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Summary – January -March 2013

28 Mar

Whew, three months of 2013 have already flown by.

I started the year off with a new full-time job. It turned out to be more full-time than I had imagined. At the beginning, I would come home dead tired and still try to continue my usual household workload. I realised very quickly that that wouldn’t work and have since ‘outsourced’ various chores to my family members, to be specific, husband and daughter. That has been a bit of a relief but they can only do so much.

My new job has obviously lead not only to a change in how the household is managed but also to my eating habits. I used to cook low carb meals for lunch and eat leftovers for dinner, cooking a teenager-friendly meal for my daughter in the evening. Everything has gone topsy-turvy now. When I get home, I don’t have time to think about making elaborate meals. Dinner has to be quick and teenager-friendly (not spicy, exotic or meatless!). I only have time to go shopping on Saturday afternoons and when I get to the supermarket, many of the ingredients for meals I had planned to cook for the coming week would be gone! Lunch in the office means eating out at one of the few poor-quality cafes in the office neighborhood. Sigh!

To compensate for the increased carbs in my diet, I have had to inject more insulin. Somehow, the accumulated carbs in my body are leading to higher fasting blood glucose levels (110-140). I also started forgetting my basal insulin injections before going to bed cos I would be so tired, I just flopped into bed. The dismal readings really made me miserable. Sometimes I would over estimate the carbs, inject more insulin than required and end up with hypoglycemia. All in all, these sugar ups and downs are another major set-back for me.

So when I went to my docs for my quarterly blood test last week, I was expecting a huge jump in the figures putting me back into square one. I couldn’t believe it when the nursing assistant said Hb1Ac was 6.3, same as last quarter. This would mean that if I had continued my low carb diet, I would have had an even better reading! So I have managed to maintain the same reading while consuming more carbs by injecting more insulin. Not satisfactory for me but nevertheless, better than an increased Hb1Ac.

Well, I am not sure how to continue. I am now trying to cook meals during weekends to freeze and hope to find more easy low carb stuff to pack for lunch every day. I am not the ‘raw vegetable sticks’ type of person. Once thing is for sure – I’ve got to try my best to keep that Hb1Ac figure down!

But let me enjoy Easter first!!

HAPPY EASTER!

Chocoholics rejoice!

24 Mar

Chocolate pcs


Chocolate and diabetes ?- Does chocolate have a place in a diabetic’s food plan? Do you think you need to stop eating chocolate because you have diabetes? Or start eating diabetic chocolate because you still want to enjoy it?

Well, when I first started to seriously control my diet, I thought I had to stop enjoying chocolate (real chocolate, not the diabetic variety) otherwise my blood sugar would hit the roof – I used to eat tons of chocolate before I knew that I had diabetes. I would sometimes eat chocolate till I got sick!

Now, I know – not all chocolate is chocolate! People think milk chocolate is good because there is milk in it … but … it also contains a lot of sugar. White chocolate – forget it. It’s not chocolate. There is no cocoa in it! It’s the dark chocolate you have to go for. And if you believe the various studies which purport unproven health benefits due to the substantial antioxidant content in chocolate (hinders the formation of free radicals), then this is another reason to not restrain your urge to indulge in a piece of good quality chocolate. The emphasis here is on ‘good quality‘.

While scouring the supermarket shelves for low carbohydrate products to have as snacks, I noticed the difference in carbohydrate content between chocolate with varying amounts of cocoa. A lower carbohydrate figure points to a lower sugar content, a figure which may not always be shown on the label. My local supermarket carries a range of dark chocolate from a particular manufacturer with cocoa solids content ranging from 30% to 81%. So one day, I stood there and looked at all the fine print on the back of the packets and lo and behold, the chocolate bar with 81% cocoa solids had 22.8 gr carbohydrates in 100 gr chocolate. The whole bar weighs 125 gr and is already pre-portioned into 24 squares – that works out to  0.95 gr carbohydrates per square!

Lindt (Swiss) even sells dark chocolate with over 90% cocoa. I bought a pack once but I must admit, it was really tasteless. Between 80% – 85% cocoa is about right for me. The important thing is to still look at the nutritional information at the back. Each manufacturer produces its chocolate differently. We can only hope that the nutritional calculations are more or less accurate. You have to try the different brands available in your area before settling for something. While on a trip recently in Asia, I picked up a bar of Whittaker’s chocolate (manufactured in New Zealand) with 70% cocoa. It was pretty tasteless and I felt like I was eating something synthetic. It could have been the emulsifier in the chocolate which contributed to this texture. I have come across this same sensation when eating other brands of chocolate (even 85% cocoa ones!), so it is really important to try them out.

Despite my frequent (1-2 squares max a day but not every day of the week) consumption of dark chocolate, I am pleased to see that my blood sugar readings are still under control. 🙂

So don’t hold back – enjoy a piece of high cocoa content chocolate now and then without guilt! Make hot chocolate by putting two squares in a cup of hot milk. Drizzle melted chocolate over low carb berries. If you’re going to eat so little at a time, spend your money on good quality chocolate. Consume in moderation and you’ll still have your sugars under control!

And please, stay away from that diabetic crap!

Summary – October-December 2012

23 Dec

Well, the world did not come to an end, so I am now obliged to write this post …a summary of how I’ve coped with keeping my blood sugar in control from October to December and what I’ve been doing.

Happy to report that my Hb1Ac went down one point to 6.3. I was there before but it went up. 😦 So I’m glad that it went down to this level again.  I discovered something interesting last quarter. In my last summary, I reported that my Hb1Ac value was 6.4. This was measured by my endocrinologist. Four days later, I went to my GP and he did a blood test to check other stuff. I was told that my Hb1Ac was 6.8 and I got a bit of a shock. This time around, I questioned my endocrinologist about it and he said they use a different measuring method! So which is more accurate now? Well I’m going to believe the endocrinologist cos he is the diabetes specialist, and make myself happy. So beware, this may be happening to you too! Different testing methods result in different values!

Another good thing happened recently. I was having pain in my right elbow for a long time (about 2 years) and the doctors have diagnosed this as ‘golf elbow’. I got cortisone injections and went for acupuncture,physiotherapy and chiropractic adjustment but nothing helped. If anything, things got worse and then the pain started in my left arm too. After reading another of those health books, I started taking vitamin supplements – Vitamin E, Magnesium, Zink, Calcium, Vitamin D. Yikes, I’m turning into a hypochondriac! Just noticed the other day that I haven’t noticed the pain in my elbows for some time now. When I press the spot, it doesn’t hurt anymore! I’m sure it’s the vitamins but which one did the trick, I don’t know – although I think it’s the Vitamin E. So a tip if you are having problems which no one can pinpoint. In your next blood test, get your GP to check your vitamin levels. Funny, I’ve been to so many doctors and no doctor even thought about checking this.

I haven’t been experimenting much with new recipes lately cos I’m quite happy with the way things are. I’ve got my staples and work around them. What I did was to buy two low carb bread mixes from a German online shop to see if they were better than mine. I don’t want to mention which products I tried (anyway, I think if you don’t live in Germany you probably won’t come across them). They were a lot worse than my low carb sunflower bread :). The first loaf I baked was ok in texture  – a little less rubbery than mine but it lost out on taste. The second one was like eating rubber. My husband refuses to eat anything so I’m slowly eating my way through the two loaves. Still contemplating dumping the rest in the bin.

To sum up my year, I can say that it has generally been a good year for me – glucose-control wise.  Doctors are happy so I’m happy.

On this note, I’d like to end off today and wish everyone a very Merry Christmas and a Happy New Year!

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Legumes, pulses, beans or lentils – aren’t they all carbs?

9 Mar

Beans, beans, beans – I’m suddenly full of beans! No, I hope I’m not going crazy. Why then, the sudden interest?

It all started last week when I found a cake recipe containing white beans. Curious, I started surfing for more recipes and found that there are cake recipes using all kinds of beans.  Cooking with beans is nothing new to me. Prior to this, I had been using beans in my cooking – chili con carne, chili sin carne, cassoulet, feijoada, gallo pinto, red bean soup, to name a few – but soemtimes, I found that my blood sugar readings were high after the meal. I rationalized that this was because beans are high in carbohydrates and if a dish is made up primarily of one ingredient, it goes without saying that you would be eating a lot of that particular ingredient in one serving. So except for soya bean-based products (soya beans are funnily, low in carbohydrates but high in fat), I have been avoiding bean dishes. You’ll later see that I was too quick in throwing beans out of my diet.

Baking with beans is however, something new to me. After seeing the nutritional information for one muffin made with white beans on the Healthy Indulgences Blogspot, I was intrigued and decided to try one of the recipes. I now realise that if you bake a cake, you only eat a slice or a muffin and since your intake  is much less, there are less carbohydrates to convert to glucose and hence, the better post-priandal glucose values. I’ve tested this out and am very happy with the results! Yay, I can eat beans again.

So let’s take a closer look at the BEAN.

Beans fall into the class of vegetables called Legumes or Pulses. Legumes have been part of the human diet for a long time. Evidence that these have been eaten as early as 5000 years ago have been found in settlements in many parts of the world. Today, legumes still form a part of our diet, enjoyed by both vegetarians and non-vegetarians.

There are over 1000 types of legumes out there. Dried legumes are broken down into three categories – beans, peas and lentils.  Beans are favoured in western cooking – white canellini beans, red kidney beans, garbanzo beans (chickpeas), black beans and pinto beans. The Chinese use soya beans a lot and turn them into all sorts of delicacies and products ranging from silken bean curd, soya bean curd dessert, soya bean milk, fermented bean paste, tofu and so on. Indians cook up some great dishes with lentils, called dhal in Indian. Have you heard of moong dhal, chana dhal, urad dhal or tuvar dhal used to make vadas, sambhars and likes.

Legumes are low in calories, low in fat, contain no cholesterol, low in sodium, high in complex carbohydrates and provide our body with protein and dietary fibre.  The dietary fibre contained in beans is released into the bloodstream slowly and keeps you feeling full for a longer period of time.The Idaho Bean Commission website says that “about 75% of the fiber is insoluble which may reduce the risk of colon cancer. The remaining 25% of the fiber is soluble fiber which may reduce blood cholesterol. Studies have confirmed that beans are effective hypochoesterolemic agents when added to the diet. Consumption of beans produces a moderate increase in blood glucose and insulin levels which may be helpful in the metabolic control of diabetes. … The slower release of glucose and the increased satiety from beans may also enhance the effectiveness of weight-reducing diets.”

Let’s go back to the carbohydrates mentioned above – the complex carbohydrates. The main goal of any diabetic is to try not to increase blood sugar too much.That is why we try to avoid eating foods containing sugars and carbohydrates and are following a low carb diet. I’ve recently learnt that there are good and bad carbohydrates. The good carbohydrates are digested more slowly, causing blood sugar to increase slowly over a longer period of time. These foods have a lower  glycemic index. Good carbohydrates are complex carbohydrates, also called starchy foods. This carbohydrate is called complex because it is made up of chains of three or more single sugar molecules linked together. The bad carbohydrates are the simple carbohydrates containing singular sugar molecules and these are found in sugar, white bread, sodas and sweets. I can testify to that – when I eat white bread, rice or stuff loaded with sugar, these foods cause spikes in my blood sugar and are really difficult for me to control with insulin. So contrary to popular belief, not all carbohydrates are bad! Well, the complex carbohydrates still aren’t good in large amounts but if you are going to eat carbohydrates, then choose those of the complex carbohydrate variety, like beans and try not to eat too much at one go.

And now back to the beans – besides all the positive points mentioned above, there are a host more. Let’s not forget the vitamins and minerals they contain, among them folacin (also known as folate or folic acid), thiamin, some B vitamins, iron, phosphorous, magnesium, manganese, potassium, copper, calcium, and zinc! Wow!

This may sound too good to be true but wait a minute, you say – beans cause flatulence and I can’t have that. Yes, beans do cause flatulence. Beans contain a type of sugar molecule called oligosacchiride. Our bodies lack the enzyme to break down oligosaccharides. These unbrokendown oligosaccharides are digested by bacteria in the large intestine causing gases to develop.  There’s a way around that though.  Rinse your canned beans thoroughly before using. Do not use the liquid it comes in. Better still,  start from scratch with dried beans, soak them overnight in water with about 1/2 tsp baking soda (sodium bicarbonate). In the morning, throw away the water and rinse thoroughly before cooking. Adding baking soda to the water helps to relieve ‘gastrointestinal problems’.

Here is a link to a chart which gives the nutritional values of several types of beans.

Jack and the Beanstalk was one of my favourite fairy tales as a child. I also read it often to my daughter. In the story, Jack traded his mother’s cow for some magic beans and got a big scolding for his stupidity. In the end, those beans really turned out to be magic and brought wealth to him and his mother. I do love fairy tales as there is always a happy ending. Well, it looks like beans can also contribute to a happy nutritional plan for diabetics and low-carbers and bring us a wealth of health so don’t cut them out completely!

Reference Sources:
http://en.wikipedia.org/wiki/Bean
http://www.treehugger.com/files/2009/01/beans-without-flatulence.php
http://www2.state.id.us/bean/nutrition/value.htm
http://www.beanslentils.com/about_b&l.htm
http://www.dietbites.com/Diet-2/beans-calories-nutrition-info.html
http://www.brighthub.com/health/diet-nutrition/articles/42071.aspx

A1c, HbA1c, A1C, or Hb1c

13 May

What do all of the above have in common?

Everything! They are the same thing called differently. People who have diabetes know exactly what their A1c value means for them, people without diabetes, less. However, this is an important figure that everyone in today’s society should at least find out some time or other, better sooner than later. It may tell you a lot more than you expected.

Hb1Ac (as the Germans call it) is glycated hemoglobin. Wikepedia explains it as:

a form of hemoglobin used primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic pathway by hemoglobin’s normal exposure to high plasma levels of glucose. Glycation of hemoglobin has been associated with cardiovascular disease, nephropathy and retinopathy in diabetes mellitus. Monitoring the HbA1c in diabetic patients may improve treatment.

In the normal 120-day life span of the red blood cell, glucose molecules react with hemoglobin, forming glycated hemoglobin. In individuals with poorly controlled diabetes, the quantities of these glycated hemoglobins are much higher than in healthy people.

Once a hemoglobin molecule is glycated, it remains that way. A buildup of glycated hemoglobin within the red cell therefore reflects the average level of glucose to which the cell has been exposed during its life cycle. Measuring glycated hemoglobin assesses the effectiveness of therapy by monitoring long-term serum glucose regulation. The HbA1c level is proportional to average blood glucose concentration over the previous four weeks to three months. Some researchers state that the major proportion of its value is related to a rather shorter period of two to four weeks.

So long-winded explanation aside, that means that the value of your Hb1Ac will tell you whether you have had too much glucose (=sugar) in your blood or not over a period of time.

Someone without diabetes will probably have a Hb1Ac of somewhere around 5.0 (according to the articles I’ve read, this could be anywhere between 4.0 and 5.9).  Diabetics will have a higher Hb1Ac because their bodies aren’t producing enough insulin to carry the glucose out of the blood. However, with the help of medication and a sensible healthy diet or if you have borderline diabetes, just a sensible diet, one should try to strive for a good Hb1Ac reading. And what is a good reading?

Dr Richard K. Bernstein in his book, Diabetes Solution, believes that even those inflicted with diabetes are entitled to Hb1Acs of normal people. He is a Type 1 diabetic and has succeeded in bringing down his Hb1Ac to below 5 and has kept it that way. My doctor does not agree with this.

Many diabetes associations, including those in Germany, believe that those inflicted with diabetes are not able to and should not try to achieve Hb1Acs of normal people. To ensure that diabetes patients do not suffer the medical complications mentioned in the Wikipedia quote above, they advocate a Hb1Ac of under 7! At this level, you are considered quite safe from the above mentioned diseases. If you have your diabetes well under control then you would be in the 6 – 6.5 range. What about a lower value? An article on the Islets of Hope website explains: ‘The risk of loss of consciousness, insulin shock, seizure, coma, and death from hypoglycemia for a person with diabetes increases significantly when an HbA1c falls below 5.0.’  Ok, so by reasoning, if you want to and can get it to above 5, you should still be ok.

But wait, things get a little more complicated. In Blood Sugar 101, Janet Ruhl cites a study which found that Hb1Ac accurately predicts heart attack risk.

Persons with hemoglobin A1c concentrations less than 5% had the lowest rates of cardiovascular disease and mortality. An increase in hemoglobin A1c of 1 percentage point was associated with a relative risk for death from any cause of 1.24 (95% CI, 1.14 to 1.34; P < 0.001) in men and with a relative risk of 1.28 (CI, 1.06 to 1.32; P < 0.001) in women. These relative risks were independent of age, body mass index, waist-to-hip ratio, systolic blood pressure, serum cholesterol concentration, cigarette smoking, and history of cardiovascular disease.

So on the one hand, a diabetic should not reduce his Hb1Ac to below 5 because it could be dangerous but for every point above 5, you are increasing your risk of cardiovascular disease. You can’t win them all can you. I think the general conclusion to draw from all this is that if you are diabetic, you’ll want to try to ensure that your Hb1Ac is as good as you can get it (but do work with your doctor to achieve this)!

I found this great chart which tells you what kind of blood glucose you are averaging for your Hb1Ac value. This is useful. Now I know in what range I am going to have to keep my blood glucoses in order to achieve a Hb1Ac close to 6. A Hb1Ac of under 6 really seems impossible for me to reach at the moment judging by my blood glucose readings and the stuff I like to eat.

HbA1c (in %) average blood sugar in mg/dl average blood sugar in mmol/l
4,7 70 3,9
5,0 80 4,4
5,3 90 5,0
5,6 100 5,6
5,9 110 6,1
6,2 120 6,7
6,5 130 7,2
6,8 140 7,8
7,4 160 8,9
8,0 180 10
8,6 200 11,1
9,2 220 12,2
9,8 240 13,3
10,4 260 14,4
11,6 300 16,7

Source: Wikipedia – German site

I also found a site with a Hb1Ac tracker. This is a free printable chart which will help you achieve your Hb1Ac goals if you want something simple to record your daily glucose readings.

If you are more into tech-stuff, Sugar Stats offers an online diabetes management program. After you’ve read through the page, click on the link titled ‘See Plans and Pricing‘ (or go straight to it here) which will take you to a page with the free download. I’ve signed on to test it out.

Please note I have nothing to do with either of the above links – just happened to come across them today.

I can only conclude – Hb1Ac is a very important small number!

What my doc says

12 May

When you’re new to low carbing, everyday is a new experience. Well, today I want to share my experience on my doctor’s visit.

If you’ve read this blog from the beginning (which isn’t very long ago), you’ll know that I only started low carbing the second week of April 2010. I carefully documented my blood sugar measurements throughout the day, trying to link highs to what I had eaten and the amount of insulin taken and to workouts. It has been a painful process – painful for my fingers (7-10 pricks a day) and painful in that I had to remember to write everything down. When you go out, it is a little inconvenient to remember to measure blood sugar on time. After 4 weeks, I decided it was time to visit my physician and talk to him about it. I was excited and yet apprehensive of the visit – what would he say?

To my decision to go on a low-carb diet – he was not against it. He said that the medical profession is beginning to recognise that a low carb diet is not a bad thing at all, if you are able to follow it. He was very impressed with the meticulous collection of data and said that he could learn a thing or two from me. I showed him my ketone readings which were ++2 (level 3 out of 4). He laughed and said ‘you’re burning fat’! I took that as a positive comment.

To my decision to try and get my Hb1AC down to under 5 – he didn’t agree to that. He said that in Germany, the German Diabetic Association follows guidelines similar to the American Diabetes Association (oh-oh!) and recommends that diabetics keep their Hb1ACs below 7 to minimize damage to the various organs and nervous system. A good Hb1AC for me would be between 6 and 6.5! 4.6 is an impossible target for a diabetic! I told him that there were many people on the English language forums with Hb1ACs of around 5 and this is what people are striving for. He didn’t buy that and said that this is the wrong way to go.

Anyway, after promising that I wouldn’t low carb myself into a stick and disappear from the face of the earth in my efforts to reach 4.6, I left with his blessing that I could continue low carbing as long as I felt good.

At home, I searched the German diabetes websites to see what the general concensus was and it is true – everywhere I read that my aim should be – get that Hb1AC under 7. Well, I know that my risks for heart failure and other diseases will reduce under 7 but I still want to try to get it to the low 5’s.

Will I make it ? – well, keep tuning in to see how I’m doing!

My new toy

8 May

A new USB storage stick?

Yes, you’re half right! It is my new blood sugar meter – Bayer Contour USB with plug and play diabetes management software! I had a check-up and I mentioned to my doctor that I would like to buy a new meter as mine was already 7 years old. I said I wanted something with a computer software programme and he recommended the Bayer Contour USB as simple and easy to use. Even gave me one!

After having tested this little piece of equipment which looks like a bigger version of a USB storage stick, I was amazed at what it can do and am thrilled to possess it.

Here are the plus points:

* no changing of batteries. There is a re-chargeable battery inside and you charge it just like your MP player. Connect it to your computer and in about two hours, it is charged.

* there is no on/off button. Once you insert a test strip into the meter, it goes on automatically. No need to shut it off either. Pull out the strip and it goes off.

* tiny amount of blood required. The test strips require about 1/5th or even less of blood compared to my last meter. The strips are also half the size of my previous strips from another company. Could be perhaps too small for those with big hands but are perfect for my small hands.

* Autolog feature lets you mark your blood sugar measurement with notations such as ‘before meal’, ‘after meal’ or ‘no mark’. There is also the possibility to make notes using pre-defined remarks such as  ‘activity’ or ‘sick’.

* there is a reminder feature which can be activated and an alarm will go off after a set time which you can define. This is great in reminding you to measure post-priandal blood sugar.

* ability to set your own target range. If your value is higher or lower than your targets, they appear in orange to get your attention.

* summary – you can get a 7-day, 14-day or 30-day summary and it tells you how many times you were over or under your target!

* easy transfer of data to your computer to analyse and study your results further using Bayer’s Glucofacts Deluxe Diabetes Management Software.

* for those who want to measure their blood in the dark (can’t imagine why anyone would do this), you can put on a little light which will show you where you should insert your strip.

Whoopee! No more writing down everything on a piece of paper! No more remembering to set the alarm clock! No more squeezing my fingers like crazy to get out enough blood.

The Bayer Contour USB has been on the market since October 2009.  The price on the package was €44.95 but I’ve seen it on the Internet being sold for €39.98 plus postage.

This is a really good piece of equipment and if you are looking for a new meter, read all about it on Bayer’s website.

Thumbs up!

 

Update 3 Jan 2011 : I was quite upbeat when I got my new Bayer Contour meter but I now find that it is not all that accurate. Sometimes I get high readings and when I measure again immediately after, there is a difference of between 20-50 points in the readings. I mentioned this to my doctor (I mentioned a 20 point difference) and he said this was normal. I don’t feel this is acceptable. My last meter, an Accucheck Comfort, also sometimes showed differences between two consecutive readings but I don’t remember them differing by more than 20 points.

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