Chinese Restaurant Effect

Alright, so there is this dude; he is a doctor dude, born in 1937 and he is a type 1 diabetic. He is a very smart man and I believe that at this point in his life – dude has seen some shit.
Please feel free to peruse his information and develop your own opinion about this guy. I respect him greatly, but I’m kinda still gonna eat carbs sometimes ’cause they taste so dang good. Anywhoodle – his wiki page is:
I shared all that ’cause I wanted to share one of his most famous theories:

Many years ago a patient asked me why her blood sugar went from 90 mg/dl up to 300 mg/dl every afternoon after she went swimming. I asked what she ate before the swim. “Nothing, just a freebie,” she replied. As it turned out, the “freebie” was lettuce. When I asked her just how much lettuce she was eating before her swims, she replied, “A head.”

A head of lettuce contains about 10 grams of carbohydrate, which can raise a type 1 adult’s blood sugar about 50 mg/dl at most. So what accounts for the other 160 mg/dl rise in her blood sugar?

The explanation lies in what I call the Chinese restaurant effect. Often Chinese restaurant meals contain large amounts of protein or slow-acting, low-carbohydrate foods, such as bean sprouts, bok choy, mushrooms, bamboo shoots, and water chestnuts, that can make you feel full.

How can these low-carbohydrate foods affect blood sugar so dramatically?

The upper part of the small intestine contains cells that release hormones into the bloodstream when they are stretched, as after a meal. These hormones signal the pancreas to produce some insulin to prevent the blood sugar rise that might otherwise follow the digestion of a meal. Large meals will cause greater stretching of the intestinal cells, which in turn will secrete proportionately larger amounts of these hormones. Since a very small amount of insulin released by the pancreas can cause a large drop in blood sugar, the pancreas simultaneously produces the less potent hormone glucagon to offset the potential excess effect of the insulin. If you’re diabetic and deficient in producing insulin, you might not release insulin, but you will still release glucagon, which will cause gluconeogenesis and glycogenolysis and thereby raise your blood sugar. Thus, if you eat enough to feel stuffed, your blood sugar can go up by a large amount, even if you eat something undigestible, such as sawdust.

The first lesson here is: Don’t stuff yourself. The second lesson is:
There’s no such thing as a freebie.* Any solid food that you eat can raise your blood sugar.

Okay, got it? That’s his theory and I don’t believe he is wrong – although I do believe that in addition to his theory that if you don’t have enough usable blood glucose in your body when you workout your body will attempt to fix that by releasing glucagon and thus raising your blood sugar.

Anywhoodle – this is the reason that quite a number of endocrinologists [including Dr. Bernstein] highly recommend and prescribe a GLP-1 drug for Type 2 diabetics and even prescribe them “off-label” for Type 1 diabetics. GLP-1 drugs are also known as incretin mimics and the most common drug names out there right now are Byetta and Victoza. Please know that a GLP-1 drug CANNOT replace insulin and a common way to adjust insulin with a GLP-1 is to keep basal the same and start with the assumption that mealtime boluses can be reduced.

Now, because there is another dude out there in the world who has already shared some great information about these drugs on a forum known as tudiabes; I’m totally copying and pasting:

[Victoza & Byetta] “…are both GLP-1 drugs, a class of drugs that mimic key incretin hormones. The GLP-1 drugs have a key action of inhibiting glucagon and stimulating insulin release in response to eating. For a T1, the insulin stimulation just won’t work, but the glucagon effect can be significant. When we eat, particularly if we eat something big, our bodies will release glucagon and insulin in response to simply the act of eating. Bernstein calls this the Chinese Restaurant Effect. This is different than insulin being released in response to a high blood sugar and instead is focused on enabling a complex dance of preemptive control of blood sugar in response to meals. That being said, even as a T1, when you eat you can and will release glucagon and that can result in a contribution to your mealtime blood sugar. So a GLP-1 may help a T1 get better mealtime control, perhaps using less insulin or just improving postprandial levels.

It is also true that the GLP-1 drugs lower both hunger and appetite and have been shown to help people lose weight. My observation is the GLP-1 drugs are mostly being prescribed to T1s for their effect on hunger, appetite and weight loss. That being said, the use of GLP-1 drugs for T1 is not FDA approved and while doctors can prescribe it off-label there is apparently lots of confusion. The prescribing information on Victozabasically says not to use it for T1 and provides absolutely no information on how to adjust insulin dosing with Victoza. There are ongoing studies on T1 use of GLP-1 drugs and I would anticipate FDA approval for their use in T1 in the near future….”

Forum Link:

Okie dokie, that was some diabetic learning for the day – if anyone has any questions, comments, concerns, stories, photos, whatever…..please feel free to comment.


Diabetes & Alcohol

Dear FLC, I’m hungover. I’m not a drinker, mainly because alcohol is just *such* a shitty drug that has too many side effects (case-in-point: hungovered-ness). Last night I heard that there was a place in town that had power so I found shoes and off I went. The bartender had her thumb on the diet coke button when a Cruzan pineapple rum with cranberry juice was ordered – coulda knocked that poor girl over with a feather (Heather? drinking?!). We had some snacks as well and by the time we were home (10PM) the power was back on. All in all, it was a good night.
See, the problem with drinking for all diabetics (Type 1, Type 2, and every other kind) is that the human body prioritizes. So, our livers go from working at a normal pace: process this, release sugar now, filter that, rinse, repeat, etc. When we throw some alcohol into the mix, the liver does the equivalent to sweeping its desk clean and focusing only on the alcohol; basically ignoring everything else.
That’s when our diabetic medications can get us into trouble–see, the medications aren’t thinkers, they are just up in there doing there jobs like a computer driven vacuum cleaner (or a Roomba) sucking up sugar. Well, if the liver doesn’t provide sugar on its normal schedule then the vacuum cleaner can suck up sugar we may have needed thus leading to potentially scary lows. The lows can be extra scary because if you add enough alcohol then you cannot feel the low happening. Then, the next day, my LEAST favorite thing in the world can happen–rebound highs. After finishing the alcohol project your liver PANICS at all of the work he pushed off his desk and just dumps a bunch of sugar at the problem leading to random HIGH blood sugars.
There is no perfect answer and I will happily smack down the first person who says Diabetics shouldn’t drink. It’s our bodies; we get to make choices about what makes us happy. I just don’t like anyone making an uniformed choice; know what your body does and why it does it. Make your choices accordingly and be happy with your life.

For anyone curious about what Herbert did last night, he did a great (and annoying(ly awesome)) alert where he stood on the picnic table to tell me that I was was trending high. I took a couple units of regular insulin to counteract the juice (but less than I normally would have to account for the alcohol). All was well. Today, despite feeling generally crappy (yes. after 1 1/2 alcoholic beverages I get a hangover) my blood sugar was a lovely 108 mg/dL.

Diabetic Stuffs – An Odd Herbert Alert

Just had an odd Herbert alert while sitting at my desk reading a draft review of our program and getting *super* annoyed. It is a 21 page report.  After reading 9 pages and putting in 16 comments while loudly chewing gum and grumbling many “ughs!”, “hell no’s”, and a variety of other profanities, I look over at a Herbert giving me the death-stare from a perfect sit (a/k/a an alert) and I said, “Oh! okay…?” and checked my blood sugar (92mg/dL). As soon as I pulled out my kit he went back to floppy sleepy Herbert – so, was he alerting me to an upcoming low (possible – haven’t eaten lunch) or has he just decided once I start radiating irritated rage he should probably pop up to remind me that it’s just a stupid report and to calm the hell down? Don’t know, don’t care. Either way – Good Herbie – here’s a biscuit.  As you can see, his under-desk snooze has returned to his non-alert status. *grin*

Herbert Under Desk

Diabetic Randomness

If you’re anything like most people who check their blood sugar (glucose) you are a big fan of your non-dominant hand’s middle and ring fingers. Why? Because it is easiest to use your dominant hand to hold the pokey and your middle and ring fingers are the least painful to receive the pokey; it is not a surprise this is the choice of the many. So after badgering y’all to poke yourself more often – now I’m going to be all judgy mcjudgerson on the where?!? Nope. But I will give you some tricks I have heard/read/learned over the years. One way to make sure you move lancet sites is to choose your Finger of the Day. This is not my system, but I am going to give it a whirl.

  • Odd days – Left Hand
  • Even days – Right Hand
  • Start on the lower side of the finger pad and continue in an arc pattern
    • don’t do more than 6 pokes on one finger pad per day (move to next finger if needed)
    • this allows each finger pad a week to heal between poke days.

Hope this helps!