I have sometimes used addiction as a metaphor for Type 1 diabetes. Think about it for a minute………

A Type 1 Diabetic (T1D) must inject insulin daily. If still taking shots then a Type 1 diabetic might have to partake in a “fix” up to 8 or more times a day. If on the pump we are constantly “hooked” up to our “drug of choice.”

But, Michael, a T1D doesn’t  crave insulin?? Try not taking it for a day or two and see if you begin to crave it.

But, Michael, it is good for us unlike being addicted to something like drugs or alcohol?? Yes, it may be good for us but we are addicted to it. We need it. Without it we will have symptoms of withdrawal.

What I am asking you to do by contemplating being an addict by being a type 1 diabetic is to hold a mental perspective that you may not have thought about. When thinking of our disease as an addiction there are a few pathways that may open up. Explore these. Think about the people around you. Are they acting like co-dependents or enablers? Are you treating them like co-dependents or enablers?  Do you hide your disease? What is it that caused the addiction in the first place? Do I own any responsibility for the onset of my situation? Is the goal to overcome my addiction?

Check out the 12 steps of AA. The first step says…..”We admitted that we were powerless over alcohol and that our lives had become unmanageable.” Does having diabetes imply we are powerless over something and that our lives have become unmanageable? What is the something that we are powerless over? For sure the goal is manage our disease. If we don’t, our lives do become unmanageable.

I don’t bring this thought exercise out to be provocative. No, my intention is to offer a momentary shift in the way  we see our disease so we may obtain additional tools to combat it. I have had type 1 diabetes for 39 years now. I can tell you with 100% certainty that if you are able to increase your level of awareness you will increase your ability to respond (RESPONSE-ABILITY) to your disease on a moment to moment basis. Denial is one of the hurdles in the recovery of an addict. Some say the opposite of denial is acceptance and it is acceptance that will “set you free.”  Screw acceptance.  I don’t accept this dis-ease.  However, I am willing to be aware.  Work on awareness and the quality of your disease control will increase and you will be on the healing path………..

Total Accountability and Total Feedback constitute the minimum and only perpetual motion system.”  Buckminster Fuller, Critical Path.

In order to re-create the system that has been compromised due to the onset of Diabetes we must determine what it is we have to account for and then receive and assess the feedback (results) we get.  There are so many things we need to account for.  Read the “Transforming Diabetes Series” in this blog to get a breakdown.  There is really one thing we want feedback on and that is our blood sugar level.  There are continuous glucose monitors (CGM’s) on the market and I think every person with diabetes should have one.  But even with a CGM we must finger prick test multiple times per day.

If you are Type 1 I believe you should be testing a minimum of 10 times per day.  If you are Type 2 you should be testing at least 10 times per day until you have reached a balanced state.  Then you can spot check throughout the day a minimum of 4 times per day.

Testing/Checking Blood Sugar levels is like taking a photograph.  It is a moment in time.  If you have eaten and are not confident of how many carbohydrate and fat grams you have digested then you may want to test more often.  If you have a lot of insulin on board then you may want to check more often.  If you are testing your basal rates you want to test your blood sugar every hour for a period of time.  If you are engaging in exercise or physical exertion you want to test more often.  Testing more often begins to transform the photograph into a video.  You can detect trending and effects of certain foods, emotional states, exercise etc.  This is important information for you to have in order to make good decisions in both the present moment and future.

Testing your blood sugar is a critical component to the system we are asked to re-create and monitor constantly.  If you are not testing 10 times per day talk to your doctor and get a prescription for 300 strips per month.  Tell your doctor you are committing to testing your blood sugar because it is the critical feedback you and he/she need in achieving a deeper understanding and mastery over managing your condition.  More feedback is good.

The primary goal in managing diabetes is to achieve blood sugar levels as close to normal as possible.  There are several subgoals:

1.  Achieve primary goal without experiencing too many lows.  Lows are blood sugar levels that drop below, let’s say, 75 mg/dl.

2.  Achieve primary goal without experiencing much time in the high blood sugar area.  High blood sugar is, let’s say. 240 mg/dl to 300 mg/dl.  Anything over 300 is an emergency situation in my book.

3.  Achieve primary goal and be able to eat well and satisfy hunger needs.  This can mean several different things for each individual.

4.  Achieve primary goal and be able to live an active and purposeful life.  Again, different strokes for different folks.

Normal blood sugar’s range for a human body is between 80 mg/dl – 120 mg/dl.  It may, at one time another, fall  a bit below or rise slightly above.  However, normal 4 hour fasting blood sugar should be around 80-100 and at most 120.  Type 1 diabetics do have an opportunity to stay in the normal range for hours at a time.  Some may be able to extend that for a few days.  It takes great skill to achieve normal range for hours at a time.  A Type 1 diabetic’s blood sugar will rise many more points after eating than a person without diabetes.  That is why the upper limit of the goal’s range is 240.  And the Type 1 diabetic is always in danger of falling too low.  Blood sugar monitors enable us to “check” our blood sugar.  Checking is just that.  It is a moment in time.  Multiple testing over short periods of time will reveal trending.  Trending and the rate of trending is critical information to the ongoing management of the disease. A1C blood tests provide the average blood sugar over a period of 2-3 months.  An A1C result of 6 represents an average 3 month blood sugar of 136 mg/dl.  An A1C result of 7.0 is an average blood sugar of 172. Continue reading The Diabetes Equation →

I recently finished a series of blog posts called “Transforming Diabetes.”  It focused mostly on Type 1 Diabetes and I want to now take some time and talk about Type 2.

Type 2 is a different disease than Type 1.  The cause is different.  The treatment is different.  However, both are diagnosed from a high blood sugar result.  When someone finds out that I am Type 1 I will often hear, “Oh, you have the bad one.”   Neither are good.  And Type 2 can be as bad or worse than Type 1.  Whereas, Type 1 is caused by an immune deficiency response resulting in the destruction of the islet cells in the pancreas, Type 2 is caused by a change in the metabolic system functioning resulting in insulin resistance.  Type 2’s are experiencing high blood sugar because their insulin is not working as well or their body is resisting the insulin that is produced.  Type 2 has traditionally been diagnosed in adults over the age of 50.  More and more we are seeing younger people developing Type 2 Diabetes.  This is a result of the diet and lifestyle our culture has been engaged in for the last few decades.

The treatment for Type 2 is weight loss, exercise, low carb/fat diet, testing blood sugar and sometimes medication that increases the insulin efficiency or reduces the the insulin resistance.  The treatment is not as difficult of a balancing act as Type 1 but it requires hard work.  Most Type 2’s are over weight.  So, the first order of business is to transform the body and get it into shape.  Unfortunately, the vast majority of Type 2’s are unwilling to do this.  They have established a certain way of being and eating and to make a change is like turning a cruise ship around.  There is a lot of resistance.  Nevertheless, upon diagnosis of Type 2 I have seen several people effectively cure themselves by changing their approach to working out and their diet.  The “dis-ease” goes away and every facet of life becomes better.  In my opinion, this is the key to both Type 1 and Type 2.  It is all about the workout.

If I was diagnosed with Type 2 the first thing I would do is make my workouts the priority.  And I don’t mean a casual 1 mile walk.  I am talking about pushing it to your edge and expanding that.  Start by walking 1 mile if you have to.  Time your walk.  Do it every day.  Try to beat  your time each day.  Expand your walk to 2, 3,4 , 5 miles.  Walk hard.  Get to the point where you are jogging if your legs are capable of that.  Go to the gym or get weights.  You must build your strength.  The workout is the first and most important step in dealing with your condition.  If you are unable to exercise because of a physical condition then read on.  You may be able to pick up a few things that may assist you.  If you are unwilling to workout then stop reading this post.  I can be of no help. Continue reading Type 2 →