One in eleven Canadians is diabetic. That means that there’s a good chance that you or someone you know at your seder has diabetes. For someone observing Passover and living with diabetes, that means observing two sets of food restrictions simultaneously. Surviving – or better still, enjoying – the holiday is possible. But it takes plenty of preparation. Fortunately, help is at hand.
Emma Elvin, clinical advisor at Diabetes UK, says: “Passover can pose a unique challenge for Jewish people with diabetes because of the changes to what carbohydrates they are allowed to eat, but with careful planning around what you will substitute your regular foods with it doesn’t need to be an issue.”
Over 25 years ago, Nechama Cohen began to exhibit severe symptoms of diabetes. That change in her life also sparked Cohen to eventually found the Jewish Diabetes Association to raise awareness about the challenges and solutions for Jews living with the illness. “Our eating requirements are intimately bound up with our religion, culture, and ethnic identity.
A Jewish person with diabetes needs to learn how to navigate their way through all these eating opportunities, and stay in control of their blood sugar levels. Go and try to explain to a doctor why you absolutely have to have four cups of wine at one meal and a given amount of matzah. I do not know if anybody knew the carbohydrate content of matzah balls until we came along!”
The association’s guide, Eating Right for Passover, is very impressive. Information in the bilingual English/Hebrew booklet includes info about: using a food scale on Pesach; how to time your taking of insulin to coincide with the Seder meal; sugar substitutes that are kosher for Passover; illustrations of recommended quantities of matzah to be eaten during the Seder; glucose and carbohydrate levels of common Passover wines; and how to water down wine and still fulfill the requirements of the Four Glasses.
• Type of wine: The best option would be a dry wine, which has almost no carbs. the sour taste bothers you, try to add some artificial sweetener. Liquid sweeteners are available with certifications for Pesach.
• Weigh, package, and label the exact portions you will be eating each time matzah is required at the Seder. Place them in clearly marked plastic storage bags. Alternatively, prepare your (non-electric) scale so that you can use it to weigh the matzah at the Seder table.
• Using a scale and pump on Pesach: Your scale was (hopefully) used all year round with chometz, so be very careful to clean it out well before Pesach. Change the batteries in your pump before the holiday starts.
• Make an appointment with your doctor to discuss insulin changes for Erev Pesach and the Seder night. If you are a type 2 on medication, remember to ask your doctor whether you should drink wine for the four cups, or if grape juice is preferred.
What can someone with diabetes enjoy on Seder nights? Diabetic-Lifestyle.com recommends Spring Vegetable Soup with Scallion and Dill-Flecked Matzo Balls, Beef Brisket with Oranges and Grilled Pineapple with Raspberry Purée. And over at Diabetic-Recipes.com, you’ll find a Passover menu consisting of Roasted Leg of Lamb, Fresh Asparagus with Lemon and Fresh Strawberries and Rhubarb.
Writing in the Forum of the Society of General Internal Medicine, Dr. Karen R. Holowitz points out a fascinating relationship between the differing ways people deal with their diabetes – and the famous Four Sons of the Hagaddah.
• The Wise Son: He is fully invested in his diabetes care. He is adherent to medication. He arrives in the office ready to learn and to continue to make positive changes.
• The Contrary/Wicked Son: He is non-adherent to the care plan. We are taught that, “by excluding himself… he denies a basic principle.” Holowitz says she can guide those who are willing to accept responsibility for their self-care but cannot do it herself.
• The Simple Son asks, “What is this?” He is the patient who really has not had the opportunity to learn about diabetes. He is open to learning but naïve (i.e. has not been taught). We should start from the beginning and teach him the basics.
• And then there’s the Son Who Does not Know How to Ask. He says nothing helps, so he has stopped trying. He often skips insulin doses and testing. So it is Holowitz who needs to kickstart the conversation. “Do you know why it is important to me to treat diabetes?”
Despite the precautions and scales and restrictions and pumps, type-2 diabetic “tmana” says “Dayenu“, there is much to be grateful for. “Given the state of diabetes care today, we can say that most of us have been ‘delivered’ from a premature death – or at least, from a much more premature death than we might otherwise have had. All of us have the tools to monitor and treat our condition. Many of us lead ‘normal’ lives, with diabetes being no more an interruption of that routine than daily prayers. …
“Take a moment tonight, and consider: what still enslaves you? what liberates you? and for what are you grateful? – both in terms of your diabetes and in terms of your life in general.”