A couple weeks ago, I wrote about how I was thinking about joining the low carb club. While I logically, critically understood that low carb was going to be better for my blood sugars (because when you have a hard time processing glucose, hello), there was part of me who really, really, really did not want to admit that maybe this was a good idea. The better idea. The only idea?
But the thing with people who are low carb is that it’s kind of like Christians (and I can say this because I am a Christian, so I know). When you meet someone who is in one of these two groups, they really, really, really think they’re right. Like, super right. Only right. Going-to-hell-fire-and-brimstone right. And it’s such a huge turnoff and I want to be like, “Oh yeah? WATCH ME.”
It’s this attitude that has permeated the low-carb-high-fat, ketotic and Bernstein groups that really just annoys the living shit out of me. It’s just smug and arrogant and the worst part is they’re kind of right. But they’re so annoying about it!
I joined several groups after my post because I wanted to “observe the other side” and see what was really going on. Some of their comments about people who eat “high carb” were so nasty. As you can imagine, I didn’t last very long in those groups. All of this happened well before I read Renza’s blog post about feeling welcome in the DOC. There was a distinct lack of welcoming other’s viewpoints and lifestyles in this group. A complete disregard for whether or not someone could live a healthy life even if it was not what you chose to do or what worked for you.
So it made me think about the whole high carb / low carb debate, and it also made me reflect on A1C goals in general. Where do those come from? Yes, we have the ADA / AACE recommendation for under 7%, but if you listened for 5 seconds to anyone in the Bernstein groups, you’d think ADA was trying to kill us all. Which I don’t think is true. But it was interesting hearing that they believe what Bernstein said about “diabetics deserving to have normal blood sugars.” Which I understand is very appealing, but then a friend of mine pointed out that her sanity was also important, and I get that too!
I’ve been thinking for awhile now about why it has taken more than two decades to finally care so much about having my A1C in the sixes. Mostly I think I thought it was too hard, that I wanted to live normal, and that living normal and having normal blood sugars at the same time was just not something you could do. I grew up — or at least since I got an insulin pump 15 years ago — hearing and believing that I deserved to eat what I wanted to eat, as long as I took insulin for it, and I kept expecting that this would work. I really believed that because I had an insulin pump, everything was fine and that I didn’t need to be different. And maybe this is true, but I have recently realized that is so goddamn hard that it might not actually be worth it anymore.
Let me show you a couple of Dexcom graphs, to illustrate my point.
After my birthday weekend, I cracked down on my carbohydrate intake. In addition, I also watched my blood sugar levels like a hawk, taking many small doses throughout the day. My breakfasts consisted of three eggs and sausage, my lunch consisted of a salad with avocado, a veggie (either mushrooms or bell peppers) and more sausage, snacks were usually string cheese or something equally low carb, and dinner was a meat and a veggie. My main source of carbohydrates was the air-popped popcorn I eat nearly every night. It’s my one vice, leave me alone.
Here is a snapshot of those 5 days (Monday, August 8-August 12).
An average glucose of 133 mg/dl equals an A1C of 6.3%. One of my CDEs, Jenny Smith at Integrated Diabetes Service, says that I should aim for a standard deviation of less than 25. Not too shabby at 28. And I spent 56% of the time in range, and although it says 41.5% of my blood sugars are high, it turns out that 37.9% of those blood sugars are between 140-180 and only 4.5% of my highs are above 180 mg/dl.
Now, on Sunday I had another big brunch here at the house, and then my husband went out of town on a business trip. We had a lot of leftovers, so I though I could swing it by just eating what we had. It mostly involved lots of toast for breakfast, crackers and more toast during the day (I went to Chipotle for a salad once), and then macaroni and cheese and leftover birthday cupcakes in the evening. As you can imagine, it didn’t go so well. Even with my attempts at temp basaling and bolusing the shit out of this food, I didn’t do so well.
Here is a snapshot of Monday, August 14-Thursday, August 18:
An average blood sugar of 151 mg/dl is equal to 6.9%, and while yes, my A1C is still predicted to be in the 6s, my standard deviation is now double what it should be. In addition, I’m now spending only 41.2% of the time in range, time low jumped from 1.6% to 4.4%, and I’m high more than half the time at 54.5%. My time between 140 and 180 dropped 10% to 27.3% and my time over 180 jumped from 4.5% to a whopping 27.9%.
You guys, my time spent over 180 mg/dl this week didn’t just double, it increased by 6x!
Okay, so one caveat I want to make is that I stayed high throughout the night because for two nights, I forgot to turn off the vibrate-only setting on my Dexcom, so I never had a chance to correct so it potentially could have been lower. But if you look at least weeks, my blood sugars never went so high overnight that I would have needed to correct. Week 1 is clearly superior to Week 2. You can also see that my highs during the day were much higher and last much longer than the highs from Week #1.
So what does this tell me? Well, it tells me that I need to eat low-carb. Yes, I understand that on very special occasions, like my birthday, I can treat myself. But I can’t pretend it’s my birthday for an entire week (or month…) even though it’s really fun. Recovering from one blood sugar indiscretion is a lot easier than recovering from five days in a row.
One of the biggest lessons I learned from comparing this week and last week isn’t just how my blood sugar responds to different foods, it’s realizing how much time I spend worrying about my blood sugars and how frustrated I get with this disease when I try to act like I don’t have it. It really sucks to admit it, but I do have diabetes and it does actually require me to live my life a little differently than everyone else.
But you know what? So what. Most people can’t do whatever they want because of how their choices will affect them and others. Whether it’s gaining weight or having some kind of food allergy, there are so many people who have to say, “No, I’m sorry, I can’t eat that.” And yes, okay, maybe I can eat that. But do I want to? Do I really want to eat that and then deal with the consequences? We use that term bolus-worthy and I used to think it was cute but I’m not sure I really ever understood it’s definition. What I think it should be is “Is it work-worthy?” because what it takes to have “normal blood sugars” while “eating normally” is that it usually takes a lot of time and effort, with a high risk and usually very little reward.
Am I solidly in the low carb club? Hardly. I don’t think you’re going to hell if you don’t have an A1C in the 5s and I’m not going to try to cast demons out of you if you eat a sandwich. But I do think my priorities are changing. Right now my focus is getting an A1C in the 6s so that I can successfully carry a healthy baby to term. But I am also realizing what a relief on the mental burden of diabetes it is to eat low carb. Because I’m not fighting against my body’s natural inclination to have high blood sugar. The stress and frustration of trying to accurately guesstimate carbs is virtually eliminated. The unknowns of “when is this going to kick in?” or “What kind of temp basal should I use?” or “Am I going to crash at 4 am?” are gone. Everything feels a little more, well, manageable.
I really wanted to believe that people with diabetes could eat anything they wanted, any time they wanted. But I don’t think that’s true and I think most of us know it’s not true. I know a lot of people who have said there are certain things they’ve given up eating because it’s too hard. And I think that’s really what it comes down to. The work. The stress. The success rate. Is it worth the work?
I would never tell anyone to do or not to do something, because that’s not my place. But I would encourage a bit of self-reflection on what’s working. What’s actually working, not what you’ve been told by, well, anyone. You are n=1. You are the only one you need to worry about when it comes to what you can or can’t, should or shouldn’t, will or won’t do. Don’t listen to me, don’t listen to your Facebook groups, don’t listen to your doctor (well, except for the whole taking your insulin thing, please keep doing that). If someone says “You should do this” and it’s not working, it’s not your fault. You didn’t do something wrong, you didn’t fail at life. It’s just you and how you work and what you need to be healthy and reach your goals. And that’s the only end result you should be looking at.
I’ve been half-following your low-carb adventure, because the topic alone brings up thoughts of arrogance and hostility. Like you said (and I admire you for speaking up about it), the low-carb communities are generally not friendly places.
Of course, that’s not to say there aren’t friendly low-carbers, but the impression overall that the followers make on me is not a good one — and for reasons that have nothing at all to do with following a low-carb diet. So I avoid the people, and consequently have an – admittedly unfair – dislike for the ideology.
There are many factors that lead to good health, and it’s up to each individual to determine how to balance those factors. One might make an argument that exercise leads to exhaustion, and therefore people must avoid exercise at all costs. Does that make any sense? Now replace “exercise” with “carbs” and replace “exhaustion” with “high blood sugars”. Get the point? Always consider the big picture.
I am not a big fan of low carb vs. not low carb. I suggest that being low carb will, of course, lower Blood Sugar. But at what cost? I feel less concerned about blood sugar than I do about pressing a belief system that has little support or understanding among people I associate with or the doctors I trust.
I applaud anyone who does it, but I also applaud anyone who does not. Diabetes is difficult enough, messing with a low carb diet is too much for me. Others? Well, that is a decision best left to them. I wish you the very best and hope it works out.
You have to decide what works for you if you do go low carb. You are right about the fanatics of low carb and I would agree that they are not for you. They are very intolerant and have no empathy for people learning about low carb. I also don’t like their attitude of its my way or the highway. Best of luck and let us know how things go if you explore low carb for yourself. Just remember that you should not cut your salt intake for the first few weeks and be careful for the first few months.
I’ve followed your line of thinking for the past few years – low carb except when something is awesome, focus on proteins and fats and a few glasses of wine a week. I’ve kept my A1C’s below 6.5 for the past three years without really any effort or heartache – just regular Dexcom use and low carb-ish eating. Then I went to a nutritionist to try to lose some weight and prepare for pregnancy, and apparently a diet free of whole grains and fruit is a bad thing for those goals? Though I had paleo wisdom to spout and “what about Mark’s Daily Apple, huh?”, she got me when she pointed out that what I’d been doing wasn’t working for all my goals, and that I’d have to change it up for pregnancy anyway. Also, apparently all that fat was causing sustained highs that I never really connected the dots on. Though the thought of adding all that additional insulin to the mix truly terrified me, like gave me pause on the Confirm button scared me, I think I’m using less insulin now because I’m not correcting as much. My peaks and valleys are more hills than spikes, and I feel…less frustrated about it all. Also, I like lentils, who knew?
Anyway, as someone who finds herself in a very similar place to you, I thought I’d share what’s rolling around in my head on this stupid question that I wish that we didn’t have to deal with in the first place.
So well said!!! The way we eat is SO personal. Will eating fewer carbs reduce our BGs? Well yeah, but if somebody can’t go to the extra of ketogenics in a natural way for them, then it’s important to find your own carb-groove. maybe that’s 150 grams a day, or 100 or 50 or 250. 10 years ago, I ate SUPER low-carb, and it worked really for my life at that time. Today, I eat moderately low-carb and I have no interest in going any lower! When I want to eat GF bread, I just eat it, ’cause that’s where I’m at in my life right now with wanting to be restrictive or not restrictive…yada yada yada.
The point is: we each get to choose. It’s a shame people bash other people for not all being the same diabetic and following the same everything!
Great post, A. Thanks for sharing your recent exploration!
So glad I found your blog!! I went quite low carb (30-60g per day) earlier this year and throughout my pregnancy I have been more moderately low carb (60-100g per day). My confession is that My A1C went from an all time high of 8.6 early 2015 to an all-time low of 5.4 last month (and eating moderately low carb works very well for me, in fact my A1C and SD is the same either way – low carb or moderately Lc). I second everything Ginger said above, and if you want to check out a really awesome and inclusive FB group ask to join Plucky Diabetics (and those who love them). There are quite a few people there (myself included) who are interested in normalizing our blood sugar and are non-judgemental about people’s choices :) good luck!
Pingback: Self-Reflection: Is Low Carb Worth It? | Healing With Minerals
I did the ultra low carb diet for 3 months and train wrecked my blood work on it. I switched to American Diabetes type diet (actually use the Eli Lilly diet sheet) and guess what? I eat much better nutritionally and my A1C stays between 5.1 and 5.3,,, so there is that! I believe it’s all about a plate set up correctly with proper portion sizes off the diet sheet.