“SMALL NUMBERS, SMALL MISTAKES. LARGE NUMBERS, LARGE MISTAKES.” – DR. RICHARD BERNSTEIN
Almost four years into my journey with type 1 diabetes, I sit back and question why my medical team did not rely Dr. Bernstein’s message to me early on – from day one. I’ve had to seek out information and resources that, for instance, taught me to modify my diet to include a small intake of carbohydrates. This shift made a huge impact in my day-to-day T1D management.
The general message from my health care team has been that I could continue to eat the food I was eating pre-T1D as long as I injected the proper dosage of insulin. I vividly remember being told not to eat a whole stack of pancakes. Frankly, I shouldn’t be eating any pancakes without really considering the immediate and long-term impact it will have on my blood sugar levels and health. I think the message should be: Can you eat pancakes? Yeah. Should you? Not without careful thought.
I understand that at the onset my health care team was trying to reduce the impact of T1D on my life, but I’m of the mindset that it was actually a disservice. A T1D diagnosis requires a complete life overhaul. If you want to minimize the damaging effects of high blood sugar, which I sure as heck do, it requires sacrifice. Every day. I am regretfully settling into that reality a little late because over the past few years I did exactly what was asked of me from my doctor and I did not seek outside information. I also did not feel confident to experiment with advice from sources outside my health care team.
But, back to the life overhaul. I get it. It flipping sucks. Let’s take this week for example. My blood sugar levels were in-range all week. I worked hard for that. I cooked almost every single meal, I exercised multiple days, and I practiced stress reduction techniques. Last night I blew the perfect score for reality – a double scoop of ice cream, matcha with raspberries and cookie dough. It was 100% worth it. I say this because I made a decision after a week of controlled blood sugars to eat something I wanted. It wasn’t a reward. It wasn’t a mindless decision. It was a choice and I returned right back to normalized blood sugars this morning. T1D management requires thoughtful decision making balanced with grace.
Over the course of the last year I have read many books, but these three books have been particularly helpful resources:
- Bright Spots and Landmines by Adam Brown
- Dr. Bernstein’s Diabetes Solution by Dr. Richard Bernstein
- Body Love by Kelly Leveque
Incorporating the information from those books, here is the advice I wish I received from my health care team:
You cannot eat whatever you want. Those days are over.
- Adam recommends to keep your carbohydrate count per meal to less than 30g. Implementing that strategy was a game changer for me. I no longer felt like I was on a blood sugar roller coaster. I saw my blood sugar levels stabilize, which as a bonus, led to less daily stress.
- Dr. Bernstein recommends an even lower carbohydrate count: 6g at breakfast and 12g at lunch and dinner. This is super challenging for me as a vegetarian, but after reading his book recently I willing to strive for an even lower carb count at meals than Adam recommends.
- Kelly is the creator of the Fab4Smoothie and Fab4Plate, which includes a meal with protein, fat, fiber, and greens. I’ve been creating meals with this structure for 10ish months and it’s honestly a no-brainer way to eat a nutritious plate of food. Additionally, the purpose behind the structure is to elongate the blood sugar curve and reduce hunger between meals.
- Implementing an overall nutrition strategy is a key to success.
Prioritize blood glucose time-in-range.
- At diagnosis I was told to aim for a specific range of 120-170. After reading Dr. Bernstein’s book, I made the decision to aim for a much lower range. I experimented (safely) for two weeks before seeing my endocrinologist to go over my goals and how to achieve them. I am currently working on this!
- As much of a downer as it is to think about diabetes complications, I remind myself almost daily about how long-term high blood glucose is extremely damaging over time.
- I wish my health care team discussed at length the likelihood of heart attack, stroke, kidney failure, cancer, etc. as an inevitable conclusion to decades worth of high blood sugar levels. That’s certainly enough to motivate me into prioritizing time-in-range.
Use a continuous glucose monitor (CGM) as part of T1D management.
- Safety! A CGM will alert the wearer of a dangerous low blood glucose level, rather than the individual relying on that “shaky” feeling.
- It provides an opportunity to analyze the data collected to make lifestyle shifts.
- It assists in managing blood glucose time-in-range.
- For me, wearing a CGM has increased personal accountability. I hate seeing an arrow facing straight up/down or the dots colored red. Even though so many factors are out of my control, a CGM helps me do my best.
Since implementing a lower carbohydrate diet, full of greens and fiber, striving for more time-in-range, and wearing a CGM regularly, I have noticed a dramatic shift in my overall ability to manage T1D. As I told me endocrinologist this week, I actually have to think less about the disease because I have put measures in place that keep my blood sugar stable and allow me to live my life. That’s not to say that there have not been challenges along the way or that the measures themselves do not take a lot of effort, time, and thought. I much rather spend the time preparing meals that help me achieve my goals, rather than the mental energy that constant dosage calculations and corrections require.
Challenges and strategies:
- Finding the time to meal prep. I truly truly believe that meal preparation is the key to success. It is the only way you can have full control over the nutritional content and carbohydrate count of your meals. Try: schedule it on your calendar. Treat the time as you would any other obligation, like a non-negotiable.
- Not having a understanding of your overall time-in-range. Try: keep a written log or use a smartphone app to write down your blood sugar over a two week period. Data-driven decision making is powerful. You can then use that information, in conjunction with your health care professional, to modify your goals.
- Not having access to a CGM or having an aversion to wearing one. Try: keep a written log or use a smartphone app to write down your blood sugar, checking 8+ times a day. The key here is to carve out time each week to review your logs and note any patterns you see. Schedule 30 mins each week to get it done.
Above all else, I recognize that I am the only person responsible for my health. I have to keep learning, experimenting, failing, and succeeding for me. I’d love to hear from you in the comments below: Have any of these strategies worked for you? What else should I be trying?