Here is what I’ve been up to, and here also is a rant about expectations and living with diabetes.
From September to New Year, I ploughed grimly on with the Bernsteinian 30g carbs a day, trying to cope on basal alone. But though my spikes from eating were almost always under 2mmol, I couldn’t get rid of them. All I could do was bump up the basal overnight and in the morning. But there are limits to what basal can do. My baseline rates and averages were too high because of the post-meal levels. Then my baseline rate started to rise, and I felt it was my fault, and all I could do was just eat less. That I did. It was miserable. I was completely caught up in the You-can-do-it-by-diet-alone narrative. I started thinking I was insulin-resistant, worrying about every eyestrain and every complication symptom (because I have quite a few of those. I suspect I started having really high blood sugars about five years ago – I’ll never know, of course). I worried extra much because it seems some people glycosylate at a lower threshold than others (their HbA1c is higher than their mean BG rate would predict), and I’m one of them. Over Christmas, it was whack up the basal and just eat less and less. Horrid.
Finally just before NY I called the hospital and was given some NovoRapid, just one unit at a time to start with, carb ratios to be worked out later. And life has been so, so much better. No more spikes. Mean BG rate 5.4 rather than 6.7 plus, fasting 5.0 and 5.2 rather than 8.0. I’ve stopped worrying about my eyes, and the brain fog is going (it was high BG). So I’m exercising better again too. I’m looking, and feeling, and sleeping, better. Everything is better now.
I’m thankful that for now I’m on a low TDD: 5u basal and 2 or 3u bolus. It’ll probably go up, but hopefully low-carb will stop it going up to stellar levels. But when I need more insulin, I’ll take it. I’m also going to try out 40 or 50g carb a day, because I want to cook real vegetables again, which includes lentils and chickpeas and beans and roots (not potatoes), because I love them and they’re nice. The 30g/day limit turned food, for me, into a sort of threat. I was barely enjoying anything I ate. That has to change.
But I draw a big lesson from this (here comes the rant): that the redemption stories we tell ourselves when we are first diagnosed and are still really in denial that we are sick can be quite harmful. It’s not true that low-carbing alone can save LADAs. It may be sufficient for some, but for others it isn’t, and each single person is different and has to have confidence in what they work out suits them.
I think this is stage two in the five stages of grief – the psychology of getting used to the idea that we have diabetes. At first, after the shock, we deny that we’re sick, and then we make bargains with diabetes – if I only do this, then it will only go that far, if I’m good it won’t develop.
But that’s what children do. We can’t make bargains. We just have to adapt to what is happening. But our self-esteem and our confidence get caught up in this need to be on top of diabetes, to be stronger than diabetes.
Well, I think new diabetics should be on the lookout for thinking like this, that when you do well you are a Good Diabetic, and when you don’t it is because you are being a Bad Diabetic. It is false and it doesn’t help.
And isolation makes things worse. I don’t know any actual physical people with either type one or type two, except a friend with iatrogenic T1 who has cancer to worry about. So it’s hard to get a sense of perspective.
What’s the answer? I don’t know really. But I’m a hell of a lot better now, thanks to insulin.
