Anniversary Dinner and Three Courses of Insulin

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Ahh, celebrations. Last night Kathryn and I celebrated our third wedding anniversary with a lovely, overindulgent meal at Eve, a restaurant in Ann Arbor owned by Chef Eve Aronoff, recently on Bravo TV’s sixth season of Top Chef — although I believe she has since been voted off. (Admission: I don’t watch it.)

As many of you know, I have been living for nearly three years with Type 1 diabetes, two of those years on an insulin pump. What’s more, I’ve done extremely well managing my diabetes through insulin therapy, diet, exercise, and a very good dose of daily vigilance to keep my HbA1c in the 6% range, and to keep my cholesterol and blood pressure at — according to my endocrinologist — wonderful levels. Each quarter, when I visit my endocrinologist, the ever-present pessimist in me expects to hear the worst, expects to have the doctor put down his foot and tell me that it has to change. But of course it doesn’t. Because of my self-management.

I do as much as I can reasonably do to ensure that I can live a long, complication-free life despite the hurdles that Type 1 puts in front of me and will continue to raise for the next forty or fifty years.

However, I do not avoid the gustatory pleasures. Therefore, when those occasions come along that call for enjoying some wonderful food and drink, when there’s a chance to sit down with the love of my life and share a meal that we’ll talk about for years to come, I do not think to myself, “Should I really do this, what with my Type 1 diabetes and all?” No. No I don’t. Because I know how to handle the food. I know that my self-management is what it should be, and I know that it’s not part of the life I want to live to deprive myself of nights such as last night.

Still, I do have diabetes, and as much as I’d like to disregard everything about the illness for the evening, a gourmet meal doesn’t come with carbohydrate levels, and I’m sorry, but I’m not asking them how much sugar they may add to this or that sauce, and I’m not asking if the chef can alter the way she prepares this dish or that dish to better accommodate my illness.

I’m eating this food. I’m enjoying this food. I’m bolusing intelligently for this food.

Because I do have to think about more than just the deliciousness of the meal. I have to think about when I’ll be eating what and how to spread the bolus rate out over two-plus hours of dining. My insulin pump has an extended bolus feature, so I employed that for the first hour, taking into consideration what I’d be eating and drinking at that point. This included an initial board of bread and artisanal butters, then curried mussels in a rich sauce with more “bread for sopping,” as well as my ginger-lime martini, with pieces of crystallized ginger and fresh lime floating in the glass. (While I don’t usually bolus for alcohol, especially because my drink of choice is beer, I did calculate some carbs for this mixed drink and appended them to the bolus.)

Around the end of the first hour I was well into my rich seasonal soup, a tomato and cheese thing that took me to new levels of tomato love, an explosion of tomato flavor beyond anything I’ve ever had before. I checked my blood glucose to see if I’d spiked or had any problems. Granted, only an hour after a bolus I knew I wouldn’t see much change either way, but I wanted to stay on top of things. I was at 168 mg/dl. Fine. Just fine.

My entrée arrived. Peanut barbecued tofu napoleon. Of course this had a few carbohydrates. I gave myself another bolus and proceeded to enjoy the best tofu I’ve ever tasted.

I had long ago switched from that one martini to Diet Coke and lots of water, so after the entrée, I excused myself to the restroom to, among other duties, again check my blood glucose.

Again I was fine, still in the 160 mg/dl range.

Dessert beckoned, and yes, it would happen. It was one of the most exciting aspects of our meal and we’d talked about its imminence throughout the meal, speculating as to whether we’d make it (and halfway through our entrées our conversation turned to how full we were).

Kathryn and I shared Eve’s Flight of Artisanal Ice Creams, which consisted of six golf-ball sized scoops of the following flavors arranged side by side on a shallow white serving dish: pear riesling, strawberry buttermilk, lemon yogurt, goat cheese with roasted cherries, salty caramel, and Belgian milk chocolate. I bolused for a little more than half of the ice creams and, with a cup of coffee next to me, began to taste and fall slightly in love with bite after bite of each decadent scoop of ice cream.

An hour after I got home, I checked my blood glucose. 135 mg/dl. An hour after that, before bed, I checked again. Back down to 118 mg/dl. At about two in the morning I woke up and checked again, 140 mg/dl.

So, all in all, a very successful use of insulin for a meal that was way outside of what it is I’m used to eating and how I’m used to bolusing for meals.

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