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October 22, 2016
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Nuts and Bolting

I recently received a solicitation to publish in the International Journal of Behavioral Nutrition and Physical Activity, an open-source journal that is part of the BioMed Central collection. While I am not a medical professional, the journal's title reminds me of the many ways in which diabetes affects and is affected by nutrition and physical activity. What we eat, and when, is dependent upon our medical plan, our diabetes therapy plan, our current blood glucose levels, our projected blood glucose trends, our physical activity preceding eating, and our projected physical activity following it.


The prescriptions and proscriptions about what foods to eat, when, and how much are enough to throw any ordinary person into what any normal behavioral psychologist would call "disordered eating" yet, if we don't follow that plan, we're considered "noncompliant". (Can't win for trying, can we?)

*A lot has been said in popular diabetes media about diabulimia on the one hand, it's not bulimia because it doesn't include binge eating behavior, but on the other hand it is, because there is deliberate purging behavior (deliberately withholding insulin).

*The Other Half's late aunt, diagnosed with geriatric type 2 diabetes, was told she could only eat if her blood glucose level was below 100. I had originally thought that a reasonable request, until I found I was so rarely going into the 90s at even three or four hours postprandial that I was having trouble consuming a scant 1000 calories a day. (Less than that, without a doctor's supervision, is considered to be dangerous but on the other hand, they say that women should not consume more than 1500 calories a day to maintain weight, and not more than 1200 if they have any weight to lose.) It was a mindset that, if not addressed early on, could have led to anorexia nervosa another, potentially lethal, eating disorder. Of course, nobody would have diagnosed it because I was obese, and one of the key signs for clinical diagnosis is being extremely underweight.

*Many of us, when we feel hypoglycemic, often before we even bother to test, eat anything sugary in sight. Sometimes the problem is that we don't feel "low" until we're very low, or until we have been "running low" for some time (perhaps even long enough for our livers to cave in and release large amounts of glycogen); sometimes the problem is that work or family keeps us from getting to the small, measured doses of sugar until we feel that a crisis has hit. While we may not, technically, eat enough during these episodes to constitute a binge, the rebound on our blood glucose levels may suggest to us that we really had been on one (especially if we are following the highly-restrictive diets that we are "supposed" to be following).

*We are given a number of glycemic "guidelines" with which to work. Failure to meet any one of these can be considered anything from "a bad number" to failure as adults to "suck it up" and properly manage our diabetes. While not every person with diabetes can control his glucose levels by withholding food or avoiding certain specific foods, if our diabetes can be moderated by our diets, and we are not doing so, we are considered irresponsible.

*On the physical activity side of the equation, how many of us fear doing "Larry Bird" (33 minutes or more of aerobic physical activity) because of the potential for hypoglycemia? How many times have we read of someone having to either crank up the flow level on an insulin pump (or conversely, suspend it completely) before starting a hard aerobic and/or endurance workout? Do we fuel for our activity level, or do we fuel for our blood glucose level? The two sets of needs may be completely contradictory, with the result that many of us choose to maintain elevated blood glucose levels (above 126 mg/dl or 6.0) during extended periods of exercise and others of us can't seem to get below that number as long as there are glycogen stores for the body to draw from.

While I don't have the background or the quantitative data to take the International Journal of Behavioral Nutrition and Physical Activity up on its offer, there is a lot of material available for someone who wishes to examine how and why people with diabetes have the idiosyncratic eating habits we do.

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