Diabetes Self-Management Blog

When I was first diagnosed with diabetes, I could tell when my blood glucose dipped below 70. Sixty was downright scary, and anything in the 50’s or lower was cause for alarm. That was almost 20 years ago. Today, my blood glucose can get well into the 40’s or 30’s before I feel the signs. The nature of the signs have changed, too. When I was younger, the signs were entirely physical sensations. I don’t remember a time when I got so low that I had cognitive effects — confusion, difficulty putting my thoughts together, disorientation, etc. That’s not the case any longer. These days, I might not notice my low blood glucose until it lands me right in that “land of fog.”

I wrote about one of these experiences a while back in a previous blog entry. I was teaching a music lesson (my primary source of income), and my faculties simply gave out. I missed any early physical signs, and didn’t realize I was low until I was stuck in the middle of a lesson, unable to even finish a sentence, scaring the living daylights out of my student, who just kept looking at me and asking, “are you OK?” As he was asking this, I was downing glucose tablets. After about 5 minutes, I began to regain my faculties and was able to at least explain to him why his teacher had turned into a nonverbal caveman in the middle of his lesson. I ended up offering him a make-up lesson the following week since my blood glucose had effectively ruined this one.

This isn’t a unique situation. We all face changes like this living with diabetes year after year. Our sensitivity for low blood glucose adjusts. This is actually one of our bodies’ great coping mechanisms — when we face the same situation or physical hardship continuously, our bodies will adjust to it. If we don’t have access to food, our metabolism slows, our stomach contracts. That’s why you don’t give someone who has been severely hungry for a long time one huge meal, but titrate smaller meals to help their system readjust to a normal level of food. Obviously, a starvation diet hurts the body in many ways, but our body does its best to adjust to a negative situation and preserve itself.

Not just physical
We don’t just adjust to physical changes. We adjust to emotional changes. There is a psychological pattern of adjustment that can seem incredibly counterintuitive from the outside. About three years ago, I was working as a therapist in a residential treatment center in Philadelphia. We worked with teenage clients who had severe enough behavioral and emotional issues that they had been removed from their homes and brought to live in this treatment center. Most of them had already had extensive run-ins with the law, and the vast majority of them came from severely depressed socioeconomic situations, from neighborhoods riddled with violence and more vacant, decaying lots than homes per block.

I was leading a group one day, and the topic of college came up. I think I was the one who brought it up, but I can’t recall for sure. In any event, I noticed that very few of the students wanted to know about it. Even those students who possessed huge academic potential were not only uninterested, but actively opposed to the idea. Coming as I did from an upper middle-class background where going to college was the expected next step after high school, I couldn’t understand why so many capable to students were resistant to the idea.

I went home that night confused, and remained confused for a few weeks until a thought hit me like a lightening bolt: Imagining college for these guys was like imagining a cure for me! Nobody they had ever known went to college. Nobody they had ever known escaped the grinding poverty they had grown up in. In fact, hope for change was something to avoid at all costs — because such hope simply made the day-to-day reality harder to endure. It was bad enough for these guys without imagining some future wonderland with a career, family, happiness, money, and stability. And I realized that I had made that SAME adjustment to diabetes. I HATE hearing about promising cures, because I still have to live with diabetes TODAY. I don’t want to go around imagining that triumphant day when they cure this disease; I need to focus my energy on managing it TODAY, and tomorrow, and the next day, and forever if need be.

What it means
How we handle these adjustments is up to each of us. The physical changes need practical solutions — I plan to simply keep a supply of glucose tablets in every place I regularly find myself. I will have a bottle in the car, a bottle at both locations of the music school where I teach, a bottle in my bike bag, and a well-stocked supply at home. In addition, I’ll continue to carry my little 10-tablet vial in my pocket. The 10-tablet vial alone is no longer sufficient. Working a full 8-hour day, those 10 tablets may be used up in the morning and leave me in a dangerous situation later that day. So I’ll stockpile.

How we handle the emotional adjustments is more subtle. I continue to avoid seeking out research news, but I’ve learned to let go of the fear and tension that used to accompany hearing about it. I’ve learned there’s a difference between living in the moment and living with blinders on to avoid seeing the phantom you fear. In all of my time helping clients confront emotional trauma, the most important ability I’ve seen is the ability to let go — to simply drop it. And I don’t mean dropping the feeling — you can’t simply “drop feeling sad”, or “drop feeling mad.” But you CAN drop the resistance to the feeling. And that goes a long way.

Living with diabetes brings changes. Some are obvious, some aren’t. Some of them are easily solved, some take more introspection and thought. Change is the essence of life — it’s the only thing that DOESN’T change. And so we adjust, adapt, and move forward.

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Making Adjustments (12/22/14)
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