My T-2 Day (at least in theory)

Here is what I do (or should do) about my T-2 diabetes on a daily basis.  I'll try to be pretty honest about what I actually manage to accomplish and what I don't by assigning a letter grade.

Note: take NONE of this as advice.  My sole goal here is to give a picture of what I do (or try to do).   Go forth, and discover what works for you.

1.  Medications (A)
It took me a long time to figure out how to be regular with my meds.  I now have one large 7-day pill sorter for morning pills and another for evening pills.  (I'd be a little better off by doing one for dinner time as well, since a couple of my bedtime pills would be better at that time, but I haven't implemented this yet.)  Using the pill sorters means I only have to think about the pills once a week.  This is a Good Thing.

I currently take prescription meds for diabetes, for blood pressure, for cholesterol, for glaucoma (not diabetes related), and for one or two other things.  I also take a number of over-the counter supplements which have been credibly (to my satisfaction, anyway) recommended at one time or another.

2.  Testing (B-)
Most Type 2s seem to be told to test once a day in the morning before eating.  That number is used as sort of the baseline for how your diabetes life is going.  I work at not letting myself be too up or down about a given day's number (unless it's way out of whack) but to watch the trend, expressed as "about how I've been running."

When I'm being conscientious, I test once or twice more during the day.  I don't have a set pattern for this: sometimes I'm checking on the effects of a particular food, if I've come down satisfactorily after a meal, etc.  If I feel weird physically or emotionally, I sometimes test to see if there's a blood sugar relationship.  (Usually, for me, there isn't.)

I'm not very good at all about testing my blood pressure, which I should also be doing on occasion.

3.  Food (D+)
Oh, boy, is there conflicting advice about optimal eating plans.  I try, when I'm doing well, to eat reasonably low carb AND reasonably low fat.  Eating this way, with exercise, helps me to lose weight.  But I'm not very good at it.  It's easy for me to feel discouraged about this area, but I have made progress in terms of laying off many of my worst choices or indulging only occasionally.

One thing that works very well when I do it is to plan a few days at a time, then hit the grocery store.  My basic approach for each meal is to plan for some veggies and/or fruit, a modest amount of carbs, and a lean protein source.  I try to lean in the direction of whole grain stuff for the carbs.  (In particular, I find that I do well on brown rice, while white rice is a spike food for me.)

4.  Exercise (C)
I'm off-and-on here.  The exercise I most enjoy doing is walking, but iffy weather and tiny injuries don't always allow for this.  I'm experimenting with other things.  I just got a Wii, but screwed up my order for a Wii Fit program.  Exercise videos tend to leave me feeling fat and clumsy.

I will tell you this: when I am exercising regularly, the effect on insulin resistance is very marked.  I not only see it in my morning numbers but think I have a much faster return to "normal" BG after eating.

That's my Type 2 Diabetes day.  (Sometimes.)

Acknowledgements

The widely-admired Ninjabetic wrote a post the other day that's really had me thinking.  (Go ahead and read his post now.  I'll wait.)  Oftentimes, folks facing a tough situation (like diabetes) are told that they should feel grateful that they're not facing a worse situation (like cancer).   The stealthy one's point (which you really should read in his own words, if you haven't already) is that we can be grateful that our situation isn't worse and STILL acknowledge grief, anger, etc. about our own plight.

Throughout my time as a diabetic, I've been strongly touched by the courage and grace of so many people whose diabetes has brought far more trouble into their lives than my diabetes has (yet) brought into mine.  This has often led me to dismiss my disease as somehow trivial or unimportant.  I now see that this is incorrect, and has maybe kept me from a healthy (!) attitude towards my disease.   

Type 2 Diabetes is tough. It's tough to worry about what your food is doing to you.  It's tough to get a little bit of tingling in your feet and wonder if that's an early signal of an amputation.  It's tough to argue with waiters about why you don't want a roll with your dinner.  It's tough to get a Christmas card from your pharmacist. It's tough to read about having greatly increased risk for everything from heart disease to Alzheimer's disease.  It's tough figuring out how to eat low carb AND low fat and still get in a reasonable number of calories.  All of these things and many more are genuinely tough.  It's entirely reasonable to feel sad, or angry, or fearful, or all of these things together when I think about them.

And it's a relief to admit that.

Thanks, Ninjabetic. 

Me and the DOC

When I started looking for Internet resources shortly after diagnosis, I thought I was looking primarilly for information and guidance. But the resources that have meant the most to me are those that brought me a sense of community. I never would have guessed how much the diabetes online community (DOC) would come to mean to me.

Here are the four resources that have been most important to me:

1. Diabetes Daily --There are a number of good diabetes communities on the Internet -- Diabetes Daily just happens to be the place I found a home.  In the early days, I mostly read forum postings; later, I spent many (many!) hours in the chat room.  I gained a lot of information about all types of diabetes and how folks go about dealing with them.  I watched "live" as folks I cared about dealt with highs, lows, first injections, and even DKA.  I got a lot of guidance from folks with more experience than I, and even (I hope!) managed to provide some guidance to the newly-diagnosed.
2. Diabetes Power Show podcast -- This podcast is done by three main voices and a producer.  The hosts include a T-1 Diabetes tech consultant, a T-1 nurse, and the nurse's husband (also a nurse).  The producer, who founded the project, is a T-2 who started the program as a way to help motivate himself to make the changes he had to make.  These folks are unfailingly positive, and just being able to listen to the voices helped me to feel less alone.
3. Blogs --  I don't read as many blogs as I could get benefit from.  But I've sure found some voices I love and appreciate, and a couple of people that I'd probably read regularly whatever they chose to blog about.
   
4. Twitter -- I came to Twitter late and slowly.  But I've really been wowed by all the smart, funny, caring folks I have the opportunity to follow.  Twitter has come to replace, actually, most of the time I once spent in the chat room.
   

Like many people, I've rarely had as much sense of belonging to something important as I'd like.  I've found that feeling of community in church organizations, but that's rarely felt like enough. 

I sometimes feel, though, that as a meds-only T-2, my "membership" in the community is a little bit provisional or something.  Never once has anybody said anything to cause me to feel less than completely welcome.  Rather, I have an awareness that there are many experiences shared by most of the DOC that I've never experienced, things that form the fabric of daily diabetic life for so many of my friends.  But everyone has been unfailingly kind and supportive, even when most of my own tweets are random wisecracks.

Thank you all.  Thank you so very much. 

Educating T-2s: Pancreas, We May Have a Problem

By the time I was able to see my doctor after receiving my diagnosis in a letter, I wasn't completely ignorant.  I'd done some hunting around the Internet, and I think I'd joined one of the online diabetic communities.  Because I'd called my insurance company to find out if there was anything they needed me to do, I'd received a blood glucose meter and even tested a couple of times.  (The first time had been a bit hard, to tell the truth.)   I knew a bit about the disease mechanism, and I knew some questions I needed to ask.  

I really expected that this first appointment would be when my serious education would begin.  What happened, though, was that I was given a fistful of prescriptions, an injunction to exercise, and an appointment for three months hence.  When I asked about diabetes education, I was told that we'd discuss that at the next appointment.  (At the next appointment, I was told that the education was for people on multiple medications.)

Huh?  Is that all there is?

In my case, being forced back on my own resources may have been the best thing that could have happened.  I'm fortunate enough to have received a good education, I'm comfortable with finding and evaluating the quality of Internet information, and I work in a major public library.   The lack of "official" information probably just caused me to take my own education all that more seriously.

But type 2 diabetes is not a disease that exclusively strikes educated people with a high degree of information literacy.  Here are some of the things I did not learn from my doctor, anybody she pointed me to, or anything she gave me to read:

• What changes to make in what I eat
• How the recommended exercise would help, and when it might be dangerous to do it
• What these medications were supposed to do for me.
• What range I should be aiming for with my daily blood tests
• That my metformin might make me sicker than a dog (as it turns out, I was one of the lucky ones on this)
• What complications I might be facing and that good control would likely help avoid them
• What to do in case of hypoglycemia or hyperglycemia
• How and why to check my feet
  
• That getting my blood sugar into initial control would initially make me hungry enough to shut down a Denny's 
  

Seems like some important things to know, huh?  (To be fair -- the test kit she offered and which I didn't need may have come with pamphlets or something.)

Why was my doctor so stingy with information, and so reluctant to get me into training?  Are there so many new Type 2s that there just aren't resources to give classes to us all?  Or was my doctor just more concerned with getting to the next patient than she was with giving me what I needed to improve my health?  Did she have me labeled as a 'hopeless' patient that wouldn't take lifestyle advice anyway?  I understand that patient education takes time and that doctors aren't adequately compensated for it.  But if my doctor had the right resources, another three or four minutes could have made all the difference. 

And here are the most important questions of all: How typical was my experience?  And, if many new patients have the same experience, what can be done about it?

Why is it So Hard to Lose Weight? A Rant.

Millions of people -- a very substantial percentage of the population, in fact -- need to lose weight.  Most of them know it, I assume, and have made at least some effort to do something about it.  Many, many people have been trying to lose weight for much of their lives.  But, rare is the person that achieves a substantial weight loss and maintains that loss over the long term.  I certainly haven't achieved that.

So why is it so hard?  Why do so few people succeed?

Even if you strip away fad diets (pineapple, anyone?) and stick only to approaches with significant medical support, there's not a whole lot of consensus about how to go about losing excess pounds.  The one approach with broad support argues that the goal is to reduce the level of calories gained through food below the level of calories expended through exercise, biological activities and the like.  Pretty simple, eh?  If it doesn't work, the problem is with the dieter.  The problem might be in the dieter's lack of knowledge or other issue beyond his/her immediate control, but (we tell ourselves) the problem for most involves defective character.  The person who can't lose weight is weak, we believe: there's just no will power.

Call me a skeptic.

Consider diabetes, which affects another area of metabolism.  Is blood glucose control simple?  No, it most certainly isn't.  Even intelligent people with extensive knowledge about diabetes and about their own bodies, people who've been managing their conditions with a high degree of success for decades, regularly find themselves in situations which they don't understand and aren't quite sure how to address.

So why should we expect that weight loss would reduce to such a simple equation?  Isn't it almost ludicrous to think that it does?

There is a LOT of good, solid research going on about the various issues around diet, nutrition, weight loss, the whole hairy set of issues.  I believe that in a decade or so we'll look back at how we now look at weight loss with a sad shake of the head.  I am hopeful that what the scientists learn will someday make successful, sustainable weight loss manageable for many more people.

Am I just making excuses for myself?  Maybe I am.

I'm NOT offering an alibi, though: the "battle of the bulge" is worth fighting even if we're not winning.  It's pretty clear that the choices believed to result in weight loss are great for us, whether we're seeing success on the scale or not.  The effort itself is worth it, so, in Voltaire's famous words, let us cultivate our gardens.  And we'll probably be better off yet if we eat mostly what we grow there. :)

Meters or Masters?

Are these tools that help us to measure our health, or judges we allow to measure our self-worth?  For me, the line can get blurry...

Diagnosis Fallout and T-2 guilt

As I mentioned in my last post, I learned about my diagnosis as a T-2 diabeticin a letter I received when I got home from work on a Friday afternoon.  My reaction, to which I lost that first weekend, was guilt -- a deep, abiding shame I'm not 100% over to this day.  

See, my dad is also T-2.  When he was diagnosed, somewhere around twenty years ago, he laid out for me what he'd learned about the disease and that I'd likely have a much better future if I could get in shape.  So, I'd had fifteen or twenty years to get my act together, and I'd failed.  Pretty miserably, too.

As i now know, obesity and a sedentary lifestyle do not cause type two diabetes.  A substantial percentage of newly diagnosed T-2s are in pretty good shape, and I think I read the other day that only 25% of morbidly obese people (those 100 or more pounds overweight) have diabetes.  It's known that there are genetic factors as well.  It's also believed that there are "environmental factors" that are not yet understood. In sum: being overweight did NOT cause my diabetes.

But, even with all that said, it's still true that, had I lost my excess weight, I might have delayed the onset of diabetes, perhaps for a very long time.  And, if I am able to change my lifestyle now, I dramatically increase my chance of avoiding serious complications. 

Maybe.

The devil's not in the details, he's in the maybes.  It's in that forest of maybes that my residual shame resides.

So I spent that first weekend in a pretty negative space.  I felt sorry for myself, sure, but mostly I felt ashamed OF myself.  It was several days before I even managed to tell my sister, with whom I've been closed for many years.

By Monday, though, I'd come to some degree of peace was ready to start looking for resources.  I'm so grateful that there were resources available.

Oh, the temptation....

I *love* ramen noodles, and before diagnosis, I ate a *lot* of them.  Now, they're an occasional treat, and probably should be a very rare treat.

My diagnosis story

I almost always find diagnosis stories to be interesting.  Even for type 2 diabetics like myself, diagnosis tends to result from some sort of crisis, whether it be a life-threatening high, the onset of complications, or just a doctor's visit resulting from persistent fatigue or other early symptoms.  I was a little luckier.

About six months before I was diagnosed, I began experiencing the classic symptoms of thirst and frequent urination.  Like many folks, though, I didn't really think of the thirst as being unusual - it was the bathrooms trips that kinda bothered me.  Did I secretly suspect the truth, down in my heart of hearts?  Yes -- or, rather, no: the 'truth' I was hiding from was my suspicion that I was developing prostate problems.  The thought scared me, though - my dad had had prostate surgery - and I took no action.

A couple of months before diagnosis, I had an opportunity to join a weight loss program at my workplace.  I made some pretty big changes: I quit drinking sugared soda (boy, had I been guzzling that!), generally ate more sensibly, did some exercising, and lost about 20 pounds.  (Alas -- they haven't stayed lost.) Guess what?  I also quit living in the bathroom, and I now know that I pretty much stopped having symptoms.  So, when I went in for my physical, I just expected a pat on the back and encouragement to keep going.

Since I have a T-2 father, the doctor must have ordered an A1c as part of my blood work. (The prostate was fine.)  A couple of weeks later, when I got home from work on a Friday, I had a letter (!) informing me that I had diabetes and that I needed to make an appointment for a follow-up.  (I learned later that my A1c had been 9.5.)

Now that I can think back on the months before diagnosis with some knowledge, a number of things make more sense.  Not only had the amount of fluid I was drinking been pretty extraordinary, but my eating (before beginning that diet) was completely out of control -- I must have been eating hundreds of carbs a day.  I'm blessed that I didn't eat my way into serious hyperglycemia.  There were other things, as well, that might have tipped a more knowledgeable person off to what was happening in my body.

How did I react to my diagnosis?  That's a topic for another day.

Metabolic syndrome, BAY-BEE!

This is a picture of the medicines and supplements I take on a daily basis.  One pill sorter is for the mornings, the other is for the evenings.

"T Minus Two"?

In June of 2008, I was diagnosed as a Type 2 diabetic.  This type of diabetes is often abbreviated as T-2, thus "T Minus Two".

I treat my diabetes through oral medications and trying to implement lifestyle changes.  At this time, I do not need to take insulin, the substance needed by all Type 1 diabetics and some T-2s to stay alive.  (Because T-2 is a progressive disease, however, I may someday require insulin.)

As such, my life is significantly different from many other PWDs.  (PWDs is "persons with diabetics", a term preferred by some.)  I am not at this point exposed to many of the more dangerous aspects of life with the disease, nor to many of the more aggravating aspects.

Nevertheless, I feel that I have some things to say.  Saying them may help me: conceivably, they may help others.  Providing a little entertainment would also be good -- while I'm a serious person in many ways, humor comes easily (and sometimes oddly).

Welcome.