Having written many times in the past about Halloween, candy, and trick –or –treating, I thought I would address the upcoming holidays of Thanksgiving, Chanukah, and Christmas. As all three holidays involve food, I thought it would be helpful to provide some insight that allows for enjoyable and relatively stress-free celebrations and myth busting for those who have insulin dependent diabetes.
MYTH #1- Timing of the feast
Much anxiety is centered on the timing of the appetizers, main meal, and dessert. Flexibility is key and there are “work-arounds“ for all types of insulin regimens.
Solution: For those on basal/bolus regimens, try to carbohydrate count as effectively as possible (and realize that you can only do the best you can!) and bolus accordingly. Know that you will most likely need to correct blood sugars in three hours and if the eating continues three hours thereafter! For those using insulin pump therapy, use the fancy applications that are often not routinely considered such as extended bolus, dual wave bolus functions to assist with the timing of the eating. Discuss strategy with your healthcare team before the holidays! For those who use multiple daily injections with Lantus/Levemir and rapid acting insulin, the same applies. However, in order to mimic the special pump applications of extended or dual wave bolus feature, one might consider mixing “regular” insulin with rapid acting insulin in a syringe in a ratio. Different ratios work for different people. One might consider 30% rapid acting insulin with 70% regular before the main meal or a 50%/50% ratio. Experimentation is in order!
For those using conventional split mixed insulin with NPH/Regular or rapid acting insulin three times/day, simply give the regular or rapid acting before the main meal and not worry about giving the rapid acting before the usual dinnertime. Yes, you might have to give an extra dose of rapid or regular insulin if your blood sugars are high later, but since you will have discussed options with your healthcare team prior to the holidays, you will have an action plan!
MYTH 2: “ I can’t have that (fill in the blank).” In my opinion, deprivations of certain festive foods only lead to dissatisfaction, unhappiness, and perhaps consuming the forbidden food later on the sly.
Solution: Go ahead and consume (within reason) your favorite foods associated with the holidays, but make sure you cover with the appropriate amount of insulin. Keep in mind that celebrations often lead to underestimation of portion sizes. Though you may be an expert carb counter, if you have three portions of the food item, you need to triple the calculated insulin dose. And don’t forget the correction bolus (for the pre-big meal snacks) if it has been at least two and a half to three hours.
MYTH 3: Exercise doesn’t really make a difference if I ate a huge meal.
Comment: It is probably a good idea to take a walk or conduct some form of mild-moderate exercise to assist with insulin sensitivity either before or after the main meal. However, a tackle football game or other strenuous activity may lead to hypoglycemia or even a cardiac event. Please be careful and use good judgment!
MYTH 4: “Eating leftovers over the next few days shouldn’t be a problem”
Solution: Be mindful that the same amount of carbohydrates and calories are present both before and after the festive holiday. Be wary of portion sizes and grazing. The pattern of “grazing” is a major issue in diabetes control due to the fact that we must bolus before our meals and snacks. A constant flow of carbohydrates will wreck havoc with blood sugars if we are not mindful of how to adjust insulin. Remember to use the provided extra features of your pump if you have found this to be helpful in the past. Try to bolus before consumption of the food as much as possible. This is a good idea every day of the year, not just at the holidays.
Lastly, have fun with the non-food aspects of the holidays and enjoy your loved ones!
Published On: November 26, 2013