Rethinking Type 2

I just watched a YouTube video of a Barbara Walters show with Paula Deen as co-host, and Dr. Jeff Nathan and young Misty Ayala as guests. You can see it at

http://www.youtube.com/watch?v=Ny5fKOK7DMU&feature=plcp

First off, Dr. Nathan DID distinguish between Type 1 and Type 2 very clearly, and to me, it was obvious that when he was talking about lifestyle changes and about Misty, that he was talking about T2. My only real complaint is the label "the Fat Show", simply because the real problem with merely correlating T2 with obesity is that it doesn't HELP anyone. Telling people they're fat when they know perfectly well they are, and already feel guilty and ashamed about it is not really helpful. Seems to me that the issue is not whether people with T2 are fat, but understanding that metabolism is complicated, poorly understood, and very hard to regulate when it's malfunctioning. And there is increasing evidence that T2 is NOT a merely a disease of pancreatic malfunction, but a panoply of metabolic dysfunctions. The fact that Misty was able to come off Metformin, and get good control of her diabetes while remaining obese points very clearly to the fact that obesity is not the CAUSE of T2, but more likely a result of metabolic dysfunction, whose mechanism is not yet fully explored. I think this is what T2s are trying to say when they object to the linking of T2 and obesity. And it seems like many people are plugging their ears and singing lalala when T2s try to make this point.

One of the things I am working hard on is NOT to take it personally when the media is clearly talking about obese T2s. I know that T1s get upset when they are ragged about why don't they clean up their diet, etc. by people who really don't know anything about diabetes, but it's JUST ignorance, and we really need to learn to let it roll off our backs. In my mind, it's just about the same as when people tout miracle cures for ANY disease. I do have my own personal crap detector (AKA Snopes) in my brain, and I'm really working on learning to use it more automatically. The real issue is to call out the bullshit when appropriate and to be able to distinguish when it IS appropriate. When your best friend tells you that your diabetes could be cured if you'd eat less, call them out on it, and when the media fails to clearly distinguish between the types, send out answers and press releases, but when the media IS appropriate, even if not perfect, as I thought this show was, I think they should be applauded for it, not criticized.

The 4 D's

It started when I was in the 5th grade. I made a naive remark that grossed someone out, and they started avoiding me, or else tagged me and ran after the others screaming "I've got the cooties and I'm going to give them to you! Ha ha!" and it turned into a game of tag. For everyone else, not me. No one to eat lunch with, no one to walk home with, no friends to play with after school. I must have been acting badly at home, too, because my mother was always yelling at me as well. And I remember thinking to myself that the only time I was at peace (not happy, just not being tormented) was while I was walking between home and school.

Eventually, the other kids forgot about it, and we moved on, and I began to have friends again and became more content, but the experience seems to have scarred me for life, because I have had recurrent major depressions ever since then. Events that other people find stressful can throw me into a tailspin, and I have had as many as 5 suicide plans in my head at any one time.

And then diabetes came into the picture. I was 45 when I was formally diagnosed, and I was distraught. Blame and guilt and confusion, and poor medical guidance threw me for a loop. I spent many hours crying, alternately pretending it wasn't true, and frantically trying to get information and guidance. In the beginning, I didn't even know whether I had diabetes or not (my doc called it hyperglycemia), and even though it is beyond question by now that I have diabetes, my emotional self still wants to deny it, and I don't always take care of myself. And when I'm depressed, I really DON'T take care of it, and we all know where that leads!

So I call my illness the 4 D's: Diabetes and Depression, the Deadly Duo. Either one would be bad enough, but together they almost killed me.

I think mental health care needs to be a component of EVERYONE'S diabetes management plan. For me, the one makes the other worse. If my blood sugar is high, I'm more likely to get depressed, and if I'm depressed, I don't take care of myself, resulting in high blood sugar. Vicious cycle if I ever heard of one. So I would like to see more mental health professionals who are familiar with diabetes and what it does to a person's head, and better access to mental health care for people with diabetes.

And I am happy to report that I AM now getting very good care, both with antidepressants and talk therapy. I've been pretty stable for the last couple of years, and I now have a plan and a way to get help if I do get depressed. I wish everyone had that.

Not a teenage issue

When people think eating disorders, they think of girls in their teens and twenties, and they think of the stereotypically emaciated models and actresses. And the media feeds on this image, showing young women in bikinis whose bellies have sagged (oh no, she's gotten fat!) or women whose backbones look like mountain ridges.

But it's blatantly untrue and damaging to ALL women, no matter what their age. I've been talking to other women about whether they compare themselves to other women they see and judge whether they are fatter or thinner than the other woman, with corresponding despondent or joyful feelings. And most of them have admitted that they do. How depressing!

And we all know that T1 diabetic women are more susceptible to eating disorders, because they have the diabetes to deal with on top of the discomfort that most women feel.

But I'm going to posit that eating disordered thoughts occur in older women as well as younger women, and that they exist in T2s and well as T1s, because all of us are dealing with food issues, regardless.

With that as an introduction, I'm going to freely admit that I have an eating disorder. I have had it since I was in my early teens. At the time, having been restricted from eating anything with sugar by overly health-conscious parents, my brother and sister and I used to spend our $1 of allowance money buying 20 candy bars each (and they were bigger in those days), and consuming ALL of them in one sitting. Looking back, I recognize that that was the beginning of binge eating, although I was not aware of it at the time.

Later on, when I got out on my own, I went into full scale rebellion, deciding that I would eat anything I wanted, however much I wanted, any time I wanted it. This developed into a habit of eating only one food at a meal, sometimes a giant portion of ice cream, and subsequent weight gain, although I was never actually obese.

Then came the diagnosis of diabetes, which caused even more feelings of rebellion. I couldn't stick to the meal plan I was given, and I was so starved that I would eat until my stomach was distended and painful, and still feel hungry. Once I went on insulin, the hunger abated, and I actually LOST weight on insulin, even though the literature says insulin causes weight gain.

But I was still bingeing, and in the summer of 2010, I started bingeing hardcore. And binged myself into a life-threatening coma. As a result, I became hypersensitive about food and began to limit my carbs. Well, at first it was only a few foods that I eliminated, but my food vocabulary got more and more limited, until I was only eating a cup of milk in the morning, a cup and a half of Greek yogurt midday, and a small hamburger patty at night.

And I lost more weight, and people kept telling me how good I looked, and I kept on trying to assuage my guilt for being fat (most recently, not even overweight) by eating less and trying to feel virtuous when I was hungry. And still occasionally bingeing. The only concession I made to the bingeing was to monitor my BGs and take insulin when I thought they had gone high enough. Needless to say, this was NOT a good way to live.

So about a month ago, I started to take steps to deal with it, which first of all, took awareness of the condition I was in, and then the willingness to do something about it. But it's HARD for someone as old as I am to admit to having a "teenage" condition, and second to actually seek help.

So I've been in treatment for about 2 weeks, and yes, it has been EXCEEDINGLY stressful and difficult. They're making me eat more than I feel comfortable eating, and making me eat foods that I had eliminated a year and a half ago. Some people can do well on a low carb diet, especially if they like a lot of different vegetables, and are creative with and like carb substitutes. But I've been a picky eater since I was tiny, and never liked to cook, so the obsession with eliminating carbs became an illness for me.

The reason I'm telling you all this is because May is Mental Health Awareness Month (or something like that), and eating disorders are a mental health issue. And they're probably a lot more common than we realize. And they're NOT just a teenage issue!