The Power of Pre-Commitment to Manage Type 1 Diabetes
I often repeat that managing type 1 diabetes is not something you do at random. As boring as it sounds, you need to do the math, every day, and stick to the numbers. That is an important mantra to keep in mind, and I will go as far as to say that it is the most important concept you (I) need to stick into your (my) head if you want (I) to get a hang of your (my) diabetes.
As tedious as it may sound, for each meal, at the very least, we need to:
Weigh the food
Know how many carbohydrates we are about to eat
Adjust the amount of insulin we need
Keep track of all these info somewhere (I log them in a spreadsheet)
Revisit the spreadsheet multiple times a day, before each meal
The logging and tracking process is one that constantly equires time and mental energy every day, and that is why it is important to design it in a way that reduces any friction, removes as many obstacles as possible and is conducive of sustainability and success in the long term.
Make Food Logging Easy with Pre Commitment
When you know what and how much you eat, and how that affects your BG, then you can master your diabetes. Without that information, you cannot do the necessary math (calculating the insulin to carb ratio), and diabetes management becomes a random wandering into unknown waters and hitting an iceberg will be almost inevitable.
Managing type-1 diabetes at random.
One way to smoothen the navigation and avoid icebergs is to simplify your food intake and pre-commit.
By “pre-committing” I simply mean this: design and prepare a few meals in advance, log their ingredients to estimate the nutritional content (you can use Cronometer), decide when you are going to eat them, and commit to eating only those at the time you have decided. Nothing more!
For instance, I decide that this week I will eat a dinner made of X grams of chickpeas, X grams of starchy vegetables, X grams of whole grains and X grams of nuts. I batch cook, I make equal portions, I calculate the nutritional content once for all and simply pull those out of the fridge at the designed time. Knowing the exact composition of my meal will reduce the mental stress and effort of having to sit down and compute my bolus intake every time.
There will always be some adjustments to make (for instance, if I run before or after the meal, or if that day I ate more fats than usual), but accounting for these external factors will be much easier because we have less variables that are changing in our equation - the food is a constant now.
Pre-Commitment for Blood Glucose Stability
The nice side-effect of pre-commitment is that it helps a ton to stabilize blood glucose levels and makes it easier to maintain in range. Why? I see two main reasons:
Since you are standardizing your meals, you’re reducing the guess work regarding your bolus and macronutrients. Your insulin to carb ratio will be much more reliable, the injections more spot-on, and the potential corrections to the dosage much easier to estimate.
It helps with accountability. When you set out to eat that meal at that time, and you commit to it by writing it down on a calendar or on your journal, you’re less likely to slip away from the path. If you design your meals appropriately, you know that you’ll get to the end of the day with enough calories in the tank, and you’ll be much less likely to indulge into some extras to “make up” for the calorie deficit.
The second point has been a source of frustration for me. For a long time I was burning much more than I was eating, and this often resulted in me having a bigger dinner than what was ideal.
In general, to help with insulin sensitivity and stabilize fasting blood glucose, dinner should be the lighter meal of the day (eating the most of your calories earlier in the day also means that you are more likely to burn them off simply because you’re more active during the day. You’re unlikely to go for a walk or a run or carry the groceries during the night!). There are exceptions to this rule, but this is a good rule of thumb, and you can rest assured that making your dinner lighter will be a tremendous help.
But because I was randomly designing my meals, most of the time I got to dinner with a huge appetite and with no other way to tame it than by overeating my portions. As a logical result my poor meal planning regularly disrupted my night blood glucose, which inevitably skyrocketed “out of the blue” some time around 2am.
No longer binge worthy since I started to pre-commit.
Designing my meals fixed that. Knowing what I was going to eat and that I was going to eat enough improved my self-accountability and my time in range: I naturally became more disciplined at the dining table (no more splurging on extra calories), and my blood glucose became more stable because I knew how to handle my injections much better, and with less mental effort. Meal planning ensured I was eating enough calories during the day, making it easier for me to avoid late night food cravings.
Meal planning was a major contribution to brings my time in range from 60-70% all the way up to 85% on a regular basis.
My caveats for pre-commitment to work
All of the above goes out of the window if what we eat and our lifestyle are not conducive to the results we seek - blood glucose stability, easy calculations for our insulin dosages, and overall tranquility of mind. Meal planning and pre-commitment (”I am going to eat this at that time”), in my opinion, will only work if the following three requirements are met:
Whole-food, plant-based, carbohydrates rich, low in fat. If the foods you put in your dish are picked from the Mastering Diabetes “Green Light” Foods List, diabetes management and blood glucose stability will become a fun, easy and tasty endeavour. Eating carb-rich whole foods will satiate you and put in your tank all the good energy you need to do whatever you have to do. Keeping the fats low will ensure you are actively reducing your insulin resistance. Making it plant-based will reduce the overall inflammation in the body, improve your bio-markers for insulin sensitivity and time in range, and a thousand of other benefits.
Sleep. never in my life have I had a better insulin sensitivity and an easier time managing my blood glucose than since I made my 8 hours of sleep a non-negotiable. This alone changes everything. I cannot express into words the magnitude of the benefits of good regular sleep for type-1 diabetes. You just have to try.
Exercise. This is absolutely crucial for insulin sensitivity and blood glucose stabilisation (and for your health in general). Getting into the habit of walking for 10-20 minutes after your meal will do wonders to your blood glucose levels. Getting into other forms of cardiovascular training like running will compound on that magic. Adding some form of regular resistance training will make you a Master Wizard. If you think you don’t have time to go to the gym, you can stay fit with no gym in sight by making your environment your gym, for instance:
Never take the elevator, always the stairs;
Carry the groceries home with your hands, walking (if you still need a car, park it one kilometre away from the store);
If you have a desk job, stand up every 30-60 minutes and do some squats, lunges or pushups;
Take every occasion you have to carry heavy stuff around;
and on and on and on.
Staying fit with no gym in sight!
Pre-commit to all of these things, understand why they are so important and make them a habit. All the rest (logging food regularly, calculating your dosages more easily, improving your time in tange) will fall into place without you even acknowledging it.
Let me know how it goes!
