Food For Thought

My husband and I were having dinner out in Indianapolis one day last week, when one of those "small world" things occurred: A former colleague of his — from more than 20 years ago and another state, yet — spied us. He and his wife came over to our table and we began catching up with each other’s lives.


The food came and the colleague’s wife stared at me as I began eating a Vietnamese summer roll.

"I can’t eat those," she murmured. "I’m a diabetic."

“Yeah? I have diabetes, too,” I responded. “Why can’t you eat them? It’s basically salad in a rice-paper wrap.” There probably wasn’t as much carbohydrate in the entire order as there is in a slice of bread.

All I could get out of her was that her doctor is a stickler on her having “good numbers” and yells at her if they’re not “perfect.”

I think that more doctors need to have diabetes and try to maintain “perfect” numbers all of the time. Barring that, if they can’t at least understand that we are mere humans and can only do the best we can, they need to be fired.

There are so many things that can affect blood glucose. Many people believe it’s only food that makes blood glucose rise, but stress, physical activity, hormonal changes, and more also have an effect — and not always the one you expect. Right now, my podiatrist is convinced my blood glucose should be elevated because of my torn Achilles tendon. Instead, even I am surprised that it’s running on the low side. Maybe my body has decided to “stress down” this time around. Maybe my hormones are squirrelly. Maybe it’s because the sun is about to reach the same position in the heavens that it was in on the day of Creation. And isn’t there a full moon this week?

It will be interesting to see what happens after my surgery tomorrow to repair my torn Achilles tendon. Especially since I then immediately go into Passover cuisine mode and change my entire diet for eight days.

HA! Let a doctor try that and keep those numbers perfect! Have surgery, come out in a cast so that your activity level declines precipitously, and change your entire menu for a few days.

I think that food remains the sticking point with diabetes. I put off getting serious about my diabetes for years because I didn’t want somebody telling me what I could and could not eat. I was diagnosed in the days of the exchange list (and told I couldn’t even eat a sweet pickle). So I was pleasantly surprised to find that, in the interim, the standards had changed from a strict menu to (with apologies to Gertrude Stein) “carb is a carb is a carb is a carb.”

To my great delight, it was no longer something like “half a sandwich, a bowl of soup, and a three-inch apple” for lunch. I could eat anything I wanted as long as I matched insulin doses to the amount of carbohydrates.

Many people still don’t understand that, however, and will wag their finger at you for eating a cookie, but ignore that huge plate of spaghetti you’re scarfing down. Not that it’s any of their business what you’re eating anyway.

I’m sitting here chuckling, remembering a family practice doctor I went to — once — back in the days of Regular insulin. He yelled at me for eating some cookies. He then told me I didn’t need to see an endocrinologist, saying, “You’re MY diabetic.” (Little did he know that I’m nobody’s “diabetic.” I don’t like that word.) Kept the endo. Fired the family practice doc. If he didn’t know that Regular insulin has a peak and you need to feed that peak, he had no business overseeing anybody’s diabetes, much less mine.

Speaking of food, I should get myself to the kitchen. Passover begins tomorrow evening, and it seems I’ll be a bit busy when I normally would be finishing up the seder meal. Lemme see…tzimmes, chicken soup, matzoh kugel…

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  • Nicky

    Of course, high insulin levels are just as damaging as high blood glucose levels. I think I’d rather have your acquaintance’s doctor than yours…

  • Ephrenia

    I totally disagree with Nicky. I don’t want any doctor (or anybody else for that matter) yelling at me over what my numbers are or what I’m eating! TALK with me if yoy have an issue, okay. Yelling? “Doc, you’re fired!”

    My doctors all talk with me and I’m the major decision maker on my care or they don’t stay my doctors for long. I listen and take her advice, but I decide on my own treatments. Its my body and my life at issue. I live with the decisions 24/7, they don’t.

  • amyt101869

    I’m with Nicky. I am on pretty low amounts of insulin and would like to keep it that way. Yes I let myself have a treat at times, but I can live without them. I also am happy with my present weight, and plan on keeping that good also.

  • Shelly

    I am a new diabetic and am still learning what spikes me and what doesn’t. With that being said, if I eat anything but a salad at lunch my coworkers give me the “should you be eating that?” question. I even go so far as to have 10 croutons on my salad as my carb choice and that throws them into a tizzy. Meanwhile they are eating calorie (and carb) laden lunches and complaining about feeling too tired after lunch to join me on a walk. Imagine if they understood what diabetes was all about?

  • victoria

    Thoroughly enjoyed this column. I’ve been at this for more than 15 years now. It’s a constant struggle in which no one understands unless they’ve personally been there. The best endo I ever had was my peds endo at Children’s Hospital in B’ham, Ala. (She’s still there.) Dr. Joy Atchison… she is a diabetic herself, and as a stubborn child, found it much easier to listen when she told me something.

    I don’t mind answering questions about my diabetes, but I get extremely annoyed when people “wag the finger” or tell me I shouldn’t be eating something. I don’t do as well as I could, but I’m in my late-20’s, and I manage just fine.

    Thanks for the expressing what – so often- I feel. Keep up the good work.


  • tmana

    First things first: insulin-users have greater diet flexibility than those of us on oral medications or on diet-and-exercise alone, since we must use our diet to control our numbers. Fast-acting insulins give the flexibility of a greater meal bolus or a correction bolus that is unavailable with oral medications or diet alone.

    That said, schools of thought vary between “as long as you’re within bounds at the two-hour postprandial” to “minimize ALL blood glucose excursions (both high and low)”. All have something to be said for them, and against them.

    Research and observation into glycemic index and glycemic load suggests that while “a carb may be a carb” as far as nutritional value is concerned, all carbs are not equal when it comes to an individual’s blood glucose levels. Of course the rest of the meal comes into consideration as well (otherwise there wouldn’t be server-banks-full of comments on “the pizza effect”).

    Fear can be a motivational factor. It’s generally not the best motivational factor — especially if it’s externally imposed — but if it’s what works for the individual, I won’t knock it.

    And for what it’s worth, I still “don’t get” T2s treating a low with a Hostess Twinkie rather than an orange or an apple and follow up with a low-fat string cheese…

  • Lili

    I’m confused – where are people getting the idea that using *exogenous* insulin causes the problems they’ve found to be associated with high endogenous insulin levels? I don’t get it.

    Oh, and chag sameach!

  • {cher}

    i will say that now that i’m an insulin user, i have more freedom than when i was on “the pill”. being on the pill meant i had to work off any extra sugars, where now, i dial up my pen and zap.. done! sometimes i feel the insulin is a lazy way out of type ii’s eating right. not saying some lil rice roll is bad for you, but i know in my husband’s family their whole view is.. “meh, i’ll just take an extra shot or two”, with i don’t think is a very wise choice.

    blog: just cher’ing a bit of myself

  • Laurie

    Granted, Passover is not the easiest time for great BG numbers, but oooh, the foods are fabulous. And then there’s spring around the corner.

    It surely is easier to fine-tune dosing with insulin than with pills. I’ve had Type 1 for 38+ years and back then, I was put on oral meds during what I now know is the honeymoon. Poor beta cells, never had a chance!

    My Type 2 pals seem to fear shots, which I surely understand, but once they move to shots – as Cher says, it’s easier to cover foods. Of course, with that flexibility comes heftier dose of responsibility to manage food and weight.

    Another one of life’s double-edged swords.

  • concerned diabetic

    Just spotted your blog. I would have to agree 100% with your decision to fire that primary and keep your endo. I had to do something similar one time regarding a philosophical differance I had related to another medical condition I have in addition to my diabetes. You need to be the manager of the teams of experts helping to manage your diabetes.

    I hope you enjoyed your Passover without too many highs or lows. There is a website out there with lots of information related to being Jewish and diabetic. There also are some Jewish diabetic cookbooks out there too.