Depending on where you live, low-carb can be expensive. It can be even more expensive if you want grass-fed beef, lobster and asparagus.

You also want to do your blood glucose a favour by eating low-carb. Combining that with a lack of funds isn’t easy but it’s possible!

The trick to low-carb on a budget is to buy on sale and buy seasonal which means abundance and reasonable prices. It’s probably a good strategy for all food shoppers on a budget.

By ‘sale’ I don’t mean horrid looking limp vegetables. You don’t want to buy rubbish vegetables that have been sitting on a shelf for a week and every vitamin has long evaporated into thin air, yet you can’t afford what you think is low-carb.

Vegetables you buy have to look good, smell good and hopefully taste good. It’s not enough for the veggies to be on sale, you have to think about why they’re on sale. Are they in season and abundant, or are they an over-purchase that the vendor can’t move? Are they a loss-leader to get people into the store? Are they completely out of season or imported?

If budget buying means driving an extra 5 minutes, the petrol is minimal compared to the favour you’ll be doing your bank account, your body and your budget.

Similarly for meat – buy what’s on special at the butcher’s but don’t buy rubbish meat that looks like it’s about to go off. With low-carb, you NEED the fat! Don’t think buying low-fat will save you anything. It won’t. You can buy cheaper cuts that need long, slow cooking, or mince that can be made into any number of tasty low-carb dishes.

Buy in bulk and store appropriately, eg freezing or in long-life vegetable bags. If you’re not in the city and you need vegetables, then buy direct from farmers or go to local farmers markets. At the end of the market, that’s when the produce is often cheaper.

Buying larger quantities of cold pressed oils is often more economical. Take your calculator to the store or make use of the one in your mobile phone – I do, often!

Buy cheese in bulk  - as much as you think you can eat before it goes off.

In Australia, if you know someone with an ABN, then get a Campbells card and go bulk shopping. It’s a huge money-saver.

Another trick is to shop like many Europeans do – don’t go to the store with a meal in mind. Go to the store with an open mind. See what’s on offer. If chicken is cheap, that’s what’s for dinner. If lettuce is expensive and cabbage will stretch further, then make a cabbage salad instead (recipe below). If the Roma tomatoes you want are expensive, then see what other tomatoes are on offer.

Eggs can be  a cheap or expensive meal. In the city, often your only option is a choice between organic, free range or battery hen eggs. In Australia, there’s a huge difference in price between these options. In rural areas, find a local farm which sells eggs and buy in bulk! In the city, go for free-range at the very least, if you can afford it.

In Australia Aldi supermarkets sometimes have a two-for-one on chickens. That’s a great way to get 2 or 3 meals (for two) out of a low carb ingredient. Or a large pack of steak, at a reasonable price.

Go shopping at the end of the day if possible – that’s when specials often appear.

If you work, then take your lunch. A salad with some meat and cheese is easily transportable, so is tuna and any number of other low-carb lunches. Put your homemade salad dressing in one of those tiny containers and only open it right before you’re going to eat the salad.

Here’s a salad dressing I keep made up in one of those chefy squeeze bottles at home. It’s not only used as salad dressing but as a marinade or a splash of it across some BBQ meat.

SUSI’S SALAD DRESSING

Fill about 3/4 of the squeeze bottle with good olive oil – the best you can afford (cold pressed if possible)
About 1 teaspoon of Mustard – I use wholegrain, mild (love the crunch when eating the salad)
Sea Salt & Freshly Ground Black Pepper to taste
1 large Clove of  Garlic, finely grated
Red Wine Vinegar – a quarter volume of what you already have  in the jar – try half that first, taste and add as needed

Close the lid and shake. Taste! If it needs more of something, add it. 

The dressing is better after a couple of hours. Can be kept in the pantry up to a week.

Another cheap option is cabbage salad, especially in winter. This salad tastes great with fatty dishes. The vinegar in the salad seems to cut the fat.

HUNGARIAN CABBAGE SALAD

Also great for a crowd

Half a head of plain old-fashioned cabbage (sugarloaf cabbage is ok too), shredded into long strands  (must be shredded very finely or the salad doesn’t work) .

Half a mild Onion (use a whole one if you love onion), very finely chopped or sliced
5 tablespoons of plain vegetable oil (this salad doesn’t work with olive oil or any other flavoured oil)
3 tablespoons of plain white Vinegar – don’t use red or any other type of vinegar
3/4 – 1 teaspoon sweetener (I use Splenda, but you can use whatever you want, including sugar – there’s not enough sugar in there to make a huge difference if you consider 1 tsp sugar is around 11 grams of carb).  
Salt & Pepper to Taste
Note about the vinegar: you may like more vinegar, I do, I put about equal amounts. It won’t taste good right away. 
Combine the dressing first, then pour over the cabbage

IMPORTANT: once the dressing is on the salad,  get your clean hands in and squeeze the cabbage to get the juices out of the cabbage. These will dilute the dressing some so what you think might be too much vinegar, isn’t after the salad has been sitting for a while. 

This salad is much better made a few hours ahead and is great the next day. 

There are definitely ways to make eating low-carb much more affordable. If you’ve not tried low-carb because you think you can’t afford it, give the budget way a try! Your waist-line will love you and so will your blood glucose!

And please don’t start on me about ‘healthy whole grains’! When you have diabetes (of any kind), there’s nothing healthy about whole grains. The body does not need this kind of carbohydrate, despite what you may think. Carbs are also converted in the body from about 58% of protein and 10% of fat, as well as from low-carb vegetables. Plenty for your body’s needs! You don’t need high-carb fruit or high-carb vegetables when you’re trying to get your A1C into a normal range and further down into a range that won’t cause complications. It goes without saying that grains aren’t necessary.

Are you asking what a rage bolus is?

In case you are, it’s the act of giving insulin, often much more than you need, when you’re really angry at a high glucose reading that you can’t immediately explain, or one that refuses to come down.

If you read any diabetes blog or forum enough, or have it yourself, you’ll know that for many people with diabetes, in all its incarnations, it’s a 24 hour job to look after it. Yes, even when you’re sleeping you have to make sure before you rest your weary head, that you have calculated and mashed together, to the best of your ability, food, insulin, activity, stress and more, so that your blood glucose won’t go low or high overnight.

There are very few things in life that you can’t take a break from – even for one day, let alone a week or two of blissful holiday. Diabetes is with you 24 hours a day and it has to be managed 24 hours a day.

So now and then I get cranky with it. Even though I know a lot of the science, on occasion, diabetes doesn’t behave as expected.

I probably under report every last bit of the bad stuff here on this blog, but tonight I’m sorely tempted to put some very raw feelings on the screen.

It’s more than annoyance and less than outright anger – somewhere in between. Let’s see if I can contain myself.

Here’s the scenario:

Dinner: BBQ
Food: Hungarian cabbage salad (oil, vinegar and a tiny bit of Splenda – a scant teaspoon for a whole cabbage), steak, tomato, cucumber, avocado – just with salt, half a corn cob (as a treat) with some butter.
Drink: Water and some diet mineral water.

Easy to bolus for? Supposedly! On paper, other than the corn, it’s lowish carb. I’ve bolused for this kind of dinner a gazillion times and been fine. Hadn’t eaten for many hours before.

I calculated about 30gr carbs, figuring that I would probably have maybe 1.5 loosely packed cups of cabbage salad (I could eat that stuff all day long!), half a tomato, the half cob of corn (definitely not low-carb), 3 slices cucumber, plus I also bolus for protein and fat and a few extra carbs for the diet soda (the one I drink has 3g carbs per glass). It would easily be way less “carbs” if I didn’t add in 50% of the protein and 10% of the fat (TAG bolusing).

My BG was were I expect it to be when I’m not eating – perfect. Total already bolused for today 20gr carbs. Am happy with that.

I entered the carbs into my pump, went for a combo bolus of 2 hours (very thick steak with fat) and thoroughly enjoyed my dinner, with the steak rested well before I started eating.

I really thought I did everything right. Apparently not…

At 2 hours I checked my BG and it was fine – just inside normal and the combo bolus was just ending so the insulin should still be working and keep working for another 2-3 hours as the rest of my dinner hit my bloodstream.

At 4 hours I should have stayed within normal range yet I was way higher, totally on the wrong side of normal. Not too much but enough to make me cranky. Diabetes you are not behaving tonight!

Did I underestimate the carbs? I didn’t think so but I probably did – it was probably the steak that I didn’t calculate properly. I thought I did a small overestimate on the total I should bolus for, but thinking about it and checking some nutrition info, I’ve probably under-bolused for the steak.

Insert expletives, because I don’t want more fat-promoting insulin. More expletives because I must have screwed up. More expletives because I don’t want to be dealing with this right now. Rage bolus coming up!

At midnight, my angry fingers dialled up more than what my pump suggested.

Two hours later (2am) and I was back inside normal but not where I usually am. Technically I should have gone low.

Hmmm… more expletives. Another rage bolus, but this time more rage than bolus. It’s now 3am and I’ve stayed exactly what I was at 2am! What the bleep?

So what is it? Insulin not working? Pump site not behaving (it’s behaved fine the last 48 hours)? Total screw up on the carbs and how long they would take to hit my bloodstream?

It’s easily 7 hours since I’ve eaten. Seven hours for a steak to keep working? I’m not so sure about that but in case it is… holy cow (pun intended)!

So now I’m faced with changing out my pump site and going to bed. Never a good idea! It’s much better if you hang around awake to make sure the site is working and that you have a stable blood glucose before you hit the pillow. Or do I have another rage bolus? Maybe it was all that swearing that caused the stress that caused the BG to stay up. We all know how the just the tiniest amount of stress sets me off.

Don’t know what I’m going to do yet. I still have hope that all the insulin I’ve taken will do its job or the dinner I had won’t keep repeating the BGs I don’t want!

Dr Bernstein of low-carb for diabetes fame is anti insulin pumps. Actually, what he says is that he ‘doesn’t recommend’ pumps. He states his reasons in many interviews. Just one example from here:

Many of the female patients seemed to have wings on their sides where the pump tubing was inserted and they got lipohypertrophy. But that was the least of it. None of them had normal blood sugars. Of the new patients who came in using pumps, there was only one whom I was able to get near normal blood sugars. It was because he was still in his honeymoon period. After a year on the pump, his blood sugar started getting unpredictable. And why is that? I believe it is because of the scar tissue that forms where you have a foreign body inserted for days at a time.

First, from Wikipedia:

Lipohypertrophy^[1] is a medical term that refers to a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action. It is a common, minor, chronic complication of diabetes mellitus.

Here’s my response, directly to Dr Bernstein:

Much as I’m a low and lower-carb fan and I respect the logic behind your low-carb theories, I’m very pro-pump.

That stated, I read many blogs and forums and I don’t know anyone whose A1C hasn’t improved, or their diabetes has become more unstable on a pump – provided they’ve had the right education and continue to tweak their insulin until it’s right for them. Lack of proper pump education can be the cause, as can many other factors (eg insulin allergy) that can be investigated and dealt with. True, I don’t know everyone in the diabetes world, but the majority of what I read and hear doesn’t bear out your statement.

Scar tissue? Sure if you keep putting the inset in the same place and leaving it there longer than is recommended.

On the other hand, I can show you the huge, deep, very-slowly-fading bruise I still have 18 MONTHS after stopping Levemir! I was told to inject NovoRapid on one side and Levemir on the other. For now I’ve lost that area on my belly for my pump cannula because it’s as unreliable as I could ever imagine! All my pump occlusions have occurred in that area. I dare say there’s also some lipohypertrophy in that area.

One can get lipohypertrophy on injections too!

The body has plenty of areas to insert a pump cannula before there’s no place left because of hard, fatty deposits, if indeed you get them at all. If you really run out, you’ve been pumping for an awfully long time. In addition, the possibility of  lipohypertrophy is reduced if you change your site within the recommended time. Some seem more prone to these fatty deposits than others.

And really, do you think, Dr Bernstein, that in 10 or 15 years time, we will still be using the same insulin pump technology?  Surely not with current advances! But maybe we will. Who knows?

I don’t see a whole lot of people scrambling to get off insulin pumps because their blood sugars haven’t improved and stay improved. Sure, people do go back to MDI or take a break, but mostly for other reasons, as far as I can tell.

My own experience of moving from MDI to an insulin pump saw a 3 % point decrease in A1C by the first test after! It was the very best thing I’ve ever done for my health. My A1c is still improving as I tweak what I do with my pump ! How does that in anyway reflect unstable blood sugars or ones that don’t approach normal?

Actually, your idea of normal seems a tad narrow. Research shows when the damage from diabetes happens, and it’s certainly still within the higher range of blood sugar recommendations for people with diabetes, but above what you recommend. So, neither recommendation is necessarily right.

In this age of people being interested and involved with food, cooking, lifestyle programs, good restaurants, farmers markets, recipes, entertaining and so on, some of us simply can’t always do the 30 grams of carbs a day you recommend. Some of us also don’t want to. Some of us do mostly low-carb and everything in between. But we’re still achieving good A1Cs and we’re avoiding those damaging blood glucose spikes.

I’m not saying low-carb and injections don’t work, but for me, some days I do want to have an occasional piece of cake or pizza, or a slice of that new sourdough bread that everyone’s raving about, and my pump allows me to do that with extended boluses and calculations that I was so sick of doing in my head when on MDI and often getting nowhere even on low-carb.

Pumps are also great for people with gastroparesis, particularly with the ability to do extended boluses. Yes, I know you can achieve similar with longer acting insulin injections. Why bother?

I don’t want to continually draw attention to myself in restaurants with friends by having a 15 minute conversation with a server about what he or she can and can’t bring me to eat. I don’t want to live my life like that and I don’t want my friends to be subjected to that conversation ad nauseum. I just want to order the lowest carb thing I can find on the menu and if that ends up being way over a particular carb allowance, so be it. I yank out my pump, enter an extended bolus and I’m done. No bringing out shots or insulin pens and being looked at like I’m a drug addict. Not that I ever much cared about that, but it’s an issue for many from what I hear.

Sometimes my friends want to dine where almost everything on the menu is carb-laiden, or I’m invited someplace where there’s little that is low-carb. Do I have to stay home? How would I manage that with injections? Pull out a syringe every half an hour? Or maybe I just shouldn’t eat? Yes, people do manage on injections, but I say I have better and far easier control with a pump AND I have the quality of life I want. I can and do participate in social meals as a nearly normal person. That’s priceless!

I have another autoimmune disease that sometimes plays havoc with my blood sugars. Do I really have to manage that with injection boluses or an increase of a 12-24 hour  basal when I can’t predict when it will stop? With a pump, I have minute-by-minute control of basals. I increase for a couple of hours at a time, test every hour or two, to see what’s happening and I’m done.

In conclusion, I would much rather have 10 years of far better A1Cs than I had on shots, and be more easily able to sometimes live outside the low-carb regime than not. And I would much rather and more easily achieve that with an insulin pump than with injections. If someday I have to go back to injections, because of lipohypertrophy or because my BGs have become unstable because of a pump, then I’ve still had 10 or 15 years of doing much less collateral damage from diabetes in a far more convenient way.

Again, I’m not saying your “normal” blood sugars can’t be achieved with diet and insulin injections, but why bother when most insulin pump users will probably tell you it’s so much easier with a pump?

If you think that all pump users have unstable blood sugars or that their A1Cs are not more normal than they were on MDI, you’ve been hanging around in the wrong places!

With the greatest of respect for what you’ve done to help people better control their blood sugars (me included), I’ll wear my pump and have better A1cs until the last place I can wear it is on my big toe! I dare say that most people using a pump would agree.