Confused...

annapanna93 said:

One thing I've been confused about since being diagnosed - hypothetically, we can eat anything as long as we bolus for it. So really, are we free to eat whatever we like as long as we cover it with insulin? (Obviously within reason, not eating high sugar foods every day.)

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Moderation is key here.

I have absolutely no restrictions on my diet in terms of what I eat, but I am pretty strict with how much I eat. You'll find most T1's have a similar approach.

Advance bolusing is a powerful tool to minimise/avoid post prandial hyperglycemia following high carb and/or high GI foods. You can read about it in this book:

https://www.amazon.co.uk/gp/aw/d/B06XCDTPP1/ref=tmm_kin_title_0?ie=UTF8&qid=&sr=

Although I don't pay much attention to my fat intake, I do make sure that I don't eat too much of it. I find it makes a mess of my BG's even when I advance bolus and count carbs properly.

In non diabetics the pancreas can release insulin directly into the circulation as needed depending on glucose level. But our insulin is injected into subcutaneous tissues and absorbed into the blood stream more slowly. That's why we avoid Froot Loops right? Because they spike the BS and our insulin delivery lags behind, even though it may eventually bring it back down to normal. Personally I don't check my 2 hour PP glucose levels like some here to, just my pre meals, AM, and bedtime, and after a correction bolus sometimes. I am not an ultra low carb person like some here, but I stick to low glycemic carbs for the most part. I don't really watch my fat intake at all. Bacon and avacados work!

Agree with @GrantGam that moderation is the key word.

annapanna93 said:

One thing I've been confused about since being diagnosed - hypothetically, we can eat anything as long as we bolus for it. So really, are we free to eat whatever we like as long as we cover it with insulin? (Obviously within reason, not eating high sugar foods every day.)

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Short answer: yes! I did exactly that for the first 29 years of my life with diabetes.

For the last two years though I've found that my life is easier when I make lower-carb choices. I still count carbs and dose accordingly, just like before, it's just that these days I:

• take a little less insulin
• have fewer hypos
• am much slimmer (I'm not chasing excess insulin with excess food like I used to)

Many many many people with type 1 eat a typical diet with plenty of carbohydrate, and find that with accurate carb counting and good timing of bolusing that that is absolutely fine in terms of blood glucose control.

I find the maths easier, and my likelihood of hypos less, by choosing a slightly lower-carb existence. But in my opinion yes it is perfectly perfectly fine to cover carbs with accurately counted and timed insulin.

annapanna93 said:

One thing I've been confused about since being diagnosed - hypothetically, we can eat anything as long as we bolus for it. So really, are we free to eat whatever we like as long as we cover it with insulin? (Obviously within reason, not eating high sugar foods every day.)

Click to expand...

Within reason and in moderation I eat everything - but not all at once and not in huge portions. I also choose carefully and think about the best time to,eat foods eg before exercise.

I eat approx 180g carbs a day. I eat desserts sometimes but choose wisely (eg I wouldn't have a very sugary dessert as it would be hard to cover the carbs). I eat bread, pasta, potatoes, rice, cereal, etc - but, most importantly, I'm always aware of controlling my BS. So I advance bolus, watch my portion size, etc

I'd also say that I think each person has a carb limit per meal - that is, I couldn't eat a vast amount of carbs at one meal without finding it hard to maintain control, so if I'm at a meal which is a total carb fest, I do keep that in mind, so I might choose a slice or two of pizza and have extra salad if I know more carbs are coming up.

I have very good insulin sensitivity and I want to keep it that way, so I avoid going too low carb.

So briefly, see what suits you, watch your portions and use your insulin wisely

@annapanna93 . I think you've had your question answered by everyone so far.
I tend to view diet and diabetes the following way....... remove diabetes from the equation.
What diet would I follow to be the individual I want to be achieving goals and standards of life I would be happy with?
If I'm happy with my diet then introduce diabetes back into the equation and manage / control my life with available medication.
It's a simlplistic approach and admittedly I tweak things but it's a basic principle that works for me.

annapanna93 said:

Thank you so much! That's cleared a lot up for me.

So the portion size is key really, is that right?
What do you do about snacks? Chocolate, crisps etc?

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It depends. Crisps I onky have occasionally as I don't think they're particularly healthy, nevermind the diabetes. I do sometimes have them with alcohol without a bolus to keep my sugars up, or I occasionally have some as a snack or nibble and then I bolus for them.

Chocolate - adore it! I don't eat a whole bar as a snack. I save it for pre-exercise or a long walk (without a bolus) but I do sometimes have a few squares after a meal with a bolus.

For other snacks, I don't avoid carbs but I tend to keep snacks under 25g and bolus for them unless I'm exercising or need a top up. I eat fruit,digestives and cheese, oatcakes, cereal bars, etc etc

annapanna93 said:

Thank you so much! That's cleared a lot up for me.

So the portion size is key really, is that right?
What do you do about snacks? Chocolate, crisps etc?

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Firstly. Are chocolate and crisps a good and healthy snack choice?
Depending on yes or no.
Yes. Well then you will have to bolus for these snacks, you will risk weight gain and may become less healthier. Chocolate in moderation but not a regular snack the same with crisps. Chocolate can be good if you plan to or have used a lot of energy in a short space of time i.e. physical exercise. It's not best option but an option nonetheless.
No. Chose a different/ better/healthier snack option.

I find I cannot get the tight control I need by eating more than 30g of carbs a day. I tend to restrict fat too so mostly eat eggs, veg, meat and fish. I take a lot less insulin now which means less room for error. I also don't have cravings for sugar anymore and eat a lot less than I used to. I could scoff a huge family bag of crisps, bagels, toast, it was ridiculous, feeding the insulin. Now I fix mild hypos with a couple of dextro tabs instead of a mars bar, biscuits, any sugar in the fridge. OMG I hated that.

It would be great if I could eat what I want, even within reason, but after 25 years of MDI and feeding the insulin, I'm sure I have a sugar addiction. The DAFNE course I went on told me that I could eat anything and cover it within insulin, but on MDI I could not stop the spikes at all.

I need my libre to stay within range which I achieve with only the odd mild hypo. This should improve when I start on a pump in September. But this won't tempt me to start eating bread again...

You'll find the right amount for you with recording everything and what feels right because everyone is different.

annapanna93 said:

Thank you so much! That's cleared a lot up for me.

So the portion size is key really, is that right?
What do you do about snacks? Chocolate, crisps etc?

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What's a "crisp"? Is that what we call a potato chip? I know what you call "chips" we call French fries. I love all that stuff, but I mostly steer clear of it.

TheBigNewt said:

What's a "crisp"? Is that what we call a potato chip? I know what you call "chips" we call French fries. I love all that stuff, but I mostly steer clear of it.

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Yes, crisps are what you call potato chips, and chips are what you call fries

annapanna93 said:

So the portion size is key really, is that right?

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Absolutely, just the same as it should be for people who don't have diabetes.

annapanna93 said:

What do you do about snacks? Chocolate, crisps etc?

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If you want either then just bolus for them, depending on the carb value you might just get away without bolusing if your still in your Honeymoon Period.

annapanna93 said:

What do you do about snacks?

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Snacks are a good, practical way of learning a little about the shape of insulin, the way it operates over, generally speaking, say 4 to 5 hours with a peak after say 1.5 to 2 hours (depends on the insulin, and the person etc. but let's use those timings as an example).

So, say you've had lunch, you've carefully counted the carbs, carefully adjusted insulin for carb count/anticpated exercise later in the day/after-drop from previous exercise/ correction for how low or high you are etc. etc.

But because of the number of variables going on which you cannot measure, and the randomness of T1, you're never going to get that right all the time. None of us do.

So, you might find that you start dropping more than expected mid/late afternoon because that lunch bolus is still working for up to 4 or 5 hours. After the event, the drop has made you realise the bolus was too large. In a loose sense, it's gone "wrong" on that occasion, you might rethink it for next time, but I think the more practical way of looking at it is to say, ok, tried my best, can't get it right all the time, now have a slow slide, need to fix that, soo....snack time.

In such situations, if it's a slow slide towards a hypo, not a full on hypo, you'd be well justified in having a small snack, say 10 to 15g, to tweak it back up, eg couple of small biscuits. If it's a proper hypo, obviously treat as accords.

Snacks can fit in quite well as part of dealing with the unpredictability of timing of insulin.

I'm quite partial to a couple of biscuits a few hours after a meal, so sometimes I'll deliberately have slightly more with the lunch or tea bolus to account for that, knowing it'll be peaking 2 hours later, so allows me a snack with peak insulin without having to bolus again for the snack. It's all a bit of a balancing act.

If you're fine between meals, generally snack under 10g doesn't need another shot, but over 10 may, and the higher above 10g you get, the more likely it gets. I'd definitely bolus for a bag of crisps, assuming there's no heavy drop setting in from the previous bolus. None of this is set in stone - it is influenced too much by the other factors relating to that particular moment - so you'll need to make judgment calls for each occassion.

Recently bought a box of the new dark chocolate Digestive Thins, a new take on digestives - 4g each. Will have to do some snack experiments with those...

annapanna93 said:

Thank you so much! That's cleared a lot up for me.

So the portion size is key really, is that right?
What do you do about snacks? Chocolate, crisps etc?

Click to expand...

There's a good phrase floating around this forum: "eat to your meter". It's really good advice and says it all really.

Like @azure, I'll sometimes have crisps if I'm drinking alcohol (neat spirits only) to keep my BG up. Otherwise, I'd require a bolus for your typical 25g bag (10-15g carbs) of crisps.

I smashed in a whole slab of chocolate last night, it was 100g... It was 84% coco dark chocolate though and only contained 22g carbs/100g. Because of the fat content, I actually bolused after I'd finished the lot.

You can be smart with your food choices and live a fairly normal life in terms of diet as a T1. Moderation (not too much and not too often) and substitution (dark chocolate over milk/white chocolate, low GI vs high GI, etc) will help you a long way

Hi. Freedom just means being able to pig-out occasionally but you can't normally just eat what you want unless you want to gain weight; the medics don't tell you about weight gain.

annapanna93 said:

One thing I've been confused about since being diagnosed - hypothetically, we can eat anything as long as we bolus for it. So really, are we free to eat whatever we like as long as we cover it with insulin? (Obviously within reason, not eating high sugar foods every day.)

Click to expand...

Hi Anna - yes, the "official" advice is to just lead a normal life, and to dose insulin correctly - however, this doesn't take any account of the real-life issues that insulin dependent diabetics actually face; for example, the fear (and significant reality) of hypos, and the constant worry of having a high dose of insulin circulating in your system. For me, knowing that I've taken a large dose of insulin makes it difficult to "switch off" and relax, and significantly adds to the "diabetes burden". I now don't take more than 3 units with any given meal, and manage my carbs accordingly - that way, if there is an error in dosing, it's far less worrying; where those carbs come from however - whether healthy or not - is just a personal life-style choice!

annapanna93 said:

One thing I've been confused about since being diagnosed - hypothetically, we can eat anything as long as we bolus for it. So really, are we free to eat whatever we like as long as we cover it with insulin? (Obviously within reason, not eating high sugar foods every day.)

Click to expand...

Yes and no. The only thing I'd say is never touch anything remotely 'diabetic'. The sugar is replaced with all sorts of synthetic rubbish that'll give you the runs.

Other than that, fill your boots, remembering that moderation is key. Yes, chocolate is on the menu too. One or two squares of dark (72% cocoa solids) should do it. Ask to see a dietitian too, doing this really helped me. Good luck.