Navigating Passover With Diabetes
By Diane Scherer
diaTribe’s Diane Scherer shares strategies for managing diabetes around Passover.
Faith has always been an important part of my identity, history, and culture. I am very connected with Jewish religion and, like having diabetes, it guides much of my everyday life.
Depending on the season or upcoming holidays, different spiritual thoughts drift into my mind while I still have to navigate the practical challenges of diabetes: managing my blood glucose, diet, and physical activity. These thoughts and challenges come together when a holiday such as Passover, with its rituals and customs, restricts my food choices and daily schedule.
In the 39 years that I have had type 1 diabetes, I have found that Passover is the holiday that makes me reflect most upon living with diabetes. This year, Passover begins at sunset on April 22 and ends at sunset on April 30. Passover (Pesach in Hebrew) is the "holiday of freedom," commemorating the Jewish exodus from Egypt following 210 years of slavery. It is regarded as the "birth" of the Jewish nation, and its lessons of struggle and identity continue to this day, more than 3,000 years later.
For the entire eight days of Passover, Jewish people abstain from eating leavened bread, instead eating matzo, a type of flat, unleavened bread. This holds significance both spiritually and physically. Matzo is bland, simple, and humble in taste, and reminds us to have a humble character. When the Jewish people were rushing to leave slavery, they didn’t have time for their dough to rise, so they packed quickly and only had unleavened bread. Matzo does not contain baking yeast, baking powder or baking soda – ingredients that cause the dough to bubble and rise, creating a light, airy product.
As I reflect during Passover, I think about one of its central themes, the notion of slavery versus freedom. When thinking about my diabetes, instead of feeling “enslaved” by negative thoughts or victimhood, I try to be thankful for the whole person I am, reframing my mindset to focus on my loving family, fulfilling career, and life beyond diabetes. I also feel empowered to be a role model for others by offering my experiences through writing, mentoring, and listening to those who also live with this condition. I hope the following strategies will help you navigate Passover and allow you to reflect and enjoy the holiday.
How I prepare for Passover with diabetes
Similar to the way that diabetes can be a different experience, how Passover is celebrated changes depending on how one practices, or whether one is Ashkenazi (of Eastern European descent), or Sephardic (of Spanish, North African, or Middle Eastern descent). I am writing from my own experience as an Ashkenazi and as someone with type 1 who uses an automated insulin delivery (AID) system.
In the week leading up to Passover, I typically start shopping for Passover-safe food and removing bread products from the house. Some people may also change the dishes and cookware to use dishes specific for the holiday. The extra stress and physical activity from preparation can affect my blood sugar in either direction, leading to both highs and lows. If I am cleaning a lot at one time, I treat it like exercise and increase my target range or temporarily decrease my basal insulin.
I also pay attention to the nutrition labels when buying Passover foods, as many of these products have added sugars to help in the taste department. I try to avoid these products because if they aren’t in my house, I won't snack on them. If you are new to diabetes or have questions in relation to Passover, try, if possible, to make an appointment with your healthcare provider before the holiday to discuss any potential treatment changes.
There might be an assumption that Passover is an easier holiday for glucose management. I don't eat pasta, pizza, muffins, bread, or even rice, corn or soybeans, so what could be so hard? In reality, however, many of the foods I eat during Passover do affect my blood sugar, having added sugar, eggs and oils.
Navigating Passover Seder with diabetes
On the first two nights of Passover, family and friends gather together for the Seder meal. If you are the host, you may have more control over the menu and schedule. However, because I often go to someone else’s home for the Seder meal, there are many different factors I have to consider, such as:
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Timing of the meal: Passover begins at sundown, so the start of the meal may be later than usual. Consider eating a healthy snack or small dinner before if needed. In addition, if you are going to someone’s house, make sure you pack what you need in case you experience hypoglycemia. I typically bring apple juice boxes, which are transportable and approved for Passover.
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Length of the Seder meal: The entire Seder, with all prayers and intermittent eating, can take up to four hours. There are many prayers that come before eating, so I am mindful about not bolusing too early. Plus, there are many ritual steps throughout the Seder, which means that eating occurs at several different points throughout the night. If you feel comfortable, ask your host approximately what time the meal will start in order to calculate when to bolus. Know that your dosing might be in frequent and smaller increments throughout the night (similar to a multi-course meal). Be sure to carefully monitor your glucose levels throughout the night to make the necessary adjustments.
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The menu: There are a few rules in regards to what and how to eat during the Seder that can affect glucose levels, which include:
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Drinking four cups of wine (or grape juice). The cup should traditionally be at least 3.3 oz. I make sure to calculate and bolus the carbohydrates for the 3.3 oz (times four over the course of the night). I also try to find, or ask the host, if the grape juice is “lower sugar” grape juice (grape juice that has additional water added). When it comes to drinking wine, be mindful of how to bolus for alcohol and watch for hypoglycemia hours later.
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Eating matzo. A store-bought box of matzo has the nutritional facts on it, so I either bolus accordingly for the exact amount I plan to eat or choose to limit the amount of matzo I eat. (For other types of matzo, including handmade matzo, the Jewish Diabetes Association has a handy guide for carb counting different types of matzo.) If my glucose levels are higher, I may make a choice to not eat the full amount of matzo that tradition says you should eat.
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The main meal of a Seder dinner usually has a protein, vegetables and perhaps some kugel, which normally includes wheat-based noodles, but the noodles are made with eggs and potato starch on Passover. I use an extended bolus feature for the higher protein, high fat meals, or input the protein and fat and let my AID system handle it. I also try to speak with the host privately about the recipes to make an educated guess on the carb count. If you really want to plan ahead, you could also ask the host to send you the recipes days before the holiday.
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The rest of the week of eating continues with no leavened bread. Because I do not eat at restaurants during Passover, I find that I can control exactly what I eat. I continue to pay close attention to how vegetables, fruits, protein and fat affect my blood sugar, and I make sure to increase my water intake!
Wishing you a happy Passover
Managing diabetes can be a different experience for different people. While these strategies have helped me, others may not be able to follow the restrictions of Passover while safely managing their diabetes. In the Jewish religion, preserving one’s own health and life supersedes any tradition, including the dietary restrictions of Passover. I do the best that I can to observe these traditions without endangering my health as a person with type 1 diabetes.
To those of you who are celebrating Passover, I wish you a holiday of reflection, freedom from worries, and physically and emotionally balanced diabetes management.
