Know Thyself

Explaining diabetes to other people is tricky sometimes. It’s a complicated thing to manage, and for those who don’t live with diabetes day-to-day, it’s easy to oversimplify. So many times at dinner parties, gatherings, or other festivities someone might catch me having some dessert and inform me that, “you shouldn’t be eating that, you’re diabetic!” I usually take that opportunity to explain insulin-to-carbohydrate ratios, how sugar can be part of that ratio as long as it’s not the majority, and other facets of the disease. If nothing else, they walk away a little more informed, and it’s one less person who will worry the next time they see me with a piece of pie next Thanksgiving. The point is, diabetes is not a simple, concrete, “A plus B equals C” kind of thing.

I was thinking about this a little more in depth the other day. You see, last night I had Mexican food. Mexican food ALWAYS requires a slightly higher carbohydrate ratio than other foods containing equivalent carbohydrate counts. My body has always been this way with Mexican food — maybe it’s the sodium. But regardless of the reason, it’s one of those little “quirks” of my system that I have always had to be aware of. And there are others. I know that after certain meals, a bit of dessert will work just fine — my numbers won’t spike, and everything will run smoothly. But other times, I know I should avoid adding in dessert. Pizza is one of those foods.


The “pizza effect” was explained to me years ago by my endocrinologist. I can’t remember exactly WHY it does what it does, but it does do what it does do (like that?). (Editor’s note: To learn more about the “pizza effect,” click here.) Pizza will give us Diabetians that weird “late spike,” and that can make insulin ratios a little tricky for it. Mexican food doesn’t do that same “late spike,” it just requires more insulin. The curve isn’t weird like it is for pizza, it’s just a matter of upping the ratio.

I’ve just been talking about food, but our awareness has to extend well beyond food. We need to understand how a simple virus like a cold will affect our systems and blood glucose responses. We need to know how exercise will affect us, how lack of sleep will affect us, how stress will affect us. And we need to know how LONG these effects will last, too.

We have to have a complete and comprehensive awareness of ourselves living with this disease. And we have to develop a pretty comprehensive set of skills, too. We need to be good at managing patterns, we have to be good at managing stress, we have to be good at managing a schedule, and so much more. What ties it all together is the ability to know ourselves. We have to know who we are; we have to know our physical selves, our emotional selves, and our intellectual selves. We have to know our default patterns, our default coping strategies, and our habits. We have to keep an encyclopedia of patterns in our minds — both the regular patterns (my usual insulin ratio is X), and our “alternate” patterns (when I’m sick, my ratio is X, I shouldn’t eat X, I SHOULD eat X, etc.).

Diabetes is the “disease where you can’t have sugar” to many of the people we meet. And that’s OK. There’s no reason other people should occupy THEIR minds with the minutia of details, patterns, and information that we all have to carry around with us. But it’s important that WE understand what this disease really requires, because it’s so much more than just keeping track of a bunch of numbers and writing them down in a log book. This disease requires a level of self-knowledge that is pretty extraordinary. And every once in a while, I think it’s important to stop and give ourselves some credit. That so many of us live so successfully with this disease day-in and day-out is a pretty remarkable thing.


  • Diane

    Right on! I was trying to explain to my new doctor who is a youngster that diabetes is much more than exercise and eating right. In fact I said that was the easy part. It is the rest of the package that makes it hard to keep the levels on an even keel, and that he should help his other diabetic patients realize that.