Diabetes Self-Management Blog

My friend James usually manages his Type 2 diabetes quite well. He eats right, exercises, and all that good stuff. But last week, something went wrong. He had a tough Thursday at his job, worked through lunch, and got yelled at by his supervisor.

Trying to fix things up, he stayed late doing paperwork and dragged himself home, looking forward to dinner and a quiet evening with his wife, Ellen. But when he got there, Ellen had gone to a program at their daughter’s school. Dinner wasn’t ready. He went to the freezer and grabbed a box of ice cream.

You can imagine the rest of the story. James kept splurging, and his blood glucose levels were out of whack for three days, courtesy of what Alcoholics Anonymous founder Bill W. called H.A.L.T. (Hungry, Angry, Lonely, Tired). Bill W. knew that these were four danger situations for drinking. They apply with equal force to smoking, breaking your diet, or almost any other bad habit we are trying to change.

Psychologist and diabetes educator William Polonsky says people who struggle with their diabetes “frequently blame themselves for not having enough willpower. But most people have plenty of willpower. The problem is not understanding and solving the particular problems that interfere with self-care.” Hunger is one of the most common problems. How can we deal with it?

Avoiding Hunger
James moved into the danger zone when he skipped lunch. “I had so much work,” he said, “and I knew the boss wasn’t happy with me. My stomach was all knotted. I didn’t feel like eating.”

Those things happen, but skipping meals, especially breakfast, will lead you to grab concentrated comfort foods like sweets and fats. It will also make you grouchy and miserable.

What could James have done differently? If he didn’t have time or space for a meal, he could have eaten some healthy snacks, like fruits or nuts. We should have such foods with us at all times, and people using insulin should also have some glucose tablets or gels in case of lows.

Avoid hunger by eating a good breakfast every day. It’s best if breakfast includes some protein; it will keep you going longer. If you have to prepare it the night before, that’s better than rushing out in the morning without it.

Dr. Polonsky identifies two other types of hunger that can sabotage us, even when we have enough nutrition.

  • Stomach Hunger. This comes when your stomach feels empty, even though you’ve had enough calories and nutrients. When empty too long, stomachs may start to growl and send “feed me” messages to the brain, even when food isn’t really needed.

    We can reduce stomach hunger by eating foods that stay in the belly longer. Raw vegetables or pulpy fruits or whole grains take up more space per calorie than do sweets, fats, and most proteins. They also move through your system more slowly. So snacking on vegetables may keep your stomach happy. But there is also:

  • Eyeball Hunger (or “Mouth Hunger”). Food isn’t just fuel; it’s a major source of pleasure and comfort. “While your stomach may be satisfied,” says Dr. Polonsky, “your eyeballs, mouth and brain may still feel famished. If your meal plan is too limiting (in terms of food types, not just amounts), you may be depriving yourself of the joy of eating and the sense of satisfaction your mind and body crave.” I wrote about this in blogs called “Try the Tastes Good Diet” and the “Make It the Feel Good Diet.”

    Carrot sticks and celery will probably not satisfy your mouth and eyeball hunger. People who think they can switch from cupcakes to cucumbers without a fight are usually kidding themselves. But one thing that can help is eating with awareness. In other words, take the time to really taste and savor your food, whether it’s healthy vegetables or fatty potato chips.

    People with Type 2 and overweight people sometimes say they “enjoy food too much.” I think they often don’t enjoy it enough. Dr. Polonsky said of one client, “when she paid close attention to the M&Ms she was eating, she enjoyed them much more but — surprisingly — became satiated after only a few handfuls.” This is a fairly typical response. If you wolf down food too fast, your mouth and eyeball hunger won’t be satisfied.

In James’ case, it probably wasn’t just hunger that got to him. “I was angry with my boss for yelling and my wife for not being there,” he said. “I wanted someone to talk to. And I was tired.”

I’ll write about the other elements of H.A.L.T. (angry, lonely, and tired) in coming weeks. But what do you do to avoid hunger or deal with it successfully?

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