Quick pseudo-science lesson: In the most simplistic terms, the human body needs sugar to survive. Sugar enters the bloodstream and can only be absorbed into cells when it is accompanied by insulin. If the islet cells in your pancreas are working properly (as they are for all you non-diabetics), then you will always have a perfect level blood sugar level, or glucose. My islet cells, for whatever reason, ceased to function ten years ago and now I have to attempt to do their work. I try to estimate how much sugar is entering my body and then measure the appropriate amount of insulin to match it. Diabetic complications inevitably arise because no one can keep perfect glucose readings all the time. When the bloodstream is thickened by too much sugar, small vessels (in the eyes, kidneys, heart, fingertips and toes) are damaged and sometimes damaged beyond repair. One final point: ALL carbohydrates are broken down into sugar for the body to use as energy.

When I first became a diabetic, I was taught “exchanges.” One starch exchange equals 15 grams of carbohydrates. One fruit exchange equals 15 grams of carbs. One milk exchange equals 12 grams of carbs. I never truly learned meat or veggie exchanges just because they have very little value. Basically, I took a couple shots of insulin, both long-acting and short-acting, that would “cover” my meals. A dietician would work hand-in-hand with my endocrinologist to tell me how many starches, fruits, meats, etc, I could eat per meal, considering my insulin intake. You can imagine how tiresome this process could be. Sometimes I wanted to eat more food, or less food, or food at a different time of day, or sleep in and avoid food all together. But I couldn’t. I was stuck with the rigidity of the exchange system.

Around the time I got married, I learned that I should either begin to use an insulin pump or consider MDI, multiple daily injections. I hated the thought of poking a needle into my flesh more often than I already was, but I also despised the thought of a little insulin computer attached to me 24/7. Circumstances pushed me over the edge of tolerance for the exchange system and I ended up wholeheartedly endorsing the insulin pump.

It was the best endorsement I have ever made. In short, my freedom with food was back. No more set diet. No more set eating times. No more, no more, no more! FREEDOM!

So here is what I do now, merrily all the day long: carb count. Everyone is into counting carbohydrates today thanks to the popular Atkins diet, so I imagine most folks understand something of carb counting. In a perfect world, I’d know the exact number of carbohydrates that enter my mouth every time I eat. Then I could do the calculations, “Nine grams of carbs per one unit of insulin, so this sandwich equals 3.4 units.” And voila, I’d punch in 3.4 units of insulin to be delivered from my pump and the deed would be done. (The pump can deliver a tenth of a unit of insulin, whereas I could never be that precise on shots.) The problem with carb counting is that I’m not always certain how many carbohydrates are in that delicious piece of lasagna, or that enormous cobb salad, or that dutch chocolate/key lime M&M ice cream from Ivanna Cone. So one learns to guesstimate. Perfection has not been yet been found, but a livable lifestyle has been embraced.

Back to Bob’s confusion regarding ice cream as taboo for diabetics… Not meaning to slam you, Bob, but yes, it is an ignorant thought. However, it used to be the truth for diabetics so I’ll give you that. If it was only ten years ago that I was given a rigid diet, you can imagine how strict life was for diabetics 20, 30 and 40 years ago. It was terribly hard to keep glucose readings in line, so sugary foods were a big no-no. The problem today is that most people’s ideas on diabetes are based on old scientific knowledge and techniques. Other than the fact that whole wheat crackers are healthier than a slice of apple pie, it doesn’t matter whether the food I eat is “sugary” or not. It all comes down to “how many carbs are in that?” and “how much insulin should I dose?” My Uncle Tim, also a type 1 diabetic, was in a hospital a few years ago and was given an outdated handout that said something like this: “Diabetics should not eat dessert, soda pop, jams or jellies.” Want to know a sure way to piss off a diabetic? Tell them they shouldn’t eat that piece of chocolate cake being served for dessert! An educated diabetic will know if s/he can eat it or not. The more sugary foods can causes spikes in glucose readings and make it tough to keep glucoses balanced, so I don’t mean to sound like all foods are equal in this regard. But more or less, a carb is a carb is a carb. I eat ’em. I count ’em. I love ’em.