by David Marrero
From the Editor: Whether we are trying to avoid diabetes or live with its consequences, one of the harsh realities is that we have to decide what goes in our mouths and in what quantity. Food isn't something we can swear off like alcohol or addictive drugs. Even though we remove ourselves from the places where food is found, no matter how much willpower we have, the constant press of temptation will sometimes overcome our best defenses.
In the article below the author points out that occasionally we will succumb to temptation and suggests a strategy for figuring out a way to deal with it. Dr. David Marrero is associate editor of Diabetes Forecast. This article appeared in the January 2009 issue. Here is what he says:
Thirty years ago, after my diagnosis of diabetes, I found myself confronting the many rules about diet: in other words, what I should and should not eat. Back then the rules were fairly rigid, and the exchange list was the norm. One thing was clear: sweets were not on the list, yet I had a very developed sweet tooth. As a result I often struggled with my desire for foods that I loved yet thought were bad for me. Naturally I did stray on occasion and paid the price of too high blood glucose.
Luckily modern thinking about the diabetic diet is much less rigid and more flexible about incorporating a wide variety of foods. But some things are still the same. My previous experiences did teach me that, while I could be pretty good about following a healthy diet, I couldn’t do so all of the time. This led me to learn about ways to adjust my insulin, and I quickly found that I could take enough bolus insulin to minimize the impact of various foods on my glucose. From these experiments I learned two things. First, if I miscalculated my insulin adjustment, my blood glucose would run too high, which in turn would be reflected in an elevated A1C, not good. Second, if I successfully covered a large calorie load too often, I gained weight, also not good.
After some experimentation (and recognizing that I was likely to give in to temptation) I created the “three-to-one” rule: Every time I indulge in a food that is rich and high-calorie, I have to follow with three meals that are more modest in calories. I treat my indulgences as units and adjust them to fit the situation. Thus I might follow one nonstandard meal with three predictable ones; one day of indulgence with three days of more sensible eating; or even one weekend with six days of eating in a predictable fashion. I still carefully adjust my insulin and test frequently to see how accurate I am in selecting the correct dose.
How effective is this strategy? I find that, if I follow the three-to-one plan carefully, I have a good A1C while maintaining my weight. I feel much less guilty about the occasional indulgence knowing that I will balance it out. Oh, and why three-to-one? Through experimentation I have found that this is the ratio that seems to work best for me. You may find that a different ratio is more effective for you. What is essential is to pay attention to all the adjustments you try and then use self-monitoring to determine their effectiveness.
Let’s face it, diabetes is not a game of perfection; it’s a game of averages. Your blood glucose is not always going to be perfect. This does not mean that you should throw caution to the wind. The key is to adopt a lifestyle that you personally can live with while maintaining the best possible health. For me the three-to-one rule lets me enjoy myself, while ensuring that I keep in good health.