Good News, Praises, and Foot Pain

Good News and Praises:
Well, the good news is that I survived the blood draw for my second A1C test last week. (Needles and I have a negative relationship) The other good news is that my count went down by 2 whole points.  The other other good news is that I lost 17 pounds since July and the final good news is that I got high praise from my medical professional for being so diligent with my diabetes self-care.

It feels good to have your doctor praise you for taking good care of yourself, even though we don't usually seek approval from our doctors.  In this case the praise is appreciated and taken to heart.  After all, who better than your medical provider to know whether or not you are succeeding in your efforts.  

Since I'm still not testing my blood sugar daily, it's been a challenge to watch my glucose count. The A1C results indicate that I've kept my blood glucose at a pretty steady 150 each day. While this is not a perfect number, it's better than if it could be.  

Neuropathy:
Recently I did some research into diabetic neuropathy due to some severe foot pain.  I found out that neuropathy can develop when blood sugars are consistenly very high over a long period of time.  The first thing I did was to do some online checking.  (See my reference section below for links)  My research also took the form of a discussion with my friend, who has been Type I diabetic since she was about 6 yrs old.  

After reading the articles online I wasn't sure if I was suffering from neuropathy or some other problem.  So, I talked with my friend, who suffers from it herself.  The sensations from neuropathy turned out to be very different from the pain I was feeling.  This made me glad for now, but also gave me a better idea of what to look for in case that problem should arise for me.  

Sensations:
The pain I was having was sharp and seemed to be muscle related.  It turns out that I have a cyst on one foot that was exacerbating my troubles.  After talking to my friend, and to my mother (who has the same cyst on her foot, in the same place), I determined that my foot problem was not neuropathy.  

The sensations for neuropathy are tingling, pins and needles, and numbness. Numbness is one of the most serious because the lack of sensation in the feet can mask an injury. Infection in the feet and legs in a diabetic can be quite serious due to another complication, poor circulation. Since I'm not a medical expert, I will refer you to information available on websites such as www.foot.com that has a section on "the diabetic foot".  Needless to say, I was happy to find that I was not suffering from neuropathy yet.  

Research:
However, I do not think that diabetics should be ignorant of this or ANY possible complications to this disease.  Knowledge is, after all, power.  Don't let any foot pain go un checked. To fix my pain I just needed to get inserts for, and wear better shoes.  An easy fix for now. But, down the road, I could be looking at a very different problem.

Remember to keep tracking your carbs, take your medication and test your blood sugar as prescribed by your medical provider.  Exercise is also a must and I plan to talk about that in my next post.  Keep up the good work and be healthy.  

References:
http://www.foot.com/site/foot-conditions/diabetic-foot
http://www.diabetes.org/living-with-diabetes/complications/neuropathy/
http://diabetes.webmd.com/diabetes-neuropathy

Birthday Party

It's hard to throw a birthday party for teen girls and keep your diabetes under control.  We had pizza and cake.  I had a bit of both. Had to keep portions very small because neither are a diabetics friend. The temptation is a bit high for me since I love both cake and pizza.

I've read that the best thing to do when faced with a party and dietary restrictions is to pick carefully what foods to partake and then be careful of portions.  So, one piece of pizza and a small piece of cake are all I had.  They were probably too much, but it was my daughters birthday.

Have been counting my carb intake for about a month now and the one thing I've learned is that I cannot keep my carb intake within a certain range.  One day I'm around 140-150 and the next I'm over 200. This is so much harder than I could have ever imagined.  I haven't decided whether I'm glad not to be checking my blood sugar throughout the day or not.

This last week I began a new job and I've found that my eating habits are changing because of that.  I have a very long commute to and from work.  Because of that I found that from the time I have a snack in the afternoon until I get home I am having low blood sugar.  This has made me take an extra snack for the ride home from work.  Low carb, high protein snacks are so important in this case.  I am having low fat cheese sticks or a 2 tbsp serving of peanut butter to keep the overall carbs as low as I can.

In two weeks I'll have my A1C level checked again.  Honestly, I'm worried that it won't be as low as it should be.  While I can imagine insulin is in my future, I'd like to postpone that as long as possible. I'd also like to postpone having to check my blood sugar throughout the day as long as possible.

So thus far, I'm realizing more fully just how hard living with diabetes will be for me.  I wish I could say that it will get easier, but I know that it won't.  All I can suggest for myself and others is to keep learning as much as possible.  This is the only way to give yourself the best chance to be healthy as a diabetic.  I don't know about you, but I'm not giving up, no way.  I'm all in.

Meals Away From Home

As you can see by the title of this post, I've been away from home this week and meals have been a challtenge.  I've been at a hotel in an orientation program for a ew job I start next week. Breakfast, lunch, dinner and two snacks each day were provided.  While the food was very good, although sometimes cold when it should have been hot, it was a challenge to put together a diabetic friendly plate at mealtime.

Selection at breakfast proved to be difficult because the hotel caterers had the same choices each morning; eggs, oatmeal, toast, bagels, danish, bacon, sausage and accoutrements for the oatmeal and eggs.  So, I had eggs bacon and toast pretty much each morning.  Ordinarily I would not have eggs every morning.  I broke things up one day by having a yogurt (20 grams of carbs) and another day by having a 1/2 cup of skim milk (12 grams of carbs).  I also had peanut butter on my toast (whole wheat) one morning.

For the snacks, I had the forethought to bring some homemade diabetic oatmeal cookies and granola bars.  I know how many carbs in each and divided them between my three snacks per day.  The hotel provided chips, salsa and cheese sauce for one snack, nothing for another, cookies for another and bags of chips and pretzels for another.  I was glad I had brought my own.  One boon was that they had those tablespoon portion sized peanut butter cups for the toast and bagels at breakfast.  I swiped those to have with my snacks a couple times.

Lunch and dinner were a bit better because they had salad as a choice each time and a healthy protein choice.  However, the first two dinners and first lunch were all chicken.  It was a relief when the second lunch had pork and the third dinner had fish. My carb choices were based on what types they offered at each lunch and dinner.  I had a bit of potato salad at lunch one day and a small portion of long grain and wild rice at dinner another evening.  Another dinner had pasta as the main course so I took about a 1/2 cup serving and plenty of salad and a piece of chicken.  

Overall, I believe that, despite not always knowing the amount of carbs per serving throughout the week, I did a good job of eating well-balanced meals with a modicum of carbs.  All my hard work in researching how to assemble a good diabetic meal and learning the amount of carbs in different foods prepared me for my week away from home.  While I'm not fully prepared for things like eating at restaurants yet, I feel that I am making some progress.  My next challenge will be making meals ahead and to take for lunch to my new job starting next week.  I'll also, hopefully, be preparing evening meals ahead of time since I'll be working long days., 

The lesson for this post is that, if you do your homework, have confidence, and pay attention to what you're eating, you can be successful in eating right and controlling your blood sugars.  Now, I know I'm not tracking my blood sugars throughout the day at this point, but I am starting to notice how my body feels after I eat.  I'm also doing better at keeping my carbs to around 45 grams per meal and under 175 per day.  This is a huge improvement over my first two weeks.

During this trip away from home I started to realize that thinking about food differently and having to be selective about what I eat, how much I eat and how often I eat is becoming second nature to me rather than a chore.

So, I hope that this post has been beneficial in showing you that taking a new step in your life with diabetes doesn't have to be hard, or scary or unsuccessful.  Be confident, do your homework and keep making choices based on what you know.  

Carb Education

Following the instructions of my medical professional, I have been tracking carbs for every meal and snack, even my drinks.  In addition, I’m to become an expert on carbohydrates.  To this end I have been reading every label and only cooking with recipes that have the nutrition information for the dish.  Also, I have done some initial research on carbs.

While I’m not yet an expert, and may never be, I’m learning more every day.  Some of the things I’ve learned will be shared in this blog.  For instance, I’ve learned that there are secret carbs, hidden carbs, that carbs will probably be confusing and frustrating for the rest of my life, that there’s more information out there than I could possibly ever completely learn, and that you can reduce the carbs in your food to help your body.

Having come to terms with all of the above, I am prepared to share the first round of carb information that I’ve gathered thus far. 

Secret, Hidden Carbs:

Just from reading labels on prepared foods, I have found carbs in places that I don’t think anyone would have ever guessed to find them.  For instance, did you know that peanut butter, milk, balsamic vinegar and tomato pasta sauce have carbs?  I knew that lactose in dairy products was a sugar but never realized that this would translate into carbs in those foods.  Why peanut butter has carbs I will never know, but they are there nonetheless.  I am equally unsure of why balsamic vinegar has carbs, but the label is supposed to be factual.  As for tomato pasta sauce, I’ve been using jarred sauce.  Will probably switch to making from scratch. 

These unexpected carbs have shown me the importance of paying attention to food labels.  Even your vegetables can have carbs, like green beans and broccoli, so make sure you read EVERYTHING!!!

Confusing, Frustrating Carbs:

As anyone who has ever been on a diet or had necessary dietary restrictions placed on them for any reason, having to pay attention to everything you eat can be frustrating and overwhelming.  I’ve never been able to diet for very long during my lifetime so far because I hate to constantly think about what I eat.  I prefer to just enjoy the food I do eat and let it be a simple pleasure. 

Well, my fellow diabetics, if you’ve been thinking and acting like me you will probably go through, or have gone through, this initial frustration.  Or, it may still be with you.  For instance, I have a very good friend who has been a Type 1 diabetic since she was a child.  She told me that she’s been watching what she eats and exercising every day.  She has gone through countless changes to her routine and eating habits in order to control her blood sugar.  What this tells me is that I have only reached the very tip of the iceberg in my life called ‘diabetes.’ 

My friend has already been a great inspiration to me and a source of reassurance that I need right now.  If you don’t have someone like this in your life, someone with experience with this disease, try to find someone you are close to who can be support for your efforts.  I believe that we need someone other than our medical professionals to help us with the day to day efforts of maintaining healthy blood sugars and being healthy overall. 

As for the carbs per serving, I found several sources that told me a serving of carbs is 15 grams.  (Quick & Easy Diabetic Menus, Betty Wedman, M.S., R.D, American Diabetes Association website)  Well, if that’s the case, how do you equate that to the fact that every food has different carbs per serving and various serving sizes?  I asked my Dad about this, he’s a diabetic too.  He told me that I shouldn’t try to get that specific with it or I will be too confused.  He’s right.  I am confused.  I have no idea how to calculate the 15 gram carb serving to the varied carbs and serving sizes of the foods I’ve been eating.  So, I’ve decided that this is not something I can tackle and will be asking about it when I meet my medical professional next month for my A1C test.

Abundant Information:

As I’ve been learning about diabetes and carbs I’ve uncovered some interesting facts that I never would have known.  One thing that I’ve been concerned about is knowing the amount of carbs to eat at each meal and how many carbs should be in a serving of different foods.  I’ve actually been quite concerned about this since I’m to count my carbs and I know how important carbs are to my blood sugar.  I found out that there’s no exact number for the amount of carbs for a meal.  The American Diabetes Association (ADA) website gives a range of 45-60 carbs per meal. 

The best I can do on this point is to count the carbs I’m eating, try to stay in the range outlined by the ADA and wait to see how my A1C is next month.  Once I’m checking my blood sugar periodically throughout the day I’ll have a better idea of how the carbs I eat affect my sugars.  (This is according to both my Dad and my friend)

The amount of carbs consumed each day is important, but so is the type of carb eaten.  Some are simple and some are complex.  Complex carbs are those that break down into sugars more slowly and simple carbs break down more quickly.  Granulated white sugar and white flour are two examples of simple carbs.  Whole grains and whole fruit are examples of complex carbs.  Vegetables are considered complex carbs as well.  The fiber in our foods helps to break down sugars more slowly because fiber takes longer to digest than simple sugar or white bread or pasta. 

Conclusion:

This post is getting pretty long, so I’ll finish now.  The most important thing to take away from this posting is that you should never stop learning about carbs or anything related to your diabetes.  I believe that if I ever become complacent about my health again the consequences could be much more extreme.  So, never stop doing everything you can to keep your sugars under control. 

What Do I Do After I Get the News?

The first reaction to any bad medical news will be different for everyone.  My initial reaction was disbelief, followed very quickly by a realization that I had been on the road to diabetes for several years.  Then I was disappointed to have received the next round of bad news.  After I got past all that I scheduled an appointment with my medical professional to discuss medication, my test results and my next steps.  

I got my diagnosis over the phone on a Thursday and my appointment wasn't until Monday morning.  I had several days to compile a list of questions and to start eating better immediately.  

The list of questions is essential whether you are unfamiliar with the disease or have been around it for as long as I have.  Among my questions were:

1.  Will I be on medication? If so, what will I need to be on and how do I take it? Will there be side effects?

2.  Will I have to test my blood sugar everyday, like I did when I had gestational diabetes?

3.   How does exercise play into this diagnosis?  If I have to exercise, how much and what types of exercise should I do?

4. Nutrition is important with diabetes.  What do I need to know, learn and do to have good nutrition?  How will nutrition affect my disease?

So by the time I made it to the clinic on Monday morning I had a short list of questions and made sure they were all answered.  I also took a notebook and made notes from my conversation.  I asked as many questions as I could and scheduled my next appointment.

As I mentioned, I started eating better right away.  While I didn't track everything I ate, I did use several cookbooks for meal ideas and looked through my books on diabetes to get some idea of what my diet should be.  (I will provide a list of the books I have used so far at the end of this post for your reference)  I found that one book of diabetic menus not only listed weeks worth of menus, but had recipes and a nutrition guide.  This book was the most helpful and I refer to several charts from it everyday now.

Test Results:
By the time Monday came I had lost three pounds since my physical two weeks before and I was armed with my questions, notebook and a couple of my reference books.  The first topic of discussion was my test results.  My fasting blood sugar was not far below 200.  The normal range is between 65-99.  Even the low 100's would have been better than my reading.  Another factor that went in to my diagnosis was my A1C. This is a count of how much glucose is in my blood for the last three months.  My A1C value was way, way, way above normal which is 5.7 or below.

I had never heard of A1C before so we talked about this a bit and I was told that this must be measured every three months.  The blood cells are only alive for about 3 months, so this must be tested that often to see how well your body is handling the glucose you intake.  

In addition to this, we discussed insulin, diabetes and how things work.  In a nutshell, insulin is a hormone that processes the glucose in your body.  Your body either uses or stores the glucose.  If you are not producing enough insulin then too much glucose will be stored in your bodies cells, causing problems.  This is what most people think of with diabetes.  However, there is another problem with insulin.  Your body may produce insulin just fine, but your cells are resitant to it and the insulin, therefore, cannot do it's job.

Medication:
My medical professional did not put me on insulin as a medication at this time.  She first put me on a medication to assist my body in using the insulin that is produced naturally in the pancreas.  We discussed when to take it and the side effects.  I am taking Metformin, so is my Dad.  Hopefully, I won't need to take anything in addition to this.  Time and other blood tests, etc. will tell for me.  The side effect to be aware of with this medication is upset stomach.  It does fade quickly as you continue to take the medication.  One plus right now is that I am not testing my blood sugar yet.

Nutrition:

Nutrition and exercise both play a big part in living with and controlling diabetes.  Some have supposedly conquered this disease with diet and exercise.  I am not confident that this will happen for me, but I don't let this thought discourage me.  I just want to feel better, live as long as I can, and be as healthy as I can.

So, we talked about my new eating habits and I showed her my books.  She was impressed with the nutrition charts and menus in the one book.  She said that the information is appropriate and should be followed.  The book has charts giving the starch/bread, vegetable, fruit, milk, protein and fat servings to have at each meal and as a snack.  Then it covers diabetic nutrition, has charts giving portion sizes for foods in each food category and finally gives menus and recipes.  I follow the meal chart for the amounts in a food group from this book for every meal now.  

My medical professional asked me a few questions and determined my Basal Metabolic Rate, how many calories you burn if you are at rest for the day.  The figures you need for this are your height, weight and age. Here is a link to a website to calculate your own: http://www.bmi-calculator.net/bmr-calculator/
This figure tells you how many calories to eat in a day.  However, this isn't the only thing to consider in your diabetic nutrition.

In this discussion I brought up the Glycemic Index and asked if it would play a roll in my meal planning.  I was told that it does.  The Glycemic Index tells you how fast the sugars in your food enter your blood stream.  A food with a low GI will enter slower than a food with a high GI.  (I have a couple books to recommend on this subject.)  The Glycemic Index can be very important for diabetics, not for diet reasons, but in the selection of foods that will NOT spike blood sugar.

One of the most important nutrition things I learned in my discussion with my medical professional was that weight loss is not to be my priority as a diabetic.  My priority is to learn about carbohydrates.  I am still in the process of learning about them and will share what I learn here in my blog.  Did you know that there is a basic guideline for how many carbs you should have with your meals?  I didn't know that and tried to find out.  What I found is a range for carbs per meal for a diabetic, but nothing specific.  The range is 45-60. The exact number for you depends entirely on you and your body.  I have also wondered how many carbs I should have in a day.  I tried to find this out and couldn't find a specific answer to this either.    My source for these questions was the American Diabetes Association website.  http://www.diabetes.org

Exercise:
The last topic in my first appointment about my diabetes was exercise and this was simple.  For now I will be trying to get at least 45 minutes of cardio exercise in every day.  I have been working up to this so far and am at 20 minutes right now.  Cardio exercise means doing something that gets you into a sweat and increases your heartrate, but not so much that you cannot talk normally while doing it.  Walking, aerobics, biking, etc. are all good choices.  The important thing for me is finding something that I can enjoy doing everyday.  I will probably be looking for several options to use throughout every week so I don't get bored.

Wow, this has been a very long blog, but all of this information was important, necessary and helpful as I begin my new life with diabetes.  I'll never consider diabetes in a positive light, but I should at least learn to live with it comfortably.

So, don't get frustrated, get creative.


Bibliography:
Quick & Easy Diabetic Menus: More than 150 Delicious Recipes for Breakfast, Lunch, Dinner, and Snacks, Betty Wedman, M.S., R.D. Published by Contemporary Books. This book is based on the American Diabetes Association Exchange Lists.

Fast and Simple Diabetes Menus, Over 125 Recipes & Meal Plans for Diabetes, Plus Information on Complicating Factors Including: High Blood Pressure, Kidney Disease, Celiac Sprue, High Cholesterol, Betty Wedman-St. Louis, Ph.D., R.D., C.N.S. (Former president, American Association of Diabetes Educators) Published by McGraw-Hill.

The Everything Glycemic Index Cookbook: 300 appetizing recipes to keep your weight down and evergy up!, Nancy T. Maar, Published by Adams Media, Avon, Massachusetts.

The Simple 0-10 GI Diet, Azmina Govindji & Nina Puddefoot, Published by Ulysses Press.

Getting the News

No one likes to get bad news and I am no exception to this.  In fact, in the last year and a half I have gotten almost nothing but bad news.  I lost my job, found out my daughter has partial onset seizure disorder and that I have high blood pressure.  These are just the big items on the list.  Needless to say, this has been a pretty stressful time for me and my family.  

Unfortunately, I've never been one to cope with bad news and stress very well.  With the help of family and friends, I've dealt with everything to the best of my abilities.  Yet, I've still felt the stress .  Under stress I don't take care of myself, I take care of others and the problems that cause me stress.  I tend to eat comfort food (which is not always healthy food), get insomnia, and shut down completely (become a couch potato).  All of these behaviors lend themselves to weight gain, poor nutrition and bad health. 

Despite my lack of everyday self-care, I do try to go to the doctor each year.  So, I had a routine annual physical with the standard fasting blood test.  Just about a week later my doctor called with some news.  The blood test revealed that I have diabetes. My blood glucose was high and so was my A1C level.   I felt like this was the straw that broke the camels back.  I've already been through so very much, and now this lifelong disease.  Then I realized that I'm pretty familiar with diabetes and gained some confidence in my ability to cope

While diabetes is bad news again for me, at least it's something that I'm very familiar with.  I grew up with a grandmother and other older relatives who had diabetes.  Then when I was pregnant with my daughter I had gestational diabetes.  Additionally, during my last job, I worked closely with several people who are diabetic.  Finally, about six years ago my father was diagnosed with it.  All of this exposure taught me quite a few things that make me both comfortable and uncomfortable with my own diagnosis.

I'm not happy about the potential harm that uncontrolled diabetes can have on my body like neuropathy in my feet, glaucoma in my eyes and heart problems.  But, since I had to live with diabetes during my pregnancy, I've been through it and that gave me something positive to cling to.  Even though I was on insulin during my pregnancy, my blood sugar normalized after I gave birth and my baby was a healthy birth weight.  I was successful in watching what I ate and exercised everyday.  If I could do it before, I can certainly do it now. 

So, even though diabetes is a negative diagnosis, it doesn't have to have  a negative overal outcome.  This blog is intended to provide the results of my diabetes education in hopes that others will benefit from it, whether you have it or are helping someone else who does.