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A recurring theme throughout last week’s ADS ADEA meeting in Perth was the need to manage expectations. I think, in general, we do a really lousy job of this in diabetes.

We’re told that can expect to live a ‘normal life’ after a diabetes diagnosis, when that’s not necessarily the truth.

We’re told we can expect to eat whatever they want, when really, the effort that goes into calculating medication doses depending on the nutrient value of our foods is hard and it may be easier for some to actually limit food choices to make things a little easier.

We’re told to expect a cure in five years’ time, when the truth is that a cure is not even on the distant horizon.

We’re told that we can expect new technology to significantly reduce the burden of living with diabetes, when the reality is that sometimes, it’s more – not less – work.

We’re told to expect person-centred care, when, really, our health system, is not designed to cater for the individual needs of people living with diabetes.

We’re told that emerging technology will be fully automated, smart and cure-like, but we are not told that there will still be human-input necessary and that the devices are not as smart as a functioning pancreas.

We’re told that if we keep our A1c below 7% we can avoid complications, and yet, there is no guarantee, and some of us do develop complications despite an A1c regularly hitting that magic number.

We are told that if we count carbs and dose the right amount of insulin at the right time, we can keep our glucose levels in range, often neglecting to be told that there are a lot of other factors at play.

We are told all this, and then, when these expectations are not met, we are told we’ve failed. Or we are disappointed.

Here’s the thing. The tools are actually really great. Our health system here in Australia is mostly terrific. The majority of our HCPs genuinely do want to give us the best care they can. We don’t need to oversell things as much as we do.

Our expectations are being set so realistically high, that it’s impossible to meet them.

So, THIS is what I would like to say about all the things I’ve covered above to help manage expectations:

Your life will be different after a diabetes diagnosis. But that’s okay. Your new normal is going to be different to your old normal, but hopefully, there will be very things that diabetes will prevent you from doing. Acting like a pancreas is not really normal, but you can do it!

Yeah, you can eat whatever you want. But it’s undeniable that certain foods are harder to manage after your pancreas decides to go on strike. Find what works for you – and that can change. But do be prepared for food to become something that can be a little fraught because you may find that some of your most favourite foods are a little difficult to deal with.

Researchers are brilliant and amazing and the advances in diabetes management are actually quite mind blowing, but a cure? We’re nowhere near that yet. Keep up to date with everything and try to mine through it to work out what is relevant for you. Keep getting excited about management and tech advances – but do keep it in perspective. (Also – consider the source. I promise you that the Channel 10 news or Buzzfeed is NOT going to be where you learn that diabetes has been cured forever.)

You are going to have a lot that you will want to know and work through, and possible a variety of healthcare professionals to see. As wonderful as it would be to have someone to coordinate it all for you, you’ll have to put in the leg work to find the right team, the right service and the right people. And then, once you’ve found them, it’s still up to you to direct what you need. Otherwise you might find yourself at the mercy of a system that is not really going deliver exactly what you need to get the most from it.

You may have heard that in the US there is a (hybrid-closed loop) pump/CGM combo. Some are calling it an artificial pancreas. It’s not. The tech is incredible, but it’s not fully automated. It still requires calibration and it still requires operator input. This is not me being negative, because the tech is exciting. It’s me being realistic about the level of automation

No new devices are going to completely remove the load diabetes adds to your life, or your involvement in their operation.  Insulin pumps need buttons pushed; CGMs need calibration, food needs to be considered. Full automation may be the goal, but it’s a while off.

An A1c of 7% or below will indeed reduce your risk of developing diabetes-related complications and there is a lot of evidence to support that. But it doesn’t eliminate the risk. That’s the annoying and somewhat unfair reality of diabetes. Unfortunately, it’s the reality. Obviously, do what you can to manage your diabetes as well as you can. But don’t expect that a number is a guarantee of anything.

Carbs and insulin are only part of the equation. How you’re feeling emotionally, illness such as colds and flus, hormones, nutrients other than just carbs, the phase of the moon (well, maybe not) … all these impact on your numbers. And they change. Don’t expect that there is an equation that will work all the time.

In life, we’re often told to expect the unexpected. But in diabetes, the unexpected is often only that way because what we have been told to expect is unrealistic. If we were told the truth, and provided with realistic expectations from diagnosis – and throughout our diabetes lives, perhaps we wouldn’t feel that we’re constantly falling behind and failing.

Here’s me and my boss talking about expectations in technology. 

Disclosures

Roche Diabetes Australia has covered my travel and two night’s accommodation for my stay in Perth as I am a presenter at the Roche Educators Day (RED). There is no expectation from Roche that I will write anything about the RED, but I expect I will because it’s always such an interesting and enjoyable day!

The remainder of my time in Perth is part of my role at Diabetes Australia.

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If you can, think back to when you were diagnosed with diabetes. Can you remember much of it?

I can. I can remember almost every word that the endo, diabetes educator and dietitian said to me. I can remember that, in amongst the explanations of what diabetes was all about and how it would impact on my life, there were thinly-veiled threats about what would happen if I strayed from the plan I was being given with the expectation that I would follow it. I remember the rigid ‘my-way-or-the-highway’ instructions about how life with diabetes would be.

But mostly, I remember what was missing. There was no mention about the impact of diabetes on my emotional wellbeing. No one suggested that speaking with peers – others living with diabetes – might provide me with some much need comfort or camaraderie. No one hinted that I might like to do some of my own reading and investigating to come up with my own ideas of how to best manage this chronic condition that had moved into my body, my mind, my life.

No one told me there were options or suggested that I needed to carve out my own path and then work out to navigate it best.

If only I’d had a guide to help me do that – something to give me some ideas that felt more in line with how I lived before diabetes. I wanted something that shared real-life experience about how to make diabetes fit into an already really busy life, and help me be conscious of making healthier choices, but choices that didn’t feel as though they were suffocating me.

Now I have it – albeit 19 years too late!

Adam Brown from diaTribe has written Bright Spot and Landmines which he has sub-headed ‘The Diabetes Guide I Wish Someone Had Handed Me’. 

Click on link to be taken to the first chapter.

As I read this book, I started to think about how different those early diabetes years would have been for me – the years before I found my voice, my people and an ability to work out my own way with diabetes.

I could use words such as ‘sensible’ and ‘practical’ and ‘level-headed’ to describe the advice gently doled out in Adam’s book, and they would all be accurate.

But they would be underselling the value of the book.

Adam highlights the landmines – the things we all do to take short cuts – that inevitably negatively affect our diabetes. Often we think these short cuts save us time or ‘fix’ a diabetes problem quickly, only to find that they often turn out to be time consuming and actually end up causing more problems than the original one we were trying to address.

The bright spots are suggestions on how to positively and sustainably live with diabetes. They are easy to manage, and don’t ask for a significant shift in thinking, or large financial or even time investment to make the changes.

The book is segmented into four sections: Food, Exercise, Mindset and Sleep. This makes it super easy to use as a reference book and dive into it to help target specific areas that you want to think about. I’ve read the whole book through twice now, but keep going back to the sleep section, because I realised that it is an area of my life that I really need to address now.

I honestly wish that the day I’d been diagnosed with diabetes I’d been handed this book. I wish I’d had it on my shelf all those years as a resource to refer back to in moments of burnout or no motivation, or when I needed a little push to encourage me. I wish I’d been able to tap into Adam’s wisdom on specific issues when I was struggling with being in a food rut that was affecting my glucose levels, or in a funk because my mind was not clear or focused.

I’m so glad to have it now and have already made some changes which have been very positive. It might be 19 years late to the party, but this book will be on my shelf to be pulled down very, very often.

It doesn’t matter how long you’ve had diabetes; you WILL get something out of Adam’s book. But if you or a loved one is newly diagnosed, I would recommend you stopping whatever you are doing RIGHT NOW and getting a copy. You can buy a paperback copy here, or download the PDF here, naming your own price.

If you would like to win a copy of Bright Spots and Landmines, I can hook you up! Adam generously provided me with some copies when I caught up with him recently at ADA. Just click here and tell me in 25 words or fewer why you would like to win a copy of Bright Spots and Landmines. But chop chop! You’ve only got until the end of the weekend to enter. 

It’s the final day of the eighth annual #DBlogWeek, created by Karen from Bittersweet Diabetes. This is the sixth year I’ve taken part and it’s a great opportunity to not only write about some truly interesting topics, but also a chance to read some blogs you may not otherwise.  Here are the links to today’s posts. 

Today’s prompt: Let’s wrap up the week by sharing a little more about ourselves, beyond the chronic illness we or our loved ones live with.  Share an interest, hobby, passion, something that is YOU.  If you want to explore how it relates to or helps with diabetes you can.   Or let it be a part of you that is completely separate from diabetes, because there is more to life than just diabetes!

I have lived with type 1 diabetes for 19 years. I work for a diabetes organisation and have done so for over 15 years. I write a diabetes blog. I am an ambassador for a couple of diabetes-related charities. Occasionally, I can be found speaking about diabetes on radio and television, or writing about it for online and print publications. There is a lot of diabetes in my life.

And yet diabetes is actually such a small part of my life. It may be hard to believe, but it is the truth.

When I have a few idle hours, you won’t find me thinking about diabetes. If I catch up with friends, we rarely, if ever, speak of diabetes.

In fact, the thing that takes up a lot of my spare time, and spare mental space, is food and cooking – especially baking. I thought today I’d share some of my recent baking activities and recipes, just in time for weekend bake-ups!

One day, about two weeks ago, I had an urge to get out the piping bag and make macaroons. As you do. Not to be confused with the ubiquitous macaron, macaroons are little mounds of coconut, egg white, sugar, vanilla and (in my world) edible glitter. This was the outcome.


(For the record, two days later, I decided to up the ante, looking for fancier macaroons. I tried another recipe that called for shredded rather than desiccated coconut, and they were an unmitigated fail! Also, I broke my piping bag in the process of trying to push the too-large coconut strands through the nozzle. Moral of the story: sometimes the more elaborate the recipe, the poorer the outcome!)

The kidlet decided that we’d not made gingerbread folks for a while. So we did. And they were so much fun, dressed in bright colourful candied-sugar buttons!


These came on the heels of a shortbread bake-up a few weeks earlier. Again, it was the kidlet saying that we’d not made them for ages, and this was the result of a Sunday afternoon in the kitchen. We used a Stephanie Alexander xmas shortbread recipe, but simply shaped the dough into weird square/rectangular shapes. The Smarties on top are a nod to a local café we used to drop into when she was just a little kidlet. She’d slurp on a babycino, getting the sprinkled chocolate from the top all over her face and we’d share one of their colourful, spotty shortbread cookies. She promised that these tasted just like she remembered!


And while we’re talking fun biscuits (or cookies for my US friends), check out these doughnut-inspired masterpieces created by the kidlet using Nigella’s basic butter biscuit recipe. They tasted as amazing as they look! (This recipe is THE best never-fail biscuit recipe and a brilliant opportunity to show off any cookie-cutter shape you have!)


For Mother’s day afternoon tea last weekend – with Autumn in full swing – I made this delicious and rather impressive-looking caramel apple upside-down cake to serve up, with ice-cream generous dollops of double cream to my mum and mother-in-law.


But one of the most wonderful things I’ve made of late are these Nutella biscuits. The recipe was sent to me by none other than #DBlogWeek creator, Karen Graffeo, who knew I’d not be able to resist the Nutella-y gooeyness of these cookies. They were an absolute hit with everyone who tried them and will definitely be making a regular appearance in the kid’s lunchbox!


And finally – this recipe appeared in my inbox yesterday morning, and yesterday afternoon, with 10 minutes before a teleconference was due to start I whipped it up and threw it in the oven. It was delicious!  I love an easy recipe that turns out exactly as it promises.


It’s not hard to know why baking is such a wonderful outlet for me. I love the methodical process of following a recipe combined with the freedom to tweak and adjust as I want. I often bake with the kidlet by my side, and as we throw together ingredients, or decorate cakes and biscuits, we chat and catch up – often about not much at all, but sometimes about pretty serious things too. Creating those opportunities to just hang out and talk with her is important, but mostly, I really like baking with her!

And the end result is always worth it! A house that smells divine, and homemade, delicious treats pulled from the oven to share with family, friends and the neighbours. A pretty damn perfect hobby!

A couple of days ago, I woke up at 5am low and stayed that way until about 12pm when I decided to have a sushi roll for lunch. My thinking was that if white rice didn’t solve this low, nothing would! I’d already thrown a lot at it – juice, black tea with sugar, jelly beans – sitting there watching my CGM trace stay in the red area apart from very occasional and very small rises before dropping back below that comfort line.

The rice did the trick. And then some. I watched the spike as the evil rice did its thing and sent me into the mid-teens. Thanks rice; thanks you very much. (I know, I know…we’re not supposed to think of food as good and bad, but rice is the freaking devil.)

I then watched the spike change direction and start to plummet. I’d done everything ‘right’… dosed at the right time, calculated the carbs, delivered the correct amount of insulin… Rice is my food nemesis. I’ve tried everything and just can’t get it to work which is why I rarely, if ever, eat it. But I was getting nervous at the non-budging CGM lows and knew that rice was a sure-fire way of getting me out of low-zone.

Rice: evil little grains of misery.


Everything fell back into place by the afternoon and then that night, dinner consisted of a low carb meal. The roasted cauliflower, warm salad of broccoli and green beans, avocado and cucumber salad with pepitas, and roast beef barely caused a blip on my CGM graph for the rest of the evening. The tiny bolus that accompanied the meal did its trick and the line stayed in-range and mostly flat. The dark chocolate and cup of tea I had before bed had no effect either.

Before I started using CGM, I had no idea just how different foods truly impacted my glucose levels. Carb counting can be pretty hit-and-miss, but I wasn’t too horrid at it – at least for most of the time.

Doing the recommended four or five checks a day hid most of the truth about what was going on for most of the time. Sure, my glucose levels may have been not too horrid when I checked before meals or before bed, but in between those random checks, there was A LOT happening to which I was completely oblivious.

CGM doesn’t necessarily need to translate to being more limited (or more boring) about food choices. But it does arm us with a lot of information about how our glucose levels react to certain things, which means that we can make more-informed choices about what we eat, and how we eat it.

Using CGM means that I can be much smarter about timings of boluses (and the types of bolus), and even the times I choose to eat different things. I know I am more insulin resistant in the mornings, so it’s a lot more difficult to manage with high carb foods at that time of day. I learnt that delaying my morning milky-sugar-added coffee by just half an hour results in less of a spike.

Of course, we need to remember that food is not the only factor that impacts our glucose levels. CGM has offered great insight into hormonal changes, effects of stress and different meds and eating a certain way cannot guarantee a flat CGM trace.

For the record, THIS is one of the main reasons I use CGM. I get a little tired of the constant focus there is on the technology ‘saving lives’. Do I honestly believe that my CGM has saved my life? Sure, it makes me feel safer – especially when travelling on my own – but for me, the real reason I use it, and its real benefit, is to be armed with information about how to best deal with diabetes.

DISCLOSURE

I probably just should mention that I generally self-fund all my own CGM costs. This includes the $540 I just spent on a new transmitter! When I’ve been given product while participating in trials, or in exchange for speaking gigs, I’ve always disclosed on this blog.  

I also have some very generous friends in the US who have most kindly given me sensors when they’ve had spares. They are wonderful, wonderful people and I am so grateful for their generosity!

There’s a war going on and it’s getting very, very messy.

Fat or carbs? These are the two big hitters in our diets, and when it comes to diabetes, are demonised by some, celebrated by others. And it’s confusing to say the least.

It’s also incredibly polarising and some of the most brutal arguments I’ve seen online within the diabetes community are about the foods we choose to eat or the eating plans we choose to follow.

My own personal decision to eat a lower carb diet was met with almost comical responses. Both sides of the fence told me I was being an idiot, all of which I happily ignored and continued doing what I was doing. Because it was working for me and is none of anyone else’s business.

When we look at the science of food, it’s confusing. I don’t for a minute pretend to understand how things work, I really don’t. I know how different foods impact my glucose levels, I know foods that make me feel better and I know that I like to eat.

But having made all of those disclaimers, I am health (and food) literate and I do understand some aspects of the science. I understand the basics of the carbs versus fat argument. But mostly, I understand that choice needs to be the driving force, along with acknowledging no one way of eating will ever work for every person. (Because if that were true, we’d all just eat Nutella ALL the time, because it tastes so bloody good and if you believe their spin, it’s a health food! Don’t believe their spin.)

What I really don’t like about the debate though is the acrimony. It makes me uncomfortable when either side take to cheap shots or aggression. Exhibit A is in the form of a tweet which I’m not sharing, because its writer is selling diet books and I’ve no intention of giving her any publicity here. But the gist of her tweet was condemning dietary guidelines and slamming carbs because she doesn’t (and this is a direct quote) ‘want to be fat and diabetic’.

The tweeter managed to food shame, fat shame, stigmatise and judge – all in 140 characters. As well as get things wrong. There are plenty of people who do follow dietary guidelines and eat carbs, yet do not have diabetes and nor are they overweight.

I get that there is some real anger, particularly within the LCHF community because there is so little recognition of how eating in this way can, for some people, help manage weight, diabetes and overall health. And some feel cheated that LCHF is frequently not even presented or recommended as an option, instead ignored or claimed to be dangerous. I get that this is frustrating for people who have seen great results after adopting this sort of diet.

I’m actually one of those people. But I refuse to think for one minute that just because this is working for me that everyone else should do it, too. I’ve never subscribed to thinking that any aspect of diabetes management is one size fits all.

So, what’s the answer? Well, I’ve no idea really. Ever since taking an interest in different eating habits, I’ve been astounded at just how many new diets are released. Obviously some of them are more sound than others, but regardless, there are always new ideas out there.

Perhaps the answer is to be patient. The ‘in’ and guideline-approved way of eating changes every decade or so. Perhaps those who are cross that their chosen eating plan isn’t the plan de jour just need to wait a few years before it is. And then they can say ‘told you so’. At least, until it’s old hat and replaced by some other new trend.

This is the first of a couple of food/diet-related posts I have ready to go over the next few days. I’m really interested to hear what others have to say about what works/doesn’t and why. And also how people deal with the judgement and commentary that inevitable comes when we are talking about what we eat.

A few people read this blog. I actually checked the stats just before, and was surprised to see that each day a significant number of people check in and read what I have to say.

So, given that people seem interested in what I have to write, I’ve decided I should take advantage of this. With this profile, I am going to do good for the world.   

Just so you know – because I’m all about disclosure – I’m a classically trained flute player. Also, I like to cook. And I’m quite good at air hockey. Also, I write some mindless crap a few days each week and publish it here, so that OBVIOUSLY qualifies me as MORE than suitable to give advice – any sort of advice I’d like, but specifically medical and nutrition advice. In fact, I’d argue that I am probably more qualified than most people who have gone to medical school, because they have been brainwashed by all the evidence and peer-reviewed journals they’ve been forced to study. I haven’t.

I think that it’s fair for me to advise that insulin is actually really poisonous. It’s dangerous and it’s dodgy. Doctors, of course, won’t tell you this. They want to keep you on insulin because they are in the pocket of Big Pharma, and like their holiday houses on the Peninsula, so they won’t tell you what they know.  

Really, you should all be off insulin and use air and water, and maybe some cinnamon, which is NATURAL and can be found in NATURE and is ORGANIC. Because NATURE’S NATURAL ORGANICS are health care. Medicine (such as insulin) is sick care.

Also – if you are ingesting grains, dairy, fruit, vegetables, sugar, protein, carbs, caffeine, flowers, condiments, oils, sauces and/or food (except organic kale) and drink (except organic kale juice), you should stop. Dietitians know this, but they won’t tell you that because they are in the pocket of Big Food and they want you to be sick so you’ll go to doctors who are in the pocket of Big Pharma.  

It’s the circle of life and everyone everywhere is trying to keep you sick. Okay? OKAY?????

And, finally, I’ve seen the way and realise now that vaccines are really dangerous and I wish that I’d never vaccinated my kid and will be cancelling my flu vax appointment for early next month. I’m trying to work out if I can actually somehow withdraw the vaccines I had injected into my kid last week so she doesn’t have those evil pollutants floating around her otherwise perfect self. Vaccines are full of toxins and heavy metals and evil pixies. Plus, vaccines cause frizzy hair, skin tags and bugs to fly into your mouth making you cough. Doctors know this, but won’t tell you because … well, you know why…

Also: kale. Because KALE, KALE, KALE, KALE, KALE!! (Must be organic.) 

I know. I sound like a lunatic, right?

Actually, I sound kinda like Pete Evans. To be honest, I didn’t watch Pete Evans’ interview last night. I’m not interested in seeing him being allowed to spruik his dangerous crap on a television station that employs him (poor form, Channel 7), plus he’s full of shit. Most importantly, we were watching ‘Shut Up and Sing’ in preparation for seeing the Dixie Chicks next Saturday night and needed to bring the kidlet up to speed with her political education. #TeachingMoment

But I did catch up online with some of his rubbish claims and am once again flabbergasted that people actually believe what he has to say and defend his right to say it.

If Pete Evans said ‘You know, it’s always best to eat fresh, healthy, in-season foods and as a chef, I’m going to share some recipes that will show you how to make an easy and healthy dinner’, I’d be ALL over it. I’d love that! I’d make his recipes and then Instagram the shit out of them. Because I care and share.

But that’s not what Pete Evans does. Pete Evans tells you that fluoride is bad and that babies should be fed bone broth and drink camel’s milk and that sunscreen is pointless. He blunders about in a way that is oddly (and frighteningly) similar to fools including Donald Trump and Pauline Hanson who seem to think that just because they have a public profile, they are qualified to give health advice.

And people believe their claims and then blindly follow them.

I (somewhat stupidly) had a look at Pete Evans’ Facebook page today and found this:

I’m not here to debate whether any people are taking medicines they maybe don’t need to take. I’ve no qualifications in health (real or imagined) and it’s not my place.

But this sort of meme is really damaging because it lacks any sophistication at all. It suggests that if a doctor puts you on any drug, they do not have your best interests at heart.

Could our HCPs be more holistic about the way they treat us? Maybe. Do some doctors over- and unnecessarily – prescribe drugs? Possibly. Do ALL doctors do this? Absolutely not. Most doctors – the vast majority, in fact – do not prescribe drugs that people don’t need. (I’ll just let the conspiracy theorists make their ‘ALL DOCTORS ARE IN THE POCKETS OF BIG PHARMA claims for a bit…Done? Okay, let’s move on.)

And, of course, I’m not stupid, and I know that when Evans puts up a meme like this on his Facebook page, he’s not really about people like me who need insulin to stay alive.

But the problem is that not everyone realises that.

Just last week, we heard another case of a child dying after his parents took him off insulin to treat his diabetes using ‘natural methods’. I still have people telling me to try <insert ridiculous and pointless herb> to treat my diabetes. There will always be people who just need a tiny push to stop the drugs they’ve been prescribed, because meds are bad, right? And natural is good, right? No. Not right.

Evans (and his ilk) speak in generalisations and sound bites that make sense to some people. But he fails to in any way address the intricacies of health. And he certainly has no concept of the complexities of living with a chronic health condition and how the drugs we take HELP keep us well (and alive).

This could be because he is a chef and doesn’t need to. And if he stayed being a chef and shut the fuck up about health, I wouldn’t be writing this blog post. Or getting into online arguments with members of his ‘tribe’ who keep offering me unsolicited and wrong medical advice*.

*Also – note to self: You are a fool for voluntarily falling down the rabbit hole and engaging with conspiracy theorists!

You may not have noticed, but the festive season is upon us. (Actually, according to Woolies, the festive season has been upon us since the first week of September which was when I first saw mince pies on their shelves. And as Louden Wainwright III says ‘It’s a season, it’s a marathon….’ Sorry; digression.)

Anyway, it’s the festive season and with it comes lots of messaging about eating with diabetes during this time of the year. Now, I’d like to leave my diabetes behind whilst eating during the holidays, but I’ve come to learn that diabetes is a shit and doesn’t work that way. Because, diabetes IS for Christmas….and every other bloody day of the year as well. Happy holidays!

I saw an article this morning about how to keep your eating and drinking in check during Xmas and other parties, and by the time I finished reading, I was weeping uncontrollably and wanted to shoot myself. (Except not really because I’m a huge supporter of gun control and don’t own a gun.) I also wanted a drink, but it was 6.45am and I was feeling the judge-y eyes of the writer staring at me and the Moscow Mule I was about to make for breakfast.

All articles about diabetes and festive-season-eating demand limiting everything – alcohol, food, happiness. Quite frankly, limiting alcohol at family gatherings is not an option for many people, which seems to be lost in the horrific and laughable suggestion of taking your own water to water down drinks. (I lost the will to live at that suggestion.)

Obviously, a blow-out is best avoided, but that is wise even if you don’t have diabetes. There is nothing worse than feeling as though you literally cannot move from the sofa – mostly because it means you could be stuck sitting next to a distant relative who wants to tell you, in detail, about their recent adventure in passing kidney stones, or (worse) about their neighbour who died from diabetes complications. Diabetes – the gift that keeps on giving.

So, here are some of the things I’ll be doing to survive the next few weeks.

  • Acknowledge that this time of year is about food and that is okay. This is definitely the case for my family, and I am already counting down the days until I gorge myself on my mother’s freshly made zippoli.
  • Throw any thoughts of guilt out the window (along with suggestions of BYO H2O).
  • Make a game out of my CGM by seeing if I can spell out any swear words in the ain’t no mountain high enough/valley low enough trace.
  • Remember that even though I have diabetes, I have every right to enjoy whatever I feel like eating. Or don’t feel like eating. The low(er) carb thing may or may not stick over the festive period. Obviously, my mother’s zippoli are carb- and fat-laden parcels of perfection, so the low(er) carb thing can fuck right off once they are set down in front of me, but I probably will still avoid other carb-y things because dealing with high glucose levels or inadvertently overdosing on insulin does not a festive occasion make.
  • Seriously, give me a huge bowl of cherries for dessert and I am a happy chicken. (The non-watered-down alcohol has probably helped get me to that state, but cherries also make me undeniably happy.)
  • Brush up on my responses to ’Should you be eating that?’, which (thankfully) I probably won’t need to use anyway. Funny how I only ever needed to hit someone once over the head with a spoon after they asked me that…
  • Find red and green Sharpies and write ‘My Diabetes; My Rules’ in festive script on the inside of my hand to remind me to do whatever works for me. And to shove in the face of anyone who does actually ask ‘Should you be eating that?’
  • Thank the Xmas angels that Brunetti in Carlton is open on Xmas morning, meaning that we can make the ten-minute dash there, drink coffee and eat pastries before the onslaught of family, food and festivities.
  • Make a donation to a diabetes-related charity because not everyone gets to decide if they will use extra insulin to cover the second slice of passionfruit pav. Here are three ideas:

Spare a Rose, Save a Child

T1International

Insulin for Life Global

This blog is not about giving advice, but I am going to give some now as I believe this is possibly one of the best ways to survive until the end of the year:

Don’t read any articles telling you to eat nothing but cardboard or watered-down grog. Or suggesting you take your own plate of crudités to parties. I don’t care that it’s a French word, it just means carrot sticks. And having spent the festive season in France, I can tell you no one was serving carrot sticks for the family Xmas dinner. Plus, if I’d taken my own, I probably would have been mocked in French, and not been allowed to drink any of the delicious non-watered-down red wine or bûche de Noël for dessert.

Here’s some Louden Wainwright III. He makes everything better. (Bonus points if you know his character in M*A*S*H…without consulting Dr Google for the answer!)

There are few topics guaranteed to polarise and cause debate like food and what we are eating. Our choice of what we put in our mouths will always generate comments, whether invited (and welcome) or not. And add diabetes to the mix and it gets even worse. From ‘Should you be eating that’ to ‘Here, this is low fat, low sugar, high cardboard content’, we get it all!

I wrote a couple of months ago about how I had unintentionally started eating low(er) carb, and shared my thoughts on how that was going. I’ve also made a few comments on my social media feeds about some things I’d been trying. Interestingly, and as a result, I’ve been contacted by complete and utter strangers wanting to give me their thoughts. This in itself is not that odd; I frequently have messages from people I don’t know about my blog.

What is different here though, is the tone that is often used. And it is not always particularly positive. I’ve been accused from jumping on a bandwagon, loving Pete Evans (that one made me laugh for about four days straight!), letting down the team and being untrue to my Italian heritage. I ignored them all.

I’m a few months in now and couldn’t really care less what people think. I am trying something to try to improve my own diabetes management, not anyone else’s and I’m certainly not even considering suggesting that this is something others might like to try. The My Diabetes My Rules thing possibly applies here more than anywhere else.

The experiment has been continuing, and what I have been most interested in is not only the results regarding my diabetes, but I also really wanted to know if this change in my hearting habits is truly sustainable.

So, a couple of things I want to say to begin with. I have not adopted low carb high fat as a way of life for me. I am ad hoc at best. There are some things that I refuse to change and I have no problem with that at all. This lack of real commitment has drawn criticism from a few people who also thought they would message me to say that if I wasn’t doing low carb high fat properly that I was a fraud and should just shut up. I ignored them too. (That’s the beauty of writing your own blog – you don’t have to listen to people!)

The sustainability issue seems to have worked for me by muddling through the best way I can, making sure that I never say no to something I really want to eat. And perhaps, that was the ‘Aha’ moment for me. There is no right way to do this – except the way that works for me.

For example: I love bread. Love it. Adore it. Love. Love. Love. But there is bread and there is bread. When I eat bread, I only eat bloody good bread. Like a beautiful, chewy seeded sourdough from Baker D Chirico, bought fresh from the bakery and slathered with lashings of real butter – preferably French; always salted.

I’ve decided that there is no point eating a piece of highly processed square bread out of a packet that is not freshly baked and is full of preservatives. So I don’t eat it.

My breakfast most mornings continues to be a milky coffee. I’m nor cutting out the milk or the sugar, even though I know both do raise my BGLs. But I manage that as well as I can, hoping for no spike within half an hour of consumption. I am not good in the mornings without that first (and often second) coffee. And for the love of all that is good and those around me, it’s best that I just have my latte and get on with it.

Overcoming the mindset of needing to eat carbs has been a huge challenge for me. HUGE. It is possibly a combination of 18 years of conditioning about the need to include carbs in my meals and also generally loving carb-based foods.

But there are options. And as I work out what they are, meals are becoming easier.

Where I think I have been getting the biggest bang for my buck is adapting evening meals to be lower carb. This has resulted in far nicer glucose levels in the evenings, overnight and, subsequently, in the mornings. For me, it’s complete
ly and utterly undeniable that not loading with carbs equals diabetes that is far easier and nicer to try and manage.

So, here are just a few things that I’ve prepared recently to give you an idea of what I have been doing to lower my carb intake. Often, my evening meal is zero carbs which is generally what I have been aiming for as this offers the best post-prandial results.

For the colder months, the oven has been working overtime, cooking braises and stews for hours at a time. Or one pan wonders like this that combine chicken, chorizo, lemon, garlic and spinach.

 I always love to serve them with mashed potatoes, but have tried mashed cauliflower instead. I refused to even entertain the thought of mashed cauli until recently, when I decided to try it and have found it it delicious. (I either steam or bake it first
and then pulverise it with a stick blender with salted butter (lots) and milk. Or cream if I have some in the fridge.) I can eat a huge bowl of it and my glucose levels do not shift a smidge. (I know this to be true because I have, on several occasions, eaten nothing but a huge bowl of it for dinner and then watched the flat line of my CGM.)

Actually, cauliflower has become a favourite food. And it’s insanely cheap at the moment. Roasted cauli has become another staple. My favourite way is to cut out the core and bake it whole, drizzled with olive oil, oregano and fresh garlic. But cauliflower is one of those veggies that simply soaks up flavours, so anything goes. I’ve also tried lemon, garlic and rosemary which works a treat. (I’ve worked out that steaming the cauli in the microwave for about 5 minutes first cuts the cooking time down, so usually I do that before shoving it in the oven.)

I made low carb gnocchi one night with hazelnut meal instead of flour and tossed them through a burnt butter and sage sauce, with tiny pieces of crispy fried pancetta sprinkled on top.


Do I feel as though I missing out on anything? Not really. Because if I want something, I still eat it. No foods are considered taboo, there are still no ‘good’ or bad’ foods. I still bake heaps and sample everything I make. (Case in point – these amazing squidgy choc-chip cookies I made the other day that are delicious!)

But what I do know is that minimising riding the blood glucose rollercoaster makes me feel better and this is by far the easiest way I have ever known to do that. It’s not perfect and there are still un-explained highs and lows. There is no name for this way of eating. But it is working for me, so for now, I’ll stick to it.

Overdosed on all the carbs!

By the time I walked into the office yesterday, I was ready for the day to be over. Horrendous low on my way in (seriously, I hate the two-hour warm up phase when I put in a new or restart a Dex sensor) and the frenzied, gluttonous consumption of as much glucose as was in my car. (For the record –  two juice boxes and large packet of jelly beans.)

A morning mountain of sugar does not start the day at all well with the overdose of glucose pulsing through my veins turning my muscles to lead and my brain to pulp. And it continued throughout the day, with reminders of the rotten start peppering my day, all the way to bedtime when I found four rogue blood glucose strips stuck to my body. They fluttered like butterflies to the ground when I took off my bra. (That sounds a lot prettier and more delicate than it actually was.)

Hypo mornings are the worst. Especially when they involve the guzzling of the equivalent of my body weight in glucose.

I arrived at work 15 minutes late for a meeting, covered in sweat, hair plastered to my head and my sunglasses skewwhiff on my head. Nothing says ‘I’m-ready-for-the-week-and-to-be-a-smart-sassy-expert-contributor-to-an-important-meeting-with-important-people-and-yes-of-course-I-know-what-I-am-talking-about’ like post-hypo glow.

These days start badly. And don’t end well. I take a ‘begin as I mean to go on, and go on as I began’ approach literally, and figure that if beginning with a carb load suitable for an Olympic marathon runner the day before race day, then I may as well keep it up and compete in my own little Olympic challenge: the carb race.

I mean, why not eat a doughnut or two for breakfast next, right? Or waffles with jam AND syrup AND whipped cream?

And of course, I’ll have morning tea. ‘Biscuits,’ you say? ‘I’ll take six…teen,’ I respond.

Sushi rolls for lunch, because today is not the day to work out how to bolus for white rice and who cares anyway?!

It would be rude to say no to the brownies on the counter of the café next door to the office that I am visiting for the fifth time because caffeine is the only thing that is making me remain upright and remember how to string two words together that actually make sense. (So: ‘Yes, another milky coffee please. And sure, add sugar! All the sugar!’)

Pasta for dinner with more pasta and then add some pasta on the side because carbs, carbs, carbs. And the chocolate chip cookies that the kidlet made over the weekend as treats for her school day lunchbox make excellent treats after dinner for carb-mummy.

And while this is all going on, I am bolusing, bolusing, bolusing; insulin stacking, insulin stacking, insulin stacking. And chasing my tail because of course I end up low and then high and then low.

I know, I know. I didn’t need to keep the high carb day going after my breakfast hypo. But sometimes, when the days starts off going to hell in a handbasket, sometimes, I can’t work out the way (or be bothered) to salvage it. And I wonder what is the point of limiting my carb intake for the rest of the day if the floodgates were jammed open before 9am.

I climbed into bed last night exhausted. Exhausted from the low that started the day, the sluggishness of so much glucose still in my system and a day of peak-and-trough glucose levels that always make me feel listless. I said a silent prayer to the diabetes angels to please, please, please let me sleep through the night and not be up all night weeing out the sugar due to the glucose overdose, or needing to treat a low due to the likely insulin overdose. I pleaded for balance and flat-lines and an absence of alarms.

I woke this morning with the slight hangover the comes from too much sugar and a day on a rollercoaster. Waves of nausea wash lightly over me occasionally, reminding me of the day before. Delicately, I am stepping through the day. Watching my CGM trace, reacting gently, eating cautiously, dosing warily. And cursing diabetes. Completely and utterly inelegantly.

‘Do you eat a lot of carbs?’

This was the question that had me stopping and thinking about my diet and how it has changed in recent times.

It is also a little bit of a taboo topic and I feel a little odd writing about it here. I really don’t care about being judged by others when it comes to my diabetes decisions, however for some reason, food attracts so much attention and judgement, I am somewhat reticent to write this post.

Firstly, and most importantly, please do not take this as medical advice. Or nutritional advice. In fact, there is no advice here at all– just some thoughts about what I do that seems to work for me. I am not a healthcare professional of any sort whatsoever. Please keep that in mind while reading.

I should also say that I had no intention to change my diet. It was just one of those things that happened slowly over time.

So what’s different? Well, mostly, it has to do with my carb intake. I eat considerably fewer carbs these days than I have in the past. Why? No idea. As I said, it wasn’t planned. It hasn’t been part of a no or low gluten diet; it certainly hasn’t been part of a weight loss strategy. And it utterly has not been part of an intentional low carb (high fat or otherwise) plan.

Honestly, I get a twitch in my right eye when I hear talk about low carb, because anyone who wants to suggest that I should stop eating doughnuts is, in my opinion, in need of a cup of tea and a lie down.

But even with this aversion to the LC idea, the thing I have found is that, by default, I have adopted a far lower carb diet than is recommended by dietitians and other healthcare professionals.

In my case, where this is has been most obvious is not in the ‘sometimes foods’ I eat. When I want a doughnut, I still eat a doughnut. Because as much as I write about them here, I actually only eat them occasionally. And that hasn’t changed. On the occasions I feel like a doughnut, I eat a doughnut.

The real change has come in the day-to-day foods I eat. Some of these changes include:

  • I cook and eat less pasta than I used to and when I do, there is more protein and vegetable-rich sauce dousing the penne or orecchiette or farfalle or macaroni.
  • If I make a risotto – again, a rare occurrence – the vegetable and meat component has been significantly increased so that I am getting a lower carb hit.
  • I eat breakfast only on the weekends (this has always been the case and always will be and that is all there is to it!) and will only ever eat half or, at the most, one slice of toast that comes with my eggs, bacon and avocado (or whatever I have ordered).
  • I don’t snack on carb-y foods – I’m now more likely to grab a handful of nuts than a piece of raisin toast.
  • I’ve stopped thinking that a meal is not a meal unless there is a large serve of carbohydrate on my plate. This was tough, because old habits die hard and the very first dietitian I met, the day after I was diagnosed with diabetes, insisted I eat ridiculously huge quantities of carbs with every meal and I stuck to that for a while.
  • I prefer sugar to artificial sweetener in my coffee, but instead of two sugars, I’ve cut down to one and sometimes, none.

Am I eating a low carb diet? Well, strictly, no. Is it lower carb? Yes, you bet! The Dietitians Association of Australia website suggests that an ‘average adult’ should eat 310 grams of carbs per day. I can’t think of the last time that I ate that many carbs in a day. (Looking back through my pump boluses for the last couple of days, my total carb intake is well under 100 grams.)

So, how does all this affect my diabetes management? Mostly, it has shown me just how much easier my diabetes is to manage when I eat fewer carbs. Low carb days result in far smoother CGM lines. Fewer carbs mean less insulin, which means less likelihood of lows, which means less likelihood of rebound highs, which means I ride the glucose rollercoaster less frequently. It’s an equation that makes so much sense and, for me, it works because, overall, I feel much better.

Is it right for everyone? Hell no! It’s right for me now, but who knows what I’ll be like in a few weeks time!

So why the hesitancy to write about this? Diet is a highly personal issue. But there is undoubtedly a real sense of reluctance to enter a debate about how a diet that is not necessarily endorsed by dietary guidelines may be beneficial to managing diabetes. I have too frequently heard HCPs shut down conversations about low carb diets – often low carb, high fat – however there are more and more people with diabetes saying this way of eating works for them.

Is this a case of the science needing time to catch up with what people are doing? I think yes. But I am not a scientist or a dietitian and I certainly don’t understand the science behind diet. But I know what works for me. And that is really all that matters in this case!

As it turns out, I made mushroom risotto for dinner. This huge mound of six different kinds of mushrooms was cooked with chorizo and onion before being stirred through a small amount of perfectly cooked arborio rice. A huge bunch of baby spinach leaves were stirred through at the end of freshness and a touch of green.

 

 

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