Tuesday, February 4, 2014

Top 10: Dietary Changes I Never Expected To Make

When I first got diabetes, I remember being terrified to eat anything. I was 9 years old. My first day home from the hospital, I went into the kitchen in the morning and grabbed a graham cracker. After taking a few bites, I suddenly realized that something was different. Then I stared at it, wondering if this food which had once been so normal was now a poison to me.

Over the coming months and years, I gradually came to realize: "Hey, no problem! Insulin covers it!" I ate pretty much anything I wanted, whenever I wanted. My A1Cs weren't great, but I guess I didn't really know what they were supposed to be. People would often ask me, "So, you have diabetes. Does that mean you're not allowed to have sugar? Do you have to be careful about your diet?" The question was always a little embarrassing, because...I don't know, maybe. Maybe I was supposed to cut out sugar and be careful about my diet. But I didn't. No problem, insulin covers it, right?

I carried this attitude into my first pregnancy. But I quickly realized that when your bolus ratios are 1 unit of insulin per 5 grams of carbohydrate, you are tasked with the responsibility of assessing the number of carbohydrates in a giant plate of pasta, the life of another human being depends on it, and you get it wrong...? I was up and down a LOT during that pregnancy. Mostly down, because I was terrified to get it wrong. I overestimated a lot, and gave extra manual boluses all the time, simply out of fear that my blood sugar would be too high. I managed to keep my BGs down to a level with which my doctors were impressed, but it was only because I just pumped myself full of insulin and ate constantly.

By the time my third pregnancy rolled around, I realized that a stricter dietary regimen was in order. I was hoping to avoid the 50+ pounds of weight gain I accrued during my first two pregnancies, and not only because it was hard to lose it. It made me really uncomfortable at the end of pregnancy, and made my insulin resistance higher. But this was not a welcome realization. I resisted it. I wavered and faltered. I convinced myself that maybe I was fine "indulging," or eating like I did when I wasn't pregnant. I wasn't a super-hero, so how could anyone expect that I would act like one when I was choosing what foods to eat?

Now, half-way through my fourth pregnancy, I am fully convinced of the necessity of combining healthy, controlled insulin rate changes AND dietary changes to achieve the healthiest pregnancy I can. Believe me, I don't like it. It's stinkin' hard, most days. But I've had my fun, and it turns out that some kinds of fun leave you pretty miserable and either in a sweaty, unconscious, hypoglycemic mess or an always-thirsty, anxious mom making constant trips to the bathroom.

So with that, my list of the top ten dietary changes I never expected to make:

10. Resist the urge to eat when my blood sugar is high but I feel weak like a low. Ugh, this one took forever to get through my head. It still takes every ounce of willpower I have to resist eating.  It's so counterintuitive, because food usually makes me feel so much better when I'm weak like that. This often happens in the morning, after breakfast, and after dinner before bed. During my first pregnancy, I just pumped myself full of insulin, thus necessitating - among other things - a "second breakfast" at work right about 10 o'clock in the morning. But by my third, I realized that keeping my weight gain down would mean cutting out extra snacks meals to be a realistic goal.

9. Sleep instead of eat. This is related to #10. Once I had two toddlers and was in my third trimester of pregnancy with my third child, this was actually not very hard. Feeling like eating after dinner before bed? Don't. Don't start the cycle that might end with a high or a low. Your bed is calling. Answer it. But I will admit that I love a post-kids-bedtime-celebratory-milkshake, and those are now out (boo hoo). (Auto-correct just changed "boo hoo" to "boo hop." There, it did it again. Is that even a real phrase?)

8. Don't eat within two hours of bedtime. Again, I don't like to start the cycle that may make me high or low while I'm sleeping. It also helps me get my basal rates in order, since I don't have to wonder whether it's my basal or my bolus that's setting off my readings. If my basal rates are good, I just rest in the confidence that they'll carry me through to the morning.

7. Middle-of-the-night snacks. Pretty much every rule has an exception, and the big exception to the above three rules are the times when I wake up in the middle of the night and truly can't get back to sleep because I'm so hungry or my blood sugar is low and I need to eat. I take this as my body's way of making sure it gets what it needs...but I make it work pretty hard to communicate its point.

6. Eat like a dinosaur! One thing that helped me get on a better dietary regimen during my third pregnancy was my father's adoption of the Paleo diet. This diet includes no carbohydrates (corn, beans, potatoes, bread, rice, etc. are all out) except for the natural sugars found in fruit. Since we live with my parents, and I like to cook food for them as a way of thanking them for their hospitality, I ended up cooking a lot of meat and vegetables dishes and serving carbs sparingly. This also taught me to decrease my carbohydrate portions, even when I did serve them.

5. Breakfasts devoid of carbohydrates are a total wild-card. For every rule an exception, right? I remember a few times having a carb-free, eggs and sausage breakfast, without any accompanying toast. I thought to myself, "Great! No hassle trying to estimate carbohydrates with crazy-high insulin resistance in the morning! We'll just cut that part out all together." BIG MISTAKE. High or low, it doesn't matter. It's going to be off two hours later, guaranteed. Mornings are so weird. I eat the same thing literally every morning so as to cut out at least some uncertainty. This pregnancy, it's a cup of milk with a splash of coffee, a cup of Greek yogurt, and a slice of toast.

4. Have a doctor recommend ice cream to raise my blood sugar. I don't actually have ice cream when my blood sugar is low, not least of all because I can't take it with me nor can I actually measure out one-half cup accurately to figure out how many carbs I'm eating. But I do carry pre-packaged pudding cups. Those are, I have discovered, a great low blood sugar snack!

3. Gatorade is my life-line. Just so you know, I get very sensitive when people start talking about banning sports drinks in schools. Sports drinks save my life when I'm out of the house with toddlers and I need to raise my blood sugar fast to keep them from running into the street and/or peeing in their pants. Sports drinks are designed to get into your system fast and they do just that when your blood sugar is low. I wonder if they could market that to the tiny demographic of pregnant, Type I diabetic moms: "Not just for athletes!"

2. Pull out a measuring cup for my morning cereal and milk. I laughed at myself the first time I did this. And the worst part is that it didn't even help all that much, because my blood sugars are just crazy in the morning. Now, I rely on pre-packaged bread and yogurt to save me some time. I put an unmeasured glop of peanut butter on the bread, just to keep me a little on the wild side...But seriously, eating the same thing in the morning helps make sure that it's at least not my carbohydrate estimate that's off. So I also get really sensitive when people talk bad about pre-packaged, processed food. No one has yet managed to convince me that the evils of preservatives are so great that I should prefer unpredictable blood sugars to the consumption of them...

1. Hot herbal tea and seltzer water. These are a carb-free way to make me feel special and not deprived, even though I basically am. :)

What are your rules and tips for healthy eating during pregnancy?