Disordered?

I read Lee Ann’s post today about National Eating Disorders Awareness Week and it stuck with me. Not because I’ve experienced diabulimia, but because, even though I’ve not, I can still relate to her comments and experiences.

And, like  Lee Ann, I have often struggled to put into words my complex relationship with food, exercise, and insulin. How do you explain a behavior that is clearly detrimental to your health, but so wrapped up in emotions and memories that you do it anyway?

You see, when you grow up with a constant focus on food, your ideas about it become warped. You learn early to see the two very different sides of food. To treasure it as a sarced gift, and to despise it as an enemy. An ice cream cone can be the reward for a hard-earned 82, the punishment for a foolish 23, or the reason for a disappointing 265.

My mom (also a type 1 diabetic) did her best to allow me to enjoy activities that revolved around food. She learned early on how to use regular insulin to cover an extra treat. But I was still taking shots then, so the treats had to coincide with a regularly scheduled injection or meal.

When we had holiday parties at school, I was allowed to choose three pieces of candy to enjoy with my classmates. The rest was packed carefully in my valentine box or my Easter basket so that I could enjoy it later at home. We tested and corrected for the treats before dinner. At Halloween, I trick-or-treated with the best of them and brought home a large selection of goodies. My cousins and friends would devour most of their loot right there on the spot, but I would have three pieces and save the rest. I was allowed three pieces every night after dinner until the candy was so stale I had no choice but to throw it away.

School lunches were always a struggle and I spent many a lunch with my Cabbage Patch Kids lunchbox, gazing with envy at the trays of my friends and classmates. Oh how I wanted chocolate milk, instant mashed potatoes, and canned corn. The food messages I learned in those early school days are burned in my brain. To this day, I can’t bring myself to eat mashed potatoes with corn, breaded meat on a bun, or canned fruit in syrup.

So even at a young age I was learning about rationing food and choosing my treats carefully. I can remember lining up my skittles by color and forcing myself to eat them one at a time so that the experience would last. I ate them in order from least favorite to most favorite: all of the green ones, then the yellow ones, and so on until I reached the best flavor: grape. This habit stems from a suggestion from my grandma one morning over my oatmeal. After she poured the carefully measured ½ tablespoon of maple syrup onto the center of my oatmeal, she suggested that I eat around the edges, working into the center of the bowl to save the best part for last. I took that one and ran with it. I saved the best for last with everything from breakfast to dinner. When I have a choice, I still eat the foods on my plate one at time, starting with my least favorite and ending with my most favorite. And I still divvy up my skittles, jelly beans, and gummy candies by color if given the chance.

In middle school, I learned that if I wanted to eat something extra, I could exercise to burn it off. So I would ride the exercise bike for an hour, or run up and down the steps until I had “earned” a popsicle.

As a teenager, when I was chunkier and stockier than the other girls in my class, I struggled with body image. My doctors said I was healthy, but I was not tall and lanky like my friends. My mom mentioned to me once that the only way to lose weight is to take less insulin. I never omitted the insulin I needed to cover my food, though. I was too scared of the consequences. Instead, I starved myself: no breakfast, a juice box for lunch, and a light dinner. Of course, I couldn’t survive for long on this kind of a diet, and after months of “success”, I would give in to the cravings and binge on pizza or fast food with my girlfriends.

My exercise obsession continued through high school. I played soccer, swam with the swim team, and generally tried to stay active. During one summer, I worked at a day camp chasing kids all day, practiced with the swim team at noon, and worked out with the soccer team in the evenings. All summer. And I existed, most of the time, on that noontime juice box and a light dinner after soccer practice.

In college, my obsession turned to foods and their values. I embraced carb-counting, but I still also relied on the old exchange program. Always counting and weighing and measuring. A half cup of this. 8 ounces of that. How badly did I want that cookie? It was worth two slices of bread. Or two servings of potato chips. Or a serving of ice cream. Was I willing to give up my afternoon snack? To take an extra shot? To run around the block?

It never crossed my mind that these behaviors might be unnatural, or even dangerous. In fact, I was proud of my accomplishments and my ability to “control” my weight. And no doctor ever asked me about my eating habits or feelings about food. As long as my A1cs where good, I was given a clean bill of health and sent on my way.

Today I like to think that my relationship with food is much more balanced. I do not starve. I eat when I am hungry. But I still struggle with my internal dietician. How bad do I want that order of French fries? Could I settle for the side salad? Just this once? I will pour over a menu in a restaurant, considering all of my options. And if I’m trying out a new place, I might scour the restaurant’s webpage first so that I can compare calories and carbs and fat ahead of time. I am typically the last to order at the table and, at home, deciding what to make for dinner is often an epic dilemma.

And when I finally do decide to have the fries, I blame myself for making a bad decision. If my BG is high afterwards, I tell myself that I deserve it. It’s my fault. I made a bad choice. I should have done better.

I’m on better terms with my body now, too, but it is a daily struggle. I am always trying, but it’s hard. Because this damned disease has done weird things to my metabolism, my appetite, and my body shape. It is hard to keep your weight down when you are always hungry. Add to that the fact that I take exorbitant amounts of insulin to cover the food that I eat, and weight loss and a sense of balance are an uphill battle.

I’ve talked to doctors, dietitians, and therapists about these issues over the years, but none of them really get it. We never really dig into the issue, just skim over the top. There seems to be little interest in helping the diabetic with this ongoing issue. When will the medical community recognize the mental effects of this disease on our ability to maintain a healthy perspective on food and body? And, as patients, what would we ask them to do to help us?

Like a horse

I have been eating like a horse lately. Sometimes at dinner I can put away more than my husband. I’m not sure what to make of it. Maybe it’s the hormones? I do my best to follow the dietitian’s advice, but I find that, somedays, my belly is just always hungry and grumbly.

I do a relatively good job of avoiding the junk food … I save that for treating lows :). I haven’t had a junk food binge since the marshmallow and corn dog dinner I told you about, but the number of calories I’m consuming … wow.

So far today I’ve eaten a whole peanut butter and jelly (no sugar added) sandwich, a turkey and swiss wrap with mustard, a 1/2 cup of pasta salad, a half of a ham sandwich with mustard, and an oatmeal cookie. I’ve also downed three large glasses of water. And it’s only mid-afternoon!

I’m sure you noticed the theme in all of those items: carbs. It’s like my carb switch is ALWAYS on. I’ve tried substituting veggies, but it just doesn’t work. I just end up eating the carbs anyway. The only “healthy” thing that does the trick is fruit. Sure, it still has all of the carbs, but at least the calories are generally lower and I’m getting a couple of vitamins, too.

The good news is that the lows have dropped off considerably, so I’m not wasting nearly as many calories on those. And my weight gain is still under the acceptable amount, but I’ve noticed that it is coming on faster now. I know that an increase in the rate of weight gain is normal for this stage of the pregnancy, but sometimes I wonder whether the weight is just the normal amount or if I’m not building a little extra fluff as well. I’ve got 16 weeks to go … the fluff could really add up in that amount of time.

Thankfully, maternity pants are very forgiving … because I’m starting to feel like I’ve got a beach  ball in my gut … and an inner tube around my hips!

School Lunches: Hope on the Horizon?

If you’ve been following this blog, you are probably already aware of my disdain for school lunches, their lack of nutrients, and their over-abundance of empty calories. And it seems that these unhealthy midday breaks strike a nerve with others, as well. I get a lot of visitors to that post about the dangers of chocolate milk, and I am so happy to know that I am not the only one who sees red when I read the school lunch menu in the local newspaper.

So you can imagine my excitement when I heard that Michelle Obama is tackling the childhood obesity crisis and — even better — that she is targeting school lunches as one of the main ways to combat the epidemic.

On the initiative’s Website, Let’s Move, Mrs. Obama tells us through streaming video (you can read the transcript here) that the goal of the program is to  “solve the epidemic of childhood obesity within a generation.” A commendable, although ambitious goal, if you ask me. The site goes on to say that Let’s Move will accomplish this goal through a four-pronged attack:

• by providing parents with the support they need
• by providing healthier food in schools
• by helping kids become more physically active
• by making healthy, affordable food available in every part of the country

These all sound like excellent ways to help us fight this epidemic with our children, and the information provided on the site seems like much more than the sound bite or photo op that I expected. We’re talking real resources and information that school officials and even regular citizens like you and me can apply today in our schools and communities. I like it!

For example, in the Healthier Schools section there is link to “How’s My School Doing? The School Health Index.”  The School Health Index, developed by the Centers for Disease Control (CDC) is a self-assessment and planning guide that schools can use to identify the strengths and weaknesses in their school health policies and programs, develop an action plan for improving their students’ health, and involve teachers, parents, students, and other community members in the improvement process. The index focuses on five health topics, most notably, physical activity and healthy eating.

Another link takes you to the HealthierUS School Challenge, where your school can apply to be recognized for excellence in nutrition and physical education. The site provides criteria, guidelines, and requirements.

Also, under What You Can do In Your Community, there are a number of links to organizations where you can get involved and have a direct impact in your community. For example, the “Help a school get healthy,” link takes you to the Website for the Alliance for a Healthier Generation where you can join the Healthy Schools Program, learn about your school’s “School Wellness Policy,” or join the School Wellness Council.

On the Accessible & Affordable Healthy Food page, there is a link to the Food Environment Atlas where you can use an interactive map to locate “food deserts,” where access to affordable, quality, and nutritious foods is limited,  and get an overview of the food choices, health and well-being, and community characteristics in your community. Pretty cool.

There’s also a great section called Kids Collection, which is full of activity books, games, videos, posters, and magazines all geared towards children and adolescents.

If your interested learning more, you can join the call to action, or you can follow the Let’s Move initiative through their blog, through their Public Service Announcements, on Facebook, or on YouTube.

Weekend Update

This weekend was busy, busy, busy. Back at work, I am wondering where the time went. Here is the rundown:

Nesting is in full force. I am beginning to panic that the house will not be ready when baby arrives. My husband keeps suggesting that we make a list of all the things we need to buy and do before the baby comes, and I keep avoiding it. Every time I start one, I get overwhelmed and then give up. There is just so much to do that it makes my head spin!

This weekend we finally looked hard at some living room furniture. We moved into our house less than a year ago. Before that we lived in Germany for two years and we got rid of most of our furniture before we moved there. As a result, we are squeezing onto one couch together in the living room and nearly lying on top of each other in the full size guest bed in our master bedroom. We don’t even have a kitchen table (or chairs, for that matter). As my belly gets bigger (and it seems to be doing that pretty rapidly!), we are quickly running out of room in our small collection of furniture. This weekend, though, we found something we both like (a small miracle), in a practical, baby-resistant, dark upholstery, and it was at a great President’s Day sale price. At least the three of us will have something to sit on. Somewhere to sleep? That’s a different story altogether.

After a snowstorm derailed my exercise intentions two weekends ago, I made it to the gym for my water aerobics class on Saturday. It was fun, and I was tired at the end. Also, the maternity swimsuit held up beautifully, although I should report that it is a bit lower cut than I had hoped. It was not a big problem for water aerobics, and I was not exposed or anything (in fact, the bust support is pretty amazing), but I imagine it could cause some drag if you were swimming laps. Additionally, for someone who is not accustomed to even having cleavage, showing it off in the pool is a little disconcerting. In other body image news, my belly continues to bounce around in the water during the jogging exercises. Sometimes I just give up the arm exercises so that I can hold my belly.

My husband and I celebrated Valentine’s Day with a nice brunch on Sunday. We have not been out as a couple for a while thanks to my fatigue, but my energy seems to be coming back a bit now, so we decided to spend some time out together. Plus, this is the last Valentine’s Day that will be just for us, so we wanted to do something nice. Starting next year, we will be three!

Pregnancy cravings are hitting me hard. This weekend it was corn dogs and marshmallows. Together in the same meal. Disgusting, right? I’m doing my best to balance the junk with some healthy stuff. I made a great tomato soup for dinner on Sunday night and I tried to pick up some healthy alternatives at the grocery store on Friday. I bought lots of fruits and veggies, and some low-fat proteins. Which reminds me, have you seen this “Carb & Sugar Control” yogurt? I haven’t tried it yet, but it only has three grams of carbs in it! I bought the vanilla one.

Bloodsugars are still spiking into the 160’s one to two hours after meals, but I am doing my best to fight them back. My insulin usage is up about 25% over my pre-pregnancy rates. Of course, those corn dogs and marshmallows are not helping matters! So far, my weight is still below the anticipated weight gain for this stage in the pregnancy. Not to worry, though, baby clocked in at exactly the right size at the ultrasound last week.

Those good vibrations from week 13 turned into less subtle kicks around week 18. Now I am feeling them higher up and with more frequency. They are still not incredibly forceful, and sometimes they do actually feel like gas bubbles except that they are in the wrong place! One thing is for certain though, this little one is really moving around in there. Sometimes I wonder if maybe he is practicing his dance moves.

I’m hoping to recuperate from my crazy schedule this week because, for the first time in months, I don’t have any doctor appointments! Hopefully that means I can get home early every night this week and get a little extra rest because next week it is back to the one or two appointments a week grind. Whew!

And so the journey continues …

Food for Thought

I had my much-anticipated appointment with the dietitian today and it was definitely worthwhile.

As I have mentioned in previous posts, my diet has basically fallen apart over the course of this pregnancy. Between treating the ever-present lows, soothing my nauseated stomach, and catering to my temperamental digestive system, I have thrown all of my diabetes-friendly diet techniques out the window in favor of foods that are comforting, easy to digest, and quick to raise a 24 mg/dL blood glucose. Out the window went my fiber-rich whole grains, fruits, and vegetables. In their place, I am living on juice boxes, white pasta, white bread, and gummy candies (my newest craving.)

But I am into the fifth month now, and that placenta must finally be doing it’s thing because the spikes after my meals are higher and more stubborn. And the lows, while still severe, are fewer and farther between.

The dietitian asked me to keep a food log for three days and to bring it along to the appointment. I was embarrassed with what I had to show her. Besides my carb-laden meals, I also documented an alarming number of trips to the vending machine for things like donuts and Rice Krispies treats. Yikes.

Luckily, she was one of the “good dietitians” — you know, the ones who realize that we live in the real world with real world temptation and real world schedules. She did not try to beat me up over my bad choices, and instead offered a few suggestions for how I could do better.

She put together a pregnancy meal plan based on the old-fashioned exchange system  and it is very reasonable. But the suggestions for better choices were probably the best take away. For example, I am struggling with a ravenous appetite in the mornings. It starts when I wake up and doesn’t die until after lunch. Mid-morning is when I spend most of my time at the vending machine … hello donuts.

Instead of donuts, she suggested a sandwich. Or, if I just can’t give up the donuts, half of a sandwich and half of the package of donuts. That is a pretty basic idea, and  I probably could have come up with it myself, but it sure helps to have the reassurance from an “expert.” Plus, it really helps that she did not try to tell me that I absolutely could not have the donuts. Because the craving center in my brain has been on fire lately and there is no telling what I will feel like I “need” to devour next.

We also talked about my ketone issues. Like the High Risk OB, she thinks I can get away with moving the 2AM snack to before bed, but she disagrees with him about the protein. She thinks I need the protein to keep my energy level up overnight to prevent going into “starvation mode.” I tend to think she is right, and proteins are starting to sound better now, so I think I will take her advice. She suggested string cheese and a box of juice for my pre-bed snack because it is quick and easy and has the requisite number of protein and carb exchanges. I think I will give it  a try.

Sidenote: My Endo thinks that moving the 2AM snack to before bed is a recipe for disaster. I have not been able to test this change yet, because my BGs are bottoming out every night at 3AM, so I’ve had to eat then anyway. Hopefully I can get him to change my basal rate and then I can give this snack time change a try. Just goes to show you that even the experts disagree on these things!

Another idea she had was with my boluses. In the past, I have used the dual wave bolus to offset my slow digestion, but recently, I haven’t needed it. She suggested that I experiment with the square wave instead of the dual wave when I eat a higher-fat meal. She said to start with a duration of an hour or so and see how it goes. I have noticed in the last couple of weeks that my digestion is really slowing down again … another of the side effects documented in the book … so I think this could be really helpful, too.

All in all, I am really glad that I finally found a dietitian. She made some good suggestions that I think I can use to improve my diet and she gave me the tools I need to make better decisions. Perhaps most importantly, though, she has given me the information I need to at least partially relieve my diet-based anxiety. Whew!

Craving Du Jour

Something about my appetite is changing and it is happening fast. Just two days ago I was complaining about having to eat ALL DAY. And while the low-blood sugar demons are still forcing me to use 45% temp basal rates with regularity, and I am still slurping lots of juice boxes, a funny thing has happened all of the sudden. On occasion, I actually find myself hungry. And not just a little “oh, I could eat” hungry, but more like a stomach-gnawing, mouth-watering hungry.

This hunger comes on with sudden and ferocious power, like if I don’t eat RIGHT NOW, I might start gnawing on the table.

You might also remember me saying that I had not experienced a whole lot of cravings. Well that might be over, too. The cravings also come on quickly and with ferocity. And they are for things I would not normally even think of eating.

Yesterday the craving du jour was a hotdog. A hotdog! Not just any plain old hotdog, though, oh no. If I didn’t get an all beef hotdog, with ketchup, mustard and dill relish within a half hour, there was no telling what I would do. And if the hotdog was not on a squishy white bun I could not be held responsible for my actions. White bread! I don’t eat that!

Luckily, my husband has (again) been a great sport about all of this. We made a frantic evening run to the store for these very specific ingredients and he prepared the hotdogs for me. He sure is a trooper!

About a month ago a lady at work told me about her pregnancy-induced cravings for watermelon. They were so strong that her husband broke into the melon for her in the car so that she could devour it on the way home from the store. I thought this woman must have been crazy. Ah, but now I SO understand.

It is almost noon and even though I have already consumed two juice boxes, a half a bagel, and a pack of hostess powdered sugar donuts (damn vending machine!), I am looking forward to lunch.

If this keeps up, that lack of weight gain is not going to be a problem much longer!

Time to Eat the Donuts

This whole eating thing is getting old. It seems that I spend most of my time these days with some sort of snack or meal in my mouth. Every time I turn around, my sugar is low again and I need to eat. And I am just plain full. Full and still low.

This morning was a good example. I woke with a BG of 67. I slurped down a box of juice and adjusted my temp basal rate to 65%. An hour later, I was 74. Another box of juice and another temp basal adjustment.

Breakfast was half of a small bagel with cream cheese and I only bolused for half of the carbs. Before leaving the house I was 93. I tested after arriving at work and I was only 94, even with the bagel still in my system. We are having a kickoff breakfast at work, and I know my BG is on the way down, so I make a small plate.

An hour later I am 122 and that is the highest BG I have had ALL DAY. An hour later: 58. An hour after that: 61. And an hour after that: 57. I am now running at a 35% temp basal and in addition to the breakfast(s) I ate, I have also consumed a fruit cup, two handfuls of cheese popcorn, and a Lean Cuisine. And it’s only 2pm!

If you know me, you know that I like to eat. I enjoy food of all types, both healthy and unhealthy, high-calorie and low-calorie, low-fat and high-fat. So I am usually on the other end of this spectrum, fighting the desire to eat more than is best for my BGs and my waistline.

Boy how things have changed. Between the struggles with ketones and lows, I am always eating something now. And believe it or not, it is not a great as it sounds. I feel overfull and generally NOT hungry. My stomach feels filled to capacity most of the time, which is not helping my other pregnancy-related digestive struggles. On the bright side, it seems that my body is somehow finding a use for all of this food because I really have not gained a whole lot of weight.

I’m sure I will look back on this experience someday and wish that I could go back. But for now, I am just trying to keep up with the energy demands of this baby. Man, he or she must just be growing like crazy in there!

Wouldn’t it be nice if someone would bottle these hormones so that we could use them when we’re not pregnant to reduce our day-to-day insulin needs?

What’s for dinner?

This question is the hardest one of the day. As a result of my recent morning sickness, which is thankfully finally starting to subside, nothing sounds good.  Couple that with my complete exhaustion, and the digestive distress that pregnancy has brought along with it, and dinner time has become one of the most difficult times of the day for me.

My husband is probably nodding in agreement right about now. Normally a pretty basic guy when it comes to dinner, he favors a no-fuss, simple-to-prepare and simple-to-eat menu. If it weren’t for me, I think he would live on bologna sandwiches (complete with squishy white bread, American cheese, and ketchup) and SpaghettiO’s. Most of his suggestions sound less than appealing at this point in time, but he has been a real trooper, continuing to suggest ideas that I continue to turn my nose up at.

Luckily, he has been more than helpful in the kitchen, pretty much taking over all of the food preparation and clean-up duties. This is no small feat for a man who prefers not to make meals that require more than one utensil to prepare. Have I mentioned how great he has been through all of this?

Additionally, I have had to nearly abandon most of my normal, diabetic-friendly foods. Fiber is a no-no for my newly sensitive digestive system, so I have had to cut out most of the whole grains and strictly limit my vegetable intake. So much for my vow to eat lots of veggies throughout my pregnancy. I am reduced to low fiber fruits as well (think grapes, not apples). Even a modest amount of fiber leaves my stomach feeling like it has a lead weight in it, while at the same time, resulting in bloating and smoother-than-preferred results on the other end. Luckily, my blood sugars are still running on the low side, so I have not had to rely on the fiber to offset my insulin resistance. Yet.

Acid is also an irritant thanks to my new heartburn and acid reflux issues. That limits my intake of tomatoes and all tomato-based sauces, and acidic juices and fruits like oranges and pineapple.  And I really miss my spicy foods. Bye-bye chicken wings, salsa, hot pickles, and Tabasco sauce.

Milk products and most proteins are also causing me grief in the nausea department, although I have had some success with Carnation instant breakfast mixed with skim milk.

So what’s a pregnant diabetic to do? I’m growing tired of boxed macaroni and cheese, white pasta (sometimes with a small amount of mild spaghetti sauce,) and white toast, English muffins and bagels. Besides, Baby is not exactly getting a well-balanced diet out of these selections. Thank goodness for prenatal vitamins, I guess.

Does anybody have any easy-to digest dinner ideas that are quick and easy to prepare? My husband would be oh-so-grateful for your advice.