Diabetes Self-Management Blog

How do you come to terms with the changes you need to make to manage Type 2 diabetes? For the most part, we’re older, with jobs and families and habits galore. If you’re like me, you’ll go through several styles before finding the one that fits you while still allowing you to maintain as much control as diabetes lets you. (You see, diabetes doesn’t like to play nice.)

Jan's Emerald

Jan’s emerald from Colombia.

When I selected my emerald in Colombia earlier this year, I chose a rough cut. It hasn’t been cut and polished and fit into a premanufactured setting. Instead, it was allowed to maintain its natural shape and the setting was fit around the stone. I chose it because I don’t want to have something everybody else has. However, while looking at it recently, it seemed to fit my way of looking at diabetes: Don’t stuff me into a box (or prongs or bezels); teach me how to run free.

My fasting level was 311 mg/dl when I was diagnosed on January 2, 1986. The only education I got was: “Here. Follow this. Don’t eat any sugar.” And I was given a piece of paper with the American Diabetes Association’s exchange diet on it. Diabetes education? What was that?

For those of you who are unfamiliar with it, you ate a set amount of meat, fat, vegetables, fruit, dairy, and grains per meal. Portion sizes were listed under each category, and you could substitute this amount of, say, peas, for that amount of carrots, etc. Also, as I recall, it was a pretty bland diet. There was absolutely no nod to different ethnicities, religious practices, or anything like that. Heck, I couldn’t even figure out how to make an everyday casserole from that darned piece of paper, much less whomp up a batch of tzimmes. And when Passover came along and I couldn’t even find anybody who knew what a matzoh was, much less how much equaled a slice of bread…I gave up.

Oh. Did I tell you about my job? It wasn’t exactly conducive to carefully thought-out meals. It was more grab-and-go whenever you could. I was a reporter and then night city editor for a daily newspaper. Meals tended to be interrupted by things like murders, fires, earthquakes… Stuff like that. Schedules? You could make all you wanted, but they usually fell apart.

So I ignored diabetes for nine years or so. The problem with diabetes is, it doesn’t ignore you. I had a recurring yeast infection for three years, but didn’t know enough about diabetes to know that running consistently high blood glucose contributed to that. I was told to check my glucose, but — still not sent for education — didn’t have a clue what my glucose was supposed to be. I couldn’t drink enough water. I couldn’t stay out of the bathroom. I couldn’t stay awake and was afraid to drive very far.

Why didn’t I go to the doctor? I at least knew that insatiable thirst and frequent urination was connected with diabetes. Simply, I didn’t want somebody to hand me that dreaded piece of paper.

Came the day when the mayor (I was then working for the city) told my assistant to take me to the emergency room. There, I gave myself my first insulin injection. At that point, I later found out, my HbA1c was 17.4%. (I believe they have different charts now that don’t go that high.)

I started taking insulin, but my doctor didn’t quite know what to do. A friend recommended an endocrinologist. She promised they wouldn’t give me a piece of paper with a diet on it, so I went.

Wow! The office had certified diabetes educators (CDEs)! I saw a nurse educator and a registered dietitian (RD). Not only did I begin learning about diabetes, but the RD, CDE was asking me questions like what did I like to eat? What brands? When did I eat? She worked with me to develop a meal plan I could live with.

The plan was based on two injections a day of NPH and Regular insulin — which is what was available at the time. I had three meals and three snacks, of a set amount of carbohydrates, at particular times, based on insulin peaks.

“I can do this for the rest of my life!” I told myself. “Everybody should eat like this!” And I set forth to convince my friends with diabetes that I’d found the Holy Grail and they should all jump on the bandwagon and ride it with me into everlasting diabetic euglycemia.

Luckily, my friends listened, smiled, did what they wanted, and remained my friends.

Did it last? Well, there was the day I went slamming into the bedroom, threw myself on the bed and began crying, “I can’t do this any more!” And there was the dinner out when I decided to finally order a dish I’d been looking at for some time and (after the server left and I’d taken my insulin) my husband said, “Jan, your diab…” After which I wasn’t hungry, but had to eat, and did so with tears running down my face.

Needless to say, even without the dreaded piece of paper, lack of flexibility in carb counts and timing of meals and snacks weren’t my thing.

Next step? Multiple injections and a loosened schedule made easier by the release of rapid-acting insulin. Although I did get the usual, “but you’re a Type 2 in good control,” from my endocrinologist. (So what? I wanted my freedom! Why don’t people with a functioning metabolism understand that?)

Finally, the ultimate freedom: an insulin pump. With only rapid-acting insulin in that puppy, I count my carbs and eat what I want, when I want.

Does that mean I run amok, lounging around eating bon-bons, chips and dip, and food of that ilk? Nope. For the most part, I eat healthful foods. Sometimes I don’t. I just don’t have to eat set amounts at particular times. My forays tend to be along the lines of, say, potato soup, which is an old comfort food my grandmother made me. Back in the day, however, I ate potato soup with my crackers and I ate potato soup frequently. Now, I eat potato soup maybe twice a year and with nary a cracker in sight. I don’t make a lot of potato soup at a time, either. (I do make a huge batch of vegetable soup, however.)

Since I tend to think of one package as one serving, I buy small packages of treats.

Depending on my mood, I can make a pizza with a prepared crust, a little bit of sauce, lots of veggies, and a sprinkling of Parmesan cheese. Or I can eat a piece of pizza and a large salad. Or I can join the hordes of young adults who tend to gather in my house and just eat pizza. The latter doesn’t happen very often. The pizza-eating; not the kids.

Exercise is good for lowering blood glucose. It doesn’t have to be fancy: Taking a walk will do it. I grew up walking, roller-skating, and riding a bicycle. I roller-skated into my 50s (somebody had to teach the grandchildren!), then I broke some bones in my foot. Walking continued until my arthritis got too bad. Bike riding continued until the Achilles tendon fiasco. Now exercise is kind of contained to moving back and forth from my scooter to chairs, my kitchen stool, the toilet and bed, and boogying in my chair. A friend told me about recumbent tricycles, which I still need to check out to see if I can get in and out of one.

I feel like I have freedom now while still taking care of diabetes. I’m not perfect — far from it. But I’ve learned that, when I stumble, the best thing to do is pick myself up and get back with the program.

If you want more freedom, more flexibility, there may be a way. Find a good CDE and see what you can work out. My belief is that you’re more likely to maintain decent control most of the time if you have a diabetes regimen that fits your style.

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Comments
  1. This was an excellent article. I never found a CDE that would work with me though. It was all so rigid and regimented. I have never been able to fit regular scheduled meals into my life for one reason or another. And the drugs just made me more ill. I quit the drugs and use diet and exercise to control my sugar. I try to eat healthy and I am proud of the fact that I don’t have the swollen ankles and red face and other give away signs of diabetes. I find that fruit, veggies and greens allow me to maintain my health. No dairy and not much grain. I was in a scooter for about 10 years, but lately, despite the neuropathy, I have been more on my feet. Life is so much better!

    Posted by J. White |
  2. When my husband was starting the diabetes journey (out of the blue at age 49 he was diagnosed with Type 1), our insurance paid $1200 to send him and a guest to 12 hours of diabetes classes. It was about the best money the company has ever spent on us! I would hate to think of what would have happened to us and our marriage (still happy at 31 yrs) if we hadn’t had such good training at the beginning. Diabetes is a hard disease. Ha! but I’m preaching to the choir.

    I read your blogs whenever you post. Your real and authentic conversation about living with diabetes encourages me a lot. thanks!

    Posted by Sheri |
  3. I have been a CDE in the Boston area for close to 25 years and I am also Jan’s friend. Jan and I ‘met’ close to 20 years ago - over the phone. She called my office to interview me for a newspaper story she was writing about diabetes and needless to say, we have been friends ever since. I still laugh when I remember the heading for ‘my’ story –

    “You know you have diabetes when …
    … You get stuck in traffic and have to create a meal out of a handful of stale pretzels, two glucose tablets, three lifesavers and a tube of icing!”

    On a more serious note, I would like to post some of my thoughts in response to past comments about Jan, as well as Jan’s blog today. I understand the challenges and struggles a person faces with newly diagnosed diabetes and how difficult it is to progress toward healthy lifestyle choices that affect diabetes control. I also know many people who have had diabetes for 25, 50, and even 75 years and I have learned a great deal from them about how they have lived their life with this chronic condition.

    There is no doubt that when you have diabetes, you not only have to deal with a chronic condition, but with the rest of your life as well. Each day, people with diabetes are faced with a choice between doing the ‘right thing’ or ‘living normally’. Diabetes control is not about being perfect, it’s about good control. Every situation presents a choice that respects both the needs of your diabetes and your need to live a fairly normal life.

    Jan always speaks with knowledge, respect, concern, and tenderness. She understands that despite the wonderful advances in diabetes therapy over the years, there are no perfect tools and that life is not about being perfect. It’s about choices that allow you to live a reasonably normal life with diabetes. Jan has learned how to integrate diabetes into her life, and not segregate it from her life. The coping skills she uses to deal with diabetes are the very skills she uses to deal with her day-to-day existence – education, research, humor, a touch of sarcasm, a heap of courage, and a big dose of ‘reality’. Yes, Jan’s Pollyanna gene is alive and well. You go girl!
    K.A. Chalmers, MS, RD, CDE

    Posted by Karen |
  4. Hi Jan & Karen,

    I’m new to this blog, however Jan’s story was really good for me to read. The final words that hit home were: “when I stumble, the best thing to do is pick myself up and get back with the program.”

    I am a type 2 diabetic and have been working with a doctor for the past year to control and manage my diabetes and weight loss. I’ve managed to lose 30 of the 306 pounds I carry since August/2011 but it’s been an up and downhill battle. I was on a low carb program for several months and managed to get my A1C down from 6.5 to 6.1 in May, however I had vacation scheduled in late May and my daughter’s graduation in June with out of town guest in my home. Then with the Independence day barbecue, I’m still so off balance. It’s been such a struggle for me to get back on track. The low carb program I’m on is pretty strict. I have a list of things that I can have as much as I want which is primarily green food and protein. Sugar free popsicles is used for my treat!

    It’s been almost 6 weeks since I got off track and I am having so much trouble getting back on the program. Can anyone share how you do it? How to get my mind back in the groove so that I’m back in the safety zone? Any thoughts are appreciated.

    Thank You,
    Gloria

    Posted by Gloria |
  5. HI Gloria

    Congratulations on the weight loss and lowered A1C! And I sure do understand the problem with getting back with the program. I think the first thing to do is figure out why you’re having problems. Are you in a rut on what you’re eating? Scout around for some new recipes. Craving foods you “can’t” have? Can you alter them? (i.e., if you want tacos, you can put the stuffings in a lettuce leaf. For crunch, crumble up a taco chip — not a lot of carbs — on the top.) Are you adding physical activity to your diet changes? Do something you like: dance, skate, bicycle, walk, whatever gets you moving. It helps get your weight down, plus lowers your sugar. Add strength training. Maybe you need a different kind of meal plan. Have you scouted around for something that might better fit your style? Just because you started with one thing doesn’t mean you can’t change to something else. We all go through changes throughout our lives.

    Let us know what you come up with.

    Jan

    Posted by Jan Chait |
  6. Hi Jan,

    Thanks for your prompt response. My biggest problem is “what’s eating me?” I tend to get involved in lots of things and sometimes I feel a little overwhelmed. Right now, like most people in the world, I’m going through some financial issues. I’m an administrator at a university and teach part time as part of my job. My university is going to be cutting back on classes and I’ll only be able to teach one class which is about a $15-20k pay cut. I’m a bit troubled about that and concerned that I might have to pick up part time work which is an imposition on time. In the meantime, I’m about half-way through the process of completing my doctoral dissertation…hooray!!! That’s going to help with the job I’m sure, however with everything going on with me trying to handle eating right, I’ve had trouble incorporating exercise.

    Recently, I got involved in a spiritual program in my church which I committed to walk on the treadmill at least “5″ minutes every day. The program gives several areas for me to focus on my spiritual growth and since this was a struggle, I chose exercise. I know that’s not much right now, but at least its a start to get me going. What I’ve found is that if I get on the treadmill to make that 5 minute commitment, I end up walking 15-20 minutes each time. I just started and am now on day 12 and I’ve only missed (3) days which is excellent for me.

    I have some goals of walking a few 5k walks in the fall, so I plan to pick up on the routine and add more time as I go. I have a few friends who want to walk outside too, but the heat wave is murderous in Atlanta and we haven’t gotten started on that yet.

    Today has not been too bad for eating. I’ve been reading information on the website and trying to focus more. Lunch was primarily protein and a little left over baked beans (about 1/2 cup) so I’m being conscious of portions.

    I printed the 21 days to better diabetes control and noticed that its sort of a journal and some action. I was thinking that if I used it that it might help get me back on track. Any thoughts? I think if I can just continue to focus on getting back on track and at least to tell someone what I’m really feeling is going to help.

    Posted by Gloria |
  7. I have been Type 1 for 55 years, my entire life. There has been so much wonderful change in treatment and knowledge of the formula for treating diabetes (medication, insulin pumps, food, exercise, adequate sleep, etc. I am a brittle diabetic, but my A1c has improved since getting an insulin pump. American Insurance Companies should pay for insulin pumps and supplies 100%, but do not. Something should be done to convince this issue as I have had fewer emergency room visits for hypoglycemia than prior. Every emergency room visit that is avoided saves the insurance company a minimum of at least $1000. The other best treatment approach to come about has been carb counting. We now know that carbs are the factor that causes blood sugar increases and decreases coupled with exercise. When I was a child, carb counting was not even understood. I ate a certain amount and took the same insulin no matter what the carb/protein/fat balance of the meal was. The diabetic diet is something all of America should eat. One other dietary matter that helps is using low GI foods, and also adequate fiber. I have been using this principle for about 12 years, but did not get really serious until I had a silent (no symptoms) heart attack, and was told I quit working 64 hours a week. I am now working part-time and recently approved for disability. Not working so much has given me more adequate time to focus on my care, which is a full time job. I wish family and friends who are mentors could and would attend diabetes education also, as they often do not understand that management is an individualized issue. The same does not work for every one. I am doing much better with my A1c with all of the above approaches. Yes it is a lot of work, takes a lot of teaching, and learning. My endocrinologist and CDE are the members of my care team I most highly rely on.

    Posted by Barb |

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Living With Diabetes
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