T Minus Two Type Two Diabetes and Other Passions


Rising Against the Dragon

So, as you may know, I've been able to make some healthy changes in the last few months. There's quite a bit of exercise, both walking and things I do in my *ahem* home gym. (The "home gym" is a living room cluttered with dumbbells and exercise bands.) I'm eating right, and recording what I eat. Emotional eating hasn't been a problem. The home gym exercises can be a challenge some evenings, and some days bring other kinds of challenges Still, I've had a lot of initiative, and it hasn't been killer-hard to keep going.

And then, over the last week or so, ever so slowly, I've been slipping. The home gym sessions got skipped or foreshortened. I had a couple of days when I ate over my calorie goals … then a couple of days when I'm pretty darned sure I did, but I can't be absolutely sure because I didn't bother to record it. The eating was starting to feel out-of-control and intended to feed my heart rather than my body.

I came into the weekend feeling the hot breath of failure on the back of my neck, and I had no idea what to do about it. Then, as I was desperately trying to think of how to turn it around, I remembered the dragon.

See, as far back as the eighth grade, I've struggled with episodes of depression. These episodes can come at any time, but the midwinter months are usually hard, and those episodes have sometimes been deep.

You'd think that, since I know all this, I'd start watching for the signs. But, at least for me, depression tends to arrive pretty quietly. This morning, I realized that my healthy changes were being drug down by the challenges of emotional health. As I thought about it, I came to think of the depression as like a dragon. (You can blame a movie ad for the image.)

My initial thoughts for how to make accommodation for the dragon's presence were along the lines of partial surrender. Perhaps I shouldn't even try to do the gym exercises. Maybe I should raise my calorie limits. Maybe I should….

And then I got mad.

"Why," I asked myself, "should I give in to this? Why should I let it make me a failure?" I then talked aloud, perhaps just to myself, perhaps to make dragon, feeling all smaug over there on his gold. (See what I did there?) I would not, I said, give in. I would maintain my standards. I am not (I continued) the same person I used to be, and I will choose what I eat and how I exercise. There were other things I said as well.

Of course, telling a dragon off is not the same thing as defeating him. The dragon is still here, and he will remain here until he decides to go sit on his treasure someplace else for a while. I'm going to have to be careful, for example, to know exactly what my exercise plan is for the day. And, though I will be tempted, this will not be the time to make ambitious additions to my goals. And, I do think it's appropriate to restart the gym work a little slowly. But I will do these things because I CHOOSE to – not because I feel that choice has been taken from me.

And I must never forget that the dragon is there: he is most dangerous when I'm unaware of him.

Take that, you nasty overgrown lizard. And do something about that breath.

This post was edited on 11/25/13 to rearrange a tiny bit and to improve the post's resemblance to English.


Happy Birthday, Sir Frederick

This has become my annual World Diabetes Day post. It was first published two years ago.

Today would have been the 120th birthday of Frederick Banting, the man who (along with Dr. Charles Best) discovered insulin.

Perhaps you are an insulin-dependent diabetic, or love such a diabetic, and understand full well what you owe to Sir Frederick and why this day is celebrated as World Diabetes Day. Wish Sir Frederick a happy birthday.

Perhaps you are like me, a diabetic who is at this point still able to produce your own insulin, but realize that a time may come when insulin will be as important to you as oxygen. Wish Sir Frederick a happy birthday.

Perhaps you are not aware of knowing any insulin-dependent diabetics. But you almost certainly have. Spare a thought, today, for the acquaintance, whoever it might be, that you never would have known had it not not been for the work of these men. Wish Sir Frederick a happy birthday.

Please, take just a moment. Even though insulin is in no way a cure for diabetes, it has saved the lives of millions.

Please wish Sir Frederick a happy birthday.


A Small Matter

Years ago, I used to worry a fair amount about the psychology underlying my obesity and other things about myself that I wish I could change. Eventually, however, I decided that this whole approach (as least as self-directed) was fruitless and maybe counterproductive. I chose to focus more on coming up with strategies to help me make desired changes.

That's still pretty much my approach. However, as I've worked in a concentrated way to eat better and move more, I've found that it's necessary to think about "reframing", by which I mean how I think about who I am and the choices I make. Last week, for example, I had discovered that some challenges I'd encountered had me change from thinking myself as someone who was successfully making changes to someone who was slipping and would soon fail. That kind of thinking has all the markings of a self-fulfilling prophecy, and a pernicious one at that.
This morning, while walking to work, I was thinking about the success I'm having, when the word "small" popped into my mind, and I experienced a wrench of something like anxiety. As I worked to figure out what had just happened, I came to understand what I had reacted to. Something inside me is fearful that, since I'm quite short for a man, that losing my excess weight would make me not just a short man but a small man. And that whatever-it-is inside me found that a very uncomfortable prospect.
This seems ridiculous - I'm not aware of any conscious dislike of men that are both short and slender. I can name several that are fine men indeed. But, this reaction is worth paying attention to. Has this been an interior attitude of long standing? Has it maybe been a big part of what kept me so fat all these years? I don't know. It doesn't matter. What DOES matter, now that I know about this, is to watch for it in my own thinking so that I don't sabotage my progress.
After all, great things can come from "small" changes.

Of Tinkertoys, Perception of Self, and the Wee Small Hours

For many years, I have visualized the contents of our hearts and minds as an enormous, intricate and ever-changing network of nodes and rods. Each node represents a belief, a memory, an idea, a feeling, anything like that. The rods make up the billions of the connections between them. Do you ever travel around an area you've lived for a long time and noted all the building for which you have some kind of association? That house is where your friend's boss lived, so you've got nodes related to that house and your friend's boss, and those two nodes each have rods connecting to each other and the node for that friend, as well as to your memory of how badly that boss treated your friend and the sadness you feel about that.

(I often think of this structure, actually, as being made of the Tinkertoys I spent hours with as a child. Kiddies, come listen to Grandpa talk about how they were made of wood in those days.)

Everything that changes for us in however tiny a way requires at least a tweak to some part of that structure. Suppose you read an article about a musician you like. You learn that a forthcoming album is being done with a known producer. So, you add nodes for the new information and add rods of connection to the node for that producer. The article leads you to reevaluate your opinion of a particular album that you'd not liked, so you have to tear out the little bit of structure related to that musician and that album in order build in the new information AND the new opinions AND any new feelings.

(You –do- understand that I’m neither a neurologist nor a psychologist, right?)

When something big happens, in this metaphor, big chunks of the structure may require rebuilding, and I see that kind of work as requiring mental and emotional resources. In recent weeks, I have had trouble sleeping. No, that’s incorrect: I've had trouble choosing to sleep. Into the night, I play silly computer games and do the other things I do in period of stress. It’s my suspicion that my particular makeup uses the quiet of the late evening to do maintenance on my structure.

Why is so much work required right now? A couple of months ago, I started walking a certain amount every day. About a month ago, I started tracking what I eat and adjusting what I eat to meet the daily targets. Shortly after that, I started adding light calisthenics and dumbbell work. In short, I’m making changes. And, at this point, most of the changes feel sustainable: doing these things don’t require a triumph of will on most days.

(Do not read any of this as even a HINT that you should do ANY of this, too. I am not going to become one of those people who becomes convinced that what worked for them is The Answer. If I DO become that person, please shoot me.)

I have been seriously overweight for about four decades. For three and a half of those decades, I have made sporadic efforts to live in a way that might help with that, and I have ultimately failed in all of those efforts. I have felt bad about being fat, and I have felt bad about being unable to do anything about it. Since my diagnosis, when it became clear that healthy changes would be beneficial whether I lost any weight or not, my inability to make those changes has become deeply frustrating and deeply perplexing. More than anything else, this lack of success in moving forward has been what this blog has been about. All of this, I think, is a fairly big part of my structure of nodes and rods.

So, the change from Bob-as-I've-always-been to Bob-who-mostly-eats-well-and-exercises is a major one. I don’t know if it would be for anyone else, but it is for me. My last post was an attempt to begin to wrap my head around becoming a different-in-a-big-way person.There is, if my metaphor is valid, a great deal of rebuilding going on.

And that, I think, is what I’m doing late into the night when it seems like I’m just playing solitaire.


Makeover: Not a Post About Clothing or Hair

An allegory. Or a metaphor. Or a random neural firing. Or something.

Once upon a time there was a man who’d never paid much attention to how he dressed. He tried wear clothing appropriate to the situation, but mostly wanted things that were comfortable and easy to care for.

Then, a friend talked him into making some changes. The friend took him to a store where he replaced his business clothes with things that fit well, were made of quality materials, were fashionably cut and colored, and made him look like he earned a bit more than he currently did. Then, the friend took him to a different store for “having fun” clothes that were bright and pleasingly eye-catching.  Finally, the friend took him to a salon where he was taught to style his hair in a way that was very attractive but much different than he’d ever worn before.

Back alone at home, the man examined his new look in the mirror. The changes, he knew, were just beginning. Getting ready for work or a social event would take longer, and he’d have to spend more time caring for the new clothes. Further, he would have to regularly replace items in his new wardrobe to keep it fashionable and in good repair.

There were other things, too, maybe more important. The man suspected that the people around him would react to him a little differently, and new acquaintances would be meeting a somewhat different person.  And, he understood, he would even have to adjust how he perceived himself.

The man loved his new look. But, as he examined himself in the mirror, he asked himself:

“Am I still me?”

I’m Missing

Shouldn't I see myself?

One of the aims of ethnic and racial diversity efforts is to have advertisements reflect the diversity of our society. Similarly, concern about societal messages about beauty and body image have led to some pressure on companies to feature a variety of body types in advertising.

Those issues are important. They are worthy of both attention and action. My concern tonight is not nearly as important, but it bothers me anyway.

Periodically, I go looking for information about exercise and similar topics. Though I can cite no studies, it seems that the photographs on most relevant websites feature either healthy-looking young women or heavily muscled men. Though there are doubtless many exceptions, I believe that my basic observation is valid. When I look at magazines with a focus on general health topics, the people on the covers fit those categories almost exclusively.

I'm not female. I'm not young. And I have no desire to look like Hercules.

I don't exactly blame the sites and magazines for this. My guess would be that their core audience mostly consists of folks that either fit those categories or WANT to fit those categories. I can't complain about this.

The pictures, and the tenor and content of many accompanying articles, show a split in how the fitness goals of men and women are perceived. Women, it is apparently believed, want to be generally healthy and/or sexy. Men are seen as wanting to look like bodybuilders.

I don't know that this is a problem. What I do know is that on many websites and in many magazines, I don't see me. I don't even see the person I'd like to be.

This post is not a call for action. I don't know that what I'm seeing is a bad thing.

All I know is that it makes me a little sad.

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Not Guilty

"Your honor, we the jury find the defendant to be not guilty."

On Thursday morning, I had a checkup. Since this was my first time with a new doctor, I had worries about that in addition to the normal medical appointment jitters.

There was some good news. Most importantly, I like the doctor and believe he can help me. It was interesting to get a five minute lecture on patient empowerment, although he did not use that phrase.

Additionally, my cholesterol panel looked really good. The one number that is still out of range continues to improve.

I suppose it's good news of a sort that I was measured as being 5" 5' tall. I suspect there is some kind of error there, because I don't think I've ever been told that I'm that tall. But, maybe I'm having a growth spurt in my early 50s.

The not so good news was that my A1c jumped quite significantly and is now a little bit above the target range.

I've been puzzled about my reaction, or lack of reaction, to that last bit of news. I didn't seem to be feeling the things that I'd expect to feel, or even much of anything at all. Was I shocked into numbness?

But then I figured it out:

I don't feel guilty.

I simply don't find myself awash in the "should haves" and "could haves" I would have expected. I'm seeing my doctor again in a little over a month, and I'm going to be developing an action plan. For the moment, the doctor isn't changing my medication.

I'm sure that my good feelings about my walking program mostly explain the lack of guilt, despite my feeling lately that my eating is somewhat out of control. But, I think my heart is finally beginning to believe what my heart has known for five years: I have a disease, and a progressive disease at that. My choices are part of what determines the rate of progression, but only part. I know I have things I need to do, but I am able to see this clearly instead of through a fog of shame. I can explore options for improving the health of my body without feeling so much like my worth as a person is on the line.

I've been acquitted. Now I just wonder how I'm going to pay off my lawyer.


Walking Home

I grew up in Ames, Iowa, a community best known for being the site of Iowa State University and for appearing in many crossword puzzles. When I moved to Kansas City, after a couple of stops, my parents still lived in Ames. I used to wonder, in my odder moments, what it would be like to walk the 230 miles home. You know,  should there be a collapse of civilization or something. (You think about that, too, don't you? You don't? Um. Oh.)

So, when I began my walking program, I sort of kept an eye on the total distance I'd walked. And, last week, that total passed 230 miles. So, in a strange way, I'm home. That feels good.


Just To Be Clear

Friends, I have a couple of things to say, and I've spent over a week deciding how to say them.

I have read some things recently that have left me feeling a deep need to do my best to be clear about what this blog is and who I am. I don't think any of this will surprise those who know me. I just need to know that I have done my best to be honest.

First, about this blog. To the extent that it is a diabetes blog at all, it is a patient blog. I am not ANY variety of medical practitioner, nor am I the sort of patient with deep knowledge gained through study. I am not providing information, I am telling stories. Beyond some effort to help people touched by other types of diabetes understand a bit about Type 2, the only thing I'm trying to teach anybody is how my life goes.

I'm not a guru, a sage, or a shaman. I haven't written a book. If you need information or guidance, you need to find someone who can provide it. I can't help you in that way.

Second, about me. I hate it when people describe themselves as bad diabetics, but I need you to understand that I am not a 'role model' of coping with Type 2. Not only am I more than 100 pounds overweight, but I weigh more than I did at diagnosis. Though my diet has improved markedly, it's a rare day that doesn't include a vending machine pastry or a pint of ice cream. I go through periods when I test often, but there are long stretches when I don't test at all. Someone following me around might conclude that I don't care about my diabetes at all. That's not the case, but whatever is broken in my body or my character is deeper than my diabetes and predates it by more than thirty years.

I don't tell you this as an exercise in guilt or as a request for reassurance. I am pretty much at peace with what I am. But I can't stand the thought that I may have downplayed these things as I have written here. I just need to feel confident in my honesty.

Thank you for reading.


Flashback Friday: Aging Mind, Young Memory

An (slightly revised) odd little post from October of 2010.

Today, picking up my prescriptions at the pharmacy, I saw a young woman who looked so much like someone I knew that I almost spoke to her...could it be her? Then I realized that the young woman I'd known would now be in her 40's.

I tweeted the experience, as part of my "This is what aging is" series. My friend Jess, who blogs awesometastically, responded (translating from Twitter), "So your brain is aging but your memory isn't? :) "

I thought that was beautiful. I haven't seen the woman the girl in the pharmacy reminded me of in many years. I don't know what her life has been like, though I hope she's happy, or if she ever wishes to again be the age at which I knew her. In a sense, though, she'll live as a young woman, preserved in the amber of my memory, for as long as I live. So, too, will all the people who inhabit my memories, wherever life (or perhaps death) has taken them since we last met.

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