Wednesday, September 26, 2012

Panera Bread sourdough experiment or Houston, we have lift off!

I spent a good deal of yesterday morning reading about sourdough bread and it's virtues of being relatively low on the Glycemic Index and therefore easier on blood sugar than many other breads. Over the last 12 years, I've experimented with so many breads and things inaccurately called bread and other than one made by Julian Bakery, the results have been pretty depressing.

As any experienced diabetic knows, there's not one thing that works for all. What works for you might not work for me and what works for me might not work for you. Panera's website says two ounces of the sourdough loaf contain 28 grams of carbs. For me, that's a bolus of nine units of insulin. Meh, that's a lot of insulin but sometimes a girl needs a treat, you know? And since my body doesn't adhere to the 'a carb is a carb is a carb' grind, 28 grams of carbs from sourdough might affect me differently than 28 grams of carbs from mashed potatoes. It's all one big experiment but I'm ready, willing, and able to jump in with both feet to learn what works for me.

In light of all that, I stopped at Panera Bread last night on the way home from work to get a loaf of their sourdough. The small (and it isn't small at all) loaf of sourdough was $2.99. A little pricey but if it's real bread I can enjoy, I'm so game! They have an amazing slicer there so the employee sliced it on the thinnest setting, I gleefully paid her the money, and headed home, my precious paper bag of sourdough in hand.

At one point last night my BG was a bit low at 63 and I was hungry so I gently removed a slice of the bread from it's plastic bag, admired the softness, smell and texture and felt my heart skip a beat. I placed two slices of good quality American cheese on it. None of that processed cheese food for me, oh no! I started the toaster oven and lovingly slid the bread and cheese in. I was so anxious to eat it I didn't let it get very toasted. Instead, I got it out before it was ready and happily dug in, enjoying every bite.

I didn't bolus insulin for the treat because I was running low and had bolused a bit over ten units for dinner less than four hours earlier so I knew I still had a smidgeon of IOB (insulin on board, what remains of a previous bolus). I wanted to see what it would do without an additional bolus. I knew it might send the BG sky high but sometimes we have to play with these things to get a good picture of what's really going on.

An hour after eating the bread and cheese, my BG was 67! I was tired and ready for bed so I set the alarm for an hour in the future. And woke up this morning at about 5 AM. What? I didn't hear the alarm? Apparently not and that's rare for me. I jumped up to check the BG, knowing that it might be way too high. (Theoretically, food is out of the system after several hours but that isn't the case with me most of the time. I find that what I eat before bed definitely affects my fasting blood sugar) It was 76! Really? Yes! I checked it two more times and each time it was within a few points of that number so I know it was somewhere in that range. Very interesting so I decided to try it again.

I toasted another slice of the bread with one slice of the cheese and let it get good and toasty. I did bolus nine units for the food and coffee knowing I had no IOB other than my basal insulin. I had it with a cup of java. Normally, I bolus at least five units just for the coffee but gut instinct and my recent coffee experiments told me 14 units of insulin would be too much. By the way, Panera Bread's sourdough loaf is some of the best sourdough I've had. It isn't super light but it isn't heavy, either. For me it's just right. An hour and twenty minutes after eating, my BG was 101! Really? That's all? It's a slight increase, yes, but it's still very much in the safe zone. At the two hour mark, the BG was 83!! Can you believe this? I'm shocked and thrilled! And a little concerned. I've been running low or on the very low side of normal a lot lately and am not sure why. It isn't a bad thing but it's something i need to understand so I can manage it properly and avoid hypos.

At the three hour mark, I got quite a shock. The blood sugar registered at 56. I checked it three times. My bolus calculator said I needed to consume 12 grams of fast acting carbs and since I suck at figuring out how much of a bottle of glucose drink containing 16 grams of carbs is 12 grams of carbs, I drank it all and 15 minutes later the BG was 134. A tad higher than I like but certainly not horrendous. Rather than a ratio of 1:3, perhaps this bread requires 1:4 or even 1:6. I'll have to play with it some more to fine tune it. Also, I didn't weigh the slice of bread so it might have been less than 2 ounces which would certainly explain the lower readings. I have a food scale and will weigh the slice next time I try it.

The success of these two experiments doesn't mean I can eat sourdough and cheese every night and every morning but I think it does mean I can enjoy that as a treat now and then. And maybe once in awhile a real sandwich with real bread. Oh wow, the thought makes me all soft and noodly!

More experiments to come as long as this doesn't interfere with weight loss in the long run. Stay tuned!

Sunday, September 23, 2012

Testing for insulin to cover coffee...a fail? Well, not quite.

"Ever wonder why your blood sugar rises after drinking a cup of coffee – even when using
artificial sweetener? It’s probably due to the caffeine. Intravenous administration of caffeine
was found to reduce insulin sensitivity (the degree to which insulin lowers blood sugar) by 15%.
Caffeine produced an increase in epinephrine (adrenaline), free fatty acids and blood pressure.
The solution: either take extra insulin with your coffee, or switch to decaf!"- Gary Scheiner

I purchased Gary Scheiner's "Think Like A Pancreas" on Friday and had a very hard time putting it down because, even with 12 years as a diagnosed Diabetic and having read almost every related book I can get my hands on, I was so very impressed. I finished the book last night and spent several hours basking in the afterglow of new knowledge.

Since the spike I get from coffee has been a thorn in my side since day one of my diabetic life, I decided to try his suggested test to find out just how much insulin I need for coffee. Mind you, I use no sweetener but do add two tablespoons of half and half or heavy cream to an eight ounce cup. Plain brewed coffee and espresso have no carbs but Gary's above-quoted explanation makes sense and damn it, decaf just isn't the same. (As a side note, I don't get spikes from other caffeine-containing drinks unless I consume a huge quantity) I refuse to give up my java so I bolus for it. That's been pretty much a shot in the dark for me as sometimes my guesses are good and other times they aren't so good. I figured following Mr. Scheiner's advice would help me come up with a better plan.

What he suggests is to test the coffee without other food and bolus just for the carbs in the coffee. I use no sweetener so that means bolusing for just the half and half. Two tablespoons of the lovely stuff contain two grams of carbs and since I prepared 16 ounces of java, I added four tablespoons of half and half. That means a bolus for four grams of carbs. However, my blood sugar was 66 before starting the test and since anything under 70 is considered low, my bolus calculator gave me "0.00" for insulin needed. Got that? Uh huh, I thought you did, you smart cookie.

So, at 3:40 PM today, before the first drink of iced coffee with half and half, my blood sugar was 66. I started to drink the stuff, figuring it would take me about 30 minutes to scarf it all down. After drinking about half of it the nausea started. Yep, nausea! No way could I get all 16 ounces of it down in 30 minutes. I thought I'd check the blood sugar at one hour just to see where it was and the result surprised me. 73! Just 73? For those not familiar with Diabetes, a rise of seven points is just about negligible, especially when the usual result is much higher than that. What happened to the spike I normally get from even one eight ounce cup of coffee? Hmm, I'm not sure but it was nowhere to be found and after an hour the coffee was pretty watered down by the ice.

I kept sipping on it, fighting nausea, determined to finish the three hour test. Yes, three hours of my life spent trying to get an accurate picture of how much insulin I need just for coffee. That's how important coffee is to me but it's also how important controlling my blood sugar is to me. If I'm not willing to give up a food or drink that causes my blood sugar to rise dangerously high, then I must bolus correctly for it. There are no ifs, ands, or buts on this.

At the two hour mark, I'd managed to drink about 12 ounces. That's it. My blood sugar was 75 and the nausea was still present though not so bothersome. I gave serious consideration to canceling the test but since I drink coffee at different times of day and my coffee-free blood sugar readings vary, it's vital that I have the information a finished test will provide. So I persevered. Gagging, I sipped a little here and a little there, fighting the nausea that came and went, anxiously watching the clock for the three hour mark, and more anxiously watching the barely changing level of coffee in the glass.

Finally, at the two and a half hour mark, major waves of that sick feeling in the stomach demanded I throw in the towel. My blood sugar was 67 and I thought I'd never drink another cup of coffee. I don't think I'm getting sick and perhaps all this is related to drinking coffee on an empty stomach. Normally that doesn't bother me but who knows? I needed to eat something and since I desperately wanted to tough it out until that three hour mark had passed, I threw what was left of the coffee in the sink and went outside to sit on the patio.

The three hour mark came and I checked my blood sugar, holding my breath. 63! I put the number into my PDA and it said I needed to eat. Not a surprise. The only thing that sounded good was yogurt so I entered the 15 grams of carbs for it into the calculator and bolused the 3.2 units of insulin it said I needed. Yep, I still needed a smidgeon over 3 units of insulin to cover that fairly small number of carbs even though I was on the verge of a big fat hypo. Blast it all!

I suppose some people would say this test was a failure but I don't agree. I did learn something and that is that starting at 3:40 PM on a Sunday afternoon with a blood sugar reading of 66, I can consume 12 ounces of iced coffee with about two tablespoons of half and half without a spike. At least on this day. ;)

Truthfully, the last three hours have confirmed what most diabetics know and some experts acknowledge. Diabetes is a very individual, complicated, and ever changing disease. What works today might not work tomorrow. In fact, it might not work later today. And what works on Sunday afternoons might not work on Monday mornings. Yes, I'm going to try it again tomorrow morning and adhere to my normal routine of waking at 5 and drinking 16 ounces of hot coffee with four tablespoons of half and half before heading to work. If I can stomach it.

We'll see what happens.

Saturday, September 8, 2012

Food boredom be gone!

I get bored with my food fairly easily. I don't think it's because I eat low carb most of the time so much as I'm often tired when I get home from work and don't feel like cooking much so I eat stir fried vegetables or eggs and veggie bacon. Again. That's great for the blood sugar but it gets a bit old for the taste buds, you know? So when I saw the picture and recipe for Loaded Roasted Cauliflower Salad on my favorite blog, I knew it was a must try.

Since I don't work today, I made it this morning. I didn't have quite six cups of cauliflower but the recipe turned out just fine with almost five cups. And since I didn't have chives I added a bit of onion powder. Oh, I also forgot that some of the bacon was to be used to top the dish so it was all stirred in. And I used a blend of several cheeses rather than just cheddar. It turned out fantastic, even with my changes, and there's enough left for me to enjoy it again several times. For me, it needs a little more zip but I'm not sure yet what that zip is.

I'll definitely make this again and probably play with it a few times before I hit on just the right combination that makes it absolutely perfect for me. I think some colorful bell pepper would be a nice addition but that remains to be seen.

If you make this, let me know what you think and stop by Your Lighter Side to let Jamie know what you think, too.