Happy HoliDAZE: How To Keep Blood Sugars In Range During The Holidays

It’s that time...the holidays are upon us. Halloween has passed, the spooky eerie season is gone and now comes the cool, brisk welcome of autumn and Thanksgiving. And not too long after, Christmas, Hanukkah, and so many more wonderful holiday celebrations!

For those who don’t have diabetes, that means jolly cheerful dinners, stuffing, mashed potatoes, dinner rolls, Friendsgivings and warm cocoa by the fire. For those of us who DO have diabetes that means ALL those things plus the added stress of staying within target range.

We’ve heard those outrageous studies that say Americans eat over 7,000 calories on Christmas and gain anywhere between 1-5 pounds between Thanksgiving (end of November) through New Years Day. While I don’t doubt the validity of these numbers, that's a TON. And what’s worse is as diabetics, there’s no information on time in range and how they vary during these months. Although my expectation is that they differ largely from the remaining months of the year. 

I’ll never forget my first Thanksgiving after my diagnosis…I was so nervous! I wasn’t sure what I could or couldn’t eat.. or rather I was sure, but I just wasn’t sure I had the control. I wanted to eat the chips and crackers, I wanted to eat the creamy mashed potatoes and I definitely wanted that large slice of pie at the end of the night. We had just finished our appetizers and were setting the table for Thanksgiving dinner, when I decided to check my sugar. A big whopping 300-something popped up on my screen. I was shocked… I had only had a couple handfuls of snacks..and by a couple I mean a million. My mom was so mad...mostly out of fear.. I had never been that high before. Serious food coma...errr glucose coma. It was really awful—we all know the feeling right? We’re surrounded by good company all in good spirits, but you feel like crap, and that my friends is the Holiday Daze.

My step dad was actually crucial that first Thanksgiving. He told me to go outside and run around with my siblings before dinner starts because, “doesn’t exercise help your sugars or something?” The answer was yes! I ran outside for about 30-ish minutes and voila I was down to 190 or so. Not perfect, but good enough. 

I absolutely love the fall & winter holiday seasons. And if I’m being honest, I still love the holidays, but I also continue to struggle with them. And that’s okay. Now, as an adult who follows a fairly whole food, plant based diet, holidays bring up entirely new issues for me.  As if it wasn’t bad enough already that I had to watch carbs. 

So what’s a girl to do? 

What I found useful was NOT depriving myself. How many blogs have you read that say “fill up on carrot sticks and dip for appetizers,” or “drink a large glass of water before eating.” Now while those aren’t bad ideas, they don’t always work. My style, especially when working with patients is to encourage eating foods we love, but to be mindful of the AMOUNT we consume. So yes, go ahead and have those potatoes but a few less spoonfuls than what you’re thinking. And have those yummy appetizers, but still throw those fresh veggies on there too. It’s all about balance and compromise! 

Stop feeling guilty and beating yourself up. This is a joyous time of year and you deserve to experience the holidays just like anyone else. If we recognize some of our limitations and are able to work around them, we can still enjoy the holidays as much as the next person. 

This also includes NOT waiting to eat all day long until you sit down for your dinner! How many of us say, “I’m not going to eat all day so that I can enjoy this,” and while you think you are doing yourself some good, I hate to break it to you but you are NOT! You are ramping up your hunger levels (HELLO Hormones!) and are setting yourself up to eat everything in sight. When we haven’t eaten for long periods of time, our body begins to crave the fattiest, sweetest foods out there to help compensate for the lack of energy. Plus with diabetes when we haven’t eaten all day, we can force ourselves to go low. Being low plus super hungry equals a recipe for disaster. And around the holidays, we only like recipes that result in delicious foods. 

So EAT! Perhaps be mindful that you will have a fairly carb heavy evening meal, so stay light and low-ish carb throughout the morning and early afternoon. Staying hydrated goes along with this as well. Lack of water means increased cravings—your hormones will force you to eat anything if it means you’ll be getting energy and hydration. Save that special Diet Coke for your evening meal and make it your goal to stay hydrated during all that yummy dinner prep. 

Speaking of beverages, the holidays tend to involve alcohol, and since I’m assuming at least some of you are of legal drinking age, I think it’s an important subject to address. Drinking in general can be tough, but especially around the holidays, it is even harder to resist. Some of the highest carb containing beverages include mixed drinks, like margaritas, Moscow Mules, and novelty holiday drinks like eggnog, hot cocoa, apple cider. These drinks are easily 30-45g of carbs if not more. Beer is another guy with lots of carbs,averaging about 30 carbs. On the other hand, champagne and wine tend to have the lowest amounts of carbs. DOES NOT MEAN DRINK THESE TO EXCESS — while I’m not encouraging you to drink or providing you with loopholes to allow you to drink more, I really do think it is important to address head on rather than to ignore and hope you do well on your own with it. 

The thing about drinking is that alcohol is a depressant which means it can tank our blood sugar. A bit deceiving because if we choose the sugary beverages, we tend to be aggressive with our dosing. The problem is you seem fine, but all at once you drop out of nowhere, combine that with a buzz and you’ve got a recipe for disaster. So if you do choose to drink, be prepared, have snacks on hand for treatment of your lows. And be extra mindful of where your shoogs are at before and after. 

Now I am a fairly positive person , and never enjoy bearing bad news, but there is something I feel obligated to share. Now it is true that protein and fats have very little to no carbohydrates in them. Knowing this, over our long journeys with diabetes has provided some relief and has allowed us to think we can play it safe by eating only proteins, like turkey, chicken, or ham. The truth is however that high protein meals result in a delayed glucagon spike in our system about 2 hours after eating. (Glucagon is an enzyme responsible for breaking down glycogen from the liver into glucose for the rest of our body). 

For a person without diabetes, their body can naturally compensate  by releasing insulin, however for us, we’ve already dosed, and are so unsure why our sugars are high. We’ve carb counted, we’ve bee super strict, but we continue to see unnerving numbers that make us feel blue. And from what everyone has told us, pure protein is 100% safe, but that’s not exactly true. 

I say all of this because I am not the one to encourage a carb free holiday. Not saying that limiting carbs isn’t helpful because it totally is, but your strategy should NOT be to eat only protein containing foods. Since we’re eating so much around the holidays, we tend to attribute it to the carbs we eat, but what we are not realizing is that we are also eating foods high in protein and fat—and not the good fats. In turn this contributes to the poor results we see on our screens. Remembering to keep the plate balanced with all food groups is more effective than completely restrictive diets. 

I have to admit, my step dad really did have it right that first Thanksgiving. Never underestimate the power of getting some movement. Whether you’re a youngin and want to go run around or if you have youngins yourself, what a great chance to play with them and create some holiday memories. Plus it will help everyone’s blood sugar in the end.  Some ideas are kickball, tag, riding bikes, or even just a family walk around the block. Of course, be mindful of where your sugars are at before and after exercising. If you have CGM, then look at it before and after, and if you’re on MDIs, be sure to check both before and after exercising. 

Rather than recreate the wheel, I went ahead and did some research and found great examples to help break down different holiday foods and their carb counts. The great thing is, they have charts for holidays throughout the year, not just Thanksgiving and Christmas. 

https://beyondtype1.org/holiday-carb-chart-downloadables/

For me, I tend to just eat and eat and eat, and after I realize I’ve eaten way more than my first bolus can handle, I just guess bolus. Meaning I estimate how many carbs I’ve just eaten without actually have counted. The problem is, I’m hardly ever correct in estimating once I’ve already eaten. But it’s hard right? What do we do? Interrupt dinner to go take another shot, or reach down quietly and start playing with our pump—the dinner conversation stops and everyone is looking at you. The dreaded, “are you okay?” Which we obviously are, but it gets just a little bit awkward to answer and recover from. The answer is yes, that is exactly what we should be doing, but instead we answer with confidence. “Yeah I’m good I just ate a little more than I thought I would so I just need a bit more insulin. No biggie.” Simple easy and straight to the point. Some of you may already feel comfortable doing this, which I aspire to have too. Because what I tend to do is skip that whole part and tell myself I’ll bolus after dinner, which is even worse and I’ve definitely underestimated my carbs by then. 

The truth is, holidays are always going to be hard and nobody is perfect, but we can help make them a bit easier without depriving ourselves. By remembering to get some simple exercise, staying hydrated and vigilant about our carb counting, we result with better blood sugar control. While it may involve some awkward conversations, the more we normalize it, the less those conversations have to happen. 

Keep in mind you are a normal human, just like everyone else and you deserve to enjoy the holidays however you see fit. While it may take a few extra steps, you really can do it. Be gentle and kind with yourself, because as much as you can prepare, the holidays can always throw us for a loop, 

I hope everyone has a great holiday season. Remember to check those shoogs, and above all, enjoy yourself. Everyone stay safe and I’ll see you next year! 

Wishing everyone a Merry Holiday season and a Happy New Year! 

Taylor  

Taylor Gann is a first year physician assistant (PA) student in the first cohort with Cal State University Monterey Bay. She was diagnosed with type 1 diabetes in 2010 and has been living healthy with diabetes for the last 9 years—she is a proud pumper. Taylor’s background is in Nutrition Science, where she earned her degree from Cal Poly Pomona in 2015. Before starting PA school, she worked as a health educator in the WIC department and in primary care offices. In 2016 she created the Pediatric Wellness Program for Community Hospital of the Monterey Peninsula (CHOMP) and Salinas Valley Memorial Hospital (SVMH), a nutrition and lifestyle program designed for young children at risk for developing type 2 diabetes throughout Monterey county. She looks forward to practicing preventative medicine in her community, especially educating about the importance of lifestyle habits related to disease management.