Today In Diabetic Cooking

Since my buddy is a newly diagnosed diabetic (his blood sugar was like 500 when he was diagnosed six weeks ago), and muscular and athletic and skinny, there isn’t much medicine or exercise can do beyond a point (or so I think. I’ve spent the last couple of days since I knew he was coming and read everything I can find), it really looks like (from what I have read, again, I am no expert), that for his case, diet is going to be supremely important. He’s not a great cook, and has been killing himself eating healthy crap but hating it, so we are working on some easy recipes he can make that are really healthful and flavorful.

From what I understand, as far as proteins go, fish and beans and nuts and lentils and chicken and turkey are all great, but I wanted to ease him into it, so I made a beef tri-tip that I seasoned pretty well, and tomorrow I am going to make cod filets with a red pepper puree and then try to ease him into some more fish and white meat dishes. I don’t understand the relationship fully, but from what I can tell red meat is something that should be a treat, but at the same time, the fats from meats and oils are also really vital for a balanced meal, because it helps (might be using the wrong words) slow the release of glucose.

Again, if I am wrong in any of this, please let me know. I am trying to help a brother out and am basically taking a self-taught course in this. He has mentioned he is using a low carb approach, and this is what I came up with in the last couple of days. Again, if I am wrong, send up an SOS, cuz I’m trying to help and not kill him.

For a side dish with the tri-tip, I made a summerish cold salad with quinoa. He had never heard of it before, and my dad started eating a lot of it a couple years ago, so I have some tricks up my sleeve. Basically, I made a quinoa salad, and I added diced green onions, some diced kalamata olives, quartered artichokes (and I drained the brine and soaked them in water before dicing them, because apparently sodium is also a real issue with diabetics), a diced red pepper, an avocado, some cut cherry tomatoes, and cilantro, a little bit of garlic and an olive oil/red wine vinagrette. I looked all the stuff up under various glycemic load charts, and nothing in this should spike his blood sugar.

I also read that they still need to have some carbs, so what I did was round out the quinoa salad (with a cup of quinoa) and added a 1/4 cup of orzo. Again, not sure of the dynamics, but I read that carbs can be poison for diabetics, but no carbs is also a problem, and that you should have 1 serving for breakfast, 1 for lunch, and 2 for dinner, which makes no sense that they would break it down into three meals when Shawn has been told he should be having multiple small meals every day. I figure both of us are clueless and we will just test and retest and try to get him on the right path.

I also read that one of the best things for diabetics are leafy greens and olive oil (again, I think the olive oil is related to the fat and glucose release), so I sauteed a bunch of baby spinach in two teaspoons of olive oil and fresh garlic, and at the end when it was starting to wilt threw in some diced red pepper. One of my family friends gave me a grinder full of Pink Himalayan Salt (I cracked up when I opened it at Christmas, but I kept the joke to myself), so after it was done, I McMeganed it.

At any rate, I tried to include everything that you should while rounding it out with the necessities. It was actually awesome, and I think I may start eating like this because it makes the whole act of cooking more fun, because you have to really think about what ingredients you are using. It’s kind of like cooking in hard mode, and it tasted great and I could stand to shed a couple hundred dozen lbs.

If I am doing any of this wrong or suffering misconceptions, let me know ASAP, please. Although the preliminary results are kind of good, I think, as his blood sugar an hour after eating is basically the same (4 point difference).

Oh, and for a snack tonight, we are having Edy’s Outshine Pineapple fruit bars, which seem to have no truly objectionable ingredients, are only 80 calories, use sugar instead of corn syrup, and the primary ingredients are pineapple and water.






80 replies
  1. 1

    I admire the effort you’re putting out for your buddy. You’re a good man, Cole.

  2. 2
    tc says:

    You’re a really good friend, John.

  3. 3
    Diana says:

    I don’t know much about diabetes but “eating healthy crap but hating it” suggests your friend needs better cookbooks. There is a great deal of seriously awesome healthy cooking out there. May I suggest Alice Water’s Chez Panisse vegetables cookbook and Plenty by Yotam Ottolenghi. Neither chef is vegetarian but both believe in great cooking.

  4. 4
    burnspbesq says:

    OT:

    Dear Attorney General Holder,

    If you can find a way to block the Time Warner – Comcast mergerl, I will take back all the bad things I ever said about you.

  5. 5
    Constance says:

    http://www.phlaunt.com/diabetes/
    or google Blood Sugar 101. My A1C was 7 and I brought it down to 5.2. Took a year. Sounds like you are doing a great job, John.

  6. 6
    Just Some Fuckhead, Thought Leader says:

    See if he wants to get some exercise car hunting with you.

  7. 7
    Corner Stone says:

    @Just Some Fuckhead, Thought Leader:

    See if he wants to get some exercise car hunting with you.

    What kind of camo is best for hunting trapped Subarus in a farmer’s field in WV?
    Is there a scent masker or call one could use?

  8. 8
    NotMax says:

    No need to reinvent the wheel.

    Plenty of good advice and recipes from diabetes organizations and health centers, both online and in paper format.

  9. 9
    numfar says:

    Benefited helped me with my blood sugar.

  10. 10
    numfar says:

    That should have been benefiber.

  11. 11
    ruemara says:

    You’re an awesome mensch, JC.

  12. 12
    MikeJ says:

    @Corner Stone: I was in a short lived band called Subaru Brother, named for this commercial.

  13. 13
    dnfree says:

    If possible have him meet with a diabetes nutrition expert. If he tells them what he eats now, they can suggest modifications he can live with. For instance, I love hummus, but now I eat it with carrots instead of with pita.

  14. 14
    NotMax says:

    Quinoa is the new black.

  15. 15
    Seanly says:

    You have to be very careful with beans. While they tend to be high in protein, they can also be very high in carbohydrates. A thick, stew-like chili loaded with kidney beans & lots of tomatoes would be high in carbs. A more soupy chili with less tomatoes & other beans can be more in line with a healthy carb limit.

    Fiber is good too as you can reduce the carb count of a meal by a portion of the fiber carbs. I usually take off half the fiber carbs from the total, but it’s more like half the fiber carbs over 5 g. I shoot for keeping my meals in the 45 to 75 g of net carbs (the recommendation is 60 g max/meal for males to lose weight).

    My A1C was off the chart when they first tested it. I haven’t had any OJ since my diagnosis (beyond a sip or two). As soon as I started limiting my carbs, my blood glucose readings dropped to more normal levels though I am still taking Metformin.

    Another item is that they recommend taking a baby aspirin each morning.

    The body needs some carbs for quick energy. Everybody needs some carbs. Only 1 serving (usually about 15g) is not much and is more like a snack serving. On a good eating day I probably have 2 carbs in the morning, 2 or 3 with lunch and 3 or 4 at dinner. Since my BG is well-controlled I probably consume a little more than I should.

    One last thing is that if your buddy has a snack of say pretzels, he should also have a few grams of protein with it.

    AND your buddy is allowed to have one day ‘off’ a month. The goal with managing diabetes is to keep the sugars in line 50% of the time (though more is better). A day off once a month for holiday dinners or parties is acceptable.

  16. 16
    Tithonia says:

    You are a good man, John Cole.

  17. 17
    Villago Delenda Est says:

    Basically, avoid great heaping servings of carbohydrates. Complex carbohydrates aren’t so bad, but don’t mainline on them. When I was first diagnosed with type II, I made good progress and my doctor okayed spaghetti once a week.. Obviously, Twinkies (if you could still get them) would be right out.

    A basic rule of thumb is “white is bad” particularly when it comes to carbs. Whole wheat is better than the bleached stuff. Multigrain is good. As far as turkey is concerned, I was told to avoid dark meat and stick to white meat.

    Avoid alcohol, but you should have no problem there, amirte?

    Just stay on the meds (I’m taking three different things, insulin, metformin, and glipizide) and keep monitoring that blood sugar.

  18. 18
    vlm says:

    Delurking to chime in – Great recommendation from Constance – using Blood Sugar 101’s approach, I took my A1c from 6.5 to 4.9, with no meds. John, what you described should be great for your friend (minor quibble about the quinoa, but not a biggie), and he’s lucky to have you. But he needs to experiment on himself – different foods affect diabetics differently. Testing 1 and 2 hours after eating is going to give him sore fingers, but also the info he needs to experiment with food combos that work for him to keep his blood sugar in check. And for gawd’s sake, avoid the recommendations of the ADA!!

  19. 19
    lectric lady says:

    I hope he has insurance. Our plan has diabetes nutrition outreach. Mr. Lectric Lady gets periodic meetings/phone consults with a nutritionist. Food choice info has been very helpful, but more importantly, portion control training. I can yammer until the cows come home about how much he puts on his plate, but the nutritionist gets through to him.

  20. 20
    Mnemosyne says:

    A relatively new study that’s starting to get some attention — a 20-minute walk after every meal helps keep blood sugar levels from spiking.

  21. 21

    http://nutritionfacts.org/index.php?s=diabetes

    has lots of good articles about diabetes prevention and remediation

  22. 22
    Michigan J. Frog says:

    This is crucial: Is your friend Type 1 or Type 2 diabetic, and what is he doing about it?

    Type 1 is often called “juvenile” diabetes, but really refers to a syndrome where the immune system, or less often a virus or bacterial infection, is killing/has killed off the Isles of Langerhans in the pancreas, which make insulin. Type 1 is about 5% of cases. Type 2 is the much more common type, and is actually a complex of related syndromes having to do with insulin resistance and to some extent, in some cases, limited response to insulin, and tends to correlate with other issues e.g. elevated cholesterol. Type 2 is probably in most cases a metabolic disorder caused by a relative increase of fatty tissue. Obesity correlates, strongly, which makes me wonder if your friend is Type 1, which tends to show up young but can happen at any time.

    Both result in elevated blood sugar, which is why both are called by the same name. This is misleading, as you can and should treat both differently. As relevant to food, I can tell you this: A very dear family member (and that’s what’s motivating this comment) has been Type 1 for as long as she can remember – at least age 5 when she was diagnosed. As a (fabulous) young woman, she eats any goddam thing she wants, and has an insulin pump she programs to fit what she eats. Her A1c (the longer-term blood sugar averages taken quarterly) are consistent with *never* having side effects, per excellent research. Relatively, this is a “simple” syndrome, where it is possible to use insulin dosages via shots or pump to replace what your body should be doing. The hard part – and it’s hard, but do-able – is that you have to use your brain to calculate what the dosage should be. If you start learning to do it when you’re five, and you’re dedicated, by the time you’re a young adult you can eat pizza, and chocolate, and dim sum, and whatever, you know how your body responds and 80% of the time you get it right. It still takes work, and sometimes you’re wrong (illnesses and variations in length of day and things you will never understand throw you off), but it’s possible to manage yourself into and within parameters which are not far off from those applicable to those whose pancreas’ are intact.

    Type 2 is harder and much more common. Some variants have insulin resistance; some have reduced insulin production; some have both; some, I think are not well understood. One name, many causes, I think. Overall, however, Type 2 tends to be caused or at least incredibly strongly correlated with excess fatty tissue, causing metabolic changes. Short term, reduced carbs matter; longer term, loss of weight and *lots of exercise* seem to be often, even, a cure.

    You describe your friend as muscular/athletic/skinny. That sounds like Type 1 to me, as does *skyrocketing* to 500! That is *very* high, and suggests loss of insulin more than resistance or mildly declining production per Type 2. I very much assume/hope he has seen a good endocrinologist and *knows* what his condition is caused by. Diabetes is not one thing, and you *want* to get it right. Lowered carbs and exercise are a great idea for anybody, but if he has Type 1 the bad news is, multiple daily shots or a pump are necessary; the good news is, learn to live with it and aside from the shots and/or pump, and need to use your brain for calculations your pancreas used to do automatically, you can be thoroughly healthy and, when you’ve got that down, eat whatever you want.

    Maybe more than you wanted to know, but it affects someone I love, and she is thriving. He can too, one way or another.

  23. 23
    Bobby Thomson says:

    @MikeJ: That is the antithesis of punk.

  24. 24
    Jeffro says:

    Ditto here – you’re a good egg, Cole

  25. 25
    MikeJ says:

    @Bobby Thomson: Yeah, the early 90s were a field day for irony. It was sort of the point.

  26. 26
    normal liberal says:

    John, you’re mostly on the right track. The olive oil and limited use of other fats combined with carbs help modify the glucose spike induced by the carbs. Generally, the more processed the carb, the less you should use. (Sadly, this limits most bread, white rice, pasta, etc. Your quinoa dish probably didn’t need the orzo, but I understand the impulse, and a little pasta can be a good thing occasionally.)

    The usual advice is to balance protein (especially non-animal sources, like your quinoa, chia, some vegetables,beans and legumes) with your allotment of carbs. Steer away from the starchy, such as potatoes, or use tiny quantities. Spices help, especially turmeric and cinnamon, of all things, both for flavor and possibly for glucose management.

    I also endorse the Ottolenghi cookbooks, of which there are three; Plenty is more complex carb oriented, but all three have lots of interesting things that are or can be made diabetic friendly, and are really good. Any good vegetarian cookbook that focuses on dark and brightly colored veggies (and some fruit) will have recipes you can modify with a little meat or chicken, should you wish. There’s also dairy, but I hate most of it, so I can’t speak to how to incorporate it.

    You’re a good guy to help your friend with this – I can testify that this diagnosis can be a real kick in the teeth. Shawn will have been given some preliminary guidelines, especially if he’s on medication. If he hasn’t yet had the nutritional counseling, that will help him as well.

    Good on you, and best of luck and health to your friend. As Constance said above, this can be successfully managed and improved.

  27. 27
    mainmata says:

    I’m sure diet will be critical but exercise is equally so. I’m not diabetic but have friends who are. BTW, I assume you are getting the snows like we are in the DC area.

  28. 28
    normal liberal says:

    @Michigan J. Frog:
    Mr. Frog’s comments are especially critical, and many others above are giving you good guidance. If it is type I, the dietary stuff is important but secondary to whatever insulin management protocol may have been prescribed. Many type II people can control their condition with diet modification, weight loss and exercise, as several comments above demonstrate.

    It seems that exercise at some level is good for everyone. Who’d have thunk?

  29. 29
    Violet says:

    One of my doctors explained to me that vegetable oils like canola, soy, corn (not olive) raise blood sugar. I’ve eliminated them from my diet but because they’re so widely used I’ll occasionally have some without knowing it. Inevitably I’ll figure it out because almost immediately after eating whatever it is with the oil, I’ll be starving. When that happens, I go looking and sure enough I’ve had something with the vegetable oil.

    Olive oil and coconut oil are fine, as is butter and any animal fats. But any of the vegetable oils cause my blood sugar to spike within minutes and I end up insatiably hungry for about 30 minutes no matter how much I’ve eaten. So I avoid them whenever possible.

    Just thought I’d pass that along in case it might be helpful for your friend.

  30. 30
    Chris T. says:

    It gets complicated, but two easy, big things to pay attention to are “glycemic index” and “glycemic load” (“GI” and “GL” for short).

    Basically there are three kinds of macronutrients: carbs, protein, and fats. And alcohol.

    The FOUR kinds of macronutrients are… (Nobody expects the Spanish Inquisition!)

    Ahem. Where was I? Oh yes. Ignoring alcohol :-) there are carbs, protein, and fats. Everyone knows about protein and fats; carbs are the tricky part.

    Carbs—including starches (but we’ll get to fiber in a moment)—are basically all just sugars, but there are a bunch of different sugar molecules. Fructose (fruit sugar), glucose (blood sugar), sucrose aka dextrose (table sugar), maltose (milk sugar), and so on. Many of them are just a bunch of smaller sugars bonded together: sucrose is just one fructose glued to one glucose, for instance. And starches are just a whole LOT of sugar molecules glued together, into big polymer chains (most starches) or balls (amylose starches, such as those in corn).

    Fiber is a bit trickier, it’s technically a carb but it doesn’t contribute to useful calories. It comes in a couple of forms, called soluble (dissolves in water) and insoluble (doesn’t). Both make for something your digestive system can move around, which is mostly a plus. Soluble fiber tends to bind up cholesterol (which, incidentally, is technically an alcohol, hence the -ol ending).

    Anyway, the glycemic index (GI) of a food is: how much sugar is in it. The glycemic load (GL) is: how fast does it “get in”.

    You need sugar to live: the brain runs off glucose. Normally (in non-diabetics) your body keeps the blood level right at 5 mmol/dl by snarfing up “excess” glucose into liver and muscles, and converting back saved stuff in the liver. In diabetics, something has gone wrong with this management system.

    If the management system works, GL is not that big a deal. GI tells you how much sugar you’ll get, and you just need to get “enough” and you burn it off as you go. If not … GL becomes pretty critical.

    GL is hard to find, and even harder to compute, because it depends. On just about everything: the GL of pasta depends on what you eat with it. Other stuff in general slows down the rate of carb-ingestion. Oils (fats) help a lot, protein helps some. Fiber helps too.

    Our modern obsession with going fat-free works terribly here. Not that one should eat tons of fat (because it’s very calorie-dense), but getting some fats, and getting a good balance of “omega 3” vs “omega 6”, is important. Sugary stuff is fat-free and terrible for you. Potato chips, which are carbs soaked in fat, are better than half the fat-free stuff out there, because they’re carbs soaked in fat: lower GL for the GI. Easier for the blood sugar management system (assuming it still works), plus, you won’t feel so hungry again so soon.

    Just for completeness, though I’m skipping lots of steps here anyway: proteins are basically sugars with an extra nitrogen atom (making an “amine”), and sometimes an extra sulfur (“thio-amine”). When you have extra protein and are in need of glucose, your liver strips out the N (“de-amination”, not to be confused with “deanimation” or killing zombies). The left-over N combines (all on its own) with hydrogen (H) to make NH3, or ammonia. This is toxic, so your liver quickly pastes it together with some carbon and oxygen to make urea, which you filter out via the kidneys.

    Meanwhile, fat is perhaps best described as “sugar with the water squeezed out of it”: if you have excess blood sugar, your liver vacuums it up (under direction of the earlier-mentioned management system). To save space, it then slowly extract H2O out of the sugar, leaving fat, which is packaged up with alcohols (cholesterol compounds) so that it can dissolve in water (blood) and go get stored for later.

    In a pinch, when there’s no food, the fat is sent back around to get burned for energy (many cells can burn fatty acids directly in the aerobic cycle, although neurons demand glucose) and the glycerol backbone is converted to glucose, again in the liver.

    (Alcohol—by which I now mean the ethyl or drinking variety—is a special case. Once again the liver does all the heavy lifting here. It’s a bit complicated but it’s handled kind of similarly to fats, and in fact the competition with fat metabolism is in large part how long-term heavy drinking leads to fatty liver disease. It has 7 food calories per gram, vs the 4 for carbs and protein and 9 for fat.)

  31. 31
    John O says:

    Spent much of my life with my grandfather, a brittle diabetic starting at about age 30. He was diagnosed so long ago that he was always uninsurable, and was one of the first insulin patients out there. Watching diabetic comas and insulin shock became routine by the time I was an adult.

    Anyway, lots of hard core experience both personally and professionally, as a life underwriter, and I can tell you for sure it doesn’t much matter what you eat, drink, or smoke if you’re diabetic, from a pure mortality standpoint that isn’t specific to what you’re eating, drinking, and smoking. IOW, as long as your blood sugar is within normal limits diabetes won’t kill you. Every time your BS is outside of normal limits you’re subtracting time from the end of your life. The key is control, not the fact you have the problem.

    Just sayin’.

  32. 32
    Angela says:

    Just chiming in to say you’re a good friend John Cole.

  33. 33
    Ash Can says:

    OK, I am three sheets to the wind after coming home from celebrating the first of my mother’s 90th-birthday parties (of which there will be several). But, after glancing through the comments and probably missing 98% of what was said, I wonder if anyone has already mentioned any of the following: 1) sauteeing foods in light (i.e., low-flavor) olive oil is damned near as tasty as sauteeing in butter, 2) look up recipes from India, because Indian cuisine obtains a unique and lush flavor, for any kind of meat or vegetable, by toasting the spices in oil first (and, once again, light olive oil can do the trick, so think of that as an alternative to the dairy fat that Indian recipes tend to make shameless use of) and then frying/simmering the other ingredients in the toasted spices, and 3) canned anchovies, fish sauce, or anchovy paste, when cooked into other foods, can add a surprisingly satisfying meat-like flavor to the other ingredients.

    If any of those suggestions are at all helpful to a diabetic-friendly cuisine, then the graphic torture, mutilation, and death of the run-on-sentence rules illustrated by the above paragraph will not have been in vain.

  34. 34
    John Cole says:

    Basic info, and he knows I am posting this, because he wants the help, he is type 2, 44, on metformin, has complete insurance through the VA, and on dietary restrictions but has not yet seen a nutritionist, which I find criminally appalling. We are making some calls tomorrow. Also, he’s a kind of tough guy, spent a decade as a cav scout and did a lot of overseas service, then got out and did force protection as a private contractor for about eight years in our glorious wars of the 80’s because the money was so disgustingly good. I’m recommending (and going to demand tomorrow when we call the VA) that along with a nutritionist, he see a therapist, because a diagnosis like this is a dick punch to someone like him. I know for a fact he’d rather nurse a wound than deal with this crap.

  35. 35
    karen marie says:

    @Diana: Perhaps what he hates about it is having to cook. For someone who is not a cook, having to spend the mental energy required to create multiple “healthful meals” day after day is exhausting. The endlessly repeating questions: “oh, shit, what am I going to eat today?” and “oh, shit, do I have to eat that again?”

  36. 36
    Chris T. says:

    @John Cole: If it helps him (and it should), what he has is quite possibly a sort of wound. The regulation system I mentioned (in the very long comment) uses a bunch of parts but one critical part is the insulation secreting “beta cells” in the pancreas. In type-2s, those are either not putting out enough insulin (too many killed off, or they’re not functioning right), or the insulin they’re putting out is not affecting liver and muscles enough anymore.

    Metformin somehow (the mechanism is, as they say, “not well understood”) makes the liver do its job in spite of various insulin issues.

    Unfortunately, wounded beta-cells in the pancreas usually don’t “heal”, so it’s a wound you have to manage for the rest of your life. But it’s just as real as having a big old hole in your leg.

  37. 37
    John O says:

    @John Cole:

    Well, it’s up to you, but I would tell him straight up were he to me what he seems to be to you: Uncontrolled diabetes = very short life, Controlled diabetes = normal life.

    If I’m reading you right, this guy’s problem is going to be the discipline required to accept he has it, and to do what is necessary to control it.

    And I’m not kidding, if he controls his blood sugar (i.e., keeps it consistently around 100, and his glycohemoglobin–HgBA1C, IIRC–around 6) he can have all the dessert, beer, and steak and potatoes he wants. All that stuff does is make the disease harder to control, but not impossible.

  38. 38
    Chris T. says:

    @John O: The “A1C” is basically just a way to see what the long term average blood sugar level has been. (It works by making use of the fact that free blood glucose slowly modifies red blood cells, “glycating” the hemoglobin. More blood sugar = more changes to the hemoglobin, less = less. It takes long enough, and red blood cells are recycled slowly enough, that measuring A1C is a good way to see what the ~3 month average glucose level has been.)

    In short, manage “instantaneous” blood sugar and you’ll manage A1C automatically.

  39. 39
    Ash Can says:

    Does he like hot peppers? They can make a world of difference, flavor-wise, in any number of dishes.

  40. 40
    John O says:

    @Chris T.:

    I know. Read APS’s for 15 years of my adult life, tried to figure out how long you were going to live by reading them, along with your blood test, ECG’s, stress tests, etc., and then tried to put a price on it. Got pretty good at it.

    Kinda specialized in DM due to the family history. My grandfather was a diabetic freak of nature, and a lifelong Life Underwriter himself. Knew more about DM than most endocrinologists. :-)

  41. 41
    Luna Sea says:

    I know from experience this diagnosis can seem overwhelming. What works and doesn’t for keeping the numbers in a decent range can be frustrating, and varies for each individual, but you do get the hang of it. Aside from the technical side, the hardest thing for me was not feeling like I’d failed if my numbers went up. I have a great endocrinologist, and she’s taught me to just go with it, it’s a long term management thing, which is why the a1c results tend to be more helpful than any one stick of the needle. Sometimes stress or even catching a cold sends the numbers up, so it’s not always something you’ve done wrong. It’s really more like a dialogue you learn to have with your body.

    So, hang in there. Get a good team together, including a good endo, and after a while, finding good food becomes a joy again, not a chore.

    Good luck.

  42. 42
    John O says:

    A tip based on experience, and part of what makes it a bitch:

    Wake up at the same time every day, take blood sugar, record.

    Eat breakfast roughly the same meal every day at the same time every day. (Doesn’t matter what if you follow this ritual.)

    Take blood sugar before lunch. Record. Again, eat whatever you want, as long as it’s at the same time, and roughly the same carb/sugar load.

    Adjust meds as necessary. All Rx doses should be recorded as well.

    Eat roughly the same dinner every night, at the same time.

    Check blood sugar before bedtime, which should be, you guessed it, about the same time every night, and adjust meds accordingly based on BS results. Get A1C done every 3 months, if you’re over 6.5 you’re dropping the ball in one aspect or another of the ritual.

    It’s an awful lot of work to live a normal life with DM. Good luck to your pal, John.

  43. 43
    noabsolutes says:

    you’re a great friend. kudos.

  44. 44
    Violet says:

    Also wanted to add that the typical diabetic way of eating doesn’t work all that well for me. The multiple small meals per day isn’t nearly as effective for me in keeping my blood sugar stable (and yes, I’ve tested via glucose monitor and finger sticks) as it’s supposed to be.

    What’s worked for me in keeping my blood sugar stable is giving up gluten. I know gluten-free is all trendy and annoying, but it’s been a long process for me in figuring out that I have some kind of sensitivity (including a genetic marker for celiac, although I don’t test positive for celiac). I know I’m not alone in having a gluten sensitivity and feeling better once I’ve given it up.

    Gluten spikes my blood sugar, as do the vegetable fats I mentioned above. Those two are just as bad for me as sugar–and yes I’ve tested it via glucose monitor. Going gluten free is not that easy to get your head around initially, and it’s probably not the place your friend wants to start, but it might be something to keep in mind if he’s having trouble sticking to the dietary guidelines or they’re not working for him, or he’s always hungry despite following the dietary directives (this was part of my problem).

    All of us are different and dietary guidelines are just that–guidelines. We all have to find what works for us as individuals.

  45. 45
    Weasel says:

    @Chris T.: Wow, chemistry (plus the even geekier references) FTW!

  46. 46
    ACT says:

    Diabetic education is a must asap. When I was first diagnosed I was sent to Diabetic education at the local hospital. I also went to B&N and spent a $100.00 dollalars on books(pre computer days), bought a food scale and kept a food diary. With in a month my BS went from 400 to falling below normal and I was taken off the medication.
    I changed my diet to eating little meat,brown rice ,whole wheat pasta(2oz dry weight),beans, and lots of vegatables. Always used olive oil. Little processed foods. I cheat but not too much. Blindness or losing a leg are not worth it.
    Portion size is key, all thing in moderation is best. When people think they are being deprived they have a tendency to not follow any diet.
    Tell your friend he is not alone and he will adjust. Just take it one day at a time. You are a good man JC. PS I bought two calendars as two of my babies were in it.

  47. 47
    Weasel says:

    Oh and by the way, though I’ve never been a Republican, you continue to inspire me by your example Mr. Cole. I strive to treat my friends and my pets (but I repeat myself) as well as you do yours. Please keep on keeping on (and I’m looking forward to future reports on how Shawn is doing if that isn’t too much of an invasion into his personal space). This comment thread has been a great example of what a wonderful community you, and your co-bloggers, have created here.

  48. 48
    Mnemosyne says:

    @Michigan J. Frog:

    I’ve sometimes seen late-onset type 1 diabetes referred to as Type 1.5 or LADA (latent autoimmune diabetes in adults). Doctors kept having a certain percentage of adult diabetes patients who did not respond to the usual Type 2 treatments, and they eventually figured out that “juvenile diabetes” can occur after age 35, too.

  49. 49
    Mnemosyne says:

    @John Cole:

    If your friend’s diabetes is out of control despite the medication, his doctor needs to check to make sure he’s not really Type 1.5/LADA (see link above) instead of Type 2. It’s a fairly recent discovery, so VA doctors might not know to look for it.

  50. 50
    billgerat says:

    There’s been a lot of good advice being given in here. I’ve been Type 2 for 13 years now, and when I was first diagnosed my blood sugar was somewhere near a 1000 (!). My A1C’s have been lousy for a long time – old eating habits are hard to break. I do limit my sugar intake quite a bit – no more chocolate, soda pop, and other junk foods, but I still have a weakness for breads and pastas. Actually, I should be taking a lot of the advice given in this thread. My diet would certainly be better for it. My biggest problem is I’m not much of a cook, so I don’t make a lot of more complicated recipes that would be better (and tastier) to eat. If anything I should be on an insulin pump, but my doc says no and to do better on my diet instead.

    And exercise is very good for diabetics. Now if I could only get my fat ass off the couch….

  51. 51
    Trinity says:

    John, you are really a great friend. I send good vibes and good luck to you both.

  52. 52
    Betsy says:

    I can vouch for Violet’s suggestion of anchovy paste. A tiny squeeze from the tube adds an incredibly powerful “EAT ME” savor to any main dish, without imparting fish flavor. Try it in chili, or soup … a little dab’ll do ya.

  53. 53
    wormtown says:

    maybe he should move in with you for a while?

  54. 54
    Sourmash says:

    I’ve found learning as much as you can about the disease, to the pont where you can explain it clearly to novices, with molecular diagrams and chemical formulae is a huge help for some people. You say he was force protection and the FP guys I’ve worked with all and I mean ALL like to have a strong sense they are in control even in highly chaotic situations. It might help were he to study up on this stuff like he’s a post-doc candidate and REALLY get to know his stuff, to the point where he can diagram the digestive system, describe and draw its components, explain their function etc etc. being able to visualize what is going on is usually a big help for the hard cases I know. Plus it lets you have much more detailed and sophisticated discussions with your doc. He might even be able to teach the doc a thing or two after a while. Good luck.

  55. 55
    GHayduke (formerly lojasmo) says:

    When meat is digested, and the aminos broken down, it ends up being about a 50% carbohydrate product.

    Quinoa, while high in protein, is also VERY high in carbohydrates. The Orzo was not necessary.

  56. 56
    Scratch says:

    @John Cole:

    I’m a type 1 diabetic and thanks to participating in various diabetes forums, one thing that has become clear over the years is that there is a sort of lag in the medical establishments understanding of diabetes. It’s getting better, but there are still a lot of doctors who automatically assume that because a new diabetic is an adult, it must be type 2. But there is nothing that precludes a person from developing type 1 diabetes as an adult, or another type which is called type 1.5 or LADA. The critical thing in the case of a diabetic presenting without being obese is to do tests for islet cell antibodies and GAD antibodies so as to test for an autoimmune attack upon the beta cells mass in the pancreas. If there is an autoimmune attack and your friend’s beta cell mass is being slowly annihilated, then using medications for type 2 diabetics such as metformin will not be too helpful, and in the case of medications which stimulate insulin cells to produce more insulin, those may only serve to accelerate the autoimmune attack upon the beta cells.

    It is likely very important that your friend try to get referred to an endocrinologist and get tested. There are skinny type 2 diabetics and there is another variation of diabetes as MODY, but a correct diagnosis is critical to developing a good and reasonable course of treatment.

    On one message board in particular, we saw numbers of cases over the years of normal weight adults being diagnosed with type 2, but who could not get good control through diet alone and type 2 medications. They would end up being diagnosed with type 1 or 1.5 and in most of those cases, earlier testing for GAD antibodies and islet cell antibodies could have saved them a lot of grief and time.

  57. 57
    zzyzx says:

    The main problem is that we’re all different. I can have ice cream and candy and fruit in small amounts as long as I work out every day, but if I even look at rice bad things happen. Others can’t eat as much as 2 grapes without seeing a huge spike. Especially starting out, you have to be uber conservative and constantly test after every meal to see what your own danger areas are.

  58. 58
    Scratch says:

    And oh yeah, tested for c-peptide levels. That helps to diagnose, because if he is in fact producing large amounts of insulin in his pancreas, then the autoimmune attack can be ruled out and he’s developed insulin resistance which is the best defining feature of type 2 diabetes that we know of.

  59. 59
    zzyzx says:

    Also know that it takes a few weeks for the metformin to kick in so don’t expect any results from that soon.

    I highly recommend this blog for starting out: http://lizzysdlounge.com/2012/03/14/testing-101/

    This guy is a tad more fanatical but also is a useful read: http://loraldiabetes.blogspot.com/

    I started there and at community.diabetes.org and learned enough to go from an 8 to a 5.2.

  60. 60
    debbie says:

    Here’s a lentil and quinoa chili recipe that can be messed with:

    http://www.ambitiouskitchen.co.....uten-free/

  61. 61
    currants says:

    @Weasel: Yes, yes, and YES. Me too.

  62. 62
    currants says:

    Here’s a good salad recipe–you can make enough to have it for lunch a couple days in a row. Lots of ‘good for you’ in here–avocado and jicama especially in this context, but mostly delicious. Proportions: I don’t know–a handful of everything. Depends on how much you want to make. It should look pretty when it’s done–in other words, evenly distributed colors.

    Grape tomatoes – quartered if big, halved if smaller
    Black beans (if canned, low sodium; if dried, soaked overnight and simmered til tender)
    Avocado, cubed (one or two depending on how much you want!)
    Jicama peeled and cubed to a similar size as the black beans
    Cooked Corn (Optional–I add it when it’s in season and we have leftovers, otherwise, no need)
    Chopped scallions or red onion

    Toss together (also good with diced bell pepper or jalapeño)

    Vinaigrette with lime juice, olive oil, cilantro, salt and pepper

  63. 63
    currants says:

    Jicama is reportedly very diabetic friendly. (Not diabetic, but have 4 family members who are so I figure it’s smart to be careful)
    More to the point, it’s delicious, easy to use, and adaptable to quite a variety of dishes.

  64. 64
    mai naem says:

    Two things – first, the more under control your buddy has of his diabetes now, the easier it will be to control later. It’s a vicious cycle – you kill your beta cells the more out of control you are which makes it harder to control and makes it more likely he’ll have of going on insulin. Second, have his doc send him to diabetic education classes – not the stupid little 1-2 hr class but the one where you have to go several times. I personally think people should take the classes every 2-3 yrs as a refresher. They’ll cover diet and stuff beyond diet. BTW – The A1c is the real number you have to go by. The glucometer readings are just a snapshot.

  65. 65
    Dave says:

    John, since he’s a type 2 he could explore a ketogenic diet. Ketosis is not, repeat NOT keto-acidosis. Ketosis is a condition where your body switches over to primarily burning fat for fuel. This works very well at controlling blood glucose levels but you do need to change your attitude about fats, especially saturated fats. Research low carb, high fat, moderate protein.
    Since he is controlled with Metformin he doesn’t need to worry about getting too low as metformin works by making for bodies own insulin work better (reducing cells insulin resistance).

  66. 66
    celiadexter says:

    I’ve been a Type 1, diagnosed as an adult, for 30-some years, use an insulin pump and am on an extremely low-carb diet because I’m normal weight and trying to stay that way. I suspect that since your friend isn’t taking insulin he may want to do something similar — which would mean no grains, no fruits, no starchy vegetables, no beans/lentils but lots of greens, fish, meat, cheese, nuts and (dry) wine. Basically Atkins without the really greasy stuff. Many foods that are great and healthy for a non-diabetic just don’t work if you’re seriously restricting carbs. But every diabetic is different so he’s going to have to go through lots of trial and error before he finds out what works for him. And the more exercise the better, which doesn’t sound as though it will be a problem for him. If he does end up taking insulin I’d be happy to talk to him. Diabetes is a real challenge to NOT have it control your life.

  67. 67
    maya says:

    Shawn is a vet, right? I would assume he’s enrolled in the VA healthcare system. If not, he should be. They are pretty good at helping, as in setting obtainable standards on an individual basis, manage and lessen diabetes related issues.
    I’m a Type II diabetic and with me weight has been the key element. After diagnosis in 2005, I went from 269 lbs down to 216 in a matter of a few months – Modified Atkins – low carbs without the fatty shit, like pork rinds that I would never eat in the first place. Went from 7+ down to 5.2 AC1. Some of that weight came back on but I’ve been dealing with it again and now down to 208 and a 6.3 AC1.

    The VA can put Shawn in contact, either in person, or if not possible, telephone contact with a nutritionist who can outline a dietary plan for him to implement himself. I gather his main problem has been a diet of fast food take-outs and has no cooking skills himself? If so, you are doing a great job of at least showing him how to survive in the wilds of the kitchen. Good on you.

    I’m a fairly active person so I get a lot of outdoor exercise every day. Being a diabetic meant nothing more than taking my Metformin twice daily and being reasonable with eating habits. However, over the past 2 years I incurred an infection -Cellulitis – twice, which is some really bad shit if not treated with anti-biotics. First time being a diabetic with a diminished immune system really hit home. Got to watch out for the extremities – hands and feet – keep them all clean and watch for cuts and bruises. Diabetics take longer in the healing process than non-diabetics and that can lead to big problems – as in amputations.

    Again, I would stronly suggest that Shawn should avail himself of everything the VA has to offer. They’ve been pretty good to me.

  68. 68
    Steve S says:

    Please tell me about the verb To McMegan. What does it mean?

  69. 69
    GRANDPA john says:

    @billgerat:If you are already insulin dependantI can’t imagine why your doc woould be against the pump.Its the best thing that happened to me. My A1C went from 7.8 to 6.0 after moving from pills and insulin injections to the pump, plus it is not as messy not having to fool with syringes. I change infusion set and insulin reservoir every 3 days. Takes less than 5 min. and its all covered with part B medicare, including the insulin. no co-pays

  70. 70
    GRANDPA john says:

    @mai naem: Being on the pump, the main purpose of glucose readings is to help determine how many units of insulin to set on the pump.To use a pump you also have to learn how to count carbs. You get a book with the pump that helps you with this and even gives you carb counts for most of the major fast food and resturant chains you also need to read labels.

  71. 71
    David Rickard says:

    Probably lots of posts covering this already, but…
    <a href="http://www.diabetes.org/mfa-re.....ere's a recipe collection from the American Diabetes Association; you can get diet plans from the Mayo Clinic and ADA

  72. 72
    StringOnAStick says:

    Being resistant to accepting that he has a disease now that is life-long thing may be an issue for him, and since Type 2’s often don’t feel that bad initially, they can be bad about taking care of themselves. I have a BIL who stated that he “felt better” when his blood glucose was at about 200, when it should actually be between 80 and 120. By sticking with 200 as his goal, he is now a 55 year old looking at dialysis, which is a whole lot more limiting to lifestyle than having to learn how to cook and to avoid fast food. Poorly controlled diabetes causes problems in any part of the body that involves fine blood vessels, like kidneys, eyeballs, liver, wound healing, etc. It will kill you by inches if you don’t take control.

    I’d like to reinforce comments others have made here; diabetes is very much an individual disease, so each person has to learn what works for them and what doesn’t. Some people are brittle, some have it much easier. The new info about Type 1.5 is important too, since your friend was skinny when he was diagnosed, this may be what he really is. Also, limiting carbs, complex or not, is huge for every diabetic I know. That means that pasta is out, even whole wheat (whole wheat bread has a higher glycemic index than white bread!), beans are high carb too as are all grains. He can get all the carbs he “needs” from vegetables (carbs are the one nutrient group that humans can live just fine without; this is not true of protein or fat). Lean meats and vegetables (no corn or white potatoes) need to be his new buddies. The easiest thing for him to follow, and he might like the community too, is the paleo diet; since a lot of the crossfit folks are in that group, it might appeal to him because of their gung-ho exercise attitudes. It is an easy way to cook, and I have never missed cutting out grains or beans. After 1.5 years, I tasted a piece of scone last week – it tasted like sawdust to me and was certainly not worth the headaches wheat gives me. Paleo is also an easy way to lose a lot of weight if you are interested, and there are lots of websites with recipes for paleo. A few good recipes sites are nomnompaleo, civilizedcavemancooking, and for basic paleo info can’t beat marksdailyapple; all are dot commies.

    How about some cooking lessons while he is staying with you, like quick ways to whip up chicken breasts or grill a bit of meat/fish? Steamed veggies may sound yucky until you realize that by cutting carbs you can replace the calories with a pat of butter or a drizzle of olive oil for seasoning. Teaching an adult to cook who is just not that interested is tough, however, his ability to live a healthy life depends entirely on him doing so. My dad was sloppy with his glucose control until he started having bleeding inside his eyes and nearly went blind; that finally got his attention.

  73. 73
    David Rickard says:

    Dangnabbit… embedded URL got munged; here’s the recipes link: http://www.diabetes.org/mfa-recipes/recipes/

  74. 74
    zzyzx says:

    @StringOnAStick: I’m definitely one of the less brittle people (so far… knock on wood). I just got back my new A1C and it was 5.4, despite eating 180-200g of carbs on many days. Of course that also is done because I exercise every day. If I start slacking, I have to either cut back the carbs or take meds. For now I’m just going to try to have my 45 minutes of annoyance in exchange for making the rest of my day better.

  75. 75
    Lyrebird says:

    I’m late and this may not appeal at all, but there’s good research on doing a Dr. Ornish-style low-fat veg approach… result being A1C reduction without changing exercise or portion control.

    Some research summarized here:
    http://www.pcrm.org/pdfs/healt.....uccess.pdf

    More here:
    http://pcrm.org/health/diabete.....r-diabetes

    FWIW, I have gone from pre-diabetic w/many symptoms to just-needs-a-snack by following about 80% of this. I like the no medicine and no measuring bit… others might not like the no BBQ bit…

  76. 76
    Original Lee says:

    Thank you, John, for this thread, and to all the other commenters with their excellent advice. I was diagnosed this week with Type 2 and am finding it very frustrating. I am about 50 pounds overweight and my A1c was 13, so the first thing my endocrinologist did was to put me on a 1500 cal/day, 150 carbs/day diet. I am also on metformin. I am currently charting my blood glucose levels 6 times a day.

    So I know that I’ve started a journey into a whole new territory – that’s not the frustrating part. It’s all the little pieces of being a diabetic. It’s the nurse showing me how to use my kit, and picking up my scrips, and finding out when I get home and actually try to use my kit that the nurse called in the wrong kind of lancets. I couldn’t return them because they are medical devices, so I had to buy a lancet device that matched the lancets. Then I used a whole month’s worth of test strips trying to get readings and all my fingers are covered in bruises because the starter strips are different than the ones the nurse called in for me, so I kept getting “sample too small” errors.

    Fortunately, the kit manufacturer has a “new customer” number and a very nice woman at the other end of the phone has been able to talk me through a lot of this learning curve. And also fortunately, I started using Fitbit last month, and they have a really good food log feature that lets me track cals, carbs, fat, protein, etc. (including running totals and running percentages). Otherwise, I don’t know if I would be starting to feel as if I am getting a handle on the mechanics at all!

    So all of this information y’all have so generously shared is really very helpful to me and is making me feel more optimistic. Thanks again!

  77. 77
    Binky Bear says:

    @John Cole: By the same token he should have the discipline to be able to adjust to the new reality and make it work because it has to. I went from “uncontrolled” to “well controlled” in a year, but had to spend a lot more on food (Alaska is built on canned, preserved, fat soaked carbs and fresh food is very rare outside Anchorage and Fairbanks).

    Good man for helping out.

  78. 78
    LongHairedWeirdo says:

    @NotMax: Lots of shitty advice too. I saw one healthy snack for diabetics. Fruit smoothies! Yeah, pulverize more sugar than you can safely consume but since it’s mixed in plant matter, it *must* be okay, because it just fucking must be or a lot of nutritionists will look like a bunch of dumbasses.

    Oh, right. They do.

    Low carb is not the be all and end all, but in acute situations, that’s what is known to help. Your liver (and other organs, but the liver mostly) decides how high your blood sugar needs to be and tries to maintain that. If you eat, and you include carbohydrates (except insoluble fiber – no known effect – or soluble fiber – very minor effect), you will raise your blood sugar as the carbohydrates get turned into glucose. How fast your body can convert that to glycogen and fat determines how fast your blood sugar goes back to that level the liver’s trying to maintain.

    Too much sugar – even if it comes from the healthiest of fruits – will raise your blood sugar too high and cause some damage.

    Of course, that’s not to say all of the advice is bad, nor even most of it is. But some of them don’t get it. They’ll say “have one egg and a slice of whole wheat toast, a piece of fruit, and turkey bacon for breakfast”. You might find that you prefer two eggs and bacon-bacon, and forget the toast and fruit and you might end up healthier and happier than the person sucking down the extra carbs.

    Or you might go low carb and not pick up enough plant matter with good nutrition profiles and end up less healthy.

    The important thing is to control carbohydrate intake acutely (never too many carbohydrates at once) and finding a good set of healthy foods that you enjoy eating. And maybe that’ll be a lot of beans and whole grains for you, while I’ll do more fish and cruciferous veggies, the specifics don’t matter once the generalities are met.

    But be cynical. There are so many people who tout nonfat milk over whole milk – but nonfat has more sugar, and whole milk has enough fat to potentially slow down the sugar breakdown. What’s best? Whatever the hell you find works for you, by taste and by testing your blood sugar 1, 2, and 3 hours after eating, until you know your body’s reactions.

  79. 79
    LongHairedWeirdo says:

    @John Cole:

    It is a dick punch, and a dirty, shitty trick for a body to play on a person. But it’s also not his fault. Sometimes it just happens. Some people have their beta cells try to divide, and instead of dividing, they just die. People insist that being fat makes you diabetic, but the first symptom of out of control blood sugar is weight gain, it’s just as likely that starting to turn diabetic makes you fat. Genetics plays a strong role in this whole thing, too. It’s a shitty hand to get dealt, a shitty thing to have happen.

    It is, however, a reality. It’s one of those things that you *can not forget about*. Because it *will* kill you. And it will kill you in an exceptionally shitty manner. It’s an enemy that can be dealt with, once you learn it’s ways, but you do have to learn its ways, and learn how *you* can fight it.

    Me? My sugar isn’t under control. I won’t eat pizza any more, for the most part. Because I want it too much; because I want to bake a Papa Murphy’s and have a couple-three slices for supper, and snack on leftovers the rest of the night if I want to, and I can’t, and *for me*, saying “I can have 2 slices, maybe three if they’re all kinda skinny” just doesn’t work. It reminds me of what I *can’t* have. See, that’s the kind of thing you have to learn… he may decide he’s good with having some pizza, and then waiting an hour and going out for a run to burn the glucose as it converts. And he may find his body can handle both the exercise and the extra sugar when coupled with the exercise, and if that works for him, *great*, that’s a great answer, I wish I could do it. (I have a hard time with vigorous exercise for other reasons – and it takes vigorous exercise if you really want to burn sugar.)

    But what you need are facts – you need to know your body, recognize when it’s changing, and *never ever* put up with *any* bullshit from yourself, because if you start bullshitting yourself, you’ve started killing yourself. Yeah, you’re only killing yourself slowly, but that’s how diabetes usually kills you – slowly, and in an exceptionally shitty manner.

    First step has to be a blood sugar test kit – you need that knowledge. The rule the doctors push for now is you want blood sugar under 140 (milligrams per deciliter) two hours after eating. But you also need to check 3 hours, especially if you’ve had beans or pizza or other slow acting carbohydrates. If you can start to get to that, your body will be in pretty good shape, and you’ll miss most of the biggest, nastiest complications.

    If you can’t get to that – lower is still better than higher. 170 is another critical point – that’s where I believe the glucose starts to poison your beta cells (the cells that produce insulin). Getting back to 170 after eating isn’t *enough* but it’s better than not.

  80. 80
    Paul in KY says:

    He has to stay away from potatos, white rice, corn in any form & white bread.

    Good luck.

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