Saturday, April 28, 2012

Food Rules

"Anything to eat today?" the Starbucks barista asks as she takes my travel mug and relays my order for a sugar-free vanilla Caffè Misto [10g of carbohydrates] to her co-workers.

"No, thanks, just the coffee," I say, handing over my debit card. As I punch in my PIN, the barista leaves and returns a second later with a bag.

"Do you like blueberry scones?" she asks.

"Uh, sure," I say, still peering at the debit machine and not really paying attention.

 "Here,"—a bag appears in my hand—"a blueberry scone for the road. Free, since you're a regular." Not entirely sure what to do, I smile and thank her, retrieve my debit card, and shove my wallet and the scone into my purse.

As I wait for my coffee I decide without hesitation that I will see if anyone at work wants the blueberry scone [61g of carbohydrates]. In the end, the workday swept me away and I completely forgot about it until I found the scone in my purse this afternoon, squashed and dried out, buried under my wallet and digital camera. (I feel guilty throwing it out; but I don't think anyone would want it now ...)

A year ago, I probably would have made a different decision. I might have chosen to eat half of the scone now and half of the scone later, to divide up the carbohydrate load. Or I might have decided to try eating the entire thing and hope it would be one of the times my blood sugar cooperated. As it was, the fact that I didn't even consider the possibility of eating it is a massive improvement over how I thought just a year ago.

I think one of the hardest aspects of diabetes is that there are no hard and fast rules around food. Every time something is offered it triggers this internal debate about whether to eat it or not. There's no simple, all-encompassing ingredient or circumstance that, if present, leads to an automatic, "No, thanks."

Compared to the other dietary issue I live with—a food allergy—diabetes is like a guessing game. There are no foods completely off-limits with no exceptions. For anyone who has anything but the most mild food allergy, challenging your restriction can, at best, ruin a meal and lead to hours of misery and, at worst, lead to an encounter with the EpiPen and trip to the hospital. With diabetes, if you challenge your restriction it might lead to a few hours of high blood sugar ... but then, sometimes—if you happen to bolus just right—it may not. And, while hyperglycemia may be unpleasant, it's not nearly as unpleasant (or scary) as anaphylaxis. It's easy to ignore the fact that those hours of high blood sugars are doing cellular damage, especially if (like me) you have never seen or experienced diabetes complications firsthand.

Over the past year I've thought a lot about how automatic my refusal of anything that contains, or may contain, my allergen is. Mention even the possibility of it containing or coming into contact with my allergen and it's an automatic refusal, no exceptions. I don't feel any craving or any sense of, "Well, maybe if I just tried it this once ..." (It probably helps that I've been allergic to this food since infancy, so I never developed a liking for it to begin with.)

I like how easily and automatically I'm able to refuse food with regards to my allergy. I don't find it as easy with diabetes, and I wish I did. There's always that thought running through my head that, "Well, just this once won't hurt ... even if I do go high, a few hours of high blood sugar isn't going to kill me!" I imagine anyone with a food intolerance or a doctor-recommended dietary restriction that doesn't hold the possibility of life-threatening consequences experiences this same type of dilemma.

With diabetes, there is always the possibility that I could happen to craft that perfect bolus that keeps my blood sugar from soaring too high or sinking too low. And there's also the frustrating fact that, even if I ate perfectly, my blood sugar would still go high and low because of the many factors besides food that influence it. When I was younger, there were guidelines in the form of an exchange diet and "no sweets" rule; but anyone who grew up with that system knows how well it worked (or didn't work) at controlling blood sugars—mostly because it's carbohydrates, not sugar, that matters (and it's nearly impossible to eat a diet that eliminates all carbohydrates)

So, given that I can't eliminate my problem food (carbohydrates) entirely, I've been trying to come up with some guidelines that are straightforward enough so that I don't have to think when people offer me food. I can just take it or leave it as easily as I can with my allergy. Some of what I've come up with, that seems to work well for me, are that I will not accept a food if:
  • I don't have access to nutritional information
  • The carbohydrate count is over 20-30g
  • The item is almost pure sugar (sugared drinks, candies, etc.)
  • My blood sugar is already high
So far, these guidelines have been working well for me. I am able to assess a food at a glance most of the time and decide whether it's worth it. Sometimes, particularly when I'm eating dinner out, it is worth it and I will indulge in the pasta and take my chances with an evening of high blood sugar. But, more and more, I'm getting better at deciding quickly and easily what foods to eat and what foods not to. It doesn't always work, but overall my diet (and my blood sugar) are a lot healthier because of it.

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