Sunday, February 14, 2010

Back at home, counting my carbs

I got out of the hospital on Friday, as I was hoping in my last post. It wasn't too terrible being in the hospital - like I said, it was nice to see my nurse buddies and I did have to get some platelet transfusions, so you know, it worked out in the end.

Now my big job is blood glucose management and counting my carbs. Steroids, those wonderful little pills that have kept me from sleeping for the past three weeks, interfere with the way your body processes glucose. They bind to the insulin receptors on your cells so that insulin can't help the glucose enter the cell and be digested and turned into energy. My pancreas is producing insulin, I just can't use it properly. It's not good to have high blood sugars, for reasons I'm sure we've all heard, but it also makes you more susceptible to infection, and we know I definitely don't need that!!! We know that it was a big failure trying to manage my glucose with my diet, so I started the insulin.

Note: this is not meant to be an all-encompassing write up about how to manage diabetes, because I don't have that, or your blood sugars. This is just what I'm doing right now to make my life a little more livable. Right now we're trying to get to the point where my blood glucose is between 70 and 140 before meals. I can get to that level in the morning (when I've been fasting all night long) but I have yet to get to that point during the day.

There are two components to how I dose my insulin. First, is by testing my glucose, you know, pricking my finger with a little needle and having a machine read my blood. Based on that number I have to take a certain amount of insulin, for example, if my glucose is 215 I have to take three units of insulin.

The second component is taking insulin to cover the carbohydrates I eat during a meal. Because I have to take the insulin before the meal, this means I have to plan out everything I'm going to eat during the meal. Everything. To the point that I have to decide if I want 1/3 cup of rice or 2/3 so that I can adjust my insulin accordingly. With a measuring cup and everything! And then I can't have any more than what I've adjusted my insulin dose for. It's a totally different way to go about eating.

How does one count carbs? It's easy enough if you want to eat a piece of bread or a cup of yogurt. You look at the package, check the serving size, check the number of carbs per serving size, and calculate accordingly. For example, there are 16 g of carbs in a cup of the yogurt I like to eat. If I only want half a cup, it's only 8 g of carbs. I just have to be really careful about the serving size. For anything cooked, it's more complicated. Example: my mom made spinach lasagna this week. So we had to add up the carbs in all the ingredients - the noodles, the ricotta, the spinach, the parmesan, the mozzarella, the tomato sauce. This is where it gets complicated because you have to pay attention to serving size, carbs per serving size, and how much you put into whatever you cooked. There's A LOT of math involved, and I am terrible, terrible, really really wretched at math. Then you divide that by how many pieces there are to find out the number of carbs per serving, and then multiply that by how many pieces you think you're going to eat.

I do that before every meal: what will I eat, how much, how many carbs is it. For each 10 g of carbs I take an additional unit of insulin. I add that to the insulin I need based on my blood glucose, and that gives me the total amount of insulin I have to take before the meal. The annoying part is that even though I'm doing all of this and tring to be so careful, I still can't get my glucose under control!

The hardest part is snacking, because all of my snacks have to be under 15 g of carbs. Not that I'm a huge snacker, but it's kind of like The Passover Syndrome. I don't need to eat a bagel every day, but because it's Passover and I can't, I want to. I don't need to snack on fruit or cookies all the time, but because I can't, I want to! I would love to snack on celery or carrot sticks, but of course I can't right now because I'm still not allowed raw fruits or veggies. So my options are: 12 wheat thins, a cup of popcorn, five Hershey's kisses, a piece of string cheese, 2 Tbl of peanut butter. Or anything else I can find that's under 15 g. Actually, it should be closer to 10 g, since that's what I'm using as my insulin unit factor.

In summary, eating is better, but it's still kind of complicated. Hopefully not for too much longer. Going through all of this glucose-insulin nonsense has given me such a huge appreciation for what diabetics go through on a daily basis. I always knew it was a pain in the ass, and I've been told that after a while you get used to it and it becomes like second nature, but I can't imagine how hard it must be to do this every day of your life and deal with all of the other problems that come with diabetes. That takes real strength.

This post is dedicated to my wonderful friend Mary, who has not only put up with me for 20 years,but deals with everything life throws at her with grace and composure, and always has time to help her whiny, hyperglycemic friend. Thanks Mary!


Zhu said...

Okay, I guess I got my answer - yep, counting carbs is super complicated.

I kind of have the idea, because one of the girl at my former job went on a diet and she would explain to us (well, really, to ANYONE within ten meters from her) how she counts carbs, sugar etc.

I'm super dumb when it comes to diet because I don't diet. I'm still French for that, my idea of diet is just eat less and exercise more. And smoke obviously ;-)

Anyway, I had always thought that carbs = potatoes, bread etc. And now I was learning there were carbs in my Starbucks coffee!

Super complicated indeed.

Jacob said...

mmmmhh I don't know if I could ever do what you're doing. I admire you. :-)

you're a champ! and i <3 you!

that's pretty much all i have to contribute at this point. :-P

Sevonne said...

My little sister Michal has been a type-1 diabetic since the age of 3. It has taken her years to master the mathematics behind her carbohydrate intake, and she knows like you what a pain in the ass it is. I'm sorry you have to add this to the annoying things you have to currently deal with...

Her philosophy, which has helped her get this far, is "a carb, is a carb, is a carb." It sounds like you have managed to digest that idea as well.

Thanks for the b-day wishes and I am glad to hear you are out of the hospital and that your stay was relatively pleasant.

No more random fevers, ok?!

au soleil levant said...

Zhu - there are carbs in everything! You have the right idea about dieting. I think restrictive diets, unless medically necessary, are ridiculous. All you do is make yourself unhappy because you can't have chocolate or pasta or whatever. What's the point?

Awww, JT, you left me a message on my blog! Super cute. I heart you too!

Sevonne - I think it must be so much harder for young kids to deal with the carb problem because of course they just want to eat cookies all day long like their friends. Good for Michal for being able to master the problem. I'll do my best to keep those fevers under control :)

Loislane said...

But how often can you have snacks?? There could be a loophole here, you know? Like how many minutes must you wait in between carbs? And what a miniature snickers - like the size smaller than fun size? Those are great frozen.