Warring words

http://xkcd.com/386/

I'm not usually one to shy away from a bit of a bust up on the internet, it has to be said.  In fact, T reckons the guy in the cartoon is actually me.*  The reason I mention this is that it is becoming apparent to me that the internet is not always the warm and supportive place it initially appeared to me to be with regard to diabetes.  I have seen one website that is almost rabid in its support of low-carbing as the only dietary approach that is helpful for those living with diabetes, and summary dismissal of those who question that.

Low-carb is working for T right now, but that is as far as either of us would go in supporting it without evidence.




*Can't be - too skinny.

Business and food

There is a lot going on at the moment; I am coming to the end of my employment with my current employer, and waiting to have my start date confirmed with the employer that I am moving to. Hopefully the criminal background check will pan out...

We need to buy another car, we need to do quite a lot of DIY around the house, and we need to try to find better ways of keeping on top of the housework when I go back to 5 days a week in the office. Also, I need to get on top of my studies because my new employers will Not Be Impressed if I let them slide.

Starting from today, I am going to pay more attention to how I'm spending my time. And if I manage to get better at not collapsing in front of the TV and T doesn't, there will be words had.

T's diagnosis continues to throw us into chaos planning and cooking-wise, and B has been eating more pre-packed baby meals than I would like him to. Happily for him at least, he seems to prefer them to my cooking - wise beyond his years, some might say!  It is just so difficult to get home with him at just gone 5pm and find something to give him that is homemade - especially when there is a very high probablility that he will simply refuse it.

Perhaps I should designate one evening a week as 'Cooking Evening'. The features of this being T and I having something simple for dinner (cooked by T), the cooking of big batches of three meals for B, the consumption of wine, and T and I clearing up together.

If I make the meals fairly saucy, then they should freeze well in ice cube trays, and I can just cook pasta / potatoes / rice for him on the day. Or I could do two meals and two carbohydrates and freeze four batches; creamy fish with potatoes / rice, and fruity chicken with potatoes / rice, perhaps.  B definitely likes risotto - especially if it contains white wine and shallots. That means I might have to give up half a glass of wine, and B would be in trouble if he then didn't eat it!  Then all I will need to do is to get better at nuking food from the freezer rather than the cupboard.

Need: more recipes for toddler & freezer friendly meals, large pans, more ice cube trays, larger freezer bags / boxes, a bit of gratitude from the toddler (ha ha).

There are honestly not enough hours in the day. If I start my new job at 7:30am, and finish at 4:30pm, I will need to get up at about 6:00am each morning - so I won't be able to get to bed too late at night. It will need some adjusting to but hey, I'll get there.

Broken?

I am beginning to get my head around the notion that DB is not a disease that can be controlled just by thinking about it. And neither can it necessarily be controlled just through diet and exercise.

T manages to keep his blood glucose level below 10 mmol most of the time - last night he was hungry and wanted to eat.  His blood glucose level was 9, and he knows that if he eats a sandwich, it will still be elevated further than that a couple of hours after the food. So I cooked a stir-fry of mushrooms, prawns, fine green beans, mange tout, half a pepper, half an onion, courgette, some umami paste, and some ground ginger and chilli.  Two hours later, his glucose level was the same - which is great, but is this really what he needs to do if he's hungry but has high blood glucose?

I am sure there are easier meals to prepare than all the washing and chopping that went into the stir-fry, but it's going to take a while to find out what they are, and all the while I am half believing that it's futile anyway.

Seriously, if someone's diabetes is so bad that even a little bit of carb sends their glucose through the roof then what? Medication, obviously. And I suppose Arataeus's chilling description of the course of the disease is what would happen otherwise.


I think I'm rambling. There is a lot to take in, a lot to do, and the idea that it may ultimately make no difference with regard to whether T has to take medication is horrid.

He's trying a very low-carb day today to see what happens to his blood glucose. He had scrambled eggs and ham for breakfast, and will have chicken and fruit for lunch. Dinner? Who knows. Pork loin with roasted vegetables probably.

Still coming to terms

I think I'll be unable to view this as normal for some time yet. We visited T's brother and sister-in-law this afternoon and had a meal at their house. It was the first time we had seen them since T's diagnosis, and we found ourselves explaining that carbs in general and not just sugar are a problem for T. T's brother waxed lyrical about how much he loves roast dinners and I said that potatoes, yorkshires, gravy, carrots, parsnips, and stuffing all contain carbs. Obviously it's not good to avoid them completely, but loading up on them is definitely out.

I think it's best explained as a rum and (diet) coke. If you put ice in it, that's fine so long as the ice doesn't all turn into water at once. You wouldn't really want to put straight water into it, and you wouldn't put too much ice in either because the more that goes in, the more diluted your drink becomes. If you switch the drink for your blood, water for sugar, and ice for carbs, then you have an explanation of glucose hitting your bloodstream fast in the case of the water / sugar, and more slowly in the case of the ice / carbs. Re the carbs - it may take more time for them to be converted to sugar, but converted they will definitely be.

We have found out that pizza does unholy things to T's blood glucose level (11.5 mmol after 2.5 hours). The bulgur wheat and mackerel salad that we had for lunch was fine though.

Hypocrisy

Because I am human, I am capable of great hypocrisy*.   Since T’s diagnosis, I have been reading a lot, and have started to look at food in a different way.

In the past, whilst  being aware that I need to lose weight, and trying to do so in a half-interested way, I have joyfully eaten my way through sweets, cakes, pizzas, pies, and oh my god, the carbs. Ah, once in a while won’t hurt. I’ll be better tomorrow – it’s kickstarting my metabolism in preparation. 

The publicity about the risks of obesity didn’t apply to me, or to mine.  As with all unpleasant things, they would happen to other people. Others who were stupid about it.  There was always time.  And now that it’s all horribly important and real, and happening to my family, I feel differently about it.

When we went to the cinema, it was as though the entire place was saturated with sugar. Fizzy drinks, chocolate, sweets, ice cream, sweet popcorn. People walk to the counter to pay through the nose for food and drink that is so bad for you it is practically toxic – and that was us a few short weeks ago.

I personally have no more need than anyone else to behave myself gastronomically speaking, other than to prevent what has happened to T from happening to me.  But now that I think about it, I see things differently.  And I judge – I can’t help it. Like I said, I’m human.

* (Though not of spelling the word – hypocrisy brought to you by Microsoft Word Spell-check.)

Good readings

T has been having good readings (by which I mean lower than 10 mmol).  He had a 2 hour post dinner* reading of 7.9 mmol and was worried that the monitor might be inaccurate and so tried with the same batch of strips using monitor #2**.

Monitor #2 read 7.1 mmol.  He has ordered some of the control solution to calibrate the monitors - don't know why they weren't supplied with some, but hey ho!

Even if the readings aren't accurate, I think there is a consistent downward trend in his readings since he started to monitor his blood glucose levels.

*Pork loin steak cooked with a little olive oil in a foil parcel, beans from the garden, carrots from Co-op, and boiled potatoes. And gravy that went out of date at about the time the B was born - what can I say? It's been a busy 17 months!

**First one was purchased to keep track of blood glucose when we went to Center Parcs, the second was given to T free by Lloyds chemists after he spent a while talking them into it.  Now he has a backup to use at work if he needs it. They are both Accu-Chek Aviva Nanos with Multiclix lancet devices (aka as 'the stabby things' in this house).

Mostly beiong normal

We think that portion size is probably going to be the hardest thing to change.

T: We're going to see Harry Potter tonight!
DBW: Awesome! Nachos?
T: Can I eat nachos?
DBW: Yes, if I eat most of them.

I tries to help, I really do...

Theories and questions

So I think a lot about things. All things - even things about which I know nothing or even worse, have only partial knowledge.  These are the things I have thought about that are DB related, and would like to know more.

1)  The Newcastle Study found that the very low calorie diet reversed T2DB, and it has been surmised that when the body has to utilise its fat reserves for energy, the fat in internal organs is used first.  This clears out the liver and pancreas and enables them to function better.
Question: Why then does the body not do this to itself when it uses up its fat reserves because it can't use blood glucose effectively?

2) There seems to be something called the Dawn Phenomenon whereby first thing in the morning, a person's BG levels can be high.  This is owing to the liver churning out glucose overnight to keep the body fuelled in the long time between dinner and breakfast.  Also, it has been suggested that people who don't get enough sleep have higher blood glucose levels.
Question: Could it be that people who get up early are testing themselves in the midst of the liver's glucosefest? Of course, I don't know whether there is a cycle for the liver's night-time activity, or if it just does what it does at a constant rate until food is introduced.

3) If a person has a strong family tendency toward DBT2, they will probably get it.  If a person is very overweight, ditto.
Question: Could it not be the case that excess body fat just brings it on prematurely if a person would probably develop it anyway?

4) T2DB is where a person's body has become resistant to the effects of Insulin.
Question: How does losing weight increase sensitivity to it? Is it something to do with hormones that are heightened when someone is carrying excess body fat? If so, are women more likely to develop T2DB than men? (I think there is a female hormone which has rising levels in obese people).

Hmmm.

Holiday

We had a really good time at Center Parcs despite the usual low level annoyances. From checking his blood regularly, T has noticed that exercise has a huge impact on his BG.

It's a bit worrying that he wakes up some mornings with a BG level that is above 11 mmol, and we don't know whether this means that he needs medication to stop his liver churning out glucose overnight, or whether it is something that he can change through diet and exercise too. He did see improvement in the numbers as the holiday went on and we cycled and swam more and more.

Now we have to figure out how on earth we can get exercise into our already 28 hour days...

Cycling to work is not an option because the roads around here aren't safe and we need to get B to and from childcare before and after work. One of us needs to take him, and the other needs to collect him and we cannot get him up any earlier in the mornings as it wouldn't be fair on him. B did love being ferried around in a bike pod though. Like a mini chariot.

Swimming in the evenings is out unless we go alone and take it in turns to feed B and get him to bed. But then we would miss seeing him. Waiting until he has gone to bed might be a possibility. Will have to talk T into it though as all he wants to do in the evening is vegetate on the sofa. It's not good.

Swimming and cycling are really the only things that I can think of. Jogging is both boring and a bit too high impact for both of us. Zumba is too high impact, and the gym is just essay too boring. Walking would be good on the evenings when we don't swim.

You know what I'd love? The opportunity to learn scuba diving. Not going to happen though.

Will look into swimming times, the cost of bikes, a pod, and bike rack, and work on my arguments.

Today's the day

When T took his BG first thing, it was already 11.0 mmol. He did eat a second helping of Spungarian chicken and a handful of nuts about an hour before he went to bed, but surely it shouldn't affect his BG that much? perhaps it's what they call the Dawn Phenomenon.

Anyway, today's the day we're off to Center Parcs for lots of cycling exercise and hopefully some relaxation too. Yippee! It think we deserve this break.

Spungarian Chicken - Recipe

Before lunch: 8.4 mmol
After this dinner 9.7 mmol

2 chicken breasts, sliced,
1 red onion, chopped,
1 courgette, chopped,
4 tomatoes, chopped,
1 can chopped tomatoes, opened,
2 man-sized handfuls of wholegrain rice,
1 clove garlic, pressed / finely chopped,
1 chicken stock cube,
spray oil,
Cinnamon,
Paprika

Spray a heavy bottomed saucepan with oil and sautée onion until it starts to soften.

Add garlic and chicken and cook until chicken is browned.

Stir in courgette and the tomatoes you have chopped, followed by the rice. Cook for a couple of minutes.

Add the tinned tomatoes, the stock cube, and some hot water to allow the rice to absorb the liquid for a while without burning to the pan!

Add cinnamon and paprika to taste (more paprika than cinnamon).

When simmering, cover and periodically stir; adding more water until the rice is cooked and the sauce is thick enough.

Serve with steamed vegetables and cutlery.

And then some days

I just don't know why I bother.

Blood glucose monitor

Although the DBN seemed to think that possession of such a thing may promote hysteria and paranoia, T (being a relatively level-headed,if rebellious sort) brought himself a blood glucose monitor, strips, and lancets.

The nurse had said that the NHS do not prescribe these for T2 diabetics on diet only control because the cost is prohibitively high. I think this is barking because surely if someone wants to attempt to control and manage their diabetes through diet and exercise then a) they will be more effectively able to do so if they have a good idea which foods affect their BG levels more then others and b) if they can do this, mustn't it save the NHS money in the long run?

Politics and economics aside, T thinks that regularly testing will enable him to work out patterns of spikes in the BG numbers and that even if he ends up on tablets when he has his next appointment in three months time, he can only benefit from what he learns about himself in this intervening period. I agree.

So, he got himself an Accu-chek Aviva with associated implements, and has taken his first reading and a half.* It read 8.7 mmol and was taken just before our very late lunch. Two and a half hours later he did it again and found that his BG level was at 10.4 mmol. So we know what a handful of wholegrain rice and half a bowl of homemade bolognaise sauce plus very little exercise does (we had been walking around town all afternoon, so we weren't up to much other than chasing round after B in the afternoon.

This evening, I have been shopping with mum for food to take to Center Parcs. It took ages, and I'm so unsure about what to get. I did my best - it's all I can do besides wait for this to become normal.




*The first attempt didn't yield enough of the red stuff.

Some fings wot i fort i new about DB, but actually didn't.

I'm one of those people who loves learning new things. Evidently this is a good trait when your spouse is living with DB.

I am also one of those people who is always discovering just how little in fact they do actually know.  I am still coming to terms with the revelation that Michael Crawford, the Phantom of the Opera is also the Michael Crawford who played Frank Spencer; I have just now re-checked this on Youtube but I still can't quite get my head round it.  As for thinking that tripe is a species of fish - that is another matter entirely.

Anyway, I digress.

A brief summary of a little of my un-knowledge regarding diabetes;
Hypos are caused by a type of diabetes where too much insulin is produced;
Diabetes means that you have to avoid sugar, honey, fructose etc (and only these things);
Carbohydrate reduction diets are a fad and only followed by people who are slightly unhinged;
The biggest risks of diabetes are hypos, amputations, and blindness - in that order;
Only really, really obese people develop type 2 diabetes;
Type 2 diabetes isn't that serious and is treated with tablets, much like a headache.

That reads like a grown up version of Things Kids Say. My black sense of humour is laughing darkly, whilst I'm silently begging forgiveness of the people whose illness I have badly misunderstood.

The scary thing is that I am not an unintelligent woman; I have a good degree from a good university, and work in an arena where information and accuracy are everything.  It worries me that as Jane Public, perhaps I am not alone in thinking such frankly loony thoughts.

Looking forward to our break

We're looking forward to going away for a few days, but in the absence of any monitoring equipment for T's BG, we're not really sure how much he can push it with his diet if we eat out a lot. Since he had really been trying hard before his fingerprick test and it still came up as 13.9 mmol, then I don't think he can really push it too far.

We will have a kitchen in the lodge, so we can cook a few of our meals to make sure it's not too bad. I don't think it's worth getting the urine stick things because he's likely to be over 10 mmol and we'd then know that he was, but have no idea how far over. We think that would be more of a worry than a help.

At least there will be plenty of exercise and relaxation, hopefully in an enjoyable ratio!

Perhaps I am shorter tempered than usual, but people have been driving me mad today. In fact, while I have been trying to type this post, T has been in and out of the lounge asking question after question after question. Sometimes I can't get through a single train of thought for such a long time because people just won't leave me alone. Perhaps it's me though - like when you're tired and read the same sentence over and over because you fall off it somewhere along the line.

This year I have graduated, returned to work after maternity leave, changed job function, gone through a redundancy process, searched for another job, interviewed, been offered a job, found out that my husband has a chronic, life changing disease. It's only July for the love of god, and I need a bit of a break.

Oh, it just occurred to me that...

I sounded like a bit of a control freak when I said that I would get a monitor for T! Just to clarify; he wants me to.

First appointment with Diabetic Nurse

She was lovely. Just the right mix of straight talking and compassion.

She explained to us the mechanics of diabetes, its symptoms and complications using a sketch that she drew as she went along.  T was told that type 2 diabetes is like a key that doesn't work properly to unlock the cells so that they can use glucose effectively; this may be simplistic, but it makes sense to us.

She went through the complications in a very matter of fact way (a particular highlight was 'and if some of the bits that float off in your blood vessels get lodged in the vessels in your brain, that's a stroke'), but she was going through them quickly as though she had to do it before telling T that they are hopefully avoidable.

We were told about; heart disease, stroke, blindness (DB is apparently the no.1 cause of blindness in the UK), kidney disease (ditto), amputation (ditto after war injuries - perhaps that's a worldwide stat?), nerve damage, and impotence.

In fact, I think that just about the only thing that she didn't mention is cancer, and T has already had that.

She weighed him (105 kg ish), measured him (in the red section of tape and needing to lose 4"), spiked him (13.9 mmol 2 hours after a banana), and seemed happyish that he wants to continue to try diet and exercise. He needs to get below 10 mmol, but as he is not on medication, our Health Trust won't prescribe testing strips and we will have to pay for them ourselves if he wants to use them.  She said that he can be tested again in three months time and to go back sooner if he becomes more symptomatic.  Urine testing would be cheaper and BG levels below 10 mmol wouldn't show up as glucose in urine, but they wouldn't be more accurate than that.  I think I will get some test strips and a monitor for him so we can figure out which foods he reacts better to than others.

We are being put forward for a couple of classes with DESMOND, so hopefully that will provide more information on nutrition; she also recommended a book for us to read if we are serious about nutrition.  I'll get it so we can have a look.  T needs to look at portion sizes; it's so hard when you feel hungry.

Emotionally, personally, I still can't quite believe it; I have those few seconds upon waking where everything is okay and than I remember.  It feels like it is going to go away, but we are being given literature that says otherwise. Scary stuff with pictures of holes in people's feet. I hate this and it hasn't even become real yet. And if I feel like this when I am not even living with the disease, how the hell do people feel who are?

I wish I could do more than read, listen, and try new recipes.

Second weekend

This weekend was a funny one.  Because we had a birthday to celebrate, the eating plan went out of the window a bit.  In the absense of any real guidance, we reckon that it's probably okay once in a while.

A carvery lunch and a Chinese food dinner was probably a bit much for anyone, but T is still alive and didn't see an immediate return of the symptoms that disappeared over the first couple of days of eating a better diet.

I was offered the job on Friday, so now comes the period of negotiating start date, salary etc which, whilst a bit stressful in itself, brings welcome relief from the impending joblessness that I faced otherwise.

Next week we are going to Center Parcs for a much deserved (in my opinion!) break from reality for a few days.  Obviously as T is bringing his pancreas with him, we will need to think carefully about the food that we eat.  When on holiday in the past, we always overindulged. Not so any more - but this is not a bad thing, and I am certain that my own body is already benefitting from my diet having changed along with T's.

First appointment to see the Diabetic Nurse (DN) this afternoon.  T has asked me to go with him for this initial appointment, and I am happy to incase I can be of any help with noting things down, or remembering questions.  Not sure what to expect, though I reckon she might have things to stab him with. Just a hunch.

Thankful for Friday

This morning, I had a job interview, so I was in a bit of a mad panic delivering B to my step-mum's for the day and getting myself ready.  Somehow it all worked out and we all ended up where we needed to be at about the right time.


T tried out his brand new insulated lunch box today (I know - we know how to party)!  It's a boxy black and grey thing of cloth, and apparently it worked very well to keep his ham salad wraps cool.  He also took (and ate) a clementine.  He also got a a bacon and onion granary roll from the snack wagon near his work.

Later this afternoon, I was offered the job that I interviewed for this morning. Wow. I am definitely going to accept!

For dinner we had spinach and ricotta stuffed fresh pasta, and I made a sauce (using mum's food processor, naturally) of shredded onion, chopped tomatoes from a carton, red pepper, a bit of water, and a bit of tomato purée.  We had a tiny bit of fake parmesan dried grated Italian cheese on top.  This pasta was something we already had in the fridge when T was diagnosed - I wouldn't have brought it since as it is white pasta and (worryworryworry) we don't know how bad that is for T, if it is at all.

Colleagues at my workplace have been more supporting than T's have! One of them has Type1 DB, and the other has Type2.  Both have offered to talk with T if he needs any help or advice, and both have already offered some hints and tips (e.g. don't eat cereal bars - they are packed full of sugar, there is a type of testing machine that hurts less (an Accu-Chek, I think he said), and generally not to worry too much about the future - it's early days yet and it will become far easier over time).  One of the colleagues kindly offered to drink T's alcohol and assume the risk of personal injury, just in case it was bad for T to drink it. A nice bunch - I shall miss them when I leave.

Now we are sitting on the sofa in our lounge and T is looking into getting himself a tablet PC whilst I blog on my slightly battered work laptop (it is 22:44, I can no longer see straight)!

Oh, one weird thing - T has needed glasses for a while now, but at the last check was only borderline for having to wear them for driving.  Since changing his diet he (pardon the pun) swears blind that his eyesight is improving and has even taken to driving without his glasses today. Is this even possible?  Please let there be a silver lining!

Mum's birthday tomorrow - we are going to try to go to a carvery for lunch and T is going to indulge.  If he indulges too much, I'll try to tempt him into some exercise - the shed needs painting anyway... (How much is too much? We have no idea.)