I just read a report about a study which said that major weight loss had no effect on cardiovascular disease in T2s, but of course, they should lose weight anyway. That kind of qualifier seems to be required in studies that show results contrary to received knowledge. Why couldn't they have just said weight loss had no effect on CV disease in T2s, and skipped the part about weight loss?
I think this involves assessing just what the relationship between doctor and patient should be. For example, a hypothetical patient with T2 might have metabolic syndrome adequately controlled by meds, no other comorbid conditions, and not be able to lose weight. So his CV risk factors are being controlled and there is no reason I can see to nag him to lose weight.
Another article I saw found no fault with a doctor publicly stating NJ governor Chris Christie was too morbidly obese to be president (not advocating any personal political stance here), because of his risk for CV disease. But, in fact, she knows nothing about his personal risk factors, and I think she had no business calling him out on it. Not to speak of the fact that other presidential candidates have had high-risk health problems, too.
Then there is the study in another thread about carb counting in T1s. Our overwhelming consensus on TuDiabetes (http://www.tudiabetes.org) is that it does help, even though the study concluded that there is no difference from "usual care", whatever that means.
So what is perturbing to me is that these kind of studies and opinions devalue the insights of the person into their own health status, as if we were totally unaware of our health risks and what we want to prioritize. They talk about involving patients in their own care, but then dismiss our experiences and wisdom.
I think this is a major way in which medical care needs to evolve.
Tuesday, July 2, 2013
Tuesday, June 18, 2013
Bingeing
I'm a world champion sweets craver, and am still fighting the binge war (and sometimes losing), and I have found that the most important thing that I can do for myself is portion it out. I used to eat straight from the ice cream carton, or have the whole cake on a dish in front of me, or the whole package of cookies, and that only encouraged extreme overeating. And feeling really icky afterward, and struggling with blood sugars for many hours because of slow stomach emptying. So I'm working on serving myself out a reasonable sized portion, and then putting the rest AWAY. As in out of sight. But then, I'm an out of sight, out of my mind person! But really, if I don't see it, it's not nearly so much of a temptation as when it's right in front of me.
Yesterday, I tried to eat reasonably all day, with protein, fruit, vegetables and bread, but I was NOT satisfied. Not satiated. And all I could think of was sweets. So I went out and bought a half gallon of ice cream, and brought it home. And portioned it in a medium-size dish and ate it. It DID satisfy me, but the real victory was eating it and then STOPPING. I had enough, and did not need to go get a second serving, although I had given myself permission to do that. And I was able to control my blood sugar within reasonable limits, too, even if not perfect.
Also, I am a bit thinner, not that it shows, but my size is appropriate for my age (which is a body image issue I'm working on). I think that's the hardest part of all this. When I see all the beautiful young women who think they're fat, it drives me crazy, because they're NOT. They just have distorted body image. But that distorted body image is SO hard to change, and I do understand that it is stressful for them to have gone up in size when they start eating appropriately. But size does NOT define beauty -- and I think we should put that on our mirrors to look at every day. And eating appropriately, INCLUDING a little bit of sweets is appropriate. :-)
Yesterday, I tried to eat reasonably all day, with protein, fruit, vegetables and bread, but I was NOT satisfied. Not satiated. And all I could think of was sweets. So I went out and bought a half gallon of ice cream, and brought it home. And portioned it in a medium-size dish and ate it. It DID satisfy me, but the real victory was eating it and then STOPPING. I had enough, and did not need to go get a second serving, although I had given myself permission to do that. And I was able to control my blood sugar within reasonable limits, too, even if not perfect.
Also, I am a bit thinner, not that it shows, but my size is appropriate for my age (which is a body image issue I'm working on). I think that's the hardest part of all this. When I see all the beautiful young women who think they're fat, it drives me crazy, because they're NOT. They just have distorted body image. But that distorted body image is SO hard to change, and I do understand that it is stressful for them to have gone up in size when they start eating appropriately. But size does NOT define beauty -- and I think we should put that on our mirrors to look at every day. And eating appropriately, INCLUDING a little bit of sweets is appropriate. :-)
Tuesday, May 21, 2013
Awareness
Bob Pedersen, over at T Minus Two http://tminustwo.net, posted a thoughtful essay on awareness, using asthma as an example. It's definitely worth a read.
I have a couple of thoughts on awareness, too. The first is, that healthy people need to become aware that others are struggling with diseases and disabilities that are invisible.
We, as a society, have indeed, made some progress on making buildings more accessible to those in wheelchairs, for example. I remember seeing a lot of ads a long time ago, showing a person in a wheelchair sitting there, looking at a flight of stairs, which is an immediate and visual way of communicating the problem.
An asthmatic with an inhaler is also very visual, and an ad of someone gasping desperately for breath would be very easily understood as well. People with asthma can and do participate in sports (some people's asthma is triggered by exertion) by using the appropriate meds, (Jackie Joyner Kersee is the star example), but still, it can be life-threatening, and they are faced with the same double-sided sword as we are -- do you portray them as capable of doing what everyone else can do? Or do you portray them as suffering and taking meds for a life-threatening condition? Or, third option, do you take the forethought to portray what they are doing successfully, but clearly include the things they have to do to keep themselves alive and comfortable? And the balancing act between current and future side effects, and being comfortable now?
Can you see the parallels between asthma and diabetes? If the public were aware of how much work those successful athletes and celebrities put into controlling their diabetes while appearing "normal" during their performances, there might be more awareness of the struggle. It would also be nice to see people with diabetes who are doing impressive things in spite of complications. I think that would be a good way to let the public see both sides of the diabetes story -- the very real successes and interesting lives that people with diabetes live, and the efforts and work and difficulties that accompany them.
And of course, with diabetes, the awareness needs to include knowing the signs and symptoms of onset, and for those who are diagnosed, learning how to manage it successfully, but that's kind of another topic.
I have a couple of thoughts on awareness, too. The first is, that healthy people need to become aware that others are struggling with diseases and disabilities that are invisible.
We, as a society, have indeed, made some progress on making buildings more accessible to those in wheelchairs, for example. I remember seeing a lot of ads a long time ago, showing a person in a wheelchair sitting there, looking at a flight of stairs, which is an immediate and visual way of communicating the problem.
An asthmatic with an inhaler is also very visual, and an ad of someone gasping desperately for breath would be very easily understood as well. People with asthma can and do participate in sports (some people's asthma is triggered by exertion) by using the appropriate meds, (Jackie Joyner Kersee is the star example), but still, it can be life-threatening, and they are faced with the same double-sided sword as we are -- do you portray them as capable of doing what everyone else can do? Or do you portray them as suffering and taking meds for a life-threatening condition? Or, third option, do you take the forethought to portray what they are doing successfully, but clearly include the things they have to do to keep themselves alive and comfortable? And the balancing act between current and future side effects, and being comfortable now?
Can you see the parallels between asthma and diabetes? If the public were aware of how much work those successful athletes and celebrities put into controlling their diabetes while appearing "normal" during their performances, there might be more awareness of the struggle. It would also be nice to see people with diabetes who are doing impressive things in spite of complications. I think that would be a good way to let the public see both sides of the diabetes story -- the very real successes and interesting lives that people with diabetes live, and the efforts and work and difficulties that accompany them.
And of course, with diabetes, the awareness needs to include knowing the signs and symptoms of onset, and for those who are diagnosed, learning how to manage it successfully, but that's kind of another topic.
Saturday, May 18, 2013
Coping with an eating disorder in time of stress
Well, one of my dearest friends has been near death for 2 weeks, and I responded as usual, by manipulating food and insulin, which I know is not the world's best way of coping with grief and worry. So I asked my psychiatrist to increase my antidepressant AND I talked to Lorraine, the dietitian/therapist about the fact that all I could find comfort in was either bingeing or overdoing the sleeping pills. Again, not the world's best way of coping. So we decided that it might be a good idea if I went back and attended some of the groups at CFH. And made a commitment to eat something 3 times a day, even if it's not a "balanced" meal, which I sometimes just can't face. Starting on Monday.
So the good news is that my friend miraculously came out of her coma last Tuesday -- it was NOT expected by the doctors, who had been advising the family to pull the plug. She is weak and being taken care of in a nursing home, but at least it means that I get a little more time with her -- not going to lose her just yet.
So I've been on an emotional rollercoaster, and now that I've come down from the euphoria of knowing that my friend has survived, I realize that I'm on a downward spiral again, and even though I don't like groups, maybe it will help me get back on track again. Because I know I'm doing behaviors that aren't quite right. Like, yeah, I've been eating 3 times a day, but keeping the portions small, and sometimes just a piece of fruit and a cup of tea or coffee. And by that time, I'm full. And I don't WANT to eat any more than that.
So I'm going to have to do some work on portion sizes and meal composition and variety, because I find those very difficult. But at least I'm in a place I can work on them, now that the worry about my friend has been lifted.
So the good news is that my friend miraculously came out of her coma last Tuesday -- it was NOT expected by the doctors, who had been advising the family to pull the plug. She is weak and being taken care of in a nursing home, but at least it means that I get a little more time with her -- not going to lose her just yet.
So I've been on an emotional rollercoaster, and now that I've come down from the euphoria of knowing that my friend has survived, I realize that I'm on a downward spiral again, and even though I don't like groups, maybe it will help me get back on track again. Because I know I'm doing behaviors that aren't quite right. Like, yeah, I've been eating 3 times a day, but keeping the portions small, and sometimes just a piece of fruit and a cup of tea or coffee. And by that time, I'm full. And I don't WANT to eat any more than that.
So I'm going to have to do some work on portion sizes and meal composition and variety, because I find those very difficult. But at least I'm in a place I can work on them, now that the worry about my friend has been lifted.
Thursday, May 16, 2013
Don't be a doormat
It is unfortunate to have T1 diabetes -- I wouldn't wish it on ANYONE, but there it is. So, since our bodies aren't making insulin, then the insulin we take is what will help us be healthy and happy, just what we pretty much all wish for. While it will never stop being a nuisance (for me, the biggest obstacle is always having to be aware of the carb counts for what I eat), it's really only a small part of life, if you think about it. Many people have lived long, healthy, successful lives with T1 and you can, too. For me, it's just accepting that I have it, and it won't go away, no matter how much I wish it would, and my BG numbers will never be perfect, so, OK, fine. The second part is that my family told me I was fat as a child, which I wasn't (it's just that my sister was skin-and-bones thin), and my mantra, every day, and every time I think of it, is I'm NOT fat, and I DIDN'T cause my diabetes. I'm guessing that pretty much everyone, not just diabetics, needs to remember that humans come in a variety of body shapes, and if stupid people make ignorant remarks, it's your right to REJECT those remarks, and remind yourself of the truth. I sometimes wish that young people, especially teenagers, had the knowledge and self-confidence to simply say, "LIAR" when someone tells them how they should manage their diabetes, or how much insulin they should be taking, or what they should or should not be eating. Because we have to FIGHT against the people who are trying so hard to undermine us while thinking they are being helpful. Educate the ones who can be educated, and abandon those who can't. Or set a boundary, like "I won't talk with you about that." Because in the end, you can be healthy, and you can take control of your own life and emotions, if you don't let other people treat you like a doormat.
Monday, April 15, 2013
Name changes for T1 and T2?
There is a petition being circulated by 2 moms of children with T1 advocating for a name change for the two types of diabetes. The URL is http://www.change.org/petitions/revise-names-of-type-1-2-diabetes-to-reflect-the-nature-of-each-disease
I read the petition in its entirety, but I still disagree with it. Let me see if I can be organized about my reaction:
1. Dangers to T1 children are not caused by misconceptions about diabetes having been caused by the media attention to T2, but rather by ignorance about diabetes altogether. For example, T2s can and do have pass-out lows if they are on medication.
2. T2s frequently end up on insulin, because they DO experience beta-cell death, and this causes them to have all the same kinds of hassles that T1s have.
3. Care for anyone with diabetes depends on their personal needs, not an academically convenient type. Some people with T2 do not respond to oral meds, or have adverse reactions to them and go on insulin fairly soon after diagnosis, while some T1s develop insulin resistance and become obese during adult life, and doctors are increasingly using oral meds in addition to insulin in order to take care of them adequately.
4. There are more types than just T1 and T2. The fact that scientists have yet to discover exactly what is happening in the garbage-can diagnosis that currently constitutes T2 doesn't mean that they are all homogeneous. Plus there are other types such as gestational diabetes, ketosis-prone T2 (which is ALSO called idiopathic T1), stiff-man syndrome, thin T2, LADA, etc. etc. etc. Diabetes is actually a spectrum disorder, not an either/or.
5. MOST of the dissension between the "two" diabetes communities comes from parents and young people who react negatively to media presentations which discuss T2 without being specific. We, at Diabetes Advocates, work to educate the media -- all it takes is adding the words Type 2 to their presentations in order to educate people correctly. We feel that this would be a better solution than trying to change names.
6. Most T2s feel very denigrated and stigmatized by organizations and people who focus SO hard on T1 and don't have the time of day for T2. Organizations, as opposed to the media, almost exclusively focus on "the cure" for T1. T2 doesn't matter. The media articles are hard enough on them, and they need the support of T1s, not being thrown out into that stinky, discriminatory T2 garbage can.
7. Jeffrey Brewer, president of JDRF, IS trying to include adults with T1 into JDRF activities, but it hasn't had much effect. As a LADA, diagnosed at the age of 45, I feel very left out of the child/family-oriented T1 activities, but ALSO the diet and exercise activities aimed at T2. I feel very much like an orphan, and I want inclusion, not exclusion. Your division of diabetes into 2 types leaves a lot of us completely out, especially when we DON'T fit into the convenient etiologies which may change tomorrow. I was never a child with diabetes, and am not a person whom diet and exercise will help. I tried that, and it turned into a full-blown eating disorder, because I was trying so hard to fit into a box. It was like, if I could get thin enough, then I could accept that I had T1, and not T2. I lost weight, but it didn't work.
There is another thoughtful blog on this issue at http://www.thebuttercompartment.com which is written by Lee Ann Thill.
OK, this has turned into a rant, but the conclusion is that a name change will NOT help the greater diabetes community in any way, but more understanding from people concerned with one type for people of multiple other types would go along way toward gathering our strength to not only fight for a cure (which would only be for T1), but also help people live with the vastly difficult emotional burden that diabetes imposes on all people affected by it.
I read the petition in its entirety, but I still disagree with it. Let me see if I can be organized about my reaction:
1. Dangers to T1 children are not caused by misconceptions about diabetes having been caused by the media attention to T2, but rather by ignorance about diabetes altogether. For example, T2s can and do have pass-out lows if they are on medication.
2. T2s frequently end up on insulin, because they DO experience beta-cell death, and this causes them to have all the same kinds of hassles that T1s have.
3. Care for anyone with diabetes depends on their personal needs, not an academically convenient type. Some people with T2 do not respond to oral meds, or have adverse reactions to them and go on insulin fairly soon after diagnosis, while some T1s develop insulin resistance and become obese during adult life, and doctors are increasingly using oral meds in addition to insulin in order to take care of them adequately.
4. There are more types than just T1 and T2. The fact that scientists have yet to discover exactly what is happening in the garbage-can diagnosis that currently constitutes T2 doesn't mean that they are all homogeneous. Plus there are other types such as gestational diabetes, ketosis-prone T2 (which is ALSO called idiopathic T1), stiff-man syndrome, thin T2, LADA, etc. etc. etc. Diabetes is actually a spectrum disorder, not an either/or.
5. MOST of the dissension between the "two" diabetes communities comes from parents and young people who react negatively to media presentations which discuss T2 without being specific. We, at Diabetes Advocates, work to educate the media -- all it takes is adding the words Type 2 to their presentations in order to educate people correctly. We feel that this would be a better solution than trying to change names.
6. Most T2s feel very denigrated and stigmatized by organizations and people who focus SO hard on T1 and don't have the time of day for T2. Organizations, as opposed to the media, almost exclusively focus on "the cure" for T1. T2 doesn't matter. The media articles are hard enough on them, and they need the support of T1s, not being thrown out into that stinky, discriminatory T2 garbage can.
7. Jeffrey Brewer, president of JDRF, IS trying to include adults with T1 into JDRF activities, but it hasn't had much effect. As a LADA, diagnosed at the age of 45, I feel very left out of the child/family-oriented T1 activities, but ALSO the diet and exercise activities aimed at T2. I feel very much like an orphan, and I want inclusion, not exclusion. Your division of diabetes into 2 types leaves a lot of us completely out, especially when we DON'T fit into the convenient etiologies which may change tomorrow. I was never a child with diabetes, and am not a person whom diet and exercise will help. I tried that, and it turned into a full-blown eating disorder, because I was trying so hard to fit into a box. It was like, if I could get thin enough, then I could accept that I had T1, and not T2. I lost weight, but it didn't work.
There is another thoughtful blog on this issue at http://www.thebuttercompartment.com which is written by Lee Ann Thill.
OK, this has turned into a rant, but the conclusion is that a name change will NOT help the greater diabetes community in any way, but more understanding from people concerned with one type for people of multiple other types would go along way toward gathering our strength to not only fight for a cure (which would only be for T1), but also help people live with the vastly difficult emotional burden that diabetes imposes on all people affected by it.
Friday, March 15, 2013
Relationships
Parents come and go. Children come and go. Partners can come and go as well. The only person who will ALWAYS be with you is yourself. If you're lucky a special friend or two. But for the most part, the people who surround you are like the seasons -- they stay for a while, and then they're gone, for whatever reason -- it isn't usually because they dislike you, but because life sends us on our separate journeys.
I'm visualizing a rock in a stream. The water molecules each pass the rock, and caress it, but then they leave. There are always water molecules, but they are never the same. Some are nearer and some are farther, some pass by quickly, and some eddy around the rock for a time. But at some point, they always leave.
So loving ourselves is what we have to do first, even though it may be harder for us than for people who haven't had our struggles. Once we love ourselves fully, then we can truly commit to loving other people, and give them the love they deserve for the time they spend in our lives. Always aware that nothing is eternal, and always aware that we can love powerfully in THIS moment, and then forever, even if we never meet again.
I'm visualizing a rock in a stream. The water molecules each pass the rock, and caress it, but then they leave. There are always water molecules, but they are never the same. Some are nearer and some are farther, some pass by quickly, and some eddy around the rock for a time. But at some point, they always leave.
So loving ourselves is what we have to do first, even though it may be harder for us than for people who haven't had our struggles. Once we love ourselves fully, then we can truly commit to loving other people, and give them the love they deserve for the time they spend in our lives. Always aware that nothing is eternal, and always aware that we can love powerfully in THIS moment, and then forever, even if we never meet again.
Monday, March 4, 2013
Progress Report
1. I do binge sometimes, and then not take any insulin until my BG is godawfully high. And then I spend the night chasing it down. It comes down a bit, and then starts right back up again, because when my stomach is full, it empties only slowly. So I take some insulin, and 3 hours later, take some more, and that lasts up to 12 hours. Not fun.
2. Left-over behaviors are binge, guilt, and compensatory starving. Also limiting insulin -- I've been very good about not omitting completely, but I tend not to take enough, and I also tend to take it late, which means after my BG has gone up and my CGM is yelling at me that I'm high.
3. The only thing that helps if I'm edging toward a binge is to eat real food until I'm definitely full. I can't tell you how hard it is, because I don't really like real food, and it's a struggle to FORCE myself to eat it when what I really want is sweets. I LEARNED this while I was in full-time treatment, and I'm still seeing the world's greatest dietitian, and she reinforces what I really DO know, but want to ignore. I didn't shop for a team, because I wouldn't be able to travel, anyway, but a lot of girls travel to the Center for Hope here in Reno, because they do have specific resources for women with T1 diabetes.
4. I'm LOUSY at regimentation! The only things that are consistent with me are meds as soon as I wake up, and before I go to bed. Since I have a pump, long-acting insulin is not an issue, and my real need is to be disciplined about bolusing whenever I eat. ANYTHING. I have a bad habit of not bolusing for snacks, and like I said before, I don't usually bolus when I'm starting a binge. While I'm TRYING not to binge, I'm not always successful. I also need to bolus for protein, and not very successful at that, either.
5. I'm trying very hard NOT to weigh myself. My mantra for what may be the rest of my life is it's not weight, it's HEALTH! I need to do what's healthy for me, and not fuss about my weight. I haven't weighed myself for a month or two now, and I really don't know whether I've gained or not, but my clothes still fit, so that's doing well in my book!
And I DO have successes, in that I'm NOT omitting insulin entirely, ever, even if I'm late sometimes, and I'm working on portion control, and better carb counting. I'm working on learning to use the square wave on my pump, with varying degrees of success. And I'm making the effort to force myself to eat vegetables, sometimes, even though I really hate them. I still feel guilty about eating "normal" portions of real food, especially carbs, but I'm working on it. And I'm working on being able to eat "normal" portions of sweets, instead of gargantuan ones.
So I feel pretty good about what I'm doing, food wise, even though it's not perfection.
2. Left-over behaviors are binge, guilt, and compensatory starving. Also limiting insulin -- I've been very good about not omitting completely, but I tend not to take enough, and I also tend to take it late, which means after my BG has gone up and my CGM is yelling at me that I'm high.
3. The only thing that helps if I'm edging toward a binge is to eat real food until I'm definitely full. I can't tell you how hard it is, because I don't really like real food, and it's a struggle to FORCE myself to eat it when what I really want is sweets. I LEARNED this while I was in full-time treatment, and I'm still seeing the world's greatest dietitian, and she reinforces what I really DO know, but want to ignore. I didn't shop for a team, because I wouldn't be able to travel, anyway, but a lot of girls travel to the Center for Hope here in Reno, because they do have specific resources for women with T1 diabetes.
4. I'm LOUSY at regimentation! The only things that are consistent with me are meds as soon as I wake up, and before I go to bed. Since I have a pump, long-acting insulin is not an issue, and my real need is to be disciplined about bolusing whenever I eat. ANYTHING. I have a bad habit of not bolusing for snacks, and like I said before, I don't usually bolus when I'm starting a binge. While I'm TRYING not to binge, I'm not always successful. I also need to bolus for protein, and not very successful at that, either.
5. I'm trying very hard NOT to weigh myself. My mantra for what may be the rest of my life is it's not weight, it's HEALTH! I need to do what's healthy for me, and not fuss about my weight. I haven't weighed myself for a month or two now, and I really don't know whether I've gained or not, but my clothes still fit, so that's doing well in my book!
And I DO have successes, in that I'm NOT omitting insulin entirely, ever, even if I'm late sometimes, and I'm working on portion control, and better carb counting. I'm working on learning to use the square wave on my pump, with varying degrees of success. And I'm making the effort to force myself to eat vegetables, sometimes, even though I really hate them. I still feel guilty about eating "normal" portions of real food, especially carbs, but I'm working on it. And I'm working on being able to eat "normal" portions of sweets, instead of gargantuan ones.
So I feel pretty good about what I'm doing, food wise, even though it's not perfection.
Sunday, February 24, 2013
Initiating an eating disorder
I know a very talented young lady, Amy Hearn, who has both Type 1 diabetes and an eating disorder. Recently, she posted a cartoon she did on a private group on Facebook, but I think it's so good that I asked her if I could share it here. It really spoke to me, and I think it will speak to a lot of people. So, without further ado, here it is:
Friday, February 1, 2013
My pancreas
My pancreas is a blob of Swiss-cheese-like yellow spongy material. The
spongy material is the stuff that still works, secreting the digestive
hormones, and the holes are where the beta cells used to be. And
something that now resides in my brain got to my pancreas and stole my
beta cells. And that something is much like Gollum in Lord of the Rings.
He is pale, slimy, white, skeleton-like, and has HUGE blue eyes, and
most of the time, he sits on the back of my brain, holding my dead beta
cells, and whispering "My preciousssssss." He really loves them. Most of
the time, he is pretty quiet, but sometimes he comes roaring out, and
yells at me that I can't eat, because I did this to myself, and I need
to PROVE what? I don't know. That if I could only get thin enough, the
diabetes would go away? I already tried that. Didn't work. That I might
as well give up, and binge myself to death? I don't REALLY want to do
that, because I tried that, too. I could live with my diabetes if I
could get HIM to go away.
This is my attempt at the image I was trying to convey in the previous words. That's diabetes + eating disorder + body dysmorphia happily riding my poor skewed brain. And that's my spongy pancreas, missing all the beta cells it's supposed to have. And it's my matronly body shaped like an apple. I'm not particularly happy about all this, and I REALLY don't like poking myself with all those needles! Even though I'm now on a pump!
This is my attempt at the image I was trying to convey in the previous words. That's diabetes + eating disorder + body dysmorphia happily riding my poor skewed brain. And that's my spongy pancreas, missing all the beta cells it's supposed to have. And it's my matronly body shaped like an apple. I'm not particularly happy about all this, and I REALLY don't like poking myself with all those needles! Even though I'm now on a pump!
Wednesday, January 30, 2013
Thinking, again
I've had a pretty rough week. Out of 7 days, I restricted my eating on 6 of them. And felt virtuous about it. Just the opposite of what I would tell ANYONE else! So I saw my dietitian today, and she wasn't happy about it, and we agreed on a minimum amount of food intake, while being free to eat anything else I want to. And the thing I need to reinforce, over and over and over, is that I KNOW the road, I just need to walk it. Or crawl it. Kicking and screaming, but go on, and do the right thing.
My biggest problem is that intellectually, I know what starvation does -- it puts your body into starvation metabolism, and it struggles to provide energy to keep your vital organs alive by raiding first, glycogen stores in your liver, and then any fat you've laid down, and then by breaking down muscle, and finally, you die because your vital organs become too damaged to function. But emotionally, it seems like weight is weight, and the number on the scale somehow becomes a major part of my consciousness. And I will myself not to be hungry, but it can't last forever. And then, when I have the opportunity, I make a beeline to the cookies, or the cake, or the ice cream, without even thinking. I do it totally impulsively, because by the time I've gotten that far, there is no brain left. It's not like, I think I'm going to binge today -- I just DO it. And I don't take my insulin until AFTER the binge, when my blood sugars have gotten way too high, and then it takes me several days to get them down to range again. Does this sound like sabotage? Because it IS!
The other thing I've noticed is that even if I restrict, my body will not cooperate in keeping my blood sugar in range -- the amount of insulin I take when I'm not restricting is not sufficient to turn off my liver's glycogen release. As I said above, that glycogen release is NORMAL, and I know it's happening because I'm not eating enough.
So somehow, brilliantly intellectual Natalie has to convince little, emotional Natalie what's good for her. It CAN be done, but more importantly, it MUST be done. I cannot and must not sell myself down the river. Totally not worth it, if I can only believe!
My biggest problem is that intellectually, I know what starvation does -- it puts your body into starvation metabolism, and it struggles to provide energy to keep your vital organs alive by raiding first, glycogen stores in your liver, and then any fat you've laid down, and then by breaking down muscle, and finally, you die because your vital organs become too damaged to function. But emotionally, it seems like weight is weight, and the number on the scale somehow becomes a major part of my consciousness. And I will myself not to be hungry, but it can't last forever. And then, when I have the opportunity, I make a beeline to the cookies, or the cake, or the ice cream, without even thinking. I do it totally impulsively, because by the time I've gotten that far, there is no brain left. It's not like, I think I'm going to binge today -- I just DO it. And I don't take my insulin until AFTER the binge, when my blood sugars have gotten way too high, and then it takes me several days to get them down to range again. Does this sound like sabotage? Because it IS!
The other thing I've noticed is that even if I restrict, my body will not cooperate in keeping my blood sugar in range -- the amount of insulin I take when I'm not restricting is not sufficient to turn off my liver's glycogen release. As I said above, that glycogen release is NORMAL, and I know it's happening because I'm not eating enough.
So somehow, brilliantly intellectual Natalie has to convince little, emotional Natalie what's good for her. It CAN be done, but more importantly, it MUST be done. I cannot and must not sell myself down the river. Totally not worth it, if I can only believe!
Wednesday, January 2, 2013
Sunday, December 16, 2012
The Connecticut Massacre
There is a veritable fracas going on in the social media over the massacre in Connecticut. People saying we need more guns, fewer guns, better mental health care, remarking that a lot of the mass murderers wouldn't qualify as being mentally ill, etc.
Then I read this article by Liza Long: http://www.huffingtonpost.com/2012/12/16/i-am-adam-lanzas-mother-mental-illness-conversation_n_2311009.html
I think you should read it before you read the rest of what I say.
Mental health has long been the stepchild of medical care. For a long time, physical care was covered at 80%, but mental care at 50%. And I don't know if that is still an issue in some places. In addition, mental health visits are limited, in my plan, to 40 a year, or less than once a week. I think this is very common, and totally OK for a person who has a disease treatable with meds + talk therapy, but totally inadequate for someone like Liza Long's son. It could be that he and others like him need residential care for the rest of their lives, to keep them from ending up as Adam Lanza did, although I have also heard that Lanza was not diagnosable as a psychopath. So the question is just where do individual liberties and the duty to protect the innocent intersect? A person cannot be held against their will for more than 3 days without abundant, incontrovertible evidence that they are a danger to themselves or to others. Where do you draw that line? I hear a lot of people arguing vociferously about mental health care, and gun laws, but it just ain't so simple!
Then there is the issue of gun laws. It should be apparent that what we have isn't working. Decent, honorable people don't want their guns taken away from them, but according to Mother Jones, the vast majority of recent massacres were conducted with legally purchased weapons. The following article makes a lot of sense to me, and don't take the first sentence as being indicative of what the article is about:
http://www.jewishpress.com/indepth/opinions/the-us-should-learn-from-israel-how-to-permit-not-outlaw-guns/2012/12/16/
And now, I will go back to trying to forget (as if I could) what happened. :-(
Then I read this article by Liza Long: http://www.huffingtonpost.com/2012/12/16/i-am-adam-lanzas-mother-mental-illness-conversation_n_2311009.html
I think you should read it before you read the rest of what I say.
Mental health has long been the stepchild of medical care. For a long time, physical care was covered at 80%, but mental care at 50%. And I don't know if that is still an issue in some places. In addition, mental health visits are limited, in my plan, to 40 a year, or less than once a week. I think this is very common, and totally OK for a person who has a disease treatable with meds + talk therapy, but totally inadequate for someone like Liza Long's son. It could be that he and others like him need residential care for the rest of their lives, to keep them from ending up as Adam Lanza did, although I have also heard that Lanza was not diagnosable as a psychopath. So the question is just where do individual liberties and the duty to protect the innocent intersect? A person cannot be held against their will for more than 3 days without abundant, incontrovertible evidence that they are a danger to themselves or to others. Where do you draw that line? I hear a lot of people arguing vociferously about mental health care, and gun laws, but it just ain't so simple!
Then there is the issue of gun laws. It should be apparent that what we have isn't working. Decent, honorable people don't want their guns taken away from them, but according to Mother Jones, the vast majority of recent massacres were conducted with legally purchased weapons. The following article makes a lot of sense to me, and don't take the first sentence as being indicative of what the article is about:
http://www.jewishpress.com/indepth/opinions/the-us-should-learn-from-israel-how-to-permit-not-outlaw-guns/2012/12/16/
And now, I will go back to trying to forget (as if I could) what happened. :-(
Thursday, October 11, 2012
Focus on Health, Not Obesity
I'm still ruminating about the pitfalls of listening to our overly weight-conscious society's judgments. I just read a blog by a Type 2 talking about how to lower the body's natural setpoint to the new weight, by bringing up studies that show that people who lose weight don't function metabolically like people of the same weight who have never lost weight. He mentioned that one year out from weight loss, the body is STILL reacting as if it were starving, and still striving to regain the lost weight. And that he would slightly increase his carbs in order to maintain his weight in the expectation that his body would eventually accept this weight as its new natural and become metabolically sound again.
This just rings false to me. I don't think there is any evidence that the healthy body will EVER become metabolically sound at a lower weight than that achieved by natural, intuitive eating. Of course, one should eat when hungry, and stop when full and not become overfull. And of course, it's better to eat savory foods, and not overdo the sweets. I think that's a given. But if a person follows that philosophy, maybe their body's natural setpoint will be above what the arbitrary BMI tables say is normal. And trying to lose weight down to a specified goal might actually be eating disordered. Dieting doesn't work for the VAST majority of people who try diet after diet in the hopes of permanently losing weight -- maybe that's because diets themselves encourage disordered eating?
I think it's time for us as a society to rethink just what we're talking about when we talk about weight. I think weight is not really the issue; health is. We're genetically diverse, so why is it a problem when our bodies are diverse in shape and size as well? I want to see the media portray in equally good light people of all shapes and sizes, not just the naturally skinny. Obsessing ALL your life on how to be skinny is really not a good way to live, and of course, Type 1's are susceptible to diabulimia, and that can be deadly. But anorexia and bulimia affect non-diabetic women as well, and if they don't die of it, they can get very sick, and never be healthy again. Let's concentrate on health and let weight take care of itself!
And PS the guy who wrote the blog just called it diabetes, and I mentioned in my response that he would do well to be specific about what type he was talking about, because it does a disservice to Type 1's who may NOT need to lose weight, to have their ignorant family, friends, co-workers, etc. nagging them to lose weight in the hope that it would cure their diabetes!
This just rings false to me. I don't think there is any evidence that the healthy body will EVER become metabolically sound at a lower weight than that achieved by natural, intuitive eating. Of course, one should eat when hungry, and stop when full and not become overfull. And of course, it's better to eat savory foods, and not overdo the sweets. I think that's a given. But if a person follows that philosophy, maybe their body's natural setpoint will be above what the arbitrary BMI tables say is normal. And trying to lose weight down to a specified goal might actually be eating disordered. Dieting doesn't work for the VAST majority of people who try diet after diet in the hopes of permanently losing weight -- maybe that's because diets themselves encourage disordered eating?
I think it's time for us as a society to rethink just what we're talking about when we talk about weight. I think weight is not really the issue; health is. We're genetically diverse, so why is it a problem when our bodies are diverse in shape and size as well? I want to see the media portray in equally good light people of all shapes and sizes, not just the naturally skinny. Obsessing ALL your life on how to be skinny is really not a good way to live, and of course, Type 1's are susceptible to diabulimia, and that can be deadly. But anorexia and bulimia affect non-diabetic women as well, and if they don't die of it, they can get very sick, and never be healthy again. Let's concentrate on health and let weight take care of itself!
And PS the guy who wrote the blog just called it diabetes, and I mentioned in my response that he would do well to be specific about what type he was talking about, because it does a disservice to Type 1's who may NOT need to lose weight, to have their ignorant family, friends, co-workers, etc. nagging them to lose weight in the hope that it would cure their diabetes!
Friday, October 5, 2012
Feelings
I HATE the feelings of being fat and wanting to restrict, and omit my insulin, but the answer is NOT to cheat and NOT to
restrict insulin and food, because simply losing weight and being
ketotic will NOT make me feel any better. And I know that. But what would
make a person struggling with those feelings feel better? Could she be as loving and supportive to herself
as she is to others? Could she do something loving for her body? I
don't know what that would be, but there must be something. Can she find
the courage to be grateful to her body for giving her life and letting her do the things you want to do? Can she see that there is SO much
more to her than just her body, and that she is a worthwhile and
lovable human being no matter what?
Your body is NOT the enemy. It is your friend, and it will give you the chance to live and love, as long as you let it. The hard part is letting it. Those crummy feelings that come up are just that -- feelings. They are NOT reality. You are NOT ugly, and you may not even be seeing your size accurately -- your body image may be quite distorted, and you need a reality check there, too. Can you understand and believe that you eat and take insulin in order to nourish your body so it can serve you well? If you can believe that, and stop judging and criticizing yourself, then the guilt simply goes away, and you stop hating yourself without even trying.
The REAL enemy is the eating disorder. Call him Ed. He's abusive, and he cajoles you into thinking you have to depend on him in order to be loved, but he's a liar and a cheat, and you DON'T need him in your life. Get a divorce!
Your body is NOT the enemy. It is your friend, and it will give you the chance to live and love, as long as you let it. The hard part is letting it. Those crummy feelings that come up are just that -- feelings. They are NOT reality. You are NOT ugly, and you may not even be seeing your size accurately -- your body image may be quite distorted, and you need a reality check there, too. Can you understand and believe that you eat and take insulin in order to nourish your body so it can serve you well? If you can believe that, and stop judging and criticizing yourself, then the guilt simply goes away, and you stop hating yourself without even trying.
The REAL enemy is the eating disorder. Call him Ed. He's abusive, and he cajoles you into thinking you have to depend on him in order to be loved, but he's a liar and a cheat, and you DON'T need him in your life. Get a divorce!
Monday, October 1, 2012
No D Day
I was born in Great Falls, Montana, and raised in Los Angeles. When I was 8, we took a family vacation to Ensenada, Mexico, and I was fascinated by the fact that people were talking some kind of bla-bla-bla to each other. (Remember, I was only 8). But then a startling idea took hold: I was in the lobby, looking at the clock, and I suddenly realized that they weren't thinking "clock" and saying "bla-bla", but that it really WAS a bla-bla to them.
That inspired my life-long interest in other languages, and I resolved to become fluent in another language. In high school, I took Hebrew, French and Spanish, and in college, I took Japanese, and a smattering of Russian and Hausa, the language of Northern Nigeria. I was lucky enough to be selected to spend my junior year abroad, and actually DID become fluent enough in Japanese to be comfortable with conversation and to read at about a 4th grade level.
When I got back from Japan, I finished my major in Linguistics, and eventually decided to become a teacher of the deaf, because sign language is a real language, too (at the time, many people thought it was just pantomime and gestures), so I got my MA in Special Education of the Deaf. I did that for 5 years, and then switched to teaching English as a Second Language (which I had done in Japan), and eventually Japanese, too.
At some point, I found out about Esperanto, which is a language created and published by a Polish-Jewish ophthalmologist in 1887. It's fascinating, because he intentionally made it as easy to learn as possible, eliminating such bugaboos as gender, verb conjugations, irregularities of noun formation, and by regularizing formation of classes of words. I learned it in 10 hours (remember I have background in French and Spanish, and it is based mostly on French and Latin), and I have since used it to make friends worldwide, and to travel all over the world. It has been a lot of fun.
So my life has been very wrapped up in language, which of course expands to include culture, art, food, music, architecture, and everything else that is wonderful about our human family. How lucky I was to be able to take that vacation to Ensenada! :-)
Sunday, September 30, 2012
Comparing Bodies
One
of the things I do when I'm in a public situation and have the urge to
compare is to say my mantra over and over again: "Everyone's DIFFERENT!"
Not better, not worse, just different.
Yeah, I see these beautiful women with slender waists (I don't even HAVE a waist!) and slender upper arms (mine swing), but then I remember I also have to notice that some of them have tubby tushies, and thunder thighs, and some of them have no chins, and some of them have multiple chins, and some of them have straight hair and some of them have curly hair, blonde, black, huge boobs, no boobs, and all the other things that people can hate about themselves, and ya know what? Why am I obsessing over my "flaws" when I have so many other parts of my body that are just FINE, and why is it so important, anyway?
I have yet to see the "perfect" woman, but that's because she doesn't exist. So why should I expect perfection for myself?
When you compare, it's not reality; it's your obsession with perfection. Keep reminding yourself of that: it's NOT REAL! You are just as beautiful as the rest of them, if you can only allow yourself to see that. And while I will admit that I'm not always successful at this effort, I think it IS worth it, because I am working on allowing MYSELF to feel better. And that's what matters.
Yeah, I see these beautiful women with slender waists (I don't even HAVE a waist!) and slender upper arms (mine swing), but then I remember I also have to notice that some of them have tubby tushies, and thunder thighs, and some of them have no chins, and some of them have multiple chins, and some of them have straight hair and some of them have curly hair, blonde, black, huge boobs, no boobs, and all the other things that people can hate about themselves, and ya know what? Why am I obsessing over my "flaws" when I have so many other parts of my body that are just FINE, and why is it so important, anyway?
I have yet to see the "perfect" woman, but that's because she doesn't exist. So why should I expect perfection for myself?
When you compare, it's not reality; it's your obsession with perfection. Keep reminding yourself of that: it's NOT REAL! You are just as beautiful as the rest of them, if you can only allow yourself to see that. And while I will admit that I'm not always successful at this effort, I think it IS worth it, because I am working on allowing MYSELF to feel better. And that's what matters.
Saturday, September 15, 2012
Body Image
I
was going to send this private to a certain lovely young lady, but then I decided to post it
so everyone could read it. Just like there are stereotypes of all T2's
being fat, there are also stereotypes of all T1s being thin (and
diagnosed during childhood). None of these is true. While most (but NOT all!) T1s probably
WERE skinny at diagnosis, due to the fact that the diabetes had been
eating away at their bodies for quite some time before diagnosis, once they
went on insulin, their natural body metabolism took over, and they
once again were on track to be the size their genetics determined they should be, assuming normal and healthy food intake.
It's bad enough that MOST women buy into this idea that we should ALL be thin and pear-shaped, but for a woman with T1 diabetes, it's even more damaging, because weight loss is so easily achievable (although at a tremendous cost). If truly NORMAL women have a wide variety of body shapes, why shouldn't we? We're no different from them, except for having uncooperative pancreata!
And while I may sound like I'm preaching from on high, this is EXACTLY the issue I myself am struggling with. I was never fat, but I'm built like a barrel, with no waistline. And my family has called me fat ever since I was a child, only because my sister was skin and bones thin. And they threatened me with diabetes (my grandmother had it) if I ate things they didn't approve of. What a load of crap to put onto a child! And if it's crap for a child, it's certainly crap for the rest of us as well.
I already know that the vast majority of women don't look like air-brushed, anorexic models, but who ever said they should? The women I know and love ARE physically beautiful just as they are, and I want them to take care of their physical and mental health as best as they can (although there are always bumps in the road), and devote their lives to the causes that are important to them. Aren't you a worthwhile person who is contributing to the world, a lovable person, and a beautiful person? So who cares what those artificial, arbitrarily made-up BMI tables say, anyway?
It's bad enough that MOST women buy into this idea that we should ALL be thin and pear-shaped, but for a woman with T1 diabetes, it's even more damaging, because weight loss is so easily achievable (although at a tremendous cost). If truly NORMAL women have a wide variety of body shapes, why shouldn't we? We're no different from them, except for having uncooperative pancreata!
And while I may sound like I'm preaching from on high, this is EXACTLY the issue I myself am struggling with. I was never fat, but I'm built like a barrel, with no waistline. And my family has called me fat ever since I was a child, only because my sister was skin and bones thin. And they threatened me with diabetes (my grandmother had it) if I ate things they didn't approve of. What a load of crap to put onto a child! And if it's crap for a child, it's certainly crap for the rest of us as well.
I already know that the vast majority of women don't look like air-brushed, anorexic models, but who ever said they should? The women I know and love ARE physically beautiful just as they are, and I want them to take care of their physical and mental health as best as they can (although there are always bumps in the road), and devote their lives to the causes that are important to them. Aren't you a worthwhile person who is contributing to the world, a lovable person, and a beautiful person? So who cares what those artificial, arbitrarily made-up BMI tables say, anyway?
Friday, July 27, 2012
Dealing with an eating disorder
I'm on a list on Facebook called Diabetics with Eating Disorders. You may or may not know that I decided to go into treatment last April because I was literally starving myself, and the day I woke up and couldn't face eating at all, I knew I needed to do something. In fact, I've been bingeing since I was in my teens, but bingeing and not taking insulin is a whole different story. After I binged myself into a coma in Sept. 2010, and was confronted with the reality of the fact that I NEED to control my food intake and take my insulin. So I swung in the opposite direction, and started to limit -- at first under the guise of low-carb, but not true low-carb, because those who are following low-carb diets are not eliminating all plant and most animal foods, nor are they limiting the quantity of what they eat. So I decided to enter treatment.
So one of the women posted about the fact that she had fantasies about gaining enough weight to qualify for weight-reduction surgery, and I have to admit that I've had the same thoughts. But I know people who've had weight-loss surgery, and it's no picnic -- some of them succeed in keeping the weight off by following a draconian diet, and others just stretch out their stomachs by eating too much, and gain the weight back. So I guess we ALL, both people with ED and those without, have to accept, somehow, that we were born predisposed to our own body builds, and we AREN'T going to all look like the models in the magazines. Which is not to say that it's easy -- I just ate a Mounds bar, and felt like crying about it -- but either I work on self-acceptance, or I might as well toss it all in. Because there is no realistic or practical choice, even though your mind tells you lies. I'm going to bet that there are LOTS of other women out there listening to the lies, and trying all the miracle diets and pills, and maybe they can abuse their bodies more easily because they don't have to deal with the diabetes demon as well, but we all have to learn to believe that life doesn't HAVE to be that way.
So my goal is to accept that I'm NOT obese, and I'm NOT willowy, but I'm shaped just like a 64-year-old should be. And to accept that yes, I have to take insulin, but I'm not even taking all that much -- certainly within "normal" limits, and that it's not a catastrophe to take a little more when I'm having a big meal, which is not very often. My body lets me BE and DO, and the insulin lets my body live and not die. So I need to just let that be, and stop obsessing over it.
So one of the women posted about the fact that she had fantasies about gaining enough weight to qualify for weight-reduction surgery, and I have to admit that I've had the same thoughts. But I know people who've had weight-loss surgery, and it's no picnic -- some of them succeed in keeping the weight off by following a draconian diet, and others just stretch out their stomachs by eating too much, and gain the weight back. So I guess we ALL, both people with ED and those without, have to accept, somehow, that we were born predisposed to our own body builds, and we AREN'T going to all look like the models in the magazines. Which is not to say that it's easy -- I just ate a Mounds bar, and felt like crying about it -- but either I work on self-acceptance, or I might as well toss it all in. Because there is no realistic or practical choice, even though your mind tells you lies. I'm going to bet that there are LOTS of other women out there listening to the lies, and trying all the miracle diets and pills, and maybe they can abuse their bodies more easily because they don't have to deal with the diabetes demon as well, but we all have to learn to believe that life doesn't HAVE to be that way.
So my goal is to accept that I'm NOT obese, and I'm NOT willowy, but I'm shaped just like a 64-year-old should be. And to accept that yes, I have to take insulin, but I'm not even taking all that much -- certainly within "normal" limits, and that it's not a catastrophe to take a little more when I'm having a big meal, which is not very often. My body lets me BE and DO, and the insulin lets my body live and not die. So I need to just let that be, and stop obsessing over it.
Saturday, June 23, 2012
Working as a community
I just saw another thread somewhere in which the parent of a T1 was railing about how bad an article about T2 was. Well, it was true that the article really didn't apply to T1, but that wasn't the point. Most of the articles in the press are going to apply to T2 (but sometimes both), because it really is a common and serious disease.
think it's important for all people to have a realistic view of all types of diabetes and genuine compassion for them. SO many T1's are so narrowly focused and invested in their own disease that they remain totally ignorant, and sometimes actively hostile and biased toward T2. It's not RIGHT -- NO ONE with any disease deserves blame and shame, and while it would be nice if the media specified T2 when discussing things that are appropriate to them, a mature attitude for T1's and their parents would be to sit back and remember it doesn't apply to them, and that it DOES apply to the vast majority of diabetics. And appropriate action would be to respond to the media, reminding them that clearly indicating whether they are talking about T1, T2 or both would be welcome and educational. But the comments about how stupid an article that is obviously about T2 is, or getting furious because the diabetes isn't a T1's fault, and remaining ignorant of the very real problems faced by T2s and blaming them for something that is not their fault either is really not helpful to anyone, and only creates bad feelings in a community that should be supporting each other. We need to be open minded and empathetic toward the problems faced by all of us, even if we need to deal with them differently. We need to educate the media and the public, and while that is not easy, we need to persevere. And not take anything personally, but rather use it as an opportunity to educate.
think it's important for all people to have a realistic view of all types of diabetes and genuine compassion for them. SO many T1's are so narrowly focused and invested in their own disease that they remain totally ignorant, and sometimes actively hostile and biased toward T2. It's not RIGHT -- NO ONE with any disease deserves blame and shame, and while it would be nice if the media specified T2 when discussing things that are appropriate to them, a mature attitude for T1's and their parents would be to sit back and remember it doesn't apply to them, and that it DOES apply to the vast majority of diabetics. And appropriate action would be to respond to the media, reminding them that clearly indicating whether they are talking about T1, T2 or both would be welcome and educational. But the comments about how stupid an article that is obviously about T2 is, or getting furious because the diabetes isn't a T1's fault, and remaining ignorant of the very real problems faced by T2s and blaming them for something that is not their fault either is really not helpful to anyone, and only creates bad feelings in a community that should be supporting each other. We need to be open minded and empathetic toward the problems faced by all of us, even if we need to deal with them differently. We need to educate the media and the public, and while that is not easy, we need to persevere. And not take anything personally, but rather use it as an opportunity to educate.
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