Struggling With Blood Glucose Control? Read This
It’s 8 PM and I am finally approaching my bedroom. Time to dim down the lights, open a book and let the magic lead me to a restful slumber. My blood sugar readings are perfect: 106, 104, 107. I go to bed as serenely as ever.
Now it’s 3 AM and I wake up to use the bathroom. As always, I lay my eye on the CGM…and it reads 220. There we go, it happened again: another spike, another middle of the night corrective injection, another good night of sleep interrupted. Another day in which I have failed to keep my blood sugar in check.
This has hunted me for years. I thought I had it under control, that I had cracked the code to blood sugar regulation and everyday I felt hopeful when my CGM readings were showing the numbers I wanted to see. And almost everyday that hope, that grin, that confidence were all wiped away in a split second by an unforgiving hyperglycemias popping out of nowhere, “for no reason”.
The frustration was real and it didn’t take long to surrender a condition I seemed to have to accept without escape, passively.
I had reached the point where hyperglycemias were not even bothering me that much: I’d shrug, inject some insulin crossing my fingers that it would “do the trick” and get on with my day. I had been numb and enacted the victim for a few years because it felt comfortable, I could blame bad luck and relief myself from the hustle of finding a solution.
Then I started to feel the frustration again. Only this time the frustration arose because I had understood that what I had so far considered inevitable, was in fact not supposed to be the normal at all. I understood that because I saw that plenty of other people living with diabetes just like me who were **not experiencing my misery.
The Diabetes “Red Pill”
My reality was altered watching a video on YouTube. The incredible stability of Robby Barbaro’s glycemic index as he was blasting immense and delicious bowls of fruits in his “what I eat in a day” videos on YouTube struck me like a thunder. And it felt exactly like taking the red pill in Matrix.
To see somebody (and he was not the only one) to achieve 95% time in range and an HbA1C of 5.5% on a consistent basis for years sparked something in me. Another reality was possible, I just had not considered the idea because my beliefs were blinding me.
Suddenly, the question came: If someone else could, why couldn’t I? From that moment on, I did what you ought to do when you want to master something: you observe what the best in class, people like Robby, are doing and do just that.
I spent some time mapped their steps and some more time scheming them into a framework I could replicate.
I now had a simple framework to follow, a step-by-step process that I had downloaded in my brain directly from the best. I just had to ruthlessly replicate those steps and observe, nothing more and nothing less. And I did just that. And the results were fast to come: time in range above 90%, more energy than I ever had, increased insulin sensitivity, faster recovery times from my workouts and the overarching feeling that type 1 diabetes could be my ally to life a much better life.
Here’s the framework I have followed.
First, I polished my diet
These people with incredible time in range and insulin sensitivity had all one thing in common: their meals were made of whole carbohydrates rich foods. Their YouTube videos or instagram posts were explicit: the amount of processed junk had to be null. What they ate was fruits, whole grains, legumes and vegetables in abundance. Real food, as close as possible to how you’d find it in nature. They called these Green Light Foods.
What they did not ate was animal products, refined carbohydrates (breads, pastas, juices, pizzas, snacks, cakes,…), refined fats (seed oils, hydrogenated fats, trans-fats and any other weird name you’ll find in 99% of what’s in a supermaket) and refined proteins (protein powders, stuff labeled “high protein”, and so on). They called these Red Light Foods.
They had moderate portions what’s functional for health but should be treated with moderation: nuts and avocados, dates and other dried fruits, products derived from soy like tofu or soy milk, etcetera. The label for these was Yellow Light Foods.
These people were eating whole, plant based foods naturally rich in carbohydrates and low in fats.
I understand that not everyone is plant based, and while I encourage everyone to explore this universe, if you choose to consume animal products just make sure that what you happen to buy comes from a trusted farmer who takes care of their own animals and produce their own products. As for anything, if it’s incredibly cheaper than it should be it’s probably crap.
Second, I mimicked their behavior around meals
Regardless of what they were eating, all these people with amazing diabetes control behaved similarly around mealtime:
They timed their insulin injection with accuracy;
They ate slowly, starting with fibers and making sure that a source of fiber was accompanying every carbohydrate-dense meal;
They moved in some way after the meal.
And I can tell by experience that these three actions are as simple as they are effective.
If you’re going to eat a certain amount of carbohydrates, you have to get the insulin ready to grab that glucose as soon as it enters your body. To do that, you must calculate the amount you need based on what you plan to eat, inject it and wait the appropriate time for it to go into circulation. If you’re at, say, 105, then ten minutes will do. If you’re at 140, you might have to wait a few minutes more so that your blood glucose can come down to the ideal level to start eating. If higher, then the waiting time will increase. Once you’ve waited whatever you had to and your blood sugar is in the safe zone, you can enjoy your meal.
But how are you going to eat? Slowly, of course! Although this clashes with the frenetic nature of modern times, rushing through a meal almost always guarantees a spike. Eating slowly and dressing your meal with vegetables will help contain that spike, if not prevent it from happening at all. Packing your carbs with fiber reduces the speed at which they hit your bloodstream, and eating slowly ensures that the carbs that come into the body do so at a moderate pace instead of all at once.
One thing I have learned from Buddhist Monks of the Plum Village Tradition is the practice of putting the spoon on the table between each bite, and chewing for at least thirty times. I not always succeed, but just keeping that as my target makes me eat much slower than I would normally do. And I also get to savor my food more.
So you’ve nailed your insulin timing and you’ve savored your meal like a Buddhist Monk, you’re ready to digest. And of course that means laying on the couch or getting back at the desk, right? Wrong! Move baby! Take a five to ten minutes' walk, do the dishes, sweep the floor, do the stairs at the office a couple of times, walk around the room as you organize the rest of your day.
The goal here is to put your organisms in the best condition to store and use the newly acquired energy in the most efficient way, and because we are diabetics, without making our CGM scream “It’s over 9000” and then explode out of desperation. Moving is essential after a meal, and this doesn’t mean going for a workout (which is a great option, anyway): never underestimate the power of a short walk!
Third, I tracked my diabetes like a scientist
Tracking, logging and journaling is the pulsing hearth that supports all of the above and feeds long term success. And everyone nailing their time in range does that in some form.
You can eat the healthiest food on earth, be the slowest chewer who as ever lived and move like someone was chasing you with a bow.
But if you’re not keeping track of how your metabolism change over time, if you’re blind to the exact quantity of food you’re putting into your mouth, if you don’t know what the right amount of insulin is for a specific amount of carbohydrates then you’re exposing yourself to the dangers and frustrations of blood glucose rollercoasters.
All the Diabetes Masters I have met share one final common trait: they meticulously track everything they eat, they know the carb-to-insulin ratio that applies for every meal and how this ratio changes throughout the day, and they plan their meals ahead of time.
If this sounds like excruciating and boring, take a breath! it is far easier than it sounds. I had the same concerns but time and experience made it vanish.
Planning meals in advance means that you’ll always know the carb content of your upcoming meal, and if you tend to standardize your meals then the amount of thinking required reduces to almost zero. As an example, for breakfast I always have greens, chia seeds, one banana, three apples and oats. I log these foods into a food tracking app (like Cronometer) and I immediately know I am dealing with 150 grams of carbohydrates. Small variations are possible depending on the size of the fruits, but even when I vary the fruits I can at least estimate with a fair accuracy how the carb content changes. The same logic applies to lunch, dinner and any other snack.
I can now adapt the insulin units based on my carb to insulin ratio. The previous day’s trend informs this decision: if my ratio yesterday was 20:1, I just have to divide 150:20 and inject 7.5 units. Variations apply here too: if I have just come back from a run I should inject a bit less than that because running promotes insulin sensitivity, so I can reduce to 6 or so.
How To figure out your carb-to-insulin ratio all the time
But how do I know my ratio? Well, I know it because I have done my homework the days before. (Let me know if you need a dedicated article that goes in depth about this process!)
If yesterday morning I ate 150 grams of carbohydrates with a ratio of 25:1 (injecting 6), and two hours later my blood glucose was 180, then it means that my breakfast ratio was in fact lower (maybe 20:1?), so this morning I will inject 150:20=7.5 units instead of 6. I will make a note of the change of ratio and observe what happens. If my after-meal blood glucose is 110, perfect! If I plan to eat the same breakfast tomorrow, I know I can rely on this ratio.
If that ratio sent me down to hypoglycemia, then I was probably a bit too aggressive with my units, so tomorrow I’ll take 7 instead of 7.5 (so my ratio will be 150:7=21, 21:1).
And I just repeat the same process for every meal. This practice now only informs my plans for the day after, but it allows me to adjust with incredible precision the insulin intake for every meal. It’s a decision tree, and it works sequentially. If for breakfast my predicted ratio of 20:1 was too high and it caused an hypoglycemia, then at lunch I can try to lower it to 17:1 (so for 100grams of carbs, the units wuold be 100:17=6.
As I said at the beginning, I could reduce the amount of mental estate for this entire exercise by planning my meals and keeping them more or less the same from day to day. Variations are more than welcome in the quality of the ingredients rather than the quantity to keep the taste interesting and pleasurable.
The key is to keep track of how the ratios evolve from meal to meal and keep making the needed adjustments. I always have a sheet of paper in my pocket that I fill with all these info: the content of a meal, the predicted ratio, the injected insulin and the actual ratio.
I can’t stress enough how powerful a tool the Decision Tree is for Diabetes management.
One Last Word…
There are always periods that are tougher than others.
If a bunch of basic mathematical operations were enough to nullify type-1 diabetes then nobody would bother to study to find a cure. Something can happen at work, with our partner, an accident, an unforeseen event that shakes us, a big decision keeps us awake at night, the excitement the night before our wedding or a big event we’ve been looking forward too…every source of stress and excitement will inevitably alter the regularity of our blood glucose.
This is something we must acknowledge and make peace with. Whatever is going on, when our disease seems to be out of control we should try to find some calm and breathing space and keep doing our best.
Everyone has hyperglycemias, hypoglycemias, days when everything seems to go down the wrong path and we feel the universe is conjuring against us. Everyone experiences this, whether they claim to have 100% time in range or 0% time in range, and regardless of the perfect life they appear to be living on Instagram.
But this must not be an excuse, not for me at least. I must not raise my hands in despair and let events wreck me. I know I have great power and an immense potential for agency, and even in the tougher moments there are some very simple things that will, if not solve, at least help contain the damage.
I have outlined them in this article: eat as many green light foods as possible (moderate yellow light foods and possibly no red light foods); eat them slowly, commit to timing your insulin as best as you can and move a bit after your meal; keep track of how your insulin sensitivity evolved by logging your foods, adjusting your ratios based on the response of your body and taking notes of what happens in between.
So if type 1 diabetes sometimes feels overwhelming, know that it can happen to everyone and that these simple habits will always make things a bit easier.
Most of all be kind to yourself and when you need help know you can reach out to incredible online communities. This blog and its readers is among them, you can always send me an email or drop a comment, and I’ll always answer!
It’s full of people that, just like you, face the same struggles and want to support a friend in need. Take a breath, do your best, and remember that there is a way out. And that we’re all here for you!
