The First ‘T’

Happy National Diabetes Week!

If you haven’t already seen the flurry of posts circulating on social media, Diabetes Australia are running a third iteration of their ‘It’s About Time’ campaign, calling on earlier detection of both type 1 and type 2 diabetes.

For type 1 diabetes, the focus is on the first ‘T’ that we noticed when we were diagnosed. Once again, I’ve filmed a vlog to mark the occasion. Look out for the bit where I forget one of the four ‘Ts.’

Please do share the campaign materials with your family, friends, colleagues and networks who might not be aware of those symptoms this week – because that’s really what this campaign is all about.

It’s About Time we all knew the signs and symptoms of diabetes.

A Complex Relationship With Food

Growing up in an Italian family, food was a big focal point in our house. Food was something that brought us together as a family – whether that be birthdays, Christmases, Easters or Sunday dinners. Both of my Nonnas would always put food in front of us when we went to visit. When family gatherings were being planned, the focal point tended to be around whether there would be enough food to feed everyone, followed by days of eating leftovers. It’s not uncommon to be force fed food and drinks at family get togethers. If you don’t want to eat, you must be feeling unwell. Obviously.

Then, along came diabetes. All of a sudden, every single item of food that I once enjoyed had an impact on my blood sugar. I linked every undesirable number that popped up on my meter back to what I’d eaten earlier. I began to think of food as ‘good’ and ‘bad.’ ‘Good’ eating meant having the willpower to eat less and enjoy better blood glucose levels but feel far too hungry. ‘Bad’ eating meant overindulging in those treat foods that I once enjoyed, and feeling the guilt afterwards.

Throw in all of the diabetes websites and magazines and food police who made me think that I was doing something wrong because I was not eating a low carb, paleo, vegetarian, vegan, ketogenic, wholegrain or cardboard diet, and it’s easy to see why I developed such a complex relationship with food.

I was rather surprised to hear my daily carbohydrate totals from my diabetes educator as she looked through my Diasend report last week. I guess I was surprised because I don’t realise just how much confidence I have gained around food in the past 12-18 months. I no longer obsess over those kinds of things anymore.

Managing blood sugars around food isn’t necessarily the easiest thing, and getting to where I am today has taken a lot of time, patience and practice. I personally don’t think that kind of learning can be avoided, whichever eating plan you decide works best for you.

I prepare a great chunk of my meals at home, try to eat as much ‘real’ food as possible and minimise the processed stuff. But at the same time, life’s too short not to eat the cannoli. For me personally, I eat carbs. A lot of them, actually. As someone with a very active job and high energy requirements each day, I don’t realistically think I’d be able to meet those energy needs without some carbs in my diet.

I guess the biggest shift in my mindset over the past 12-18 months is that food is not something that I should abstain from. Food is something that I need in order to fuel my body, sustain my daily activity level, and to feel physically good about myself. Food allows me to function at my best each day. Food is ingrained in my culture, and something that I truly do enjoy.

Above all, food is something that I eat to please myself, and not others.

Diagnosis in the Wild

Not too long ago, a friend of mine was telling me about a member of her family. The family member in question was going to the doctor to get some blood tests done, because all he seemed to do was sleep. She went on to tell me that she thought that he might be diabetic, thanks to a friend of the family who had gone through the same thing.

I began to ask my friend if the person in question was thirsty. He was indeed. He was going to the toilet quite often, as well. She went on to tell me that his eating habits weren’t great either, particularly as he had a tendency to snack late at night.

A few days later, the person in question was told he had type 2 diabetes by his GP. I believe he was prescribed some oral medication to take daily. When I politely asked what the GP had said to him, it was exactly what I expected to hear.

“Lose weight, exercise, and cut back on your portions.”

It’s not the first time I’ve heard a recount like this one. GP’s don’t know enough about diabetes. To be completely honest, I don’t expect them to. But there are allied healthcare professionals who do specialise in diabetes. Their services are free in public hospitals to people with a Medicare card, and accessible through something as simple as a GP’s referral. Yet the vague, unhelpful and judgemental guidance being given is setting people up to fail.

I tried to explain to my friend the body was producing insulin, the hormone that regulates blood sugar levels, but was having a little trouble using it properly. I tried to explain that blood glucose levels typically rise after eating, and that they need time to fall back into range again after eating before starting again.

I politely asked if they’d been referred to a diabetes hospital clinic, and went on to explain that there was more customised diabetes support available for free if they needed it. I also asked if they would like one of the spare blood glucose meters I had sitting in my wardrobe at home.

Earlier this week I showed my friend how to use the meter, and laughed as she shuddered at the sight of me applying my own blood to the test strip (with my own lancing device, of course). I explained that a target of between 4 and 8 was ideal, and that mornings were a good indicator of progress as our bodies have typically been fasting overnight. I told her that if they wanted more strips in future, they could see their GP about registering with the National Diabetes Services Scheme. And I told her that I was happy to answer any questions they had.

For someone new to diabetes, I’m sure that this was a lot of information. I have no idea how much of it will stick. Or whether they will use that meter. Or how they will deal with this new diagnosis. But I don’t think that I will ask again.

The way we each deal with our diagnosis is extremely unique. We go through a range of emotions. Sadness, frustration, isolation, shame and even denial. We need time and space. Some of us might not want to know anything about diabetes, while others may feel ready to jump in and immerse themselves into this strange new world. As much as I would like to see people err toward the latter, it has to be on their own terms. Not mine.

Micro-managing Diabetes

When it comes to living with diabetes, I have all of the worries in the world. Like, whether I am doing enough to look after myself. How secure a position I am in to be able to continue to manage my diabetes well going forward. Whether I could be doing better. Whether there is a link between what I am going through right now and my diabetes.

I was sitting in the hallway of diabetes clinic yesterday afternoon, waiting to see my endo. I overhead conversations from behind closed doors, I watched two doctors consult on a course of treatment, and I saw a few people come in and out of appointment rooms. What I heard and saw isn’t really pertinent to this story, except to say that my mind wandered in about ten different directions over the half hour I was sitting there.

Right now, I’m feeling a little run down. It’s totally understandable, given uni and full time work that I’ve been juggling over the past few months. I’m pretty sure it’s nothing I can’t fix myself with a bit of TLC. But I brought it up with my endo, wanting to make sure that there wasn’t a link to diabetes.

She had a look through my notes, and asked me if I’d had bloodwork done recently (which I had). Then she made a timid suggestion.

“Is there any possibility that you might be able to relax your control a little bit?”

We had a nice laugh at the prospect of me only checking my blood sugar four times per day, but I think ultimately she was right. Although I haven’t really been ‘trying’ for any specific target, my micromanaging habits have definitely become worse the more I expect of myself.

There are times where I could definitely go without glancing at my pump screen. Or not prick my finger to detect a very insignificant movement in my blood sugar. Or counting the number of infusion sets and pump cartridges in my wardrobe and calculating a set-to-cartridge ratio.

The voice of my subconscious could definitely give me some acknowledgement for my efforts more often, which ironically is something I always value highly in my day job. I could definitely be kinder to my meter when I see a high or low blood sugar, because it really is just a number.

My endo also likened my blues to the miserable weather outside of late, and then joked that being a doctor doesn’t exempt her from being tired, either. “Everyone gets tired!”

That tiny little piece of empathy, whether it was true or not, really made all of the difference in the world.