The authors of “Choose Your Foods” should choose their words with as much care

November 30, 2012

I had a visit with a diabetes dietician today.  The meeting went well, but I was taken aback.  I oftentimes get a vibe from health care professionals that they think I’m pretty screwed up with my diabetes management.  Today the dietician said multiple times that she thought I was doing excellent.  She actually said it at least twice, once using the word “great” to exalt my efforts; excellent is the word she used the second time.  This was after downloading all my meter readings and hearing the tales of the last months, and the 30 years that led to those conditions.

The reason I was taken aback is because I did not get that negative vibe.  If anything I got more of a “you don’t really need my help” kind of vibe.  That’s a good vibe to get, and I have to get used to it.  I want to be used to it.

I got a lot of handouts from that visit.  One was called “Choose Your Foods / Exchange Lists for diabetes.”  The reason I got that handout was because I asked about alcohol.  The word exchange always bothered me for many reasons.  It doesn’t seem like a real scientific unit of measure.  I know exchanges translate to more precise units but two problems I have with that.  That translation, or conversion more accurately, is different for each type of food so there isn’t an easy to remember standard.  This book, BTW reminds me of all the big books I got as a kid.  Something about them just speaks to the idea that you should stay at home in your little bubble of carb-counting and eat your fixed amounts of food without variation.

Scan0006

Don’t teach me how to follow a plan; especially one that I did not make.  Instead, teach me how to adapt to any given situation so I can adjust appropriately if something does not follow the plan, which happens often.

Let me stop the micro rant within my primary rant and get to the point.  On page 53 of this book, under “[alcohol] Selection Tips” it states that “While alcohol, by itself, does not directly affect blood glucose….”

Whoah, Nellie.

It does not directly increase  your blood glucose, but it certainly affects it.  Lowering is an effect, dear author.

This is the kind if confusing crap that makes it harder to manage your glucose.  Had I not known any better, I might read that and think I could do shots of vodka all night and I’d be fine.  Wrong.  I’d be dropping into a diabetic coma while being drunk on top of it.  I’ve been there.  Not the coma, but all the most serious effects of low blood sugar combined with being drunk is a really trippy place to be.  As great as that sounds to you recreational drug users out there, it’s not because you didn’t plan to get to that “high” and therefore not really sure when you’ll come down.  You’d always wish you weren’t there if you were cognizant enough to generate that thought.

A lot of the info you get on diabetes assumes you’re in a very controlled environment.  There should be more info out there for people on how to deal with all the variations.  Don’t give people a static list of a bunch of food and their “exchange” amount.  Teach people how to solve the problem up front and don’t try to program them into an un-shifting regimen.  I hate to use the word problem, but I’m speaking entirely from a mathematical point of view.  How do I adjust the scope, slide the scale, hit that curve ball?


The Medical Virtues of Miller Lite

November 27, 2012

Old School Miller Lite.  Available in pharmacies across the country.

“It’s about time!  The guy with the alcohol-related blog is finally writing something about alcohol.”  Said the three people who looked at this blog so far.

First of all, let me give props to Courtney Benefiel and her blog article.  I know neither of us are doctors, but that article was the most realistic take on drinking with diabetes I’ve seen or heard to date.

In my previous post, I mentioned a loss of vision I have been dealing with recently.  (Those of you keeping tabs at home will be happy to now that when I look at the monitor with my bad eye now, I can make out letters on the screen if they are in bigger font sizes.)

Alcohol lowers your blood sugar but read on because I don’t think people always fully understand that statement.  I didn’t.  Consumable alcohol, ethanol, in its purest form lowers your blood sugar.  As to why, I still don’t know, but the point is unless you’ve got a serious drinking problem and access to an industrial chemistry lab, you probably aren’t drinking pure ethanol.  So we throw in different types of alcohol fermented from different things, mixed with different soft drinks all of which have a different carb to alcohol ratio.  Figuring out how much insulin to take–or not–with any of those in the mix isn’t quite as complicated as “…trying to hit a bullet with a smaller bullet whilst wearing a blindfold, riding a horse.” but it’s close.

Travel back about 18 years with me.  The bar I worked at in college boasted the largest selection of micro brews in town.  Dutiful employee that I was, I felt the need to get intimate with our wares.  I sampled every bock, stout, lager, cider and pale ale we had; continuously.  Every time a new beer rolled into the keg room I tried it.  I became a beer snob.  Luckily, there was a point where “lighter” (read shittier) beers became fashionable.  Though I am not susceptible to fashion trends when it comes to clothes, I am a sucker for them when it comes to beverages.  Anyway, those lighter beers still weren’t of the Miller Lite variety.  I’m talking more along the lines of Point and Blatz.  They may have had less of a carb to alcohol ratio than better microbrews but they still wouldn’t have made managing my blood sugars any easier.  Not that I would have noticed.  I was lucky if I was testing my blood once a month.  I mention this because I still know plenty of beer snobs today.  Some of which love to give me shit if they see my fist around can of Miller Lite.  There’s a reason, guys.  I may not have been conscious of it until recently, but there was a reason.

Back to the here and now.  That loss of vision I mentioned above shocked me into taking booze off the menu for about a month.  But, my 20-year high school reunion was coming up and whether I drank there or not was going to be a game time decision.

The day of the reunion, my wife and I checked into a hotel in the Milwaukee area to enjoy some pool time.  We had dinner with some very good friends planned for pre-reunion psych up, but we needed a snack until then.  As most hotels are wont to do there was an Outback Steakhouse conveniently located next door.  I ran over there to get a few appetizers for ourselves.  As I am wont to do, I sat at the bar to wait for our order.  Usually in this scenario I have a beer while I’m waiting, so I whipped out my phone and started googling.  I found and skimmed Courtney’s article.  I want to give her props because I found that article to have a style and tone I had previously not found on the topic of diabetes.  I liked it a lot.  But, my immediate takeaway from that skimming was that of all beers, lite beers like Miller Lite, have a carb to alcohol ratio that is easiest to manage and predict.  So, I ordered a Spotted Cow.  Idiot.  This was well before the reunion where I felt I would have more freedom to test and inject if needed, so I put the Miller Lite info into the middle of my head for later use.
According to the ole logbook that Spotted Cow, and some cheese fries made my blood sugar go from 88 to 157.

Indy Notebook

Keep a good log at all times.  Even in the map room.

That was the only beer I had–for a while.  I did, however have a couple Captain and Diets as the reunion went along.  Thanks again to the good ole logbook, I see that had an affect of lowering my blood sugar to 56.  It was 201 after we  finished dinner.  I got into panic mode a bit at that time.  Not just because my blood sugar was dropping, but because of it I started sweating profusely in front my old high school girlfriend.  We would have had a nice conversation, by the way, but I aborted to run into the restroom to swab off my forehead and down about a half dozen life savers.

The sweating stopped and I could feel myself getting higher.  At this point I switched to Miller Lite and dove into the appetizers.  I can’t remember how many beers I drank, but it was enough to get me drunk.  I’m sure the captain and diets help a lot on that front too.

The next morning when I tested I was at 120.  Right on the money.  I’d like to thank Miller Lite as my safety drink and bestow its virtues, but there are other tales to come that make me think I don’t quite have it figured out yet.  I tend to munch after longer nights of drinking and that may have something to do with it.