Insulin and Dieting

Like my other recent post, "Diabetes and Dieting", this one will focus on the implications of a hard diet and my blood glucose levels.

The main thing is: You have to test more often, and, under the supervision of your physician, adjust your insulin appropriately.

As a diabetic who takes insulin, you have two methods of controlling your blood sugar levels.

• Changing sugar intake.
• Changing insulin intake.

When your glucose levels are high, lowering glucose levels is usually just done with reducing your sugar intake, with your doctor's recommendation for your NPH insulin. If your sugar levels are too varying, you may have a fast acting insulin you adjust to your intake of sugars. If you are on insulin, this should be not be news to you, if you didn't know this, get more educated about your program.

When dieting, especially one as hard as I am working at, you are more concerned with keeping your glucose levels above 75 than you are with them being high. I have had only one reading above 150 in the last month, four below 55. When on a restricted calorie diet, such as I am using, correcting a low glucose level can add 300 calories to what you were hoping was a 1,500 calorie day. The best way to prevent this is by adjusting your insulin over the course of the day and checking your glucose levels when appropriate.

For different insulin types there are different time ranges. The two I use are:

• NPH

• Intermediate acting.
• Onset in 1-2 hours.
• Peak in 4-12 hours.
• Lasts up to 24 hours.

• Lispro

• Rapid acting.
• Onset in 15-30 minutes.
• Peak in 30-90 minutes.
• Lasts 3-5 hours.

(charts are from https://sites.google.com/site/diabetesmapp/insulin-action-curves)

I take the NPH twice a day, morning and evening, to maintain a consistent level of available insulin in my body. I am now reducing my dosage to 40 units, down from 50, on the advise of my physician based on my glucose levels. Per my doctor, if after a week, my glucose levels are stable, or a little low in the mornings, I will reduce it more. The up side to this is that, with the lowered insulin levels, I will not have to be as concerned with dropping too low during the overnight.

The Lispro, on the other hand was initially prescribed at 10 units after dinner. This seems to have been the culprit in my recent low glucose crashes at night. so, now I test about an hour after eating, before taking the Lispro. If my glucose levels are acceptable, I have been told to not take it. If they are a little high, I am taking 5 units, if really high, I take 10. The real trick here is to re-test 2 hours later and see what the levels are at. If I end up dropping too far, I have to change my program, maybe reduce the dose, maybe increase the glucose threshold.

I have found an app that helps me remember to test my glucose. I am still learning it, and it doesn't have the best interface. But if you are determined, you can get some good use out of it. It is called Diabetic Insulin Log/Alert. It is free, but they also have a $2 version that I cannot seem to find. Support the author if you find it useful. When you use it, you enter your glucose level and press the "Log Glucose" button. When you take insulin, enter the dose and press the type of insulin. That's it. a reminder is automatically set for your next test.

Another app I encountered was Diabetes diary. I much preferred the interface on this one, but it is set for mmol/l instead of mg/dl, so not as useful to me for logging my glucose levels. It also wanted a lot more permissions for just a log.

On a side note. I am finally free of the pepperoni sticks I was consuming on my drive. I worked the last ones into my plan and they are now gone. I also took advantage of a shorter than normal commute and cleaned out the car of my non-appropriate snacks. If it isn't there, I cannot eat it right?

Diabetes and Dieting

Whew, it happened again.

My internal low blood sugar "Alarm" woke me up this time. At least this time I had the sense to get up and verify it. Down to 49 mg/dl. A hand full of chocolate covered granola, and 20 minutes later it is back up to 90 and I felt comfortable going back to bed, as the strange feeling and sweats were absent. My morning blood sugar was at 79, about where it should be. When I took my evening blood sugar level, before taking my 'fast' insulin, it was at about 120. I cut my dose in half per my doctor's instructions but it still dropped me too low.
This

A few days earlier, I had a similar experience and so I can recognize the symptoms a lot better now.

I think the main trigger for last night's episode was a 1 day "Crash" diet, just over 1,000 calories, in an attempt to overcome my perceived plateau. I ended up at 1480 calories for the day. The crash did force a downward plunge in the weight, but I will have to be more careful of what and when I eat and medicate.

Today's plan will be:

• Breakfast: 210 calories
• Quick oats: 150 calories
• Honey: 60 calories
• Snack: 160 calories
• 16 oz Strawberries: 160 calories
• Lunch: 333 calories
• Salad: 53 calories (Just bagged lettuce mix)
• Sesame Ginger dressing: 100 calories
• Carl Budding Turkey (2): 180calories
• Afternoon caffeine: 30 calories
• Wired energy: 30 calories
• Dinner: 140 calories
• Protein shake: 140 calories
• Drive home snack:
• Pepperoni sticks: 375 calories

A total of 1,248 calories for the day. Or a deficit of 780 calories from my calculated BMR. And 2250 below my expected actual burn according to Fitbit. As long as I am careful of my blood sugar levels, I should be able to keep up this plan.

The trick, for me at least, is that I could have whatever I want. But, I have to account for it. A 16 minute mile accounts for about 275 calories. If I want that slice of cheesecake, I have to work it off, or skimp elsewhere in my daily intake. Frankly, I am lazy and will eat a pound of strawberries instead, to me they taste better, don't upset my blood sugar level as much, and I am lazy besides. I would rather that walking be done to remove weight than to compensate for a momentary pleasure.

By strictly measuring my intake I am also less likely to graze. Absent minded eating while doing other things. I can have that cup of chips, but I have to measure it out first and record it. Meanwhile I am trying to get my wife to start monitoring her intake as she was complaining that her progress is stagnating. 

Vacations and Weight Loss

Two concepts that don't go well together, Vacation and Weight Loss.

I did take a week off of work. This included Independence Day and a 2 night camp out at the coast. I am really glad I had already been working on the diet before the trips. I feel that I was able to make smarter choices than I had in the past. I drank a lot of water and managed not to gorge on camp food. Marshmallows don't count anyway, right?

All in all, my blood sugars were managed OK enough, waking numbers below 100, no bedtime crashes. A couple of days before, I experienced my first low blood sugar episode since I was diagnosed as diabetic. I was having sweats at bed time and started not thinking right. My wife asked me to check my glucose level and it was below 50. I self medicated with chocolate and a half hour later was up to around 100. Not a fun experience, it could have gone badly, as I had just taken my slow acting insulin and my blood sugar level could have gotten pretty low by morning.

The truth of my week off of work is in the numbers, I lost 3.5 pounds from the 3rd to the 12th. I think it is going OK.

Here is a startrail image I tried to make from the campsite. One of these days I want to try to stack images to get a single image instead of a trail image.

This was created using a free software for Windows called Startrails. Images were taken with my GoPro 4 Silver with an external battery pack.

Where did this come from?

Ok, I know it has been a while, but here goes.

Today's posting:

Today is day one of a month long challenge to NOT use Facebook, therefore this post, as I want to document things anyway.

I woke up, picked up my phone, and instead of going to the Facebook feeding trough, I hit all three of my email inboxes and took care of the 200 or so unread e-mails. Mostly just select all, go through and look at the senders, deselect ones I want to check, and delete the remainder.

I did my morning weigh in. Great news, still loosing weight! On June 12th I decided that I needed to loose weight. So on that day I started. My initial weigh in was 351.8 lbs. I am 6'2" but that isn't tall enough for this weight, I cannot get any taller, so I must loose the weight instead. Since the 12th I have upgraded my scale to a connected one, it wasn't necessary, but I like the better information such as BMI and fat percentage that it provides. Since the start of this, I have lost 15.9 pounds. I am not kidding myself, I have more than 130 to go until I am no longer considered obese, but it's a great start for 3 weeks into it. I am doing this by watching calories more than anything else, I am increasing my steps per day, but I am still pretty sedentary on work days. One side benefit I am seeing already, besides less strain on my shirt buttons, is that my blood sugar is down from 130 in the morning to 90. It is amazing, when you are trying to count ALL calories, how some simple changes can make a huge difference. But that's enough of that.

Here is the scale I am using. I had my doubts, as I didn't want to have other people's measurements interfering with my logging, but the phone only logs the information when the app is open to a user profile, so any number of users can use it, each with their own profile. The scale reports back a number of items besides just weight. It will give you BMI, body fat percentage, water percentage, muscle mass, etc. For me the important ones are weight, BMI and body fat percentage. I am charting them on a spreadsheet and like seeing the trend on my graphs. From the information the scale provides, I have the spreadsheet determine my ideal goal weight, one with only 22% body fat, and projecting a completion date based on my past week's loss rate. I have an intermediate goal weight, which was just a number picked from the air of 100 lbs less than when I started, or 250 lbs.
Here is my goal date graph.

I didn't expect it to stay as good as earlier weeks, but it's really nice to see a future with healthier numbers.