I have had t1 for 9 years and have always eaten lowish carb, between 50-100 carbs/day. My honeymoon lasted for about 2 years and I was and am pretty strict about foods I eat. I dont eat (and havent eaten) legumes, pizza or bread much at all for 9 years. I havent eaten pasta or rice at all since diagnosis. i have found that I am more and more anxious and stressed around food, eating in front of others, consuming carbs, just anything to do with food. The only time I feel it is appropriate to eat carbs is if I am low.
I do sport religiously, and before the pandemic did triathlon, mountain races and city races up to half-marathon.
I keep excel spreadsheets that keep track of and calculate daily bg average, standard deviation, number of daily carbs, minutes and type exercise, temp basal for exercise, units of bolus daily.
In the past I have fasted for about 32 hours twice a week for months to make sure my numbers are perfect ( or nearly) and so I dont get fat, something I am kind of terrified of. I dont want to be terrified of it, because it is ridiculously superficial, but I am. The only things I ingested fasting was almond milk or broth, tea nad coffee. I recently had to get a colonoscopy and fast for ages and it felt incredibly good and I felt so virtuous for not eating.
In November I started seeing a psychologist after I found myself crying in my office at work from the stress of food, and counting things and measuring and thinking about food all the time. The shrink is also a t1 and specializes in t1 people, which is great. I had made progress but with quarantine, I feel like I am back at square 1. I got so stressed about meeting friends for lunch at the weekend that I ended up cancelling. I couldnt face the counting and all the food choices and stress.
She has me increasing the number of carbs I eat and committing to eating things like lentils twice a week, and fruit four times a week. I do not understand why this is so hard for me. I just hate carbs so much and wish I was a robot so I would never have to eat and think about food.
Has anyone ever dealt with this? What can I do to make it better or easier to live with? Everyone else seems to be so at peace with food, and so well-adjusted. yes, maybe they dont have great numbers all the time but theyre ok with the food they eat. I belong to a national diabetic athletes team and our city´s chapter has a WhatsApp group and it seems all they do is post photos of their lunch and then others say how good it looks and talk about how many carbs they think are in it, making it a guessing game, OMG.
I can´t stand any of it for one more minute! Anything else you would do apart from seeing a psychologist? I read through this and I sound like a crazy person but I wasn´t like this before diabetes.
@pancreaswanted I understand what you are going through. Carbs/Food sort of becomes the enemy for T1Ds when initially diagnosed and it takes some time to realize that after all, none of us can eliminate food and remain healthy. So we must find a way to use insulin in a way our healthy body would. Not an easy task, but with the new technologies (CGM, pump, Loop algorithms, and access to all of that data), it is easier.
Exercise can actually make it more difficult to control BGs, at least for me, with all of the careful timing of carbs and activity required. BUT exercise is worth it and I wouldn’t give it up for anything!
I agree with your psychologist in that you should try to add carbs back into your diet, gradually at first, and in small quantities so you are able to track the changes in BGs, and make adjustments as you monitor them. Fruit, for me, is easier to monitor since it is generally metabolized quickly and has no lasting effect on my BG as compared to say pasta or potato.
Are you on a CGM and pump? This will make it much easier to monitor your progress. With the CGM you have access to your data online so you would not need to maintain a spreadsheet of all that you are tracking. Eliminating the detailed tracking may take some of the stress off yourself by not forcing you to spend those extra minutes logging data. I also used to do the same thing, log all of my data in Excel, and even generate reports. I spent way too much time on it and looking back, although having access to my data helped me understand how my body reacted, it also caused increased stress for me by getting “too close” to the data. I would obsess over the bad days, and review and review my data to try to figure out better methods of control. I learned over the years, that bad days are going to happen no matter what I eat or do. I worked on forgiving myself (for the bad days for which I blamed myself), and tried to live in the present, to make today work, to have control today.
I still do not eat huge amounts of carbs, but I do eat a variety daily and I exercise everyday, too. I do “sugar surfing” and adjust my insulin according to what I eat and what my BG is doing. I’m using Loop (automated insulin delivery algorithm) so a lot of the insulin adjustment is handled by the algorithm which takes a lot of the stress away from me. I still constantly monitor by CGM though, and make corrections, just not as many as I would need to do without Loop. My goal is to shoot for 90%+ TiR (time in range of 60-140) and SD < 20%. I have bad days where I am way off of that goal no matter what I do, and those are usually due to technology failure and me failing to take action!
Another goal is to eat only healthy foods and a variety of them. I know many believe in low carb diets and eliminate fruit, vegetables, etc. I would be concerned with not getting the recommended daily allowance of needed vitamins and minerals when restricting too many ingredients from our diet. Focusing on a healthy diet with variety could help you from stressing out about carbs in particular, even just by adding small quantities of carbs. As the saying goes, YDMV, so even if your WhatsApp friends eat large carb diets, it doesn’t mean you need to or are able to. You need to do what is best for you based on how your body reacts, but by using today’s technologies, you may be able to adjust your insulin and control to incorporate carbs a little easier.
These are the things that have helped me but I apologize in advance if you already do all of these suggestions. I wish you the best.
You certainly don’t sound crazy, but you do sound a bit obsessed. It seems like you have taken complete control of what you are eating, maybe as a reaction to the loss of freedom of T1 or maybe you have always had these tendencies and T1 made it easy. This is honestly, one of my bigger fears for my son as he heads to college in a year. (Binge Drinking is #1) He is already controlling what he eats quite stringently to help build muscle while he does body building. I hope it doesn’t stray into over-controlling which it sounds like you may have ventured into.
I hope you are able to reframe carbs into what they are, carbs. They aren’t the enemy and can be dealt with, but they can be troublesome at times. for reference my son eats about 100 carbs a day because he has a much stronger than normal reaction to carbs as evidenced by his other T1 friends.
Have you always been stressed eating out with others, or has that changed more recently?
Eating disorders of many types are super common in diabetics, because of the emphasis put on controlling food intake (which can lead to either over or under control). You don’t sound crazy, but you do sound like someone struggling with some degree of disordered eating (whether or not you meet criteria for diagnosis), because this is clearly causing considerable distress. Adding more carbs into your diet seems like it could be functioning as a form of exposure therapy, in which the goal is to do the anxiety-causing behavior, have it cause anxiety, but then after nothing terrible happens as a consequence, eventually the anxiety around doing it decreases. A key part of that is that you should expect that at first, doing that is going to be uncomfortable! That’s kind of part of the point. So if feels really hard that makes sense and isn’t an indicator you’re doing anything wrong. If it feels so hard that it’s preventing you from doing it, you are going to want to talk to your therapist about either starting with smaller goals or maybe even doing it in her office with her support.
I would also consider whether some of your tracking and online/app activities may be counter productive and encouraging over-control rather than really helping you. I would expect it to also feel uncomfortable/scary dropping some of those, but I think it could be really useful at the same time, and considering other things you might do with that time/energy that are important/valuable to you, maybe having nothing to do with diet or even diabetes.
I also suspect that all of these behaviors are functioning to control bigger, more threatening worries, possibly about what having diabetes means to you or fears of getting complications/dying or such. It may be important to work through the underlying worries that over-control behaviors can kind of distract from or offer a feeling of control over in order to make substantive progress. What do you think would happen if you ate high carb? Then what? and what else? I suspect you’ll land on the underlying concern(s) if you go down that thought train.
If your therapist feels helpful, I’d stick with them—if at some point (now or in the future) that’s not the case, I would look specifically for one with eating disorder treatment experience/training and even better if they have experience working with diabetics. A lot of times people may need to try a few different options before finding the right fit.
Thank you so much for your thoughtful replies. It helps to hear suggestions that I may have not thought of and have those previously considered reiterated by others.
I have the Libre 2 sensor-which is working soooo much better than the Libre 1-and a medtronic 640, so I am lucky enough to have tech to help control my BG.
I did actually stop the Excel record keeping for a couple of months and then came back to it. I don´t know why, but it is difficult to give up. My shrink was happy to hear I had stopped but then I started again.
Working with a psychologist has made me realize I kind of don´t know myself as well as I thought. I have discovered I am a perfectionist (really?) and that control is really important to me, and that with diabetes, it is just not working for me. Being super-disciplined in sport and at work has always brought me great results, but those things cooperate with consistency and hard work, whereas diabetes laughs in the face of them.
My sister had bulimia in her twenties, but hid it very well. My family din´t know she had it until she was well into her thirties. When I listen to myself talk about how I am feeling with my sister or best friend, I know I sound like I have some kind of disordered eating and some pretty irrational reasoning.
The behaviours are definitely coming from avoiding complications. When I think of going blind or losing a limb or needing dialysis, I think about how I won´t be able to work and support myself. And you could get lucky and not get complications with some poor control or be unlucky and be pretty well-controlled and have complications anyway. I just feel like I should be trying to do everything I can to avoid them, but it is kind of ruining my day to day!
The struggle continues, but thank you so much for taking the time to respond. 
That all makes lots of sense!
Something that might be helpful for you in working on managing perfectionism/overcontrol is an acceptance-based approach, like Acceptance and Commitment Therapy. You can work on that with a therapist (and it may be part of your therapy, I don’t know), but there are also two self-help books with that bent that I really like. Neither is specific to diabetes at all, but both teach skills that I think would be broadly useful and applicable. Both are available on Amazon etc and shouldn’t be too expensive. The first is called “Get Out of You Mind and Into Your Life” by Steve Hayes—it has a very intellectual bent, and I like it in particular for folks who tend to use logic as their primary way of approaching situations/their life. The second is “The Mindful Way Through Anxiety” by Sue Orsillo and Liz Roemer—while it’s about anxiety and some of the early chapters are specific to that, the overall book is really more skills for managing challenging situations/emotions, and I think it’s super helpful for lots of people, even folks who don’t identify anxiety as a primary issue (though I kind of suspect it’s in the mix for you based on what you’re saying, even if it’s a totally understandable anxiety about potential outcomes from diabetes—it’s a question of how to make that not interfere with you living your life though). I like the latter book particularly for folks who tend to experience their world via their emotions and have that as a major factor for how they gain information about situations. Both books have really similar content in many ways, just quite different tones and thus in my experience tend to resonate most with different people, though I think you can’t really go wrong with either.
I’m not sure if anyone has adapted that material specifically into a self-help book for diabetics—my work as a psychologist isn’t in behavioral medicine/diabetes, but I’m tempted to add that to my list of potential projects if not, since it seems like it would be super useful!
Thank you for the book recommendations. I will definitely check them out. I have lost track of the number of books I have bought on Amazon during quarantine, which has been quite strict here in Spain. I got a CBT workbook for Perfectionism a couple of months ago (OMG, it is like it was written for me!) and I have almost finished with it.
Unable to go tot the hospital for my endo appt, we had a phonecall and she estimated my a1c as 6.2, having looked at my pump downloads. When I told the shrink, I said, it is probably inaccurate as there was no real bloodwork done, and she said, If it were a 7.2, would you have believed that? And I said, Well, of course. (!!! 
)
If you ever do adapt anything for diabetes, make sure to advertise it here. 
Thanks so much for your advice.
I’m neither an athlete nor a type 1, so I can’t give you any advice. I just wanted to say I’d be stressed too if I tried to have perfect BG levels, which are almost impossible with this disease, and I empathize with your struggles. I think you’re doing a great job.
This.
I’m the same way. I’m a self-admitted “control freak” and I have totally rebooted my thinking about my diet since diagnosed last year. However, perhaps because it’s only year 1, I am looking at my new diet as a net-win vs. a net-loss.
I count every carb; I track every meal; I exercise and drink strategically to mitigate hyperglycemia.
This approach allows me to be in control of my situation vs. the situation having control over me (i.e., complications). To a fault, I am working my tail off to avoid complications, and I’m proud of that commitment.
I have a label for people like us: Type A Diabetics. 
In fact, I’m working on a Type A Diabetic manifesto (to be released soon!) that defines what a Type A Diabetic is, what we stand for, and what we expect from the diabetic ecosystem (hint: we expect a complete reboot of thought around diabetes in its entirety!).
In any case, just wanted to share that you’re not alone in your Type A-ness and this condition.
Thanks again for your responses. I zoomed with my shrink for our appt yesterday and she wants to see me more frequently. I guess she is really noting the cray cray. She´s very slick that lady, I have got to say. I said to her that well, I wasn´t really doing everything all the time, and she was like, Yeah, I know. 
I feel like I am just talking to her but there she is taking some mental notes even on my body language through zoom. scary. 
@JonDeutsch, look forward to looking at your manifesto when it is ready.
I was really crazy about my eating the first 10 or 20 years I had diabetes. I was so scared in general. I’d over correct with insulin and over correct with food. I’d measure carefully and then I’d binge eat to control my anxiety and of course afterward it would come back with a vengeance. Therapy really has helped over time. Mainly healing from a very rough childhood and getting better about tolerating and working through my fear, anger, and anxiety. Having more acceptance for and alliance with my sweet, imperfect body. All of that. I just try not to eat more than about 45 grams of carb at one time now, usually less, occasionally more. Im not obsessed or distressed about eating now. And my sugars are good, excellent really, with the help of technology.(tslim with control IQ) It helps too, that I’ve had t1 for 41 years and no major complications from that. (Other autoimmune stuff) I used to think I could never be relaxed about food and eating, but I am now.
I wish you the very best on your journey toward balance and ease in your life. I know that is easier said than done. Be patient and kind with yourself!
Hi Peg,
I am hoping that therapy helps me to find a better way of dealing with food. Thanks for your message.