Help me regain my mojo when it comes to diabetes self-care.
June 21, 2011 12:18 PM   Subscribe

Help me regain my mojo when it comes to diabetes self-care.

I was diagnosed with what seems to be a rather mild form of Type-II diabetes about 11 years ago, when I was in my mid-20s. I'd like your advice about maintaining good self-care for the very long term, because it seems like I've let myself slip a bit in recent years, and I'm struggling to get back to where I want to be.

When I was first diagnosed, after a period of initial shock and surprise, I made radical and significant dietary and exercise changes that had almost immediate results. Within weeks I was adhering to a low-carb diet of 25-50 grams/day and I resumed running 10-12 miles a week; running was a form of exercise I'd enjoyed when I was younger and I was able to get back into it pretty smoothly. As a 5'8" male, I dropped from about 180 lbs to between 155-160 lbs. I completely gave up alcohol, sweets, pasta, bread, rice, potatoes... all the refined carbohydrates and starchy foods that a diabetic should reduce or eliminate from his diet. I felt and looked good.

For the duration of this time, I've been using a variety of oral medications (including, at various times, Actos, Metformin, Amaryl and Avandia), without noticing much assistance from any of them. For a time, I injected twice a day with the starter dose of Byetta, but I lost so much weight (from my usual ~160 to 140) and had so little energy that my endocrinologist discontinued it.

I was able to maintain this diet and exercise regime for about 8 years. About 3 years ago, I increased my running mileage so that I could train for a full marathon (a lifelong goal). I was very hungry during that training and incorporated more of the carbs that I'd given up just to maintain weight and energy. I ran the race and have since been running 4-5 half-marathons and 10-milers per year since then - the shorter distances are more to my liking. You can imagine what happened - I never eliminated the carbs, and now my diet has taken a moderate - but significant - turn for the worse.

There are a few things going on here, I think:

• Running increased distances in the past three years is enjoyable and I want to stick with it, but it requires eating more, leading to the temptation to eat more carbohydrates;
• My kids are now old enough to want to snack frequently, and their snacks (and meals) are fairly carb-intensive;
• Life is a bit more stressful in recent years, as I have had some other health setbacks and some job issues; and
• I’m now in my late 30s and my metabolism isn’t what it used to be.

Frankly, however, it feels like the main issue is that I've just lost my willpower. I'll drink a beer and not worry about it, or eat pasta with my wife and kids because I don't want to make another dinner. It's pretty much just laziness, and it's taken a toll in a higher weight (low 170s), a less healthy appearance in general, reduced energy, and slightly higher HbA1C numbers (6.2-6.5, as opposed to the very high 5's and low 6's before). I haven't exactly fallen off a cliff in terms of my self-care, but it's to the point that I just can't seem to get back to what I know will be effective.

I'd like guidance from any diabetics, or those dealing with other chronic illnesses, about how to get back my mojo when it comes to my self-care. I know what to do, but I'm increasingly reluctant to do it. I know that the long-term consequences of what I'm doing may be significant, which is a motivator, but a hard one to bear in mind day-in and day-out. I do feel guilty about my "struggles," since I know I'm a lot better off than many people with other illnesses and difficult situations with which they have to contend.

If you're aware of a particularly helpful online forum to which this question could be directed, please let me know. I'm turning to AskMe first because I expect the quality of the replies will be high. I haven't participated in online diabetes forums in the past but would be willing to do so at this time.

I should add that I read and enjoyed Julian Seifter's After the Diagnosis: Transcending Chronic Illness. Any other book recommendations would be welcome, too.
posted by cheapskatebay to Health & Fitness (7 answers total) 9 users marked this as a favorite
• My kids are now old enough to want to snack frequently, and their snacks (and meals) are fairly carb-intensive;

Think about what this implies: "my kids are now old enough to get Type-II diabetes in their mid-20s, just like Dad."

Work with your family to get carbs out of the house. Maybe change the snacks first, or start with Carb-Free Friday and expand from there. If you don't have beer and pasta in the house, you won't eat beer and pasta... and in my experience, family participation goes a long way toward reinforcing willpower. Being the Only One Who Can't Eat X is really hard; being part of a family that cooks low-carb meals is easier, and is its own day-to-day motivator.
posted by vorfeed at 1:16 PM on June 21, 2011

As someone raised by a mother with Type 1 diabetes (she's 70 now and has been diabetic since she was in her early 20s), for the most part she only ever had in the house foods that she was OK eating, we weren't cut short on treats though, she would only buy those for us when were out of the house, so we still got all the junk food "normal" kids did, it just wasn't in the house where she'd be tempted to eat it and was an actual treat when we got it.

My brother and I turned out fine, and as far back as I can remember we knew why we didn't have huge boxes of carb filled sugary snacks in the house and never had a problem with it.

She also never hid her diabetes from us and roped us in to help her if needed. Get your kids onside, get them to help.

I IM'd her to ask her how she stayed on track and she said that her goal from the start was to see her Grandkids. Back when she was diagnosed no one was 100% sure how long a Diabetic like her could live (or have kids) and warned her she'd probably die young, her motivation was to prove them wrong and be a grandma. It worked for her. While your diabete's is type 2 and treatments etc are much better now a similar goal might not hurt.

Also there are a lot of low-carb paleolithic eating forums online that might give you some help/motivation on how to combine low carb eating with training for sports.
posted by wwax at 1:57 PM on June 21, 2011

I know mileage varies heavily on this, but for me, guilt and twenty-years-down-the-road are such ineffective motivators that they encourage backsliding. What works is realizing that I really do feel better physically when I am taking care of myself, and I don't want to feel like crap any more than I absolutely have to.

I second everyone on encouraging family buy-in. While I occasionally make separate meals from the rest of my family, most of the time we find common ground and make per person adjustments. (Sometimes, we compromise.) From what I've seen, low carb eating resources are more useful on that front than diabetes forums.
posted by gnomeloaf at 2:08 PM on June 21, 2011 [1 favorite]

I have been living with type 1 for years now, and it is a constant challenge to stay motivated and focused. There is no finish line to this marathon, at least not yet. It is important to be able to realize that you are going to have bad days, bad weeks, bad months, and to be able to forgive yourself when that happens, and try to put it behind you.

Probably the main thing that helps me is exercise, and it sounds like you at least have that going for you. Here are some thoughts in list form:

1. Structured physical activity (for me, this is bike riding), with a few longer "event" rides/runs throughout the year to have some kind of goal.

2. Accept that from time to time, you will need to work on identifying good habits that have slipped and trying to reinforce them. For me, this probably happens every few months or so, often depending on my latest a1C. One thing that I've tried to do is use more electronic reminders that are hard to ignore - so I have an alarm on my phone that goes off every evening at 7:45 pm. No more carbs after that, which helps my glucose get stable and normal(ish) before bedtime. I am pretty faithful to this rule. Lately I have tried to use my phone much more for this, setting alarms every 90 minutes, 2 hours, whatever to remind myself to check glucose. In general, I find that setting up mechanical/electronic reminders like this can help me to reinforce my willpower, which as you say really tends to be the main problem.

3. Have carb substitutes - chewing gum, fat (good cheese, canned fish, nuts), tea, coffee, etc., to help distract you from eating carbs when it probably would be best not to. Instead of beer, have a glass of wine.

4. Connect with other people with the disease, in a support group or online or through charitable events. Sorry, I'm not really that connected myself with any online forums for this sort of thing. I am involved with an annual fundraising bike ride for the Juvenile Diabetes Research Foundation, and the people I've met through that have been inspiring in all kinds of ways. I'm also doing the ADA's Tour de Cure this weekend, actually. Getting involved in the fundraising/awareness-raising side of the disease can help your willpower, too, even if it doesn't extend to going to regular support groups or the like - you can feel better just being involved, and again, you give yourself a goal.

Hope this helps. By the way, thanks for book recommendation! I had never heard of that but it looks interesting.
posted by chinston at 3:02 PM on June 21, 2011 [1 favorite]

Also maybe see a different endocrinologist, or see a diabetes educator? They might have some new ideas or suggestions.
posted by chinston at 3:19 PM on June 21, 2011

I'm an adult-diagnosed type 1 (in my late 30s). My latest A1c was 5.0, 6 months after diagnosis at 11.5.

Life is both harder and easier for me. Harder in that I must monitor constantly, and take insulin for almost everything I eat (including "healthy" things like fruit). I wear a pump. Easier in that I *can* eat 80% of what a normal person eats-- I can bolus for ice cream, for example. I eat fewer carbs than I used to, but I definitely don't fully do the low carb thing.

Chuck beer for wine & liquor. WAY lower carb.

Get online. I have learned a lot from Tudiabetes forums; there are other sites too.

Accept your successes. Your A1c maybe isn't the best it's been, but it sure as hell ain't bad.

Think of exercise the way you think about brushing your teeth. Do you LOOOOOOOVE brushing your teeth? No. But you do it anyway.
posted by kestrel251 at 9:04 PM on June 21, 2011 [1 favorite]

P.S. Do not be afraid of insulin.
posted by kestrel251 at 9:31 PM on June 21, 2011

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