Diabetes Self-Management Blog

Two weeks ago I wrote about a serious low blood glucose episode I experienced four years ago. Having already laid out the details of what happened that day, this week I want to begin exploring the subjective side of things; to look at the lessons I learned from the experience, how it has shaped my day-to-day behaviors, and how it has impacted how I understand the world.

If you recall, there were a number of bad decisions made that day. The most egregious was the fact that I ignored the initial, quiet signs my body was giving me that my blood glucose wasn’t right. Instead of attending to it, I put myself behind the wheel of a van, and drove not only myself, but my clients, without correcting my blood glucose first. I ignored what my body was trying to tell me.

Living with diabetes means living with an increased awareness of what your body is trying to tell you. I work as a therapist (among other things), and the practice involves a deeply refined kinesthetic self-awareness. If you will allow me to meander a bit here, there is a music phenomenon that mirrors the use of self in therapy (and I promise it will, eventually, meander its way back to living with diabetes).

When you play a note on a piano, a mallet inside the instrument strikes a copper string. That string vibrates at a particular frequency, creating the basic tone. But there is another phenomenon going on, called sympathetic resonance, that impacts the tone in very subtle, but VERY important ways. Certain other strings have strong sonic relationships to the string that is struck, and will vibrate to varying degrees in sympathetic resonance with the primary tone. They don’t vibrate nearly loudly enough to overtake the primary tone, but they enrich it, add to it, interact with it, and give the sound its character and depth.

A therapist is constantly acting as a piano string, picking up or eliciting sympathetic resonance from his clients. It is a constant interplay, a fast-paced and fluid exchange of self and other. You must remain rooted within yourself, with direct awareness of your own limits and boundaries, while also picking up the resonance of your client. For most therapists, it is as much an exercise in physical awareness as it is in intellectual analysis. The mind may interpret what is being picked up, but it is the body that is acting as the string.

OK, now to meander our way back to the topic at hand. Diabetes demands that we become very attuned to our body’s feedback. For those of you with diabetes, have you ever tried to explain what low blood glucose feels like to someone without diabetes? It’s not easy. I always find myself using a lot of, “well, it’s kind of like…”, “imagine that you’re feeling…” kind of sentences to explain the physical cues I get from my body. They’re subtle, and they require an attuned awareness to catch them early.

And our “Diabeti-sense” (Like that? “Quick, grab a tester! My Diabeti-sense is tingling!”) goes beyond simply reacting to physical signs of low blood glucose. It includes meal calculations, insulin calculations, monitoring levels of stress or exercise, understanding how time of day can affect levels, and more. It’s an ongoing “soft focus” awareness of one’s condition that never really stops — like a computer program left running in the background. In the back of my mind, I’m pretty much always tracking whether my blood glucose is OK. And this awareness is similar to the kind of awareness I use as a therapist. In both cases, I am acting as the piano string, picking up the resonance of what is happening internally and then processing that information. It is not purely physical, nor is it purely intellectual. It is, in fact, the epitome of mind-body awareness.

Let me give you an example to further illustrate this point. When I’m low, there are some purely physical cues. But even before those very quiet physical signs begin to surface, there are equally subtle cognitive signs that present themselves. For instance, if I’m trying to write or provide therapy, my ability to track multiple variables begins to diminish ever so slightly. My ability to distill complex thoughts into clear, direct language diminishes. My ability to keep a holistic overview diminishes, and I become more and more reactive to the immediate moment rather than simply remaining aware of the moment while holding a larger picture.

These cognitive signs all stem from a physical imbalance, often as little as a 10–15 mg/dl drop in my blood glucose. The “mind,” which we tend to hold as so separate from the “body,” is, in fact, part of the body, inseparable from it. Our thoughts, our ability to take in the world, our ability to philosophize, analyze and respond is tied as much to our physiological state as it is to our intellectual knowledge or education. That is mind-body awareness. And that is what those of us with diabetes practice every minute of every day.

That fateful day four years ago, I forgot to maintain my awareness. I didn’t listen to what my body was telling me, and it very nearly cost me my life. But in the weeks and months after my experience, I came to a much deeper appreciation for the integrated mind-body awareness living with diabetes has taught me. I invite readers to share some of the insights or skills you’ve gained from your years of living with diabetes and maintaining this mind-body awareness.

I’ll be back next week with the final installment of the three-week series. After a detailed description of my trip the hospital, and today’s philosophic musings, I think I’ll try for something on the practical side next week.

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