesn't matter what kind of snack they have - it always raises the reading.
So far I have been lucky in not having a noticeable "dawn effect" and being able to snack without causing a big increase in my morning blood glucose. I am keeping my fingers crossed.
Saturday, March 14, 2009
The second part of optimal post-meal blood sugar.
Controlling the peak of post-meal blood sugar is the first part of my goal. And that is to keep the peak below 140 mg/dl. Just like in the case of non-diabetics. Big question then is: how does one determine the peak?
Here is how I figured out the peak. Medical literature states that post-meal blood sugar in Type 2 diabetics peak somewhere in between the first and second hour after the meal. So that is a good starting point. Over many meals I collected sugar readings at the 1 hour, 1.5 hours, 2 hours and 2.5 hours after the first bite. Another key point is to count the time from the first bite not when the meal is finished.
Based on those many post-meal measurements, I found that in my case 1.5 hours after the first bite is when the peak occurs. For me, this is quite consistent. So whenever I have a meal whose carb content I am unsure of, I will test the post-meal blood sugar at 1, 1,5 and 2 hour points to determine the peak. Generally, a single reading at the 90 minute mark gives me an excellent measure of my peak. And this is the number I try to keep below 140. This is the first part.
The second part has to do with when the blood sugar returns to the pre-meal level. This is the hard part. Non-diabetics go back to their pre-meal levels within 2 hours of their first bite. For a Type 2 controlling with diet and exercise, this 2-hour goal can be quite challenging. There is even debate about the 2 hour normalizing observation. Some diabetes doctors I have spoken with consider a 3 to 3.5 hour clearing time.
Also the 2-hour clearing goal is difficult for Type 2s because of the delayed insulin response from the pancreas. Which is why we have this condition in the first place.
Normally, the pancreas releases insulin in response to food in two phases. Phase 1 insulin response is based on how much insulin the pancreas already has stored and Phase 2 response has to do with what it needs to make to handle the food load it faces.
For me, I have set my goal as follows: I must reach my pre-meal blood sugar within 3 hours or sooner. And that number has been consistently below 95 with my present diet and exercise routines.
Here is how I figured out the peak. Medical literature states that post-meal blood sugar in Type 2 diabetics peak somewhere in between the first and second hour after the meal. So that is a good starting point. Over many meals I collected sugar readings at the 1 hour, 1.5 hours, 2 hours and 2.5 hours after the first bite. Another key point is to count the time from the first bite not when the meal is finished.
Based on those many post-meal measurements, I found that in my case 1.5 hours after the first bite is when the peak occurs. For me, this is quite consistent. So whenever I have a meal whose carb content I am unsure of, I will test the post-meal blood sugar at 1, 1,5 and 2 hour points to determine the peak. Generally, a single reading at the 90 minute mark gives me an excellent measure of my peak. And this is the number I try to keep below 140. This is the first part.
The second part has to do with when the blood sugar returns to the pre-meal level. This is the hard part. Non-diabetics go back to their pre-meal levels within 2 hours of their first bite. For a Type 2 controlling with diet and exercise, this 2-hour goal can be quite challenging. There is even debate about the 2 hour normalizing observation. Some diabetes doctors I have spoken with consider a 3 to 3.5 hour clearing time.
Also the 2-hour clearing goal is difficult for Type 2s because of the delayed insulin response from the pancreas. Which is why we have this condition in the first place.
Normally, the pancreas releases insulin in response to food in two phases. Phase 1 insulin response is based on how much insulin the pancreas already has stored and Phase 2 response has to do with what it needs to make to handle the food load it faces.
For me, I have set my goal as follows: I must reach my pre-meal blood sugar within 3 hours or sooner. And that number has been consistently below 95 with my present diet and exercise routines.
Friday, March 13, 2009
What is the optimal post-meal blood sugar reading for me?
The optimal post-meal blood sugar reading for me is the lowest number possible. Yes, that is how I view this particular goal.
There are many "standard" targets.
The American Diabetes Association states that "Postprandial plasma glucose (after a meal)" should be less than 180 mg/dl.
The American Association of Clinical Endocrinologists cites "140 mg/dL as the 2-hr PPG". PPG here means post-prandial glucose.
In my opinion, the above two glucose goals are too generous. The ADA specifies a peak number. The AACE does not mention a peak but instead talks about a 2-hour recovery goal.
Both targets are in stark contrast with the actual observed peak amongst non-diabetics. Which happens to be 140 mg/dl. No matter how many carbs a non-diabetic consumes, his perfectly functioning body will keep the maximum glucose level below 140.
So why should we, Type 2 diabetics who are controlling the disease with diet and exercise, not reach for the same thing? I do.
My post-meal sugar goal is below 140. Occasionally, I may drift into 145-150 but not very often. And over time, I have learned the impact of certain foods on my post-prandial readings so that I can adjust my carb and/or caloric content to stay within my self-imposed limit.
There are many "standard" targets.
The American Diabetes Association states that "Postprandial plasma glucose (after a meal)" should be less than 180 mg/dl.
The American Association of Clinical Endocrinologists cites "140 mg/dL as the 2-hr PPG". PPG here means post-prandial glucose.
In my opinion, the above two glucose goals are too generous. The ADA specifies a peak number. The AACE does not mention a peak but instead talks about a 2-hour recovery goal.
Both targets are in stark contrast with the actual observed peak amongst non-diabetics. Which happens to be 140 mg/dl. No matter how many carbs a non-diabetic consumes, his perfectly functioning body will keep the maximum glucose level below 140.
So why should we, Type 2 diabetics who are controlling the disease with diet and exercise, not reach for the same thing? I do.
My post-meal sugar goal is below 140. Occasionally, I may drift into 145-150 but not very often. And over time, I have learned the impact of certain foods on my post-prandial readings so that I can adjust my carb and/or caloric content to stay within my self-imposed limit.
Thursday, March 12, 2009
What should be the morning blood sugar number for Type 2 diabetics?
I have a very specific set of blood sugar goals. These may not make sense for anyone else. As we all know, this is such a "unique to oneself" disease, that my glucose goals may have no relevance for someone else.
Let's begin with the morning fasting number. Frankly, for me, happiness is seeing a 75-85 on my monitor's diplay first thing in the morning. That really makes my day. I can live with below 90. But any number above 90 for me is a bit of a red flag.
It means one of two things. Or both. One that I ate too much the day before (and night too - dinner and late night snack). Two that the carbohydrate amount in my prior meals were too high.
There is a third possibility too but I have not been able to establish strong correlation yet. And that is, that I did not get my requisite amount of exercise. Be that the walking, treadmill or weights. My mitochondria just did not get sufficiently "awakened".
Don't know about the third factor but the first two are pretty straightforward. They happen to me all the time. Well, not totally all the time. But whenever I have a 95-110 reading I can trace it to something I ate. I have not had a reading above 110 in a very long time.
Calorie restricted meals are critical for me. Does not mean that I starve myself. It means that if I overeat it shows up on my glucose monitor next morning.
If I have more than my usual amount of carbohydrates, the strict sugar control gets somewhat compromised come daylight.
I can deal with it. I don't get frustrated or dejected. I am just glad that my body responds to some of the steps I take. Literally.
And that is a good feeling.
Let's begin with the morning fasting number. Frankly, for me, happiness is seeing a 75-85 on my monitor's diplay first thing in the morning. That really makes my day. I can live with below 90. But any number above 90 for me is a bit of a red flag.
It means one of two things. Or both. One that I ate too much the day before (and night too - dinner and late night snack). Two that the carbohydrate amount in my prior meals were too high.
There is a third possibility too but I have not been able to establish strong correlation yet. And that is, that I did not get my requisite amount of exercise. Be that the walking, treadmill or weights. My mitochondria just did not get sufficiently "awakened".
Don't know about the third factor but the first two are pretty straightforward. They happen to me all the time. Well, not totally all the time. But whenever I have a 95-110 reading I can trace it to something I ate. I have not had a reading above 110 in a very long time.
Calorie restricted meals are critical for me. Does not mean that I starve myself. It means that if I overeat it shows up on my glucose monitor next morning.
If I have more than my usual amount of carbohydrates, the strict sugar control gets somewhat compromised come daylight.
I can deal with it. I don't get frustrated or dejected. I am just glad that my body responds to some of the steps I take. Literally.
And that is a good feeling.
Wednesday, March 11, 2009
Eating cheesecake.........with Type 2 Diabetes.
Yes, it is possible to enjoy a slice of cheesecake in spite of the Type 2 diabetes. Of course, with some caveats.
First, I like to make my own. With soy flour and crushed up Equal tablets and full-fat cream cheese and butter. And it comes out beautiful. The glucometer needle does not move even a little bit after I eat my cheesecake. And it is not that difficult to make. I am sure a web search of cheesecake will yield many possibilities. Just be sure to substitute traditional ingredients with diabetes friendly ones.
Second, the Cheesecake Factory sells sugar-free cheesecake by the slice. These slices are made with Splenda (according to their nutrition information) and contain 6 grams of carbohydrates per slice. Most of the carbs comes from the thin crust made with Graham Cracker like material. Each slice is quite large. So very often I have half a slice one day and the remainder the next day. This makes for quite a treat.
Third point is that I have come across several restaurants that have sugar free cheesecake slices on their dessert menu. These are not the same Cheesecake Factory product I mentioned earlier. In fact, these cheesecake slices are made with agave nectar, a natural sweetener quite popular with the organic loving, green conscious, ultra purist crowd. Once in a while, agave nectar in cheesecake slices have not hurt my sugar control. But I would not recommend it as a daily sugar substitute.
I savor my cheesecake. In spite of my Type 2 diabetes.
First, I like to make my own. With soy flour and crushed up Equal tablets and full-fat cream cheese and butter. And it comes out beautiful. The glucometer needle does not move even a little bit after I eat my cheesecake. And it is not that difficult to make. I am sure a web search of cheesecake will yield many possibilities. Just be sure to substitute traditional ingredients with diabetes friendly ones.
Second, the Cheesecake Factory sells sugar-free cheesecake by the slice. These slices are made with Splenda (according to their nutrition information) and contain 6 grams of carbohydrates per slice. Most of the carbs comes from the thin crust made with Graham Cracker like material. Each slice is quite large. So very often I have half a slice one day and the remainder the next day. This makes for quite a treat.
Third point is that I have come across several restaurants that have sugar free cheesecake slices on their dessert menu. These are not the same Cheesecake Factory product I mentioned earlier. In fact, these cheesecake slices are made with agave nectar, a natural sweetener quite popular with the organic loving, green conscious, ultra purist crowd. Once in a while, agave nectar in cheesecake slices have not hurt my sugar control. But I would not recommend it as a daily sugar substitute.
I savor my cheesecake. In spite of my Type 2 diabetes.
Tuesday, March 10, 2009
Desserts... to have them or to not have them?
Desserts are the best, aren't they?
Can we as Type 2 diabetics, who are trying to control blood sugars through diet and exercise, afford to eat the delectable sweet dishes that we used to consume with gay abandon before we were diagnosed?
I will tell you right away that I ate no dessert ....none at all...for the first year or so when I started dealing with my diabetes. I was just too scared. Scared that I would have to take drugs...and I am drug-phobic to begin with. Scared that my beta cells would burn out and leave me with dependency on external insulin.
One of my worst fears was that I had precious few beta cells left and that they were an endangered species in my pancreas. There was no clear way to assess the damage to the pancreas. In other words, by the time the fasting blood sugar and post-meal blood sugar tests cross into the danger zone in the laboratory tests, 70-80 per cent of the beta cells may have been compromised is what the literature said.
That will put the fear of God in anyone. I told myself that if high glycemic carbs from desserts wreak havoc on my pancreas, the remaining good 20-30 per cent of the beta cells will also perish. And then I will be left with no choice but to get on insulin. Which might not be bad at all. Others manage to deal with it quite nicely. My own cousin is not paranoid about the syringe and the bottle.
Me....I just was not ready to deal with that. So fear took strong hold of my psyche and I stayed away from all things sweet and tasty.
The only desserts I allowed myself were Jello snack cups (they contained maltodextrin free Splenda) and full-fat yogurt with DaVinci syrup.
This afternoon I had a lunch meeting at Manny's, home of the best Corned Beef sandwich in the world. I had the beef without the rye bread and the potato pancake. Instead with spinach. And topped it off with a small slice of Eli's cheesecake. My, how times have changed.
Can we as Type 2 diabetics, who are trying to control blood sugars through diet and exercise, afford to eat the delectable sweet dishes that we used to consume with gay abandon before we were diagnosed?
I will tell you right away that I ate no dessert ....none at all...for the first year or so when I started dealing with my diabetes. I was just too scared. Scared that I would have to take drugs...and I am drug-phobic to begin with. Scared that my beta cells would burn out and leave me with dependency on external insulin.
One of my worst fears was that I had precious few beta cells left and that they were an endangered species in my pancreas. There was no clear way to assess the damage to the pancreas. In other words, by the time the fasting blood sugar and post-meal blood sugar tests cross into the danger zone in the laboratory tests, 70-80 per cent of the beta cells may have been compromised is what the literature said.
That will put the fear of God in anyone. I told myself that if high glycemic carbs from desserts wreak havoc on my pancreas, the remaining good 20-30 per cent of the beta cells will also perish. And then I will be left with no choice but to get on insulin. Which might not be bad at all. Others manage to deal with it quite nicely. My own cousin is not paranoid about the syringe and the bottle.
Me....I just was not ready to deal with that. So fear took strong hold of my psyche and I stayed away from all things sweet and tasty.
The only desserts I allowed myself were Jello snack cups (they contained maltodextrin free Splenda) and full-fat yogurt with DaVinci syrup.
This afternoon I had a lunch meeting at Manny's, home of the best Corned Beef sandwich in the world. I had the beef without the rye bread and the potato pancake. Instead with spinach. And topped it off with a small slice of Eli's cheesecake. My, how times have changed.
Monday, March 9, 2009
Another look at fruits.
Another interesting point raised by Adnan from Phoenix. He mentions that citrus fruits and berries have not been harmful to his blood sugar control. And that freshly squeezed orange juice is much better than the ready-to-serve OJ found in supermarkets.
This is an interesting point because it illustrates one very important truth: No two diabetics are alike and what works for one may not work for another.
I used to have freshly squeezed grapefruit juice every day in the morning before my Type 2 diagnosis. I also used to have blueberries every day because of their antioxidants. I owned a juicer that got a lot of mileage in those days. In fact, we still have it.
I mentioned in an earlier post that based on its low glycemic index, I had made strawberries a staple for my breakfast hoping that I would get the benefits of this very healthy fruit without any impact on my blood sugar.
But I was wrong. It definitely affected my A1C reading. Now granted there may have been other factors, because there are so many variables in this blood sugar equation that it is difficult to isolate one variable or its effects. The cold fact for me was that when I stopped the daily consumption of strawberries my A1C went down by 0.3. Again, its hard to say because this reduction could be the result of inherent variability in the laboratory's testing method. Or it could have been due to some improvement in my metabolism. Who knows.
I did not want to take a chance. Also, what remained stuck in my mind was what I had read about fructose, the sugar found in fruits, that it stays bound to blood cells longer than other forms of sugar and thereby raises the A1C.
Sure I'll have the occasional strawberries for dessert but not daily anymore.
This is an interesting point because it illustrates one very important truth: No two diabetics are alike and what works for one may not work for another.
I used to have freshly squeezed grapefruit juice every day in the morning before my Type 2 diagnosis. I also used to have blueberries every day because of their antioxidants. I owned a juicer that got a lot of mileage in those days. In fact, we still have it.
I mentioned in an earlier post that based on its low glycemic index, I had made strawberries a staple for my breakfast hoping that I would get the benefits of this very healthy fruit without any impact on my blood sugar.
But I was wrong. It definitely affected my A1C reading. Now granted there may have been other factors, because there are so many variables in this blood sugar equation that it is difficult to isolate one variable or its effects. The cold fact for me was that when I stopped the daily consumption of strawberries my A1C went down by 0.3. Again, its hard to say because this reduction could be the result of inherent variability in the laboratory's testing method. Or it could have been due to some improvement in my metabolism. Who knows.
I did not want to take a chance. Also, what remained stuck in my mind was what I had read about fructose, the sugar found in fruits, that it stays bound to blood cells longer than other forms of sugar and thereby raises the A1C.
Sure I'll have the occasional strawberries for dessert but not daily anymore.
Sunday, March 8, 2009
Portion control - key to losing weight.
Adnan from Phoenix reminded me about the importance of portion control when trying to lose weight. It was the single most important factor for me.
Just as Adnan mentioned the large size of the Subway sandwich that was a normal meal for him, finishing a bag of Flaming Red Hot Cheetos in one sitting late at night while watching television was no big deal for me. Likewise with Goldfish Crackers. I would eat fistfuls of this delicious snack without batting an eyelid.
I am half convinced that snack food manufacturers have figured out what to add to their products to keep people like me from being able to stop after eating a reasonable amount.
I love to eat. And I live to eat. Eating to me is an activity to be cherished. Not to be hurried. And I used to believe that satiety was equally important. Continuing to add food that seemed tasty to one's mouth until one felt satisfied, was a God-given right of every person, I thought.
Well....that upper limit kept growing. And believe me, this just didn't start recently. I think in my case, it started in my late twenties. Eating until my stomach felt distended. Binge eating. You name it.
The only way to lose weight is to consume fewer calories than you are burning. Its that simple in theory. But very tough in practice.
Two things helped me control my portions after I resolved to lose weight to normalize my blood sugars.
First, I did not wait to be ravenously hungry to start a meal. As a rule now, I try to pace my meals at no less than 3.5-4.0 hours apart. But during the first few weeks and months, I used to eat whenever I felt reasonably hungry. Not waiting until I was totally starved to start my meal helped me to not reach for seconds or thirds. It was brutal at first. But over time it became easy.
Second, I stopped bringing the dangerous food items into the house. Like all the snack foods I mentioned earlier. Even now, when there is good stuff on the counter or in the fridge, it takes a mammoth effort of willpower to restrain me from having a bite.
Portion control day in and day out will become a habit with time. But it is the most difficult type of self-control for me.
Just as Adnan mentioned the large size of the Subway sandwich that was a normal meal for him, finishing a bag of Flaming Red Hot Cheetos in one sitting late at night while watching television was no big deal for me. Likewise with Goldfish Crackers. I would eat fistfuls of this delicious snack without batting an eyelid.
I am half convinced that snack food manufacturers have figured out what to add to their products to keep people like me from being able to stop after eating a reasonable amount.
I love to eat. And I live to eat. Eating to me is an activity to be cherished. Not to be hurried. And I used to believe that satiety was equally important. Continuing to add food that seemed tasty to one's mouth until one felt satisfied, was a God-given right of every person, I thought.
Well....that upper limit kept growing. And believe me, this just didn't start recently. I think in my case, it started in my late twenties. Eating until my stomach felt distended. Binge eating. You name it.
The only way to lose weight is to consume fewer calories than you are burning. Its that simple in theory. But very tough in practice.
Two things helped me control my portions after I resolved to lose weight to normalize my blood sugars.
First, I did not wait to be ravenously hungry to start a meal. As a rule now, I try to pace my meals at no less than 3.5-4.0 hours apart. But during the first few weeks and months, I used to eat whenever I felt reasonably hungry. Not waiting until I was totally starved to start my meal helped me to not reach for seconds or thirds. It was brutal at first. But over time it became easy.
Second, I stopped bringing the dangerous food items into the house. Like all the snack foods I mentioned earlier. Even now, when there is good stuff on the counter or in the fridge, it takes a mammoth effort of willpower to restrain me from having a bite.
Portion control day in and day out will become a habit with time. But it is the most difficult type of self-control for me.
Saturday, March 7, 2009
High blood sugar readings on some days.
In the last 3 years as a Type 2 diabetic, I have observed that on some days, blood sugar readings are abnormally high in spite of no change in diet or exercise routine. This non-normal increase can be as much 20-25 mg/dl above the typical reading. I have tried to observe this divergence carefully whenever it happens to analyze the potential causes.
I had noticed that every time I had a cold or the beginning of the flu or a sore throat, my fasting blood sugar was higher by about 15-20 points. Meaning that sometimes this number crossed the 100 mark. Which is high for me.
In the beginning I was perplexed because the increase would show up even before the traditional cold or flu symptoms would appear. I would scratch my head as to why that was happening. I would go back and examine everything that I had eaten in the previous two days. I would start researching causes on the internet and go back to my books.
Then I realized that anytime I had an infection, specially a viral one, nasty or mild, blood sugars always shot up prior to the appearance of nose running or throat hurting or fits of cough. I confirmed this observation in the books and other reliable information sources.
I didn't much care about the biology of it but I was relieved that the blood sugar increase was not due to anything more sinister. I always had these two fears that I had developed from reading some stuff somewhere.
First fear was that Type 2 diabetes control through diet and exercise works fabulously in the first 12 months but that soon after that, the body becomes resistant to it and sugar levels begin to rise. Wrong! Did not happen to me. But every time I had a slightly elevated reading in the months after my first anniversary, I used to get nervous and worry about exactly this.
Second, that beta cells burn out over time after the "honeymoon" period when diet is controlled and exercise is begun. Not knowing exactly how many beta cells remained healthy in my pancreas and having read somewhere that in most cases, when Type 2 diabetes is diagnosed, 75-80 per cent of the beta cells are dead, I used to worry that a series of non-normal blood sugar readings indicated rapid beta cell burnout in my pancreas.
Thankfully, I don't think about such dreadful possibilities anymore.
I had noticed that every time I had a cold or the beginning of the flu or a sore throat, my fasting blood sugar was higher by about 15-20 points. Meaning that sometimes this number crossed the 100 mark. Which is high for me.
In the beginning I was perplexed because the increase would show up even before the traditional cold or flu symptoms would appear. I would scratch my head as to why that was happening. I would go back and examine everything that I had eaten in the previous two days. I would start researching causes on the internet and go back to my books.
Then I realized that anytime I had an infection, specially a viral one, nasty or mild, blood sugars always shot up prior to the appearance of nose running or throat hurting or fits of cough. I confirmed this observation in the books and other reliable information sources.
I didn't much care about the biology of it but I was relieved that the blood sugar increase was not due to anything more sinister. I always had these two fears that I had developed from reading some stuff somewhere.
First fear was that Type 2 diabetes control through diet and exercise works fabulously in the first 12 months but that soon after that, the body becomes resistant to it and sugar levels begin to rise. Wrong! Did not happen to me. But every time I had a slightly elevated reading in the months after my first anniversary, I used to get nervous and worry about exactly this.
Second, that beta cells burn out over time after the "honeymoon" period when diet is controlled and exercise is begun. Not knowing exactly how many beta cells remained healthy in my pancreas and having read somewhere that in most cases, when Type 2 diabetes is diagnosed, 75-80 per cent of the beta cells are dead, I used to worry that a series of non-normal blood sugar readings indicated rapid beta cell burnout in my pancreas.
Thankfully, I don't think about such dreadful possibilities anymore.
Friday, March 6, 2009
Sandwiches for a diabetic's lunch?
I love sandwiches. But as a Type 2 I can't have them anymore. Well, at least not everyday. I miss it very much though.
Here is what I do. Which curbs my appetite for this bread-based delicacy just enough. Let me trace my thought process.
I started with low carb alternatives to the white or whole wheat bread slices that are the mainstay of most sandwiches. The first candidate was the GG Crispbread. All fiber. nearly zero net carbs. Firm texture that could hold beef bologna or turkey or cheese in between two pieces.
And I followed this option for many weeks. The best tasting crispbread number was a grilled cheese one. Basically, I took 2 crispbreads, placed a big hunk of American cheese between them and then microwaved it. That made for a nice warm pseudo-sandwich. Other possibilities included crispbreads with cream cheese, canned tuna, lunch meat slices and many different kinds of cheese.
One problem, They were not quite the same as a sandwich with real bread. And the crispbreads still tasted like paper. That's when I discovered the Healthy Life bread which has only 5 grams per slice. So one can make a pretty decent sandwich with two slices of bread and still stay under 10 grams of carbs.
Not bad for a Type 2 diabetes to be able to make a sandwich and eat it too.
Here is what I do. Which curbs my appetite for this bread-based delicacy just enough. Let me trace my thought process.
I started with low carb alternatives to the white or whole wheat bread slices that are the mainstay of most sandwiches. The first candidate was the GG Crispbread. All fiber. nearly zero net carbs. Firm texture that could hold beef bologna or turkey or cheese in between two pieces.
And I followed this option for many weeks. The best tasting crispbread number was a grilled cheese one. Basically, I took 2 crispbreads, placed a big hunk of American cheese between them and then microwaved it. That made for a nice warm pseudo-sandwich. Other possibilities included crispbreads with cream cheese, canned tuna, lunch meat slices and many different kinds of cheese.
One problem, They were not quite the same as a sandwich with real bread. And the crispbreads still tasted like paper. That's when I discovered the Healthy Life bread which has only 5 grams per slice. So one can make a pretty decent sandwich with two slices of bread and still stay under 10 grams of carbs.
Not bad for a Type 2 diabetes to be able to make a sandwich and eat it too.
Thursday, March 5, 2009
How to think about lunch as a Type 2 diabetic.
As someone with Type 2 diabetes, I have tested various combination of carbs and proteins to arrive at an optimal mix for me.
There is one good thing about lunch. It is the least challenging among all three meals in terms of blood sugar control. As I had mentioned before, breakfast is the toughest and dinner is only a little better. My tolerance for carbs is at its maximum at lunch time. And my "clearing" time, i.e. time to pre-meal sugar level is the shortest.
So I have had a good deal of freedom of choice in picking a good midday meal. My first requirement is that I want to keep my carb amount to no more than 20 grams. In the beginning, I aimed for only 15 grams.
I always have a salad of some kind. This can be Baby Spinach Salad available in pre-washed plastic bags in grocery stores or salad made from Romaine lettuce that I wash and cut myself with slices of cucumbers. I add walnuts to the salad as often as I can. And I use a near zero gram carb salad dressing. Creamy Caesar or Blue Cheese dressing is also fine with me. As long as their carb content is below 2 grams and they have no sugar added. Newman's is a brand I like quite a bit.
For the protein portion of the meal, tuna fish in cans mixed with full-fat mayonnaise can be a good option. Or an all-natural hot dog or soy burger. The sky's the limit with protein choices. I sometimes have leftovers from the prior night's dinner.
The best part about lunch is that I can even have a small piece of dessert if I want, specially if I have kept the veggie portion of my meal to lower than 15 grams.
I love the lunch meal.
There is one good thing about lunch. It is the least challenging among all three meals in terms of blood sugar control. As I had mentioned before, breakfast is the toughest and dinner is only a little better. My tolerance for carbs is at its maximum at lunch time. And my "clearing" time, i.e. time to pre-meal sugar level is the shortest.
So I have had a good deal of freedom of choice in picking a good midday meal. My first requirement is that I want to keep my carb amount to no more than 20 grams. In the beginning, I aimed for only 15 grams.
I always have a salad of some kind. This can be Baby Spinach Salad available in pre-washed plastic bags in grocery stores or salad made from Romaine lettuce that I wash and cut myself with slices of cucumbers. I add walnuts to the salad as often as I can. And I use a near zero gram carb salad dressing. Creamy Caesar or Blue Cheese dressing is also fine with me. As long as their carb content is below 2 grams and they have no sugar added. Newman's is a brand I like quite a bit.
For the protein portion of the meal, tuna fish in cans mixed with full-fat mayonnaise can be a good option. Or an all-natural hot dog or soy burger. The sky's the limit with protein choices. I sometimes have leftovers from the prior night's dinner.
The best part about lunch is that I can even have a small piece of dessert if I want, specially if I have kept the veggie portion of my meal to lower than 15 grams.
I love the lunch meal.
Wednesday, March 4, 2009
For Type 2 diabetes, what other exercise besides walking?
For my Type 2 diabetes, it turns out that I need a little more exercise than just walking for optimal blood sugar control.
Most of the diabetes books mention walking and also muscle-building exercises. The problem with muscle-building workouts is that one needs equipment or one has to go to the health club. And buying equipment alone is not enough. One has to be properly trained to use the equipment to not get hurt. And at the health club a trainer would be necessary.
Also for the fifty somethings, specially this one, muscle building exercises are a little bit over the top. There is a good deal of risk in my opinion.
I am not a health club person. So that option was out for me. I am also not into ellipticals and exercycles and other complicated machines I see in the health clubs.
So I had to figure out how to go about doing some muscle-building exercises on a regular basis without hurting myself and with minimal equipment.
I settled on a simple 10 lb. dumbbell as my equipment and an easy routine that works the shoulders and arms. I do this every other day. Works just fine for me.
Most of the diabetes books mention walking and also muscle-building exercises. The problem with muscle-building workouts is that one needs equipment or one has to go to the health club. And buying equipment alone is not enough. One has to be properly trained to use the equipment to not get hurt. And at the health club a trainer would be necessary.
Also for the fifty somethings, specially this one, muscle building exercises are a little bit over the top. There is a good deal of risk in my opinion.
I am not a health club person. So that option was out for me. I am also not into ellipticals and exercycles and other complicated machines I see in the health clubs.
So I had to figure out how to go about doing some muscle-building exercises on a regular basis without hurting myself and with minimal equipment.
I settled on a simple 10 lb. dumbbell as my equipment and an easy routine that works the shoulders and arms. I do this every other day. Works just fine for me.
Tuesday, March 3, 2009
The amazing benefits of walking
We have all seen plenty of writing touting the benefits of walking for Type 2 diabetes. I agree with all of that. But in my own experience, walking has been more than that.
It is clearly the most convenient, safe and productive exercise for fifty somethings. I find walking to be refreshing, relaxing and soothing.
I have a walking routine. I cover the exact same distance every day. But the two walking routes are different. There is no overlap. I do them both daily.
Among the benefits of walking, here is the piece d resistance for me. The best part. It lowers my blood sugar after meals. Time and time again, after a 30-minute walk, my glucose readings have normalized after a meal in which I have consumed higher-than-usual carbs and after which I have observed a higher-than-usual-peak.
Sometimes, when I indulge in bites of dessert or floury stuff, I go on my trusted walk and like clockwork, the glucose monitor shows a big reduction when I return.
The logic is this. With Type 2 diabetes, the cells are normally resistant to the glucose carried by insulin because the mitochondria, a kind of gate through which the insulin laden glucose enters the cells, is nearly closed. And, apparently, walking opens them up again.
Another analogy is that with high levels of insulin resistance, the mitochondria goes into a "sleep" mode, much like the computer does when it has been inactive for some time.
In my case, walking "wakes up" the mitochondria and I am glad that it does.
It is clearly the most convenient, safe and productive exercise for fifty somethings. I find walking to be refreshing, relaxing and soothing.
I have a walking routine. I cover the exact same distance every day. But the two walking routes are different. There is no overlap. I do them both daily.
Among the benefits of walking, here is the piece d resistance for me. The best part. It lowers my blood sugar after meals. Time and time again, after a 30-minute walk, my glucose readings have normalized after a meal in which I have consumed higher-than-usual carbs and after which I have observed a higher-than-usual-peak.
Sometimes, when I indulge in bites of dessert or floury stuff, I go on my trusted walk and like clockwork, the glucose monitor shows a big reduction when I return.
The logic is this. With Type 2 diabetes, the cells are normally resistant to the glucose carried by insulin because the mitochondria, a kind of gate through which the insulin laden glucose enters the cells, is nearly closed. And, apparently, walking opens them up again.
Another analogy is that with high levels of insulin resistance, the mitochondria goes into a "sleep" mode, much like the computer does when it has been inactive for some time.
In my case, walking "wakes up" the mitochondria and I am glad that it does.
Monday, March 2, 2009
The first time I thought about exercise to normalize blood sugar.
The first time I thought about exercise as a way of normalizing blood sugar was when I was on my third diabetes book in the first month after diagnosis.
I had been exercising fairly regularly since 1999 when I bought a treadmill and set it up in my home. My exercise goal all along had been to stress my heart in a controlled way. I had been steadily increasing the treadmill incline and speed to the point where, based on the heart rate monitor strapped on my chest, my heart was getting a decent workout.
But it had not helped me lose any weight. Or reduced my cholesterol numbers. It was probably helping to keep my blood pressure down a tad bit.
In all likelihood, I was neutralizing the good effects of the tread milling by superbad diet and snacking binges at night during Jay Leno.
This time around my focus was different. I had quickly come upon a fairly consistent observation by the authors in the various diabetes books. Which was that exercise definitely helps in keeping blood sugars normal.
If diet was responsible for 75% of the improvement, exercise helped with the remaining 25%.
So I decided to do something in addition to the tread milling. That was when I discovered the remarkable benefits of walking briskly for 30 minutes.
I changed my schedule around so that I could get in two 30-minute walks every day. First one before dinner. Second one after dinner, at about 9 PM. There are of course exceptions if I have to be gone in the evening or on weekends.
However, I am quite nutty about my walks. Whether it rains or shines, snows or freezes, I am always out at least twice a day for half an hour each time.
Walking does amazing things for my post-meal blood glucose readings. More on this next time.
I had been exercising fairly regularly since 1999 when I bought a treadmill and set it up in my home. My exercise goal all along had been to stress my heart in a controlled way. I had been steadily increasing the treadmill incline and speed to the point where, based on the heart rate monitor strapped on my chest, my heart was getting a decent workout.
But it had not helped me lose any weight. Or reduced my cholesterol numbers. It was probably helping to keep my blood pressure down a tad bit.
In all likelihood, I was neutralizing the good effects of the tread milling by superbad diet and snacking binges at night during Jay Leno.
This time around my focus was different. I had quickly come upon a fairly consistent observation by the authors in the various diabetes books. Which was that exercise definitely helps in keeping blood sugars normal.
If diet was responsible for 75% of the improvement, exercise helped with the remaining 25%.
So I decided to do something in addition to the tread milling. That was when I discovered the remarkable benefits of walking briskly for 30 minutes.
I changed my schedule around so that I could get in two 30-minute walks every day. First one before dinner. Second one after dinner, at about 9 PM. There are of course exceptions if I have to be gone in the evening or on weekends.
However, I am quite nutty about my walks. Whether it rains or shines, snows or freezes, I am always out at least twice a day for half an hour each time.
Walking does amazing things for my post-meal blood glucose readings. More on this next time.
Sunday, March 1, 2009
The first time I had to use the glucose monitor.
The very first time I had to use the blood glucose monitor was tough, to say the least.
Not because I did not know how to draw my own blood. Also not because I had not yet developed the soft touch in bringing the strip to the blood drop. Now it has become habit. I could do it in my sleep.
It was tough because of the feelings I felt. I'll be honest I was not in a good place, emotionally. There was a good deal of self-pitying going on. And self-blame. Self-flagellation of all kind.
First step was to get the equipment.
A few days prior to my time of reckoning, I had mustered up whatever courage I had and called my insurance company to order the glucose meter. I'll get into the meters themselves in a later post. For now, I am back to the afternoon of June 30, 2006.
It was a Friday. Just before the Fourth of July weekend. A happy, festive, carefree time generally. At 3:21 PM. I pricked my left index finger. I brought the strip sticking out of the meter carefully to the drop of blood. Then I watched intently at the display of the Accu-Chek Aviva as it measured the sugar in my blood. The reading was 138.
I had had lunch at 1 40 P.M.. So the reading wasn't actually bad.
I felt a sense of relief. That wasn't too terrible, I thought.
And that is how I started testing my blood sugar on my Accu-Chek Aviva. The reason why I can report the exact time, day and reading is because I logged all of my measurements on a Self-monitoring Diary that comes free with the Accu-Chek Aviva monitor. I am on my 5th diary. One diary lasts about 7-8 months.
One of the best ways to overcome any discomfort with using the glucose monitor is to think about the immensely valuable data that comes out of it. And that realization came early to me. Since then, I don't go anywhere without my Accu-Chek Aviva kit which consists of the meter, teat trips and a lancet with drum.
Not because I did not know how to draw my own blood. Also not because I had not yet developed the soft touch in bringing the strip to the blood drop. Now it has become habit. I could do it in my sleep.
It was tough because of the feelings I felt. I'll be honest I was not in a good place, emotionally. There was a good deal of self-pitying going on. And self-blame. Self-flagellation of all kind.
First step was to get the equipment.
A few days prior to my time of reckoning, I had mustered up whatever courage I had and called my insurance company to order the glucose meter. I'll get into the meters themselves in a later post. For now, I am back to the afternoon of June 30, 2006.
It was a Friday. Just before the Fourth of July weekend. A happy, festive, carefree time generally. At 3:21 PM. I pricked my left index finger. I brought the strip sticking out of the meter carefully to the drop of blood. Then I watched intently at the display of the Accu-Chek Aviva as it measured the sugar in my blood. The reading was 138.
I had had lunch at 1 40 P.M.. So the reading wasn't actually bad.
I felt a sense of relief. That wasn't too terrible, I thought.
And that is how I started testing my blood sugar on my Accu-Chek Aviva. The reason why I can report the exact time, day and reading is because I logged all of my measurements on a Self-monitoring Diary that comes free with the Accu-Chek Aviva monitor. I am on my 5th diary. One diary lasts about 7-8 months.
One of the best ways to overcome any discomfort with using the glucose monitor is to think about the immensely valuable data that comes out of it. And that realization came early to me. Since then, I don't go anywhere without my Accu-Chek Aviva kit which consists of the meter, teat trips and a lancet with drum.
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