I'm diabetic, I swear!
January 6, 2017 7:07 AM Subscribe
I'm in my twenties, type 2 diabetic and need to make changes in my diet and lifestyle. I feel ashamed about the prospect of enforcing my dietary limitations because it's socially restricting if not unacceptable in some cases, and on top of that, people have told me that I "cant be diabetic" based on my appearance.
My ethnic background is one which puts me at extremely high risk of diabetes even at a normal BMI. I am still trying to figure out the details of what I need to do to get this under control, but part of it means not eating past around 4-5 PM, limiting the amount of food I eat in general, and not eating starchy carbohydrates. I'm already on metformin, but that's only helping me to a limited extent and I need more drastic lifestyle changes.
I feel very ashamed each time I even think about adhering to those lifestyle changes. Nobody where I live (white majority, very few minorities in general) seems to think that diabetics can be thin, including most of the healthcare providers here who are my peers and with whom I socialize with-- I know that if I posted my height and weight here, people would tell me that there's "no way" I could be diabetic or over-fat, even though the labs and the health consequences don't lie-- I'm in my twenties, have a low BMI, have been thin all my life but have a high body fat percentage, and am type-2 diabetic. My grandparents and parents are all thin but have diabetes, and several of my great grandparents died from complications diabetes even in a country that was basically regularly undergoing periods of famine.
But see what I did there? I feel like I have to super back-up my intended dietary restrictions with all these details just so that people really believe me and think that my adhering to my dietary limitations is justifiable and not something to be judged. I know this is stupid, because it's my body and my health and I know what I need to do to reduce my risk of awful consequences later in life... but why is this such a stumbling block for me? What's more, I myself am a physician, albeit not an endocrinologist. I should be better at this...!
BUT. Eating is such a social activity that I'm not really sure how to go about enforcing my dietary restrictions. I feel a lot of shame when I try to set these boundaries because to most people outside of my ethnic group I appear "tiny" to them, to the extent that I frequently get unsolicited comments. (I'm female.) Foregoing dining out because it doesn't fit my dietary requirements or turning down others' offers of food in other social situations is hard! To people within my ethnic group, eating with family and eating all of the cooking, clearing my bowl, is so central to establishing a sense of harmony. My parents are now more wary of the effects of diet on their diabetes, and are maybe a bit more accommodating, but I still have a large extended family that is not as convinced by western medicine.
Halp.
My ethnic background is one which puts me at extremely high risk of diabetes even at a normal BMI. I am still trying to figure out the details of what I need to do to get this under control, but part of it means not eating past around 4-5 PM, limiting the amount of food I eat in general, and not eating starchy carbohydrates. I'm already on metformin, but that's only helping me to a limited extent and I need more drastic lifestyle changes.
I feel very ashamed each time I even think about adhering to those lifestyle changes. Nobody where I live (white majority, very few minorities in general) seems to think that diabetics can be thin, including most of the healthcare providers here who are my peers and with whom I socialize with-- I know that if I posted my height and weight here, people would tell me that there's "no way" I could be diabetic or over-fat, even though the labs and the health consequences don't lie-- I'm in my twenties, have a low BMI, have been thin all my life but have a high body fat percentage, and am type-2 diabetic. My grandparents and parents are all thin but have diabetes, and several of my great grandparents died from complications diabetes even in a country that was basically regularly undergoing periods of famine.
But see what I did there? I feel like I have to super back-up my intended dietary restrictions with all these details just so that people really believe me and think that my adhering to my dietary limitations is justifiable and not something to be judged. I know this is stupid, because it's my body and my health and I know what I need to do to reduce my risk of awful consequences later in life... but why is this such a stumbling block for me? What's more, I myself am a physician, albeit not an endocrinologist. I should be better at this...!
BUT. Eating is such a social activity that I'm not really sure how to go about enforcing my dietary restrictions. I feel a lot of shame when I try to set these boundaries because to most people outside of my ethnic group I appear "tiny" to them, to the extent that I frequently get unsolicited comments. (I'm female.) Foregoing dining out because it doesn't fit my dietary requirements or turning down others' offers of food in other social situations is hard! To people within my ethnic group, eating with family and eating all of the cooking, clearing my bowl, is so central to establishing a sense of harmony. My parents are now more wary of the effects of diet on their diabetes, and are maybe a bit more accommodating, but I still have a large extended family that is not as convinced by western medicine.
Halp.
Sounds like you may have two or three distinct problems - (1) eating (not eating) at family gatherings, (2) eating (not eating) at evening social gatherings with friends, (3) discussions with peers outside of meal time. Maybe if you break those down it will get easier. (My experience: Type 2, as a pretty skinny guy, starting in 40s).
Family is hardest so set that aside for now.
Social gatherings with friends - though I am not your doctor or your expert I would be very surprised if management of your health required you to literally not eat after 5 pm. If that is really true, then so be it. But perhaps you could try for several months to eat, but eat practically no simple carbs, at dinner time. Depending on cuisine this could be salads, ceviches, plates of greasy southern vegetables, big hunks of meat, etc. If this is me giving you stupid diet advice I am sorry - but I found that when I started dealing with this stuff I felt the need to go "too far" in cutting back, which added to the pressure, and that a more sustainable path is better.
Re discussions with peers outside of meal time, this is a hard one but could you perhaps affect a breezy ha-ha-ha demeanor about it when anyone asks about your diet - "I happen to have a copy of my latest A1C report right here would you like to see it ha ha ha?" And if that does not shut them down then it is assuredly their problem not yours.
Re extended family, I got nothing right now but maybe others will ...
posted by sheldman at 7:19 AM on January 6, 2017
Family is hardest so set that aside for now.
Social gatherings with friends - though I am not your doctor or your expert I would be very surprised if management of your health required you to literally not eat after 5 pm. If that is really true, then so be it. But perhaps you could try for several months to eat, but eat practically no simple carbs, at dinner time. Depending on cuisine this could be salads, ceviches, plates of greasy southern vegetables, big hunks of meat, etc. If this is me giving you stupid diet advice I am sorry - but I found that when I started dealing with this stuff I felt the need to go "too far" in cutting back, which added to the pressure, and that a more sustainable path is better.
Re discussions with peers outside of meal time, this is a hard one but could you perhaps affect a breezy ha-ha-ha demeanor about it when anyone asks about your diet - "I happen to have a copy of my latest A1C report right here would you like to see it ha ha ha?" And if that does not shut them down then it is assuredly their problem not yours.
Re extended family, I got nothing right now but maybe others will ...
posted by sheldman at 7:19 AM on January 6, 2017
Unless you're talking to your doctor, you don't have to mention diabetes. Say something like "I just found out I have a health issue that prevents me from eating a lot of foods (or foods at certain times). It is really tough but I'm learning how to live with it!"
posted by beyond_pink at 7:22 AM on January 6, 2017 [12 favorites]
posted by beyond_pink at 7:22 AM on January 6, 2017 [12 favorites]
Don't even tell them you're diabetic. "Unfortunately my doctor has put me on a very restrictive diet to cope with some underlying medical issues. It's possible when we find the right combination that keeps me health, it can be less restrictive. It's possible it will be this restrictive forever. Anyway it's stressful AND boring, let's talk about something else."
posted by Eyebrows McGee at 7:24 AM on January 6, 2017 [25 favorites]
posted by Eyebrows McGee at 7:24 AM on January 6, 2017 [25 favorites]
(I somewhat disagree with those who say not to mention diabetes. Of course it's your choice. But I imagine that some thin people - probably especially women - are concerned that dietary restrictions are perceived as a cover-up for anorexia and that being perceived that way is unwelcome. If that's a concern, then being humorously-in-their-face about medical data - if you can do it with courage and a smile - is a possible solution.)
posted by sheldman at 7:27 AM on January 6, 2017 [3 favorites]
posted by sheldman at 7:27 AM on January 6, 2017 [3 favorites]
I'm normal weight, not white (though not of a ethnicity that appears tiny to white people), and have diabetes on both sides of the family (dad and maternal grandmother). When I was 17, my blood sugar was in the prediabetic range. I started eating low carb then and it has helped immensely. I wish I could say I never looked back, but I have bowed to social pressure in the post or been tempted. But on the other side of 30, I've finally learned to not GAF. Here's my advice: just state your position. Don't do it confrontationally or rudely, but be firm. I say, "I don't eat sugar, grains or starchy vegetables". People will feel bad for you. You will feel bad for other people. We went to a friend's place for lunch recently and she had prepared quinoa, knowing that I eat low carb. I don't eat quinoa, because it's still rather high in carbs. I just thanked for being so thoughtful, explained that my diet is rather restrictive, but that I truly would be happy with just chicken and salad. Then change the topic. Do not get stuck debating your diet. Don't complain about it either - people will take that as a cue to start telling you that one spoon won't hurt. Just remain above the fray, let people say whatever they want, and continue to only eat what you want.
posted by peacheater at 7:30 AM on January 6, 2017 [11 favorites]
posted by peacheater at 7:30 AM on January 6, 2017 [11 favorites]
If you're geographically near me, please send me MeMail. When I was singing more, I had to be super careful with my diet (and how early I had to stop eating, even), and I know how alienating it can be. I don't have the cultural issues you have, but I know it's genuinely hard.
I think at a certain point you just have to find a way to be different and still connect with people. Find a part of yourself that will let people feel close to you, and put that part forward with them.
The thing about rejecting cultural practices is that it can feel like you are rejecting people. If you can compensate by loving them in an inescapable way, all the time you are with them, then they may not have such a problem with it.
Showing up for dinner and saying "it's too late for me to eat now, but I want you to know that I love that you've cooked for me so many times" can be fake and off-putting, or, if you find the way of saying "I love you" that's most true for you, it can be wonderful.
This may feel or seem a little theatrical when you first start thinking about it, but if you think deeply and don't get stuck on just one way of expressing yourself, you may find a way to be genuine without being too heavy handed.
posted by amtho at 7:31 AM on January 6, 2017 [3 favorites]
I think at a certain point you just have to find a way to be different and still connect with people. Find a part of yourself that will let people feel close to you, and put that part forward with them.
The thing about rejecting cultural practices is that it can feel like you are rejecting people. If you can compensate by loving them in an inescapable way, all the time you are with them, then they may not have such a problem with it.
Showing up for dinner and saying "it's too late for me to eat now, but I want you to know that I love that you've cooked for me so many times" can be fake and off-putting, or, if you find the way of saying "I love you" that's most true for you, it can be wonderful.
This may feel or seem a little theatrical when you first start thinking about it, but if you think deeply and don't get stuck on just one way of expressing yourself, you may find a way to be genuine without being too heavy handed.
posted by amtho at 7:31 AM on January 6, 2017 [3 favorites]
Or if you do want to tell them you're diabetic, get a medic alert bracelet that says so. It's a good idea to have a medic alert bracelet if you're diabetic anyway, plus if some bag of dicks tries to tell you you're not or whatever, you can brandish your medic alert bracelet at them and say, "do you think I wear this because it's fashionable?!" and then get back to ordering your food.
I have definitely brandished my medic alert bracelet in the face of someone who was insisting, after steamrolling my polite and noncommittal "not for me, thanks"es for a solid ten minutes, that I, too, could run a marathon if only I believed in myself. No, asshole, I'm happy for you, now go fuck yourself. It's not something that happens often, but medic alert bracelet brandishing is extremely effective at making people who suck shut up.
posted by phunniemee at 7:31 AM on January 6, 2017 [13 favorites]
I have definitely brandished my medic alert bracelet in the face of someone who was insisting, after steamrolling my polite and noncommittal "not for me, thanks"es for a solid ten minutes, that I, too, could run a marathon if only I believed in myself. No, asshole, I'm happy for you, now go fuck yourself. It's not something that happens often, but medic alert bracelet brandishing is extremely effective at making people who suck shut up.
posted by phunniemee at 7:31 AM on January 6, 2017 [13 favorites]
Of course nobody should shame you or make you feel bad for taking good care of yourself, but it happens anyway. I think one thing you're running into is that for a lot of people, myself included, feeding their friends is how they express love. So when your lifestyle takes that away, people are at a loss as to how to be affectionate.
For me, when friends have food related issues, I compensate in other ways. Because I love thinking about food and cooking, I've helped people design meal plans for restricted diets, develop variations on their favorite foods to fit their new nutritional requirements, figure out shopping lists, and done a lot of label reading and ingredient research for issues I don't have. None of this involves these friends actually eating stuff that they shouldn't, but it's still me caring for and about them via food. Do any of the people pressuring you to eat have these kinds of skills? Could you discuss this sort of stuff with them? Once you have someone on your side who you've asked for help (even if you don't need it) they will feel proud and pleased and most importantly believe you and tell other people.
For the no evening eating thing, can you shift socializing to lunch and brunch? Having a regular weekend brunch gathering can be a great way to keep everyone in touch without taking away people's nights during the week. And if people see you eating happily during the day then they will be less likely to think you're taking poor care of yourself via diet during evening events.
I think also that there is a lot of pressure to make sure everyone has something to eat because it's something that takes part of a person's attention. If you're sitting around a table and you're the only one not busy with a drink or snack, it makes everyone feel a little odd. So consider bringing little activities to busy your hands. They would differ by venue, like, one of my friends brings a sketchbook with her literally everywhere she goes, but phone games or knitting aren't always going to be cool in a restaurant. Also spend some time assembling a list of things you can order and eat or drink very very slowly. You can sip a pot of herbal tea over the course of multiple hours if you practice.
posted by Mizu at 7:33 AM on January 6, 2017 [4 favorites]
For me, when friends have food related issues, I compensate in other ways. Because I love thinking about food and cooking, I've helped people design meal plans for restricted diets, develop variations on their favorite foods to fit their new nutritional requirements, figure out shopping lists, and done a lot of label reading and ingredient research for issues I don't have. None of this involves these friends actually eating stuff that they shouldn't, but it's still me caring for and about them via food. Do any of the people pressuring you to eat have these kinds of skills? Could you discuss this sort of stuff with them? Once you have someone on your side who you've asked for help (even if you don't need it) they will feel proud and pleased and most importantly believe you and tell other people.
For the no evening eating thing, can you shift socializing to lunch and brunch? Having a regular weekend brunch gathering can be a great way to keep everyone in touch without taking away people's nights during the week. And if people see you eating happily during the day then they will be less likely to think you're taking poor care of yourself via diet during evening events.
I think also that there is a lot of pressure to make sure everyone has something to eat because it's something that takes part of a person's attention. If you're sitting around a table and you're the only one not busy with a drink or snack, it makes everyone feel a little odd. So consider bringing little activities to busy your hands. They would differ by venue, like, one of my friends brings a sketchbook with her literally everywhere she goes, but phone games or knitting aren't always going to be cool in a restaurant. Also spend some time assembling a list of things you can order and eat or drink very very slowly. You can sip a pot of herbal tea over the course of multiple hours if you practice.
posted by Mizu at 7:33 AM on January 6, 2017 [4 favorites]
Eating is a social occasion, but you don't have to be eating to be social. You can let other people eat or drink, and just sip on some coffee/tea/water/seltzer and do the social part without the eating.
I find that refusing dessert/food gets easier if you say something like "No thanks, but I would love some coffee/tea/water!" People want you to be happy, so they are trying to offer you something nice. Give them something they can give to you.
posted by blnkfrnk at 7:35 AM on January 6, 2017 [6 favorites]
I find that refusing dessert/food gets easier if you say something like "No thanks, but I would love some coffee/tea/water!" People want you to be happy, so they are trying to offer you something nice. Give them something they can give to you.
posted by blnkfrnk at 7:35 AM on January 6, 2017 [6 favorites]
If you are in the US or Canada, a response that will work with a lot of people in their thirties: "Stacey from the Babysitter's Club books was thin, too, but she still had diabetes."
However, I'm seriously concerned that you know so many medical professionals who seem to know so little about a fairly basic medical condition. If you say "sorry, doctor's orders", without mentioning diabetes, do these people still try to force you to eat/drink?
Have you ever tried saying "I have an unusual form of diabetes" instead of calling it Type 2? I wonder if it is the label that makes people respond with such unmerited certainty that they know better than you or your doctors.
posted by a fiendish thingy at 7:45 AM on January 6, 2017 [5 favorites]
However, I'm seriously concerned that you know so many medical professionals who seem to know so little about a fairly basic medical condition. If you say "sorry, doctor's orders", without mentioning diabetes, do these people still try to force you to eat/drink?
Have you ever tried saying "I have an unusual form of diabetes" instead of calling it Type 2? I wonder if it is the label that makes people respond with such unmerited certainty that they know better than you or your doctors.
posted by a fiendish thingy at 7:45 AM on January 6, 2017 [5 favorites]
Just a side note: my wife who "doesn't look diabetic" was diagnosed with type 2 diabetes a year or so ago and put on metformin. It did very little for her. This sounds similar to you. To make a long story short, when she finally got referred to a better endocrinologist, they discovered that she really has "LADA," or what one of the doctors calls "type 1.5" This requires different treatment. It might be worth investigating this if you're not 100% sure you have type 2, or the normal treatment isn't working.
posted by primethyme at 7:50 AM on January 6, 2017 [14 favorites]
posted by primethyme at 7:50 AM on January 6, 2017 [14 favorites]
If you just need to get them to shut up, nthing that it is extremely easy to just hand-wave and say "Paleo" or "Atkins" and most people will back off. Tell them you're training for a marathon, that's also very trendy these days.
Though I do think it's important to talk about having diabetes for several reasons:
1) If you are having a medical crisis it can save your life if someone with you can intervene. (And, sadly, I'm considering a dangerous/fatal police interaction as one aspect of this issue.)
2) People with the privilege of never having a hard day in their lives need to learn sooner rather than later to stop being shits. I find that the same tactic that works great on racists - "Really, why would you say that? [...] I don't understand, are you unfamiliar with the diagnosis?" until they're forced to explain to you that they are talking directly out of their asses - works in these cases too. [I used it recently on a lady fat-shaming me on an airplane. It was, I have to say, as delightful as that interaction could have been, because I was a total bitch and yet polite as fuck all at the same time.]
3) As a female physician, this behavior toward you is some sexist bullllllshit. "I'm a doctor. Uh huh, but I'm a doctor. Still a doctor. Don't have my diploma on me, but it says I'm a doctor."
4) Look at them like you smell poop and change the subject.
posted by Lyn Never at 7:58 AM on January 6, 2017 [11 favorites]
Though I do think it's important to talk about having diabetes for several reasons:
1) If you are having a medical crisis it can save your life if someone with you can intervene. (And, sadly, I'm considering a dangerous/fatal police interaction as one aspect of this issue.)
2) People with the privilege of never having a hard day in their lives need to learn sooner rather than later to stop being shits. I find that the same tactic that works great on racists - "Really, why would you say that? [...] I don't understand, are you unfamiliar with the diagnosis?" until they're forced to explain to you that they are talking directly out of their asses - works in these cases too. [I used it recently on a lady fat-shaming me on an airplane. It was, I have to say, as delightful as that interaction could have been, because I was a total bitch and yet polite as fuck all at the same time.]
3) As a female physician, this behavior toward you is some sexist bullllllshit. "I'm a doctor. Uh huh, but I'm a doctor. Still a doctor. Don't have my diploma on me, but it says I'm a doctor."
4) Look at them like you smell poop and change the subject.
posted by Lyn Never at 7:58 AM on January 6, 2017 [11 favorites]
Eating is such a social activity that I'm not really sure how to go about enforcing my dietary restrictions.
Recovering alcoholic here. And I had this problem when I was initially trying to stop drinking. Because drinking is quite a social activity too. For me, and it may be a little different with alcohol, I had to be around people that supported what I was doing to be healthy.
Have you ever attended a diabetes support group? The reason I ask is that maybe the folks there might have some hacks to share regarding difficulties around eating with other people. And you might meet some younger people too so you won't feel so alone in your situation.
people have told me that I "cant be diabetic" based on my appearance.
People used to tell me that too about my alcoholism, particularly when I was in my twenties.
It's not easy living with a chronic medical condition, especially when friends and family are less than supportive. You can however, find people that can walk through it with you and help you to make the choices that are in your best interest.
posted by strelitzia at 8:12 AM on January 6, 2017 [1 favorite]
Recovering alcoholic here. And I had this problem when I was initially trying to stop drinking. Because drinking is quite a social activity too. For me, and it may be a little different with alcohol, I had to be around people that supported what I was doing to be healthy.
Have you ever attended a diabetes support group? The reason I ask is that maybe the folks there might have some hacks to share regarding difficulties around eating with other people. And you might meet some younger people too so you won't feel so alone in your situation.
people have told me that I "cant be diabetic" based on my appearance.
People used to tell me that too about my alcoholism, particularly when I was in my twenties.
It's not easy living with a chronic medical condition, especially when friends and family are less than supportive. You can however, find people that can walk through it with you and help you to make the choices that are in your best interest.
posted by strelitzia at 8:12 AM on January 6, 2017 [1 favorite]
I'm a type 1 diabetic and I've dealt with a lot of this. You're in a tough place because you're just beginning to sort this stuff out. I have two points that kind of contradict each other, so just go with what feels right to you. Basically, people are just going to say what they're going to say. My dad often feels guilty about my diabetes and how that plays out is telling me a little bit won't hurt or that I'm too skinny and I need to eat what he's giving me. I mean...it's inappropriate, but it comes from a place of love and guilt. Usually if people make something terrible for me I'll say, "Oh, can I just have a taste? A whole piece is too much for my bloodsugar." Then they know you appreciate what they've made but don't push too hard. Treat it like it's not up for discussion, because it's not. This is where you're at and what you need to do. People might fuss, but when they see you're not rising to the fuss they've got nowhere to go from there and they stop. People are going to take their cues from you as to how big of a deal this is. If you act like it's a big ordeal, people are going to stress and worry about you and try to fix your problems in weird ways. A lot of people worry if you're not eating that you're judging them for being fat pigs or something. Don't worry about it or try to fix it because a lot of the time you can't fix it.
The second piece of advice is to not get wrapped up in prescriptive "This is what you have to do to be a good diabetic" stuff. Your doctors often don't have to live the way they tell you to live. Obviously, controlling your bloodsugar is a big part of feeling good and living a long life. Do that. But figure out what works for you. My gut says that not eating all evening could a least theoretically hurt as much as it helps. Sure, you'll have a good bedtime and morning bloodsugar. And then you'll eat too much in the morning because you're hungry and you'll have to go all night without eating because your bloodsugar is higher than it should be. What works for me is lots of small snacks. If that isn't right for you, ignore this. Learn about free foods and carry some around. Good luck, and if you ever want a diabuddy to talk to, memail me.
posted by Bistyfrass at 8:17 AM on January 6, 2017 [5 favorites]
The second piece of advice is to not get wrapped up in prescriptive "This is what you have to do to be a good diabetic" stuff. Your doctors often don't have to live the way they tell you to live. Obviously, controlling your bloodsugar is a big part of feeling good and living a long life. Do that. But figure out what works for you. My gut says that not eating all evening could a least theoretically hurt as much as it helps. Sure, you'll have a good bedtime and morning bloodsugar. And then you'll eat too much in the morning because you're hungry and you'll have to go all night without eating because your bloodsugar is higher than it should be. What works for me is lots of small snacks. If that isn't right for you, ignore this. Learn about free foods and carry some around. Good luck, and if you ever want a diabuddy to talk to, memail me.
posted by Bistyfrass at 8:17 AM on January 6, 2017 [5 favorites]
Diabetes related dietary restrictions can be a bummer to deal with in social settings, especially in the beginning when you're still learning and adjusting. I totally sympathize.
That said, I've worked (as a dietitian) with many people with DM2, and I'm very curious to know where you got the advice to not eat after 4-5PM?
Our standard recommendation is to maintain a steady pattern of meals and healthy snacks throughout the day, including an evening meal (and depending on your daily routine, perhaps even a light snack after that). The meals should include some carbs, distributed more or less evenly throughout the day (or ideally, fine-tuned based on your individual blood glucose response, which also may vary throughout the day).
Are you monitoring your postprandial blg? It's very useful to get to know how your body responds to different foods, especially as it can vary depending on your activity and the time of day.
Btw, the endocrinologist I used to work with in a multidisciplinary team was of the opinion that it's not uncommon that what has been diagnosed as DM2 may actually be a gradually progressing LADA, especially among patients who are not overweight. It doesn't really make a difference for now - the dietary advice is still the same - but if your HbA1c doesn't improve or gets worse and you have frequent spikes, it may become necessary to recalibrate the treatment. Definitely something worth keeping an eye on.
As to how to deal with misconceptions and judginess... Yeah, most people with diabetes (or other health related dietary restrictions) have to face some of that. It really sucks. You don't necessarily need to tell people you have type 2 if that leads to unpleasant discussion; in some cases it may be enough to simply state you have dietary limitations due to health reasons. You can even say it's not something you prefer getting into, if people try to turn it into a topic. Anyway, low-carbing is such a common practice even among non-diabetic people nowadays that your food choices may even pass unnoticed.
I also want to add this: a DM diagnose is a scary thing to deal with for most people. You even say you have family members who have died from complications, so I can imagine this has hit you quite hard. Some of the social anxiety you're feeling may stem from that underlying profound fear. Are there people in your life you can turn to for support, or even just venting? It might help a lot.
In short: some of the limitations you've placed on yourself may be unnecessarily strict, you don't need to tell people any details, and in time you'll learn what foods you can eat (and in which amounts) without a spike in your pp blg. Meanwhile, look for good sources of support. Hang in there!
posted by sively at 8:43 AM on January 6, 2017 [14 favorites]
That said, I've worked (as a dietitian) with many people with DM2, and I'm very curious to know where you got the advice to not eat after 4-5PM?
Our standard recommendation is to maintain a steady pattern of meals and healthy snacks throughout the day, including an evening meal (and depending on your daily routine, perhaps even a light snack after that). The meals should include some carbs, distributed more or less evenly throughout the day (or ideally, fine-tuned based on your individual blood glucose response, which also may vary throughout the day).
Are you monitoring your postprandial blg? It's very useful to get to know how your body responds to different foods, especially as it can vary depending on your activity and the time of day.
Btw, the endocrinologist I used to work with in a multidisciplinary team was of the opinion that it's not uncommon that what has been diagnosed as DM2 may actually be a gradually progressing LADA, especially among patients who are not overweight. It doesn't really make a difference for now - the dietary advice is still the same - but if your HbA1c doesn't improve or gets worse and you have frequent spikes, it may become necessary to recalibrate the treatment. Definitely something worth keeping an eye on.
As to how to deal with misconceptions and judginess... Yeah, most people with diabetes (or other health related dietary restrictions) have to face some of that. It really sucks. You don't necessarily need to tell people you have type 2 if that leads to unpleasant discussion; in some cases it may be enough to simply state you have dietary limitations due to health reasons. You can even say it's not something you prefer getting into, if people try to turn it into a topic. Anyway, low-carbing is such a common practice even among non-diabetic people nowadays that your food choices may even pass unnoticed.
I also want to add this: a DM diagnose is a scary thing to deal with for most people. You even say you have family members who have died from complications, so I can imagine this has hit you quite hard. Some of the social anxiety you're feeling may stem from that underlying profound fear. Are there people in your life you can turn to for support, or even just venting? It might help a lot.
In short: some of the limitations you've placed on yourself may be unnecessarily strict, you don't need to tell people any details, and in time you'll learn what foods you can eat (and in which amounts) without a spike in your pp blg. Meanwhile, look for good sources of support. Hang in there!
posted by sively at 8:43 AM on January 6, 2017 [14 favorites]
Because you're thin and people can be morons, I would suggest that you drop the "type 2" and just tell people you have diabetes.
I would also suggest you investigate the LADA diagnosis that primethyme mentioned; it sounds like it may be a possibility for you.
posted by kate blank at 8:56 AM on January 6, 2017 [3 favorites]
I would also suggest you investigate the LADA diagnosis that primethyme mentioned; it sounds like it may be a possibility for you.
posted by kate blank at 8:56 AM on January 6, 2017 [3 favorites]
Thirding to get an expert opinion on LADA or type 1.5 as it's sometimes called. With correct treatment, restrictions like not eating after 4pm in the day shouldn't be necessary. As most of us probably could do with, diet and lifestyle changes aren't a bad thing, but well controlled diabetes should allow a full life and reasonable diet choices in moderation. Anything less should trigger more investigations and attempts to fine tune treatment. Getting onto insulin may actually be hugely liberating for you, and isn't as daunting as it might seem.
posted by Northbysomewhatcrazy at 9:11 AM on January 6, 2017 [3 favorites]
posted by Northbysomewhatcrazy at 9:11 AM on January 6, 2017 [3 favorites]
The cultural and extended family piece sounds the hardest. Brainstorming...I think you need a family champion, preferably with status like a matriarch. Can you go to a granny or aunt and ask for her help and advice the way you have here? Explain that you want to live a long life and maybe someday have babies (if you do and don't have them) and you are worried diabetes will kill you and you also don't want to appear rude and disrupt harmony.
My bet is that person will go tell everyone else to make you broth/salad/whatever instead and more importantly, be your advocate. If not, maybe at least your mother can take that role on?
Basically, you don't fight family with information. You fight them with family.
For everyone else, I am appalled on your behalf. I would do two things:
Say "I've been diagnosed with diabetes."
If they persist, stare at them wide-eyed and say "are you saying my doctor is wrong?" If they say yes say "wow."
I think more ease with being out and having tea, etc., will come with time.
posted by warriorqueen at 9:49 AM on January 6, 2017 [6 favorites]
My bet is that person will go tell everyone else to make you broth/salad/whatever instead and more importantly, be your advocate. If not, maybe at least your mother can take that role on?
Basically, you don't fight family with information. You fight them with family.
For everyone else, I am appalled on your behalf. I would do two things:
Say "I've been diagnosed with diabetes."
If they persist, stare at them wide-eyed and say "are you saying my doctor is wrong?" If they say yes say "wow."
I think more ease with being out and having tea, etc., will come with time.
posted by warriorqueen at 9:49 AM on January 6, 2017 [6 favorites]
"Sorry, not eating right now. I'd actually love to but I can't because I have diabetes."
"But you can't possibly have diabetes, you're so thin!"
...at which point you immediately go nuclear:
"Fuck you. I'm a doctor. I know what I have."
Won't take many rounds of that before they learn to STFU. Diabetes will kill you if you don't get it under control. That matters more than the potentially bruised feelings of the clueless clods you're apparently surrounded by.
posted by flabdablet at 10:03 AM on January 6, 2017 [1 favorite]
"But you can't possibly have diabetes, you're so thin!"
...at which point you immediately go nuclear:
"Fuck you. I'm a doctor. I know what I have."
Won't take many rounds of that before they learn to STFU. Diabetes will kill you if you don't get it under control. That matters more than the potentially bruised feelings of the clueless clods you're apparently surrounded by.
posted by flabdablet at 10:03 AM on January 6, 2017 [1 favorite]
why is this such a stumbling block for me?
Because women are taught to be polite and conciliatory and to put other people's needs before their own.
But now, it's time for FUCK THAT. This is life and death shit. You have the Internet's permission to practise being much ruder than you're comfortable with until the scales fall from your eyes and you fully internalize the fact that nobody - NOBODY! - is entitled to fuck with YOUR health just for THEIR social comfort.
posted by flabdablet at 10:07 AM on January 6, 2017 [13 favorites]
Because women are taught to be polite and conciliatory and to put other people's needs before their own.
But now, it's time for FUCK THAT. This is life and death shit. You have the Internet's permission to practise being much ruder than you're comfortable with until the scales fall from your eyes and you fully internalize the fact that nobody - NOBODY! - is entitled to fuck with YOUR health just for THEIR social comfort.
posted by flabdablet at 10:07 AM on January 6, 2017 [13 favorites]
Bitsyfrass makes a good point, and it seems like an especially American cultural thing now that we insist a thing isn't true just because we don't like the truth, and in all likelihood people really do mean well and think they are saying a nice thing to you, and it may be helpful to frame your response like, "You're very kind, but it doesn't work that way unfortunately."
posted by Lyn Never at 10:22 AM on January 6, 2017 [12 favorites]
posted by Lyn Never at 10:22 AM on January 6, 2017 [12 favorites]
2nd peacheater - just block it from discussion - and 2nd those recommending compensating with loving words (because food is love to so many).
"No thank you, really, it looks beautiful, but I don't eat that, I'm following medical advice". ("Don't", not "can't", because that invites discussion about the merits of your "case".) No and no and no, that's all - just keep repeating it. Any concern they express, you're following orders, end of.
It might take a year, but they will eventually stop. At which point, they will probably think of you as the odd cousin with the food issue, but there's no getting around that. (There's always some aunt (or somebody) who won't eat purple things, or starts every day with a drink of lemon and olive oil, or only eats fish but not on Tuesdays - whatever, you're just going to be that person to them. Eventually.)
It is hard, there is tremendous pressure and you'll have to be tough, but you don't have an option here, this is your health. (Softening those refusals with affection does help a bit.) Good luck.
posted by cotton dress sock at 10:25 AM on January 6, 2017 [2 favorites]
"No thank you, really, it looks beautiful, but I don't eat that, I'm following medical advice". ("Don't", not "can't", because that invites discussion about the merits of your "case".) No and no and no, that's all - just keep repeating it. Any concern they express, you're following orders, end of.
It might take a year, but they will eventually stop. At which point, they will probably think of you as the odd cousin with the food issue, but there's no getting around that. (There's always some aunt (or somebody) who won't eat purple things, or starts every day with a drink of lemon and olive oil, or only eats fish but not on Tuesdays - whatever, you're just going to be that person to them. Eventually.)
It is hard, there is tremendous pressure and you'll have to be tough, but you don't have an option here, this is your health. (Softening those refusals with affection does help a bit.) Good luck.
posted by cotton dress sock at 10:25 AM on January 6, 2017 [2 favorites]
Just for the social activity, it might help to have in mind a list of things that you can eat? And encourage outings to those places. Sashimi? Bars that serve a dish of olives?
The family stuff, that's hard, but maybe your parents can help. They should want to help. Maybe bring one of them to the doctor with you so they can really get their head around it, and help spread the word to your family. Also suggestions of what you can eat can be helpful here. I have a friend with a lot of restrictions and it helps me host her when she tells me what does work, in addition to what doesn't.
posted by fingersandtoes at 10:55 AM on January 6, 2017 [1 favorite]
The family stuff, that's hard, but maybe your parents can help. They should want to help. Maybe bring one of them to the doctor with you so they can really get their head around it, and help spread the word to your family. Also suggestions of what you can eat can be helpful here. I have a friend with a lot of restrictions and it helps me host her when she tells me what does work, in addition to what doesn't.
posted by fingersandtoes at 10:55 AM on January 6, 2017 [1 favorite]
There's a Comedians in Cars Getting Coffee with Jerry Seinfeld and another guy and the guy orders hot water. He doesn't drink tea or coffee or anything basically. And Seinfeld is all aghast. And his guest is all, I don't drink anything else. And then they move on.
No one can take care of you as well as you can take care of you. Plenty of people give bad/wrong advice with the best of intentions and that doesn't matter. So assume they mean well but don't make it a debate. So nthing what folks above have said. Own your condition but don't act defensive or ashamed or flustered by it. Asking you to eat X is like asking you to eat poison. That's not how others think of it but that's the story. So be proud, be clear, and don't waffle. And if you need to be a broken record (No thanks, I don't eat that for medical reasons. No thanks. Looks delicious but I don't eat that for medical reasons. Etc.) then be a broken record. Say the same damn thing 40 times in a row if you need to. Remember, you are not responsible for other people's feelings about your condition. You are responsible for taking care of your own health and your own life. Best of luck!
posted by Bella Donna at 12:59 PM on January 6, 2017 [2 favorites]
No one can take care of you as well as you can take care of you. Plenty of people give bad/wrong advice with the best of intentions and that doesn't matter. So assume they mean well but don't make it a debate. So nthing what folks above have said. Own your condition but don't act defensive or ashamed or flustered by it. Asking you to eat X is like asking you to eat poison. That's not how others think of it but that's the story. So be proud, be clear, and don't waffle. And if you need to be a broken record (No thanks, I don't eat that for medical reasons. No thanks. Looks delicious but I don't eat that for medical reasons. Etc.) then be a broken record. Say the same damn thing 40 times in a row if you need to. Remember, you are not responsible for other people's feelings about your condition. You are responsible for taking care of your own health and your own life. Best of luck!
posted by Bella Donna at 12:59 PM on January 6, 2017 [2 favorites]
Oh, and be as low key and low drama about it as possible. If you refuse to be drawn into other people trying to be dramatic about it, they will give up eventually and find something else to be dramatic about if you don't add any fuel to their flames.
posted by Bella Donna at 1:01 PM on January 6, 2017 [1 favorite]
posted by Bella Donna at 1:01 PM on January 6, 2017 [1 favorite]
I feel very ashamed each time I even think about adhering to those lifestyle changes.
Diabetic of six years here. I am poor and didn't have health insurance, so I found out when I got a case of neuropathy so painful that I couldn't sleep, and I googled the symptoms. Next day I sought care knowing what I'd probably hear, and they told me I was going to die instead. Probably soon. Great fucking bedside manner on that nurse.
I obviously did not, and I strove like crazy to get things under control - did my homework, lost weight at the best safe speed and followed my medication regimen and whatnot.
I could live a very long time thanks to all that hard work, and I am certainly going to try. However, I experience no pain relief from the usual neuropathy medications. All they gave me were frustrations and tremors. I haven't touched them in years. What I *have* experienced is chronic pain every single day of my life since the night I found out. It's less with better blood sugar control, but it's never gone. It's so pervasive I got tired of even complaining about it long ago.
I don't want to scare you, but this is what you're working to avoid. It's not as simple as 'you might die.' That's big and it's abstract, and I know it can be sort of hard to wrap your head around. There's also the very real possibility that you might experience intense discomfort for the rest of a long and storied life. That's what your family's poor behavior is putting you at risk of: not just death, but a great deal of possible suffering. There's a whole continuum of shit you deserve to avoid.
Their feelings aren't worth your health. This is not up for discussion, don't treat it like it is. "Sorry, I can't." "Thanks, it looks delicious, but I can't." Not won't, can't. If that grinds you down too much, take a break from social occasions until they come around. They can always improve later, but your health might not.
Also, don't let them make excuses for their ignorant behavior. Lack of information about diabetes is indeed widespread - I hear stuff that goes against what my doctors and nutritionists have told me from people all the time - but it's not actually that complicated. A grandfather in my family was diagnosed with it some years before I was, (in-law, no blood relation, now deceased), and my extended family pulled together practically overnight. Christmas and Thanksgiving and other holidays *immediately* saw concessions to him because they cared, and they always made sure my plate was safe as soon as I told them my diagnosis. These are not medical people, they're just ordinary folks, but they cared enough to listen to doctor's orders. That's all that was required: sincere concern.
Your own family could do the same, they are *choosing* not to. Remember that when you're worried about sparing their feelings - they're putting their willful ignorance before your health, and flabdabet's right: that's not what love looks like.
posted by mordax at 8:55 PM on January 6, 2017 [3 favorites]
Diabetic of six years here. I am poor and didn't have health insurance, so I found out when I got a case of neuropathy so painful that I couldn't sleep, and I googled the symptoms. Next day I sought care knowing what I'd probably hear, and they told me I was going to die instead. Probably soon. Great fucking bedside manner on that nurse.
I obviously did not, and I strove like crazy to get things under control - did my homework, lost weight at the best safe speed and followed my medication regimen and whatnot.
I could live a very long time thanks to all that hard work, and I am certainly going to try. However, I experience no pain relief from the usual neuropathy medications. All they gave me were frustrations and tremors. I haven't touched them in years. What I *have* experienced is chronic pain every single day of my life since the night I found out. It's less with better blood sugar control, but it's never gone. It's so pervasive I got tired of even complaining about it long ago.
I don't want to scare you, but this is what you're working to avoid. It's not as simple as 'you might die.' That's big and it's abstract, and I know it can be sort of hard to wrap your head around. There's also the very real possibility that you might experience intense discomfort for the rest of a long and storied life. That's what your family's poor behavior is putting you at risk of: not just death, but a great deal of possible suffering. There's a whole continuum of shit you deserve to avoid.
Their feelings aren't worth your health. This is not up for discussion, don't treat it like it is. "Sorry, I can't." "Thanks, it looks delicious, but I can't." Not won't, can't. If that grinds you down too much, take a break from social occasions until they come around. They can always improve later, but your health might not.
Also, don't let them make excuses for their ignorant behavior. Lack of information about diabetes is indeed widespread - I hear stuff that goes against what my doctors and nutritionists have told me from people all the time - but it's not actually that complicated. A grandfather in my family was diagnosed with it some years before I was, (in-law, no blood relation, now deceased), and my extended family pulled together practically overnight. Christmas and Thanksgiving and other holidays *immediately* saw concessions to him because they cared, and they always made sure my plate was safe as soon as I told them my diagnosis. These are not medical people, they're just ordinary folks, but they cared enough to listen to doctor's orders. That's all that was required: sincere concern.
Your own family could do the same, they are *choosing* not to. Remember that when you're worried about sparing their feelings - they're putting their willful ignorance before your health, and flabdabet's right: that's not what love looks like.
posted by mordax at 8:55 PM on January 6, 2017 [3 favorites]
I totally get what you are dealing with. I was recently (in the last 6 months) diagnosed with two different chronic conditions that necessitated drastic dietary and lifestyle changes (ie loooooong lists of foods I can't eat, including things that are really healthy and good for most people, but not for me). Like you, I also cannot eat past a certain time in the evening.
To make matters worse, I love food, my friends love food, my family is from a cultural background that sounds a lot like yours. Food=love.
And add to that the fact that I, like you, am small and thin (and female) and don't fit the profile of someone with these two (unrelated) health issues. Hell, even the doctors keep exclaiming, you don't fit the profile of someone with _____________ and ____________! Gee, thanks. Lucky me.
So it sucks. I get it. But there's really good advice above. You are just going to have to repeat yourself calmly but firmly, and find things to do when out with others who are eating when you can't. When I'm in this situation, I tend to just drink chamomile tea. (I can't even have other herbal teas anymore! I carry chamomile teabags with me in case a restaurant or place that I'm at doesn't have any, because then I'm stuck drinking water).
Good luck. This does suck and you're not overreacting. You might want to talk to a counsellor about it, because there is a certain amount of grieving for your old self you go through when having to make such drastic changes.
posted by hurdy gurdy girl at 8:55 PM on January 6, 2017 [1 favorite]
To make matters worse, I love food, my friends love food, my family is from a cultural background that sounds a lot like yours. Food=love.
And add to that the fact that I, like you, am small and thin (and female) and don't fit the profile of someone with these two (unrelated) health issues. Hell, even the doctors keep exclaiming, you don't fit the profile of someone with _____________ and ____________! Gee, thanks. Lucky me.
So it sucks. I get it. But there's really good advice above. You are just going to have to repeat yourself calmly but firmly, and find things to do when out with others who are eating when you can't. When I'm in this situation, I tend to just drink chamomile tea. (I can't even have other herbal teas anymore! I carry chamomile teabags with me in case a restaurant or place that I'm at doesn't have any, because then I'm stuck drinking water).
Good luck. This does suck and you're not overreacting. You might want to talk to a counsellor about it, because there is a certain amount of grieving for your old self you go through when having to make such drastic changes.
posted by hurdy gurdy girl at 8:55 PM on January 6, 2017 [1 favorite]
This thread is closed to new comments.
That said, it's sad that you feel you need to justify self-care to your friends. Can you just tell them that you found out you are a diabetic? A reasonable person won't shame you for a medical condition.
posted by pintapicasso at 7:14 AM on January 6, 2017 [7 favorites]