LivLife: suitable for diabetics?

When I heard about a seeded batch of bread sporting the catchy name 'LivLife' and purporting to be suitable for diabetics, I was just a little cynical, truth be told. I've eaten foods claiming to be 'suitable for diabetics' over my 27 years with T1 and have either learned the hard lesson of just what too much aspartame sweetener does to 'diabetic' chocolate, or learned the even harder way just how many carbs there are in 'diabetic' jam (around 60% of it is still pure sugar, in case you were about to make the mistake of slathering it on a piece of bread as a 'diabetic' snack.  See also: enough glucose to power a rocket).  But I do take genuine delight in a slice of bread - particularly anything anything close to a farmhouse seeded or granary kind. And there are many times when a sandwich, slice of toast or crumbly croutons would go down a treat.

Sadly most breads, even the seemingly 'safe' varieties like wholegrain pittas which have a GI score of around 57 (55 and under is considered low GI), seem to have an aggressive effect on my BG levels and turn even a saintly salad-filled lunch into a must-be-managed afternoon crisis.  So much so that in recent years I have all but given up on any kind of carb-wielding slice of bread.  

The problem is, there are only so many salads you can eat before you've tried them all.

My first impressions of LivLife were good.  There were seeds bursting from the loaf and the smell of fresh, high-quality bread overwhelmed my senses as I opened the bag and peered inside.  The slices were small, but not too much so.  In fact, two slices together make a perfect-sized sandwich to take to work.  Actually I take two; because it tastes that good.

But the real test, beyond any pretty packaging or delectable aromas, is the impact on glucose levels. A blood-sugar bashing treat is one thing, but a daily lunch choice needs to be something which won't cause repeated post-prandial spikes that cause HbA1cs to jump around and complications to come a-knocking.

LivLife claims to be suitable for diabetics because it has half the carbs of other breads - in fact, it claims to have as little as 3.8g carbs per slice!  So a sandwich of two slices with a low-carb veggie or protein filling, should be less than 10g carbs per sandwich!

This week, I put my LivLife to the test and experimented my way through lunch breaks to see just what happened with the so-called 'suitable for diabetics' bread.

The CGM trace below was a trace I had after eating two small wholemeal pittas with bacon and avocado salad stuffed inside and a smattering of mayo to give it some 'yum'.  I had bolused 20 minutes before I ate, ensuring I'd allowed time for the insulin to hit my system and become active before I devoured my well-earned lunch.

Within just one short hour of my (supposedly healthy) lunch the beautiful straight line I had been admiring all morning was gone after my 2pm lunch break and was replaced with a vertical sky-climber.  I tried this lunch three times with tweaks (once with more insulin; once a little earlier - which resulted in a nasty hypo pre-food).  This is not the way to enjoy food.

After too many frustrated days in a row I gave LivLife a whirl, and was presented with this:

Now this is a CGM trace to enjoy! 

This time I put the same accompaniments (bacon, avocado salad with mayo for yums) into two LivLife sandwiches, and the result was fantastic!  In case you can't tell, I bolused at 12.45pm and ate at 1pm. Both days I started at a respectable (but slightly high pre-meal) 8 mmol, but the outcome of removing most of the carbs but still enjoying something more substantial than just a salad, was a CGM trace that meant I wasn't going to be chasing corrections all afternoon.

So there you have it: LivLife really is suitable for diabetics, and even comes recommended by one.  If you are someone who likes to put away Joey from Friends kind of sandwiches you may need to make yours a triple-decker because the slices are about three quarters the size of a 'standard' loaf, slice.  But considering the carbs in a  modern standard slice are often nearing the 20g mark, and LivLife have managed the same taste and satisfying hunger-buster with just 3.8g carbs (with 2g fibre!), I think I can live with that!

You can get LivLife in Morrisons (only selected stores so find your most local one) and Ocado, where it should be in with all the other breads.

Let me know what you think in the comments or on email, and enjoy!

Natvia: giving back pancake day to people with D!

It's possible that when Natvia sent me two tubs of their all natural sweetener to try out with accompanying Bundt tin, they may have been overestimating my cake-making abilities just a tad.  The Great British Bake-Off may be all the rage at the moment, but unless they appreciate a beautifully microwaved omelette, I won't be on the show any time soon.

The people at Natvia: clearly not familiar with the
Presswell cookery skill level.

But there are plenty of ways I could use a decent sweetener in my life.  Since products containing aspartame became wildly unpopular after consumers discovered the many damning reports of links to cancer, toxic ingredients, notorious side-effects and the often too-bitter after-taste, there hasn't been a great deal on the market. Until recently.  

Natvia, a sweetener made from the Stevia plant, is a superb alternative.  The texture is similar to that of sugar, but with a cleaner, lighter taste.  In short, the leaf of the Stevia plant is ground up and blended with Erythritol, a naturally occurring nectar (found in melons) in order to give it the grainy texture of sugar.  It is low GI and can be used spoon-for-spoon in place of sugar.

Most of the time I've learnt to just cut sweetener out all together, but there are two major - very major - exceptions.

Coffee, and pancakes. 

The Presswell's do lent!

There is simply no substitute for a delicious morning coffee (or ten) with a dusting of sweetness to take the bite out of it  Sadly, aspartame-based sweeteners have a knack for adding a cheek-sucking bitterness that can ruin even the finest rich Columbian. Natvia, on the other-hand, with its sugar-mimicking taste gave me the sense for the first time in years, that I was enjoying a genuine barista-made coffee.  

The other treat that delights the palates of those living in the Presswell household, is pancakes.  And not these fandagled Banoffee/chocolate-marshmallow/peanut butter/cocoa crunch/strawberry ripple/chocolate raspberry pancakes.  I mean the genuine article: plain old-fashioned sugar and freshly squeezed lemon.  But with 5g of GI  blood-glucose spanking carbs in every teaspoon, sugar is a nightmare for people with D the world over.

This year however, I was just 6 pancakes into the stack Jamie had prepared us by the time I was thanking the gods for Natvia.  Never have I enjoyed a lent so much in living memory.  Mainly because diabetes and something called the Glycaemic Index, had other ideas!

So thank you Natvia, for giving me back pancake day!

You can get yours by shopping here. And remember, pancakes are for every day, not just for lent!

Eating Disorder? Unexpected.

"I'm a fraud", I thought, as I sat beneath a brightly-coloured and decidedly 70s-esque 'flower power' sign with luminous lettering, welcoming me to join in with 'Eating Disorder Awareness Week 2014'.  I was painfully aware of the emaciated girl sitting across from me, avoiding eye contact with me at all costs. I was avoiding hers, too, in fairness.  Could you have picked a more inappropriate week to come here, Anna?

I was sitting in the waiting room of the April House Eating Disorders suite in Southampton, having been referred after an emotional out-pouring to my dietician at clinic some weeks before.  I had told her through choked-up tears how all my adult life I had been overweight, except for a brief stint in my early 20s of extreme dieting, over-exercising and dabbling with diet pills (the ones that have no label and are kept 'out back' at the beautician's).  I explained that I had been on every diet going but remained obese and utterly ashamed of it; ashamed of myself.  Worse still I was gaining weight, again.  I cried and asked her for help, because I had recently found myself behaving in an inexplicably compulsive way around food - a way I had never noticed before, but which would explain why I was the weight I was, despite always exclaiming to people "I just don't know why I can't lose weight!"

I was asking for help.

Now, a few weeks on I found myself in a clinic with clinical psychologists and a host of other degree-holding professionals all wanting to take what I said seriously.  The thought now of being branded with the label 'has an eating disorder' was becoming a little too much for me.  I had said for some time that my eating was disordered, but an eating disorder?  No.

I picked at the label on my drinks bottle and shuffled my feet - left over right, right over left - all the while making sure my eyes didn't meet with anyone else's. It would be mortifying to see the looks of 'what are you doing here?' on their faces.  

"What are you doing here?" I angrily demanded from myself.  "You don't have an eating disorder, you just need to diet and lose some weight. You're just fat, that's all".

As I toyed with the idea of simply getting up and leaving - of not wasting everyone's time - the decision was all too swiftly taken away from me.  "Anna Presswell", a voice called. 

"Oh God.  Shit.  This is going to be mortifying when they tell me I shouldn't be wasting their time. Just get through the 2-hour assessment and GO!"

Lucy, was my assessor's name.  She was warm and friendly, with a clip-board full of questions about my life that in any other situation would be considered obscenely intrusive.  Perhaps the hardest question of all was "When did your issues with food start?". I still couldn't answer it, truth be told.  

We trawled through questions about eating, lifestyle, living arrangements, diabetes, food-regimes and my feelings towards myself.  Half-way through I was convinced that I would never need to see Lucy again, because I was clearly not in the right place, and we both knew it.

"Have you ever self-harmed?", "No".  

"Have you ever tried to take your own life?", "No". 

"Have you ever made yourself sick?", "No".  

"Do you have a desire for an empty stomach?", "No". 

"Are you isolated from loved ones?", "God no".

I was right.  This is dreadful.

"Do you exhibit frantic behaviour around food?" "Um, yes". 

"Do you hide your eating behaviour from loved ones?", "Uh, yes". 

"Do you eat to the point your stomach is uncomfortably full?", "Well, yes".  

"Do you eat in secret?", "Yeah". 

"Do you experience shame after eating?", "Every single day".  

The yeses started to multiply. And the questions went on.  The open-ended questions left me in tears because I had to explain things I'd never before said out loud.  Each one exposing more of my twisted relationship with food.

I told Lucy about what had brought me there: about the day when I decided to have a chocolate bar after work, and found myself six minutes later having eating four chocolate bars and three packets of crisps. Of how I saw people watching me in the car park as I ate the chocolate bars in three enormous mouthfuls, but was too frantic to care. Of how I came home, already disgusted with myself and feeling the blood sugar rise from the chaotic eating my insulin could never catch up with, and about lying to my husband about having bought myself one chocolate bar as a treat.  Of how ashamed I felt when I caught myself lying about food to one of the few people I could have told.

As the session drew to a close I suddenly found myself desperate for Lucy to tell me that I wouldn't just be left hanging if their services weren't going to be right for me.  I suddenly realised how glad I was that I hadn't run off at the start of the day.

"So, if you aren't able to help me, will anyone else?  What if I don't have a diagnostically recognised condition, can anyone still help me, or is this it?".  My eyes pleaded with her.

"Anna, our decisions about who we can work with and whether our service will be suitable for someone are made at our Wednesday morning team meeting.  But unofficially, it's clear to me that you have some real issues around food, and we would recognise those issues as an eating disorder.  You are on what we would call the binge-eating disorder spectrum.  And I am confident that we have something we can offer you."

With that I found my head in my hands as I let out a mixture of sobs and cries, as I found myself thanking Lucy.  I was grateful, but I didn't know what for.  I was relieved, but I couldn't understand why.  I felt lighter, but I had no idea what this meant.  

My relationship with food has always been, complicated.  I was diagnosed at four years old, when my parents were forced to impose strict rules around eating.  Sometimes I went hungry; sometimes I was forced to eat when I didn't want anything.  It kept my body healthy, and for that I am grateful.  But what that diagnosis did to me emotionally, is only just being picked at 27 years down the line.

Mastering the temporary basal rate

Temporary basals (TBR) have never been my strong point: it's what you'd call my 'development area'. I gained a little confidence in tweeking them for my needs at the Animas Sports weekend, which went a long way in helping me grasp the TBR reigns, but I am still clumsy, at best.

I now regularly use them for exercise and when I am ill and need an increased amount of insulin to keep me in range.  I sometimes do this successfully and sometimes blindingly badly, but I give it a shot. But there is another time that I have found them to be particularly useful; when warding off an unwelcome overnight blood glucose level drop. 

There are times when I go to bed and my continuous glucose monitor (CGM) trace shows that I am dropping, or that I have been dropping and am now teetering above 'low', but a little too close to it for comfort. At times like these in the past I would feed to raise my BGs just a little. A biscuit, a piece of toast or an apple would often suffice, but in all honesty 11pm isn't a time of night I particularly want to be snacking. That's not also considering how much weight might creep on in a year from several biscuits a week to curb a low blood sugar at night. So in recent weeks when I have seen a drop or a number I'm not too confident about leaving as it is, I've been experimenting with TBRs to restrict the amount of insulin going in, on a temporarily basis, therefore allowing my numbers to level out, or bump up just a touch. 

Last night was a great example of this. At just after midnight Jamie and I crawled into bed. I'd seen a spike after my badly calculated dinner and was all too aware of the insulin I had stacked one bolus on top of another trying to get it down. Finally it was coming down, but at this time of night? C'mon! 

I was 9.1mmol (164mg/do) and showing a downward arrow. Great.  I don't want to eat because 9.1mmol is a little on the high side anyway and I don't particularly want to go up overnight. But I'm also fairly sure the downward trend is going to continue, with just a little insulin on board still burning a hole in my CGM picture. I could ignore, which would no doubt end in a 2am hypo, or I could eat, which I don't really want to do. So I opted for secret option C: reducing my basal rate to 0% for 1.5 hours. It seems a long time to be getting no insulin for, but something seemed instinctively right about it. That's something I believe us PWDs (people with diabetes) have a lot of, instinct.

I awoke two hours later all of a sudden. I don't know why, but after accidentally punching my husband in the back of the head after a bad dream, I figured I must have been low. I turned over, clawed around for my Dexcom receiver and with bleary eyes, squinted at the screen. 

Well I'll be damned. I had nailed it, spot on. The downward trend had continued. It had continued for around two hours, having briefly danced with a 3.9 mmol around 30 minutes ago and was now heading back up, nice and safely within the very respectable 5mmol (90mg/dl) range. And back to sleep I went.

Basal rates are funny things. Something which can take days to fully adjust when you make any strategical changes can also impact your blood glucose within a matter of hours. In this case I hadn't needed to eat and was able to nod off to sleep with the use of a carefully timed basal reduction. 

Game. Set. Match. 

Sometimes you lose; sometimes you....lose

There are a handful of foods that I just can't win at. I've tried, believe me. But no matter what the approach (blousing before, after, midway through, split bolus, split bolus plus 200% basal for 8 hours...), those kinds of foods simply do not work for me.

This, is curry. The blood-sugar bashing not-so-superfood that makes my BGs go from 'hero to zero' in two hours or less. It will briefly allow me to think I've managed it by wafting in front of me a 6-7mmol BG for two hours and then BAM! I'm stroking the heels of 20mmol. 

But it's OK. Because this kind of meal is a once in a while kind of meal, and being able to bolus for it easy means it may feature a little too often for my waistline to handle. So for the meantime I will enjoy, correct, correct again and try not to let it ruin my otherwise delicious Eastern delight. 

What's your food nemesis, and do you still try to find a way to enjoy it? Do you still allow yourself it, or do you stay away to avoid the pitfalls of monster post meal spikes? 

Rocks, bottoms and food-shaped shadows

As I stood on the scales this morning taking on board the eight pound telling off my scales were giving me for the choices I've been making recently, I realised something: I am losing control.  My diabetes management lately has not exactly been something to write home about.  I've been using my CGM as a disaster safety net, rather than the pre-emptive strike it can be.  I have a lump on my abdomen that I'm fairly sure is a nasty piece of scar tissue from overuse of that area for cannulas, but I have been too apathetic to stop using the area, let alone get it checked out by someone who knows more than Dr Google. The carbs I used to cut out because they led to bouts of mountainous blood sugar landscape are back with a vengeance, and my reaction to the peaks and troughs that inevitably follow is decidedly... meh.  Worst of all, the pounds I had lost in the last 18 months using the tools Animas gave a group of people at their sports weekend, are all but regained.  And I am too tired to care.

Burnout is back.

I don't generally talk about my issues with food widely because my 14 stone out-of-shape and old-before-its-time physique does that for me.  It's not exactly rocket science to know that I overeat and make poor choices. I've always known my relationship with food was... awkward... and I've known for many years that my choices can not only be bad, at their worst they are damaging.  It goes nowhere near the realms of anorexia or diabulimia, for that I am blessed.  But my battle to lose weight because of my inability to exercise self-control around food - far beyond that of any normal person - and my tendency to use food both as a comfort and a weapon, has become much more pronounced in recent weeks. I find myself so compelled to eat a certain type of food, that I will leave the house at ridiculous times of day and night to get whatever that food might be.  And I won't eat one of them; I eat four. I eat in secret sometimes and kick myself so hard when I do, because I am the only one I am fooling.

I know where it comes from. I remember times when I was a kid where I was so, so hungry, but my BGs weren't behaving themselves, so I had to wait.  And wait.  And wait.  My diabetic chocolate (before the world realised what a conspiracy that really is) was measured two squares at a time, and I had to go and run around outside for an hour if I wanted to eat them.  I could never just enjoy them for enjoyment's sake.  At other times my parents would need to feed my snacks and meals when I was half asleep, because yet again my blood sugars demanded so. I know how sorry they must have been and how sad this restriction must have made them.  I've had 'are you allowed that?' and 'you can't eat that!' so many times in my life that I use food as a channel dor my frustrations, my anger, my sadness and even  my successes. When I lose control, I LOSE control. And that's where I am now, and have been for several weeks: Out of control.

Diabetes stole from me a normal relationship with food.

But I'm not a silent partner in this and for the most part I am well aware of the issues I have, I see them and I can keep them at bay. At any time I am probably only one bad choice away from being on the evening news as firefighters take apart the side of my house to remove me by crane, but I can manage just enough self-control to stop myself most of the time. I know this, so I try to make efforts to fight the devil on my shoulder and go for option A, rather than sink to option B.

I know that something has to change if I'm going to raise myself out of the current funky state of affairs.  I get it.  I've been here before, and I will be here again.  That is the nature of managing a chronic illness that needs 24/7 attention. But with the changes that I plan to make will come better BG control; as a side of that I will feel interested again; on the back of that, the burnout will abate.  That's how it works, you see.

So how do I move forward?  We've done this before, right?

There are so many ways that years of teaching myself how to sock burnout in the mouth has shown me.  For starters, I have re-invigorated my refrigerator with mounds of delicious, healthy, low-carb foods, ones that I know help my BGs behave less like the adolescent faff-fest they've been lately.  I am writing what I am eating in my My Fitness Pal account so that I can see just how much 'a couple of cakes' really is, calorie, carb and conscience wise.  I have an agreement with my family members that every night after work, we go for a walk.  It's only a two mile loop around the village where I live, but it is a perfect 30-minute walk with hills and slopes to keep the heart rate chirping along. The pains in my legs are still lurking thanks to having regained some weight ('some', ha!), so for now walking is the best I can manage.  And I am going to go for some thorough basal testing to use the incredible CGM tool we made the commitment to buy this year.  Because using it as a safetynet while I put crisp packets in my face practically whole and three at a time, is ludicrous.

This is how I do it.  With determination, and with friends.  But it's not easy.  You know my 'secret' now, and you will know if you see me and can tell that I've gained some weight, that maybe now is a bad time.  But if you want to join me in hitting this diabetes shit out of the park, find me on My Fitness Pal at annamac1982.

Do you struggle with food yourself?  Then maybe see you there...