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 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.