Diabetes Forecast

A Plan That Works for Me

By David Marrero, PhD, Associate Editor , ,

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. And 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, I found that 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 "3-to-1" 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 3 predictable ones; 1 day of indulgence with 3 days of more sensible eating; or even 1 weekend with 6 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 3-to-1 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 3-to-1? Through experimentation, I found this is the ratio that seems to work best for me. You may find a different ratio is more effective for you. What is essential is to pay attention to all the adjustments you try and 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 we 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 3-to-1 rule lets me enjoy myself, while ensuring that I keep in good health.



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