Your Mileage May Vary

YMMV.

That particular acronym, standing for Your Mileage May Vary, is all too common on the insulin-pumpers’ website.

It applies to those of us with any chronic disease, and one of the main problems with “evidence-based” medicine is that it tends to rely on how the “average patient” reacts. There is no such animal as an “average patient.”

I had first-hand experience of this when a doctor, pre-pump, tried to put me on what he called a sliding scale of insulin, and gave it also to nurses in the local hospital. They insisted on using his scale when I was in the hospital for something else. I looked at the dose of insulin they insisted was necessary when my blood sugar was a little high at bedtime, and said “that’s going to put me into insulin shock.” They insisted on giving me the dose anyway. Luckily insulin shock still woke me up back then, and at 3 am I woke up shocky, hit the call button, and demanded a snack for insulin shock. They insisted on checking my blood sugar first, which only confirmed what I had tried to tell them earlier. I know now that that particular sliding scale, which was probably worked out for the average diabetic of my weight, simply did not work for me. I am very insulin sensitive, and while I absolutely need insulin and will see a very fast and uncontrolled rise of blood sugar without it, I need a very small amount, given my weight.

It isn’t just person-to-person differences, either. It can be time of day, time of month, stress, air bubbles, absorption rate of injected or infused insulin, or just the natural cussedness of the universe. Sometimes it can be how what you eat gets into your bloodstream.

Your blood sugar does not rise the instant you put carbohydrates into your mouth. The food has to be chewed and swallowed, as almost nothing is absorbed directly from the mouth or esophagus. It has to reach the stomach. One of the side affects of diabetes in many people is gastroparesis, which is delayed passage of food through the digestive system. To further confuse the person trying to keep diabetes under control, this delay is highly variable.

As a general rule, food I eat at breakfast time gets into my bloodstream, as glucose, fairly quickly. I’ve taken to eating yogurt for breakfast because most of the carbohydrates are lactose, which absorbs fairly slowly, and because the relatively high protein content also slows absorption. At noon my food absorption is a little slower, and by dinner time it’s slower yet – slow enough I normally spread my insulin out over 4 hours or so.

Changing my eating habits, as I did two days ago for Thanksgiving dinner, can cause an unexpected change in how fast the dinner actually gets into my bloodstream as glucose.

I didn’t have a huge dinner, or an unbalanced one, but I had more than normal, and upped my pre-meal insulin to compensate. I kept to a four-hour dual bolus, but by the time we went to another house for dessert, my blood sugar was running low. We had pie for dessert. I had a small piece, and I was still low, but I did take more insulin to balance the pie.

By the time I got home I was well into insulin shock, with a blood sugar below 50, and over the next two hours I ate enough to bring it up to normal by bedtime.

Four hours later my blood sugar was over 300.

I’m pretty sure that what happened was that the relatively large dinner caused more than the usual delay between swallowing food and the actual rise in blood sugar. As a result the amount of insulin I took, which was reasonable for the amount of food I ate, was enough to put me into insulin shock. Later that night the food caught up with the insulin, but by that time I had eaten enough extra to treat the shock earlier that my blood sugar went high.

The only way a doctor can prevent this is by insisting that you eat exactly the same meals at the same times every day. But we’re people. Most of us can’t keep up that kind of regime. And if we don’t accept that rigid a regime, we have to be intelligent enough to treat ourselves, to a certain extent.

I’ll probably do the same thing for Christmas dinner. But I’ll know to spread the insulin out over more than 4 hours.

Cranberry Recipes

The blade to my food processor. That black is supposed to be all one piece.

Disaster struck as I was preparing to start the salad for Thanksgiving dinner — the chopper blade on my food processor is broken. It was fine when I put it away, but now the plastic that holds the blade to the processor is shattered. Guess I’ll have to use the old mini-chopper for the cranberries and chop the rest of the stuff by hand.

Here’s a photojournal of the process of making the salad without a food processor. Turned out the mini-chopper did help with the oranges, too.

Ingredients and tools for the salad. (The paring knife didn't quite make the picture.)

Chopping celery's not that hard--just make a few cuts lengthwise before you start.

Yes, the whole naval orange is cut up. The mini-chopper took it down to small pieces.

Frozen cranberries and nuts help each other in the mini-chopper. It took three rounds, though.

The mini-chopper could not handle the apple wedges, so I had to chop them by hand. Apples were left to last, when I started heating the apple juice and water for the Jello.

What, all those solids for such a little bit of Jello? (I used orange, as I couldn't find lemon.)

The finished salad, ready for the refrigerator.

Recipes?

It’s anything-goes-day as well as Thanksgiving, so I thought I’d share a couple of my favorites. After all, they go well with turkey leftovers, too.

The first is my mother’s recipe for a Jello salad, modified to avoid added sugar and take advantage of a food processor. Note that while the usual Jello salad is Jello with fruit in it, this one is fruit, nuts and vegetables with a little Jello holding it together.

Cranberry-Orange Salad

2 4-serving or 1 8-serving packages of sugar-free lemon Jello
1 12 oz can frozen apple juice concentrate
1 c water
1 seedless orange, washed but unpeeled, cut into chunks
2 cups celery, cleaned and cut into pieces
2 washed apples (Granny Smith preferred), cores removed and cut in chunks
3 cups raw cranberries, washed and (preferably) frozen This is one 12 oz bag.
1 cup walnuts

Heat the water and apple juice concentrate together to boiling, and dissolve Jello. Meanwhile, use the food processor to chop (coarsely) the remaining ingredients. (It may take several batches.) Place the chopped ingredients in a 9” x 13” pan, level them, and pour the dissolved Jello over them. Mix and level to get all of the chopped ingredients below the liquid, and chill until set.

Makes 24 servings of 82 Calories each. For each 68-gram serving:
13 g carbohydrate
1 g protein
3 g fat (mostly from the nuts.)

Don’t laugh at the gram measurement – when I eat this I weigh the portion, and I use the carbohydrate and and half the protein to figure my insulin dosage. The recipe may have no added sugar, but with all the fruits and the apple juice concentrate, it’s far from sugar-free.

A half recipe would probably fit nicely into an 8” x 8” pan; I’ve just never tried it that way as this is my regular contribution to potlucks and Thanksgiving dinners.

The second recipe isn’t mine and is probably quite familiar to NPR listeners, but here is the link to Mama Stamberg’s cranberry relish. It may sound strange and look like Pepto-Bismol, but it’s yummy. I freeze it in an ice cube tray.

Happy Thanksgiving!