Archive for the ‘Diabetes’ Category

THM Recipe: Chocolate Peanut Butter Muffins (S)

Dear Reader,

This is a new variant of my peanut butter muffin recipe. I think they’re scrumptious. They are also low-carb and gluten-free. If you are on the THM diet, they are an S.

Chocolate Peanut Butter Muffins (S):

Ingredients:

1/2 c flax seed meal

1/3 c coconut flour

1 c xylitol

1/2 tsp baking soda

4 tbsp. unsweetened cocoa powder

1/2 c peanut butter

1 c almond milk (or other milk of your choice)

1 tsp vanilla

2 eggs or 1/3 c egg whites

optional: 1/3 c chocolate chips (plan-approved if you are on THM!)

Directions:

Preheat oven to 350 and grease a muffin tin. Combine dry  ingredients. Add peanut butter, vanilla, milk and eggs. Stir well. If desired, stir in chocolate chips. Divide batter among greased muffin cups. Bake 30 minutes.

Makes 12 muffins.

 

Enjoy!

Nebby

Book Review: Sugar Surfing

Dear Reader,

This is a bit of a departure because I don’t blog very often about my daughter’s diabetes, but I wanted to give a book review of a book I read recently, Sugar Surfing by Dr. Stephen W. Ponder.

A little background info so you know where I am coming from: My now 13yo daughter was diagnosed with type 1 diabetes (T1D; aka juvenile diabetes or insulin dependent diabetes) almost 12 years ago at age 19 months. I think we are fairly diligent D-parents though I don’t claim to be an expert by any means (and nothing I say here should be taken as medical advice). My dd was on multiple daily injections (MDI) of NPH, humalog, and ultralente for the first nine months after diagnosis, then pumped using the Cozmo (RIP Cozmo) insulin pump for 5 years and then when back to MDI (Levemir and Novolog currently) by her own choice for the last 6 years or so. She has been using the Dexcom Continuous Glucose Monitor (CGM) for about 18 months now.

Dr. Ponder is an endocrinologist specializing in diabetes care and has had T1D himself for quite a number of years. The main thrust of his book is to discuss how one can best manage blood glucose (bg) levels of a person with T1D using the relatively new technology of CGMs. As such it fills a much needed gap in the literature out there on dealing with T1D.

My overall recommendation is that anyone with T1D or helping to care for someone with T1D should get this book and read it. I would particularly recommend it to those new to T1D and those who may have more experience but who are using CGMs. I do, however, have some hesitations about the book which I will get to.

Sugar Surfing is written in a conversational style and begins by discussing the author’s own experiences with T1D, having been diagnosed in the days before fast acting insulins, pumps, and even home bg testing. I love these sorts of stories so I found these bits rather interesting. One intriguing tidbit arising from this part of the book is that Dr. Ponder, while clearly knowing well that diabetes care has advanced leagues beyond how it was in his youth, seems nostalgic for those earlier days. In particular, he mentions how much less stress was involved in caring for diabetes way back when because one couldn’t know or even attempt to control all the many numbers involved. I kind of get this and I think it’s an interesting observation. It could be good to think more about how the pressure on those with T1D and those caring for them (particularly parents) may have increased with the advances in care without perhaps the same degree of increase in the support and understanding these people need.

Which brings me to what I think is the biggest contribution of this book — Dr. Ponder does a wonderful job of laying out all the factors that can influence bg and of showing how very uncontrollable it can be. My own experience was that when my very small daughter was sent home from the hospital we were told “do this and this and then her bgs will be this and that.” And then we got home and she was in the 300s for the first few weeks and we thought we were complete failures. I understand why the staff wanted to make it sound simple for us, that they didn’t want us to be overwhelmed at the start. But we were also misled in many ways and the result was confusion and a sense of failure. I think this is not an uncommon experience. I really wish I had had Ponder’s book much sooner. Though over the years, I have learned how very uncontrollable T1D can be on my own, I would definitely recommend reading the earlier chapters on all the influences on bg one has to try to cope with to anyone new to the world of T1D. It may be daunting, but it is realistic and that, I think, is a very good thing.

One of the quibble I have with Dr. Ponder, however, is in how he talks about our ability to control all those numbers. I find he is a bit inconsistent of this point. On one hand, he outlines all the influences on bg, many of which we clearly cannot control (eg. growth hormones, stress); on the other, he makes statements like this:

“In fact, almost any of the ever present forces that influence one’s blood sugar level can be managed with Sugar Surfing principles.” (p. 44)

“Control” is a big word in the diabetes world. We speak of “controlling bgs” after all and doctors (and nosy family members)  ask us things like “how is your control?” The comforting part for me in the first part of this book is how Ponder makes me feel like there is so much I can’t control. But then he turns it around and really makes it about controlling again after all.

(Warning: if you don’t like religious talk, skip this bit.) One of the things I say on this blog is that our worldviews (though I hate that term) are important; they affect everything we do and even in a book on something as seemingly practical as bg control, they seep through.  A big part of what I have learned from my dd’s T1D is that I cannot control everything — not even these things that are very essential to keeping my child alive. It is not that I say “Oh, I can’t control it therefore I am not going to try.” I do not use the fact that these things are so hard (or even impossible) to control as an excuse for bad bgs.  Instead, I do everything I can and leave the rest to God. Because He can and does control everything. My take on this book would be that Dr. Ponder has looked at these same factors which make bg so hard to control and he comes away still trying to control them. How does he do this? Well, on one hand he has certain principles and tricks he uses (which he gets to in the latter half of the book). But he also relies on himself:

“Ultimately, you must believe in yourself and your equipment. Tapping into your “Power Within” is a driving motivational force behind Sugar Surfing.” (p. 114)

If there is any statement in this book I disagree with, it is this one. It all comes down to who is ultimately in charge. In my view, it is God who ultimately causes my best efforts to either succeed or fail. In Ponder’s, despite how long he spends telling us how very much in T1D is uncontrollable, he is still in control. One more little quote before I move on — Dr. Ponder says at one point that “I no longer fear [diabetes] like I did in my younger days” (p. 47). I think this is a very telling statement. One gets the impression that it is this (quite understandable) fear that has driven him to be where he is today. All of which is to say that while there ia a lot to recommend in this book, I have some fundamental problems with the worldview that underlies it.

Now, to stop psychoanalyzing strangers and return to the main point — in the latter part of the book Dr. Ponder gets to specifics of how he manages his T1D. In general, I wish the tips and tricks he uses were laid out a little more clearly. I do like his use of his own CGM readouts; the visuals are very helpful. Personally, there were only  a few specific things in this book that I found new. Others I had either encountered on the internet previously (eg. the idea of waiting for the bend to begin eating) or somehow managed to stumble upon myself (Ponder’s i-chain method of bolusing for high fat meals is much like what I was doing anyway). More than specific methods, however, I was inspired to be more diligent in addressing bg numbers when they begin to stray from our target zone rather than waiting till they actually cross those lines.

A few more notes on the practical details in this book:

  • Ponder says that his methods work for both pumpers and those on MDI. As someone who uses MDI I really appreciated this. It feels like there is a lot for pumpers out there. On the flip side, there were times when he presents techniques that work for pumpers but left me still frustrated looking for a way to do the same things with MDI (of course if I could get my dd to pump again, that wouldn’t be a problem).
  • As the parent of a teenage girl, I was left wanting more info on dealing with the effects of hormones on bg. Of course, Ponder is giving us info based on his own experience and he has never been a teenage girl so the oversight is understandable. Still one must not expect to find answers to every question in this book.
  • Ponder spends a chapter on dealing with kids with T1D the main point of which is to say that his techniques can’t all be applied to children. I could easily see how this book might provide more frustration than help for parents whose kids due to their age or compliance are not going to be able to make use of most of the techniques herein.
  • Discussing the issue of kids and compliance, Ponder says that “for some reason which I don’t understand” teens who don’t comply “are still allowed to wear an insulin pump” (p. 116). I completely disagree with the idea that insulin pumps are somehow a reward for good diabetes behavior or that bg control and/or compliance will somehow be improved by taking away a kid’s pump.
  • Ponders’ advice on calibrating your CGM, specifically saying to only calibrate in the middle of one’s bg range, is contrary to other advice I have heard.

To draw things to a conclusion, while I would definitely recommend Sugar Surfing and think it fills a great need in the diabetes community, both with its portrayal of the realistic challenges of managing T1D and with the specific methods it presents, one should not expect that this book will answer all questions or solve all the problems associated with T1D nor can I agree with Dr. Ponder’s fundamental assumptions about how much control we are able to have.

Nebby

 

Trim Healthy Mama: Practical Details

Dear Reader,

I posted recently on the theology behind the Trim Healthy Mama diet; now I want to talk about more practical details.

How Easy is it to Get Started?

For me, there are parts of this diet that are not hard to implement because I already had so many of the products they recommend on hand. With one child off gluten, dairy, and soy and another with type 1 diabetes, I already had in my pantry: almond meal, Dreamfields low carb pasta, almond milk, coconut oil, coconut flour, low carb tortillas, xantham gum, (GF) rolled oats, and probably more things I am forgetting.

Even with all these things, however, I still found I had to consider whether to buy some of the other foods and ingredients they recommend or use in their recipes. Some are easy to get, like egg whites in a carton for their low-fat (E) recipes. Some require special ordering, like gluccomanan powder which is essential to make their puddings.

Now they do say you can do the diet without any special ingredients. And the theory behind it (don’t eat fat and carbs together) is pretty simple so I can see that would be true. But at the same time, their suggested meals and their recipes require a lot of these things. So I think that if you are trying to just pick up the book and go, it is tough to do so without buying all this special stuff. Personally, I have looked at a number of recipes in the book which sounded delicious only to say “well, I don’t have that ingredient so I guess that’s a no-go for now.”

The Recipes and Restricted Diets

I have tried a couple of the recipes, some with success (basic cheesecake; yum!), some without (cookie bowl oatmeal; just a gelatinous mush with still hard oats for me). As others have said in reviews I read, I wish they would just give the recipes in a normal format. They give them in a narrative style, adding heir own comments and tweaks which are nice to read but it would help if they just started with the recipe and then added those things later. My own feeling having certain food restrictions in the family is that it is easy to do this diet gluten-free, but it is hard to do it dairy-free. A lot of their recipes involve dairy. I am also off chocolate because it gives me headaches, and I find it very hard to do it chocolate free too. All their desserts and treats, and even some breakfast, which sound really yummy contain chocolate. When I leave out the chocolate, everything ends up peanut butter flavored. And I like peanut butter but I don’t need everything to be that way. (Now back when I could eat chocolate, I would have been happy to have everything I ate taste like it, but those days are gone for me.) Soy-free, by the way, is super easy because THM is anti-soy.

So for me at this point, I would say the implementation of this diet has been a little hard. I had a house guest for a whole which made it tough to go out, buy special things, and think about organizing my meals differently. And I realized that a lot of our favorite dishes are not THM friendly, meaning they include things like brown sugar and potatoes or they combine carbs and fat. And though I have read reviews which say the contrary, I did not think the book was very helpful in telling me how to tweak recipes I already use.

What Can’t I Eat?

Another claim THM makes is that it is about what you eat when, but does not eliminate foods. This is not really true. Here are some of the things that are, if not totally eliminated, at least minimized or discouraged:

1. Some oils– they use butter, olive oil, and coconut oil, all of which I already had so that’s not too big  a deal to me. But no vegetable oil, canola oil, etc.

2. No white or wheat breads (or cakes or cookies, etc). They do allow sourdough bread and rye bread as these are low on the glycemic index. They also allow sprouted grain breads like Ezekiel bread.

3. No blood-sugar raising sweeteners. This includes refined sugars but also honey and agave nectar and maple syrup. They allow stevia, xylitol, and truvia.

4. No potatoes. This is huge around here. Potatoes have been a staple of our gluten-free diet. And I know sometimes I can substitute sweet potatoes which I don’t mind, but the kids will only stand for so much of that.

5. No corn. Not too big a problem but we did eat tortilla chips, corn bread and taco shells.

6. No bananas. This is fine with me as they give me headaches any way. But others seem to be quite put out by this one. Other tropical fruits like watermelon and mango are also limited.

Do I have to limit calories or count things?

Which brings me to another point. These tropical fruits are limited because they are high on the glycemic index, meaning they raise blood sugar fast. As a  parent of a child with type 1 diabetes, carbs, blood sugar and the like are not new territory for me. But the whole philosophy behind this diet is that blood sugar should be kept as stable as possible and I wonder if this is really necessary for those who do not have diabetes and are not at particular risk for it. Some variation in blood sugar is natural.

I wonder also how they are figuring the effect of certain carbs on blood sugar. For instance, carrots are banned from their S (fat) meals. This is no doubt because they have a high glycemic index, meaning they raise blood sugar fast. But because one must eat so many of them to raise blood sugar, they actually have a low glycemic load which is a more accurate measure of how they will affect blood sugar. Combining foods also affects glycemic load. I suspect they know this and that this is behind their assertion that protein should accompany all meals. Both protein and fat slow down the absorption of carbs and therefore the rise in blood sugar. So even a really fast acting food like watermelon, if my daughter eats it after a fatty meal like pizza, will not cause her blood sugar quickly. A child with type 1 is like a little test tube for experimenting with these things. We can see how bad foods are for all of us by how they affect her body which has no insulin response of its own left. And fatty foods, any restaurant foods really, will still be with her up to 8 hours later. So I am a little wary that one could say they are doing the THM diet but end up eating a lot of fatty foods that are stressing out the body’s insulin responses quite a bit.

Which brings me to what I think is my last point, that this diet is not just “eat this way and you can eat as much as you like.” It is mean tot not keep you hungry which is good, but it is not a license to indulge either. They say that if your weight loss is stalled you need to do things like look and make sure you are not overeating on things like nuts which while healthy are also fatty and high calorie. So while they are not having you count calories, it is not like you get off scott-free and never have to worry about them either. On carbs they are even stricter. Again they wouldn’t have you count, but an E meal which is the most carb-laden kind is not supposed to top 45 grams of carbs. That is a cup of regular pasta or two pieces of bread. There are some in-between kinds of meal like an S-helper (a basically fatty meal but with a bit extra carbs) which is supposed to contain no more than 15 grams of carbs.

All in all, I guess I am a little wary of the philosophy behind all this. It seems strange that we must be taught how to do something as basic as eat. Yet, I also know that Americans seem to be failing at it so I suppose we do. basically, where I come down is, I am not entirely convinced, but I would like to see if it works.

Nebby

Fun with Diabetes

Dear Reader,

So this month’s Diabetes Blog Carnival is on laughing at the disease. We do try to make some fun out of this not fun situation. My daughter’s 8 year anniversary of her diagnosis is coming up in October. I don’t know what we will do this year, but usually we try to mark the occasion in some way. Once I made a cake in the shape of her pump. The first couple of years that anniversary depressed me. Now I see it more as a celebration of her life. October 26, 2003, was the day we didn’t lose her. And after another year, we still haven’t. That’s good news.

But back to the humor, one way we try to make D fun is just to guess the numbers. Especially after bedtime when she calls from upstairs, “I feel low. Can you check me?”

I will call her to “come on down.” Which of course reminds me of the Price is Right. So we will play “the Blood Sugar Number is Right.” Closest guess without going over wins. The prize . . .  you guessed it . .  . usually glucose tabs.

Nebby

September Elevenths

Dear Reader,

It seems that it is time to be reflective, now ten years after the events of 9/11/01.

For me September 11th was a national event. That is, as an American I was shocked and outraged and grieved. But it was not personal because I did not know, even tangentially, anyone involved.

But more than that, I think September 11th is representative. It symbolizes all those events that rock our lives. It is about loss–of life and loved ones and health and security and peace of mind. But more than that it is about vulnerability. It is the moment we realize that life is not safe. That what we love most can be taken from us and that our own lives and those of our loved ones are in jeopardy.

For many people 9/11/01 was both a  national and a personal tragedy. For me, it was a national event. But my own personal 9/11 was 10/26/03. This was the day my then 1-year-old daughter was diagnosed with type 1 diabetes. It was the day I personally faced loss (of security and of my child’s health) and faced greater potential loss (of her life). It was the day when we began to really feel vulnerable. Of course, just as with the real 9/11, we did not become vulnerable that day. It is only the day we realized our vulnerabilities.

I cried on 9/11/01, though I didn’t know anyone involved. I am not particularly feeling teary as I think about it now.

But the other day at a homeschool gathering, I was asked what the symptoms of type 1 are. And as I replied, I found myself choking up, thinking of how my little girl just lay in ym arms on the way into the ER. And it surprised me. I thought I was just having a conversation. And I love to let more people know about this disease. But it all came back to me in a  rush.

And that is how it is with our 9/11s. They never leave us. They change something inside us. For many of us, our 9/11s will be very private. They will not be noticed or cared about by many people. But they change who we are inside. Which is not always a bad thing. But that’s another story.

Nebby

This Makes Diabetes Seem Easy

Dear Reader,

My nine-year-old who has type 1 diabetes is participating in a research study. She will wear a continuous glucose monitor (CGMS) for three days at a  time every 3 months for the next 18 months. She had her first bout with it about a week or so ago. The monitor itself was no problem. She wore it for the 3 days with little complaining. It is the “blind” kind so we cannot see the results while she is wearing it, but they are supposed to send us copies (still waiting on that).

The hard part is that for the 3 days she and I both are supposed to write down everything we eat in detail. That means listing every ingredient and giving some sort of measurement of how much we ate of each–how many ounces, grams, cups etc. This is harder than it sounds! We do tend to eat a lot of homemade things and honestly, this study, while it is aimed at improving nutrition in kids with type 1, discourages that. Those who run the study can look up nutrition info if I say “1 McDonald’s hamburger.” But if I say “one cup of homemade pasta sauce”, it is harder. I did give them recipes for some things I made. But some things, like my pasta sauce, I made weeks ago and froze. I have no idea what in it. And with that and other things it is hard to say what fraction of the recipe we ate.

Honestly, I haven’t been this overwhelmed since we began diabetes and had to first learn to count carbs and dose insulin based on it. The pump start was a little bit of  a transition too (as was quitting the pump and going back to injections), but I think this is tougher than either of those. Fortunately, it is only for  a limited amount of time.

Nebby

Eastern Medicine, Western Medicine, and Christianity

Dear Reader,

We took my son to an acupuncturist for the first time today. He has had a headache for 9 months. And I mean “a” headache. It does not go away. It rarely changes. If you graphed it, it would be a straight horizontal line.

The acupuncturist was talking about Chinese medicine a lot (not surprisingly), and I was thinking, “I am not sure if I have faith in eastern medicine.” But then it occurred to me, “You know what, I don;t have faith in western medicine anymore either at this point.” My son has been to two neurologists. He has been on 4 different prescription medicines. His current doctor has him on 12 pills a day. He is 10 years old (11 this weekend). No one should take more pills than their age. And none of it has helped. In their defense though, I will say that the current neurologist is the one who suggested acupuncture among other things.

Now there is a lot about western medicine for which I am grateful. My daughter has type 1 diabetes. Without insulin injections she would die in a matter of days. A hundred years ago, she would have died. The story of the discovery of insulin is one of the most dramatic and heart-rending in medicine. Children were wasting away, slowly starving to death as their parents watched. And then they were given their first shot of insulin, taken from dogs and not necessarily very pure, and they perked right up. It’s a great story. Read it sometime (DLife used to have it online.) And there are other big victories in western medicine–vaccines that have caused whole diseases to become virtually non-existent come to mind.

But for all that, there is still a lot our doctors don’t understand and can’t cure or even treat very well.

Some of the things I liked about our acupuncturist today were:

-She cared about all my son’s symptoms. He was there for headaches but she also cared about his allergies and other things. Other doctors I have tried to talk to about other issues and they don;t seem to listen.

-She cared what symptoms other family members have. Again, doctors never seem to listen to me when I talk about all the things going on in our house. But it seems to me they are all connected somehow.

-She said “I am a detective and I am going to figure this out.” She approached our situation as a problem–not assuming she already had all the answers. But she also expressed confidence and interest in solving that problem. As opposed to just throwing one strong prescription drug after another at it.

-She said, “I can handle this.” I don’t know if it’s true yet. I hope and pray it is. But I liked her attitude so much better than the doctors who label the disease quickly (and the two neurologists called it different things) and then just throw pills at us in the hopes something will work.

I don’t understand how acupuncture works. I went in with a lot of skepticism. I still have  a fair amount. There is some knee-jerk reaction in me that says “Chinese medicine = un-Christian =wrong.” But I am questioning where I got that. Yes, Chinese culture is not Christian. But a lot of western culture isn’t either. In particular, western science tends to be anti-Christian. So why do I expect more truth from the west than the east? I do believe there is some truth is all cultures. And that God can reveal truth even to those who don’t know Him.

I really hope this is the answer for us. After one treatment, my son reported his headache being a shade less. Which is not much but is more than he has had from other things. I hope it is not just a placebo effect. But we will see. I am willing to give it a try at least.

If you are a Christian who has had acupuncture, I would love to hear your experiences.

Nebby

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