A confession: if you tweet too many positive-thinking text-on-a-pictures I will unfollow you. Or maybe mute you. My twitter filters include about twenty variants of ‘inspirational quotes’. I block any feeds that tell you to cheer up, be mindful or adopt a different attitude.
Interestingly, I don’t think this is because I’m a pessimist. My partner would probably describe me as a relentless optimist, but one who likes to plan for every eventuality (to the extent that might at times need to be medicated). But still, I hate those “Cheer up, it might never happen, be mindful of the lemonade you can make while you’re climbing mountains and this is all making you a better person anyway.” messages.
So. What to write for World Diabetes Day? A thousand word whinge? An ‘I can do ANYTHING with diabetes’ defiant rant? (Which I believe is – just as we can’t all be olympic athletes – absolute tosh, there are a lot of things that I used to do that it would be reckless and selfish to do now). Hopefully I’ve found something in between. Diabetes sucks, it’s painful and it makes life chaotic. But in the long run, some of that pain and chaos is useful, maybe even positive.
If something is going to hurt, hurting faster is better
I’m not talking about finger stabs and insulin injections… but the consequences of day after day of lifestyle choices, that all of us in the developed world live with. I want to step away from the idea that all diabetes, or even all type 2 diabetes, is lifestyle related. We see correlations, but they aren’t causations. We have no idea what causes most variants of diabetes, and the judgements people make about those with Type 2 diabetes are why I consider myself to have ‘the good kind of diabetes’ – at least nobody thinks it’s my fault, and I’m not required to be ashamed of myself.
However, we do know that, generally, people who exercise and are fit, and who eat a healthy diet, have better quality of life, particularly as they get older. It’s something that no rational person would choose not to do. And yet it seems like increasingly we aren’t doing it.
It’s obvious that making ‘good’ choices about diet and exercise is hard. Even our doctors, who know the risks and the benefits, find this hard. It’s hard because the longer the gap between our actions and their consequences, the less we can make the association. For most folk, the gap between food and exercise choices and the consequences is weeks and months and years. Our brains simply aren’t very good at really feeling that these kinds of cause-and-effect patterns are true. Pitched against the immediate rewards of the taste of chocolate or an extra hour under the duvet on a cold morning, the odds are really stacked against the ‘rational’ choice.
But when you have diabetes, especially if you have a volatile diabetes like Type 1, or Type 3c (which I probably have) or a brittle Type 2, when you make the less-good choices about your diet and exercise it really hurts, really fast. And that makes it easier for our brains to make connections. The fact that it actually hurts – nausea, dry mouth, throbbing head – it’s not just a kind of theoretical notion about a risk in the future, is especially powerful. Concrete beats abstract, every time.
I absolutely love rice, but I simply cannot match the timing with insulin – I seem to either hypo before I’ve eaten or spike right into the 20s. Even with split doses. So I’ve stopped eating rice, not because those kinds of fluctuations will give me vascular damage over the years but because having blood sugar levels flying between hypo and a serious high feels horrible. And crying into my rice is not fun. (I have cauliflower rice instead now, so it’s all good, except for sushi… ah, sushi, how I miss sushi…)
We might well resent these connections, the strength of the correlation, because we look around and see that Type Zeroes can eat a pizza and not suffer for three days. We might choose to have that experience every once in a while, but it’s not something we can do twice a week, or we’ll never feel well.
It can feel restrictive, but I doubt that when I’m fifty I’ll look back and think ‘I wish I’d been less responsible about my diet and exercise’. And when we do it ‘right’, when we have a great HbA1c with no-hypos because we worked really hard for a couple of months (and all the random factors like infections and hormones and the weather also blew in the right direction), it feels amazing.
Not that it’s easy. The majority of people with early-onset diabetes have some kind of eating disorder. All that mindfulness about carbohydrates can really mess you up. The pain when you get it wrong can lead to phobias about specific groups of food, or all food. And sometimes we go through phases where we’re so angry at our bodies that we screw it all up on purpose. But there are a lot of people doing that with their lives, and – again – most of them will get away with that for a lot longer before someone notices and says “Hey… what’s up?”
Exercise in particular can be hard to get right. But at least we’re mindful about whether we’re exercising at all. We can’t slip in to sedentary habits on the quiet. And that is where the benefit of diabetes is – it brings the future forward, and it magnifies the difference between good choices and bad choices, not just in terms of long-term complications but in how we feel in the here and now. And our brains respond more powerfully to feels than to thinks. We can’t pretend, to ourselves, that we’re kind-of-ok, when we aren’t. And that transparency and immediacy is a gift.
(Just don’t tell me to make lemonade, because high sugar drinks are only suitable as hypo treatments, and I’m really badly allergic to lemons.)