Welcome back to our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1 and diabetes author Wil Dubois in New Mexico. Here, you can ask all the burning practical questions you may not want to ask your doctor. With Christmas just around the corner, Wil's offering some insight this weekend about navigating this food-centric holiday with diabetes.

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Brandon, type 1 from Arizona, writes:So it’s that time of the year again. The big family holiday carb feast is on the near horizon, and it’s always a BG disaster for me. No matter what I try, it’s a near-DKA fest. It seems to me my options are to low carb it, live like there’s no tomorrow and throw insulin at it, or attempt something in the middle. What say you, Master Wil? How do you approach big celebratory meals? 

Wil@Ask D’Mine answers: Like you, Brandon, I’ve tried all three approaches. And I’ve fallen flat on my face using each one. But, luckily for you, from that prone position on the floor, I’ve had time to analyze my failures, and I’ve unlocked some secrets that will maximize your chances of success with each of these three approaches to surviving holiday meals.

So let’s look at all three survival strategies, the hidden pitfalls of each, and some ideas on how to overcome them.

 

Low Carb It!

Big, heaping, steaming plates of protein. Heavy on the salads and veggies. No bread, please. Pretend you’re allergic to desert. This approach should work, but it often doesn’t. Why? Several reasons. First off, it takes an iron will, and maybe a supportive family—both of which are in short supply nowadays. But even dedicated D-peeps with both on their side still sometimes suffer holiday meal spikes.

WTF?

Image: TeePublic.com

Does the smell of pecan pie raise blood sugar? Are there carb fumes in the air? Sometimes I think so, but the truth is that food isn’t the only thing that raises blood sugar. Stress can carry a wallop as large as confetti fudge.

Any stress at a typical large family gathering? 

And don’t forget that in addition to the stress of tolerating that annoying uncle or your brother’s twit-brained wife, simply concentrating so heavily on resisting culinary temptations is stress inducing itself. Plus your inner cave person is in fight or flight mode in the presence of that plate of holiday cookies, but you can neither flee nor engage in sugar-burning combat with a cookie—so your sugar spikes. And, of course, if you’ve traveled any distance at all to this gathering, you need to consider the on blood sugar. What can you do? As many of these stresses are constant, low-grade, and ever-present at the holiday gathering, I’d suggest some extra basal to combat it. 

But you probably knew all that. So what’s the secret I promised? The volume trap. Another factor at play with people trying to limit holiday feasting to low carb options is that they tend to eat waaaaaay more of those low carb portions than they might at a run-of-the-mill meal; and it’s important to remember that low carb foods are just that. Low carb. Not no carb. Veggies have carbs that need to be counted. Even meats have some carb. It’s slight enough that we can safely ignore the carbs when eating typical palm-sized portions, but if you are feasting, you’re going to need some insulin to process the conveyer belt of food rolling into your mouth. 

 

Isu-nami!

Why not just bolus the bastard? Eat everything in sight and cover it with enough insulin? Yes, a tidal wave of insulin should wipe all the carbs off the beach, right?

This is one of those things that works on paper, but doesn’t play out as well as you’d expect in the real world. Part of the secret is that most of us are too chicken to take the amount of insulin this approach truly requires. The number of units required just sounds too scary. We aren’t used to taking high volumes and the spector of the Hypo Reaper causes us to hold back.

And that’s just the start.

To make this approach work, you need to be a carb counting wizard, including making allowances for fiber as well as counting trace carbs in veggies. And you need to carb count each round of eating and intentionally stack the insulin. On some pumps, if you use a pump, you may have to override the insulin on board software to do this. If you’re using a pen and an app like RapidCalc you’ll need to ignore the “suggested dose” window that you usually use, and read the fine print that shows the meal and correction adjustment to determine the non-adjusted dose for the carbs. 

And that’s not all. It’s winter, and insulin doesn’t work as well in winter as it does at other times of the year because our bodies are more insulin resistant. This effect increases with volume. Just making up some numbers here so that you get the point, let’s say that you’re 10% more insulin resistant. If you were taking three units using your normal IC ratio and undershot by 10% you’d be 3/10th of a unit short of the insulin you needed for the meal. No big deal. But now let’s say you need 20 units to cover a feast. Now you’re a full two units short of what you need. Just from seasonal insulin resistance alone. Between fear of high doses, and the fact the doses don’t work “right” this time of year, you can see how it’s easy to think you’re bolusing with abandon, when in fact you’re under-bolusing.

But here’s the real secret: If you’re eating like King Henry the Eighth, you need to king-size your basal insulin, too. PWDs tend to think of our basal needs as a fixed quantity, but that’s not true. Basal should be about half of the insulin your body is using. If you’ve jacked your fast-acting through the roof, you need more basal to match it. Ideally, you want an increase of basal going into the feast, and over the night following it as well.

Still, even with heavy insulin use, it seems our insulins are poorly matched for such a huge digestion equation, so I recommend frequent follow up corrections in the hours following the meal.

So it’s more work than you’d think, but it’s a whole lot of fun to be able to eat everything in sight, and it reduces the stress that’s part of the low carb approach. For what’s it’s worth, despite all the problems with it, the Isunami has been my historic go-to approach, but this year, I’m…

 

Standing in the Middle of the Road

The last approach to the holiday meals is to lightly sample all that is offered. To not go crazy, but not do without anything either. In other words, to engage in pure and unadulterated moderation. 

As I said, this is the approach to the holidays that I’m using this year, but not so much because I like it, or that I’m good at it, but because somehow—mysteriously—I’ve become quite fat this year. Apparently, it’s from eating and drinking too much. Who knew? Oh… that’s right: Everybody.

Anyway, my weight gain hit home when I was invited to a swanky holiday party and discovered that none of my dress shirts would button over my belly. (This is the danger of mainly wearing T-shirts. They stretch with increasing weight and if you avoid mirrors, you’ll never know what’s happening.) So I’m mainly eating light portions to try to reverse my waistline, but it’s also a legitimate way to control blood sugar at holiday gatherings.

Like the abstinence approach we started with, this technique takes some will power (or in my case Wil power). Actually, many people find that it takes more will power than the low carb route because of the addictive nature of carbs. Small bites of things that melt in your mouth can leave you panting for more like Pavlov’s dog. But the upside is that you get at least a taste of all that’s being offered, and even though some resistance to seconds is needed, I personally find it less stressful than the low carb approach.

The secret here is psychological. Having a tool to keep you from falling completely off the carb wagon. What I find works best is to pretend that I’m eating a good old-fashioned TV dinner. There are no seconds, much less thirds. I only have what came served on the aluminum tray.

And extending that analogy further—the dessert? Whatever you choose, it has to fit in that tiny square at the top center of the tray.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.