Through Thick and Thin
Balancing societal pressure with good diabetes management
February 2007 — It was not love at first sight. Quite the contrary. An awkward glance, blatant distain, forced meetings...and then one day, I found myself in love. Head over heels, obsessed, and utterly hopeless, I secretly admitted that I could not live without….
Due to the rapid weight loss before my diagnosis, my medical team placed me on an ADA exchange 3,500 calorie per day diet. All of my food was weighed, measured, and deemed appropriate for consumption. Special meals, such as restaurant visits and birthday celebrations, involved an impromptu math quiz. "How much insulin would you need to take for four bites of cake, two slices of pizza, and a salad with croutons?" I dutifully divided and multiplied, injected, and dove into my meal.
By my teens, the novelty of calculating everything I put into my mouth wore off. I took it upon myself to eat what I wanted and took extra insulin to cover the spike in blood sugar. Of course, I never craved an extra helping of salad or cups of sugar-free gelatin. I would cram cookies into my mouth when no one was looking and chew furiously. If I was away from anyone who would question me, I would gulp down the worst types of junk food.
There wasn't any joy in eating these "forbidden" foods, and often, whatever I snuck didn't even taste good. It was my way of rebelling, of saying that I didn't want to be shoved into a routine that I would have to follow for the rest of my life. Psychologically, I hadn't come to terms with diabetes. I was angry and eating was the only way (for me) to stifle the anger. Did I feel good about myself? Did I have control over my blood sugars? Um, that would be a resounding: "Nope."
My mother searched until she amazingly found a nutritionist who was also a type 1 diabetic, and I visited her weekly for a few months. We discussed how I could lose weight in a healthy manner and I would write down what I ate (obviously omitting the secret "stuff my face" moments). I lost some weight, but after I stopped seeing her, I reverted back to my old habits.
I grew four inches and gained sixty-five pounds in the five years after my diagnosis.
When I arrived at university, I wanted to be just like everyone else. I savored pizza at four in the morning and if I didn't have my insulin available, I told myself that I would take a shot to cover the slices later. Sometimes, that shot wouldn't happen.
I didn't wake up one morning and decide to maintain my weight by skipping shots. I didn't have this sudden burst of idiotic brilliance. Was it intentional? Yes. I knew that my blood sugars would run high and that I wasn't getting any important nutrients, but I rationalized that at least I wasn't going to pack on more pounds.
Why did I skip shots? We, as diabetics, can't "diet", which I've come to understand now isn't healthy either. (Who wants to survive on the "all-grapefruit" or "cabbage soup" diet? Come on.) We struggle with low blood sugars and extra food intake to bring blood sugars up. I compensated by taking risks with my health, and in retrospect, gambled with my life.
I lost over twenty-five pounds in the summer between my junior and senior years of university. How? Ironically enough, it was through checking my blood sugars frequently, following my insulin regimen, eating lots of vegetables, and exercising every day.
Then, I slipped. Stress from school and relationships and the world in general catapulted me into old behaviors. Back to ignoring the disease, I would sporadically check my blood sugars – if I was over 300, I'd draw up a few units and inject. It comes as no shock that I was exhausted all the time, propping myself up with large doses of caffeine.
I will readily admit that my medical visits were infrequent, at best, during my university years, as I was living out of the country. Upon returning to the States, my endocrinologist quickly got wise to the game. My A1Cs and my logs did not match up. I fashioned a quite elaborate (and I thought, quite believable) lie to her about how I felt great and that my blood sugars were fine. She was pointedly blunt. "How often are you skipping shots?"
The climb out of the diabulima (I still call it "skipping shots") abyss was made with help from my medical team. They found a mental health professional who counseled women with eating disorders and body image issues – and she had experience with diabetics. I spent many hours talking with her and other women about the frustrations and anger I had over being signed up for a chronic illness without my permission. (Imagine that permission slip?!) We examined society's preoccupation with the "heroin waif" look – and why I was willing to sacrifice years of my life (and numerous complications) for a dress size. My weight gradually stabilized without denying myself food or insulin and I am grateful for those who counseled me how to do this without jeopardizing my health.
I discovered a few things that has helped me to maintain my weight (and my sanity, although it's still sometimes in question) over the years.
- I no longer call my food intake a "diet". (I always equated "diet" with "denial".) I benefit from a diabetic lifestyle, which opens up a culinary world of choices. Practicing good portion control and carbohydrate counting is crucial, making hypoglycemic episodes less frequent and blood sugars more stable.
- There are no "forbidden foods", but rather items that I consume in careful moderation. If I want to savor an occasional sweet, I dose for those extra carbohydrates and check my blood sugar frequently.
- I abhor the concept of "structured" exercise, but I am keen on taking nightly long walks with John and our dog. Enjoying some form of physical activity helps to keep my blood sugars and weight under control.
- I also learned to recognize harmful mental behaviors and try to take positive steps to staying fit. It's as much of a struggle to maintain a healthy weight as it is to lose it. Sharing fears and support with others is a wonderful way to keep motivated – and to know that you aren't alone.
As a young woman, I thought that being thin was more important than my health and my future. The societal pressure to be "slim and trim" can be in direct opposition with a healthy body, and living life with diabetes can be difficult enough. Working with those who can guide you along to the right choices in food, exercise, and mental attitude is crucial, but it begins with one's own mindset. For me, it begins with this thought:
I still love food, but I love myself much more.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
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Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...