I should start this post with a heavy trigger warning about eating disorders and mental health. It's been years since I saw this quote on Twitter but it's one that stayed with me... "teaching someone to be a perfect diabetic is akin to teaching someone to have an eating disorder."Sounds a bit drastic, I know. As a type one diabetic, I have to measure every single thing that passes my lips. Every. Single. Thing. There is an undeniable amount of hard work and maths that goes into controlling blood glucose.
We do this with everything, even drinks. Caffeine can effect BG just as much as a plate of fruit for some people. There aren't really any rules, everyone is different. The hardest thing about diabetes can be the inconsistency. There are so many factors going into what controls our BG, all we can do is a series of guestimating until we find something that works and keep trialling it. Aim of the game? To try and reduce the fluctuations in our BG. We want it to look more like this... And less like this... Which, in some ways, is quite an unrealistic goal. Yes, it is achievable and with a lot of hard work you could find yourself with graphs looking like a muggle. However, pining for this result day in and day out can end up eating away at your soul. The pressure of achieving perfect diabetes control can massively affect our mental health. I was in two minds whether to write about this as haven't been diagnosed with an eating disorder. I have friends who have been through a lot worse than I have and in a way, my story seems irrelevant. But that got me thinking, maybe this is why I should tell my story... As with any of my blogs, I open up with the hopes of helping other people feeling the same way. There are many contributors to how food and diabetes affects my mental health, a few being: focusing on carbs and calories.The way I have to obsessively divulge information about food, makes me constantly aware of the carbs and calories before I eat. As a young woman, already concerned about my weight and the way I look, you can see how this would end badly. Some people with diabetes follow a keto or low-carb diet to try and have less fluctuations in their BG, done correctly, this can have great results but it isn't for everyone, nor is it essential. Theoretically, if we're bolusing for our food, we can eat it. As an insulin pump user, there are times I have to 'basal test'. This means for a period of time, I have to skip meals or eat low carb meals and watch how my glucose drops/rises. This indicates where I need more basal (background) insulin. This is a method which is encouraged by DSN's and dieticians to make the most of using an insulin pump. A lot of time and effort goes into basal testing, again, with the purpose of achieving a 'perfect' result. However, it almost glorifies the results of not eating. Sometimes I find myself purposely skipping meals and certain carbs, with no structure, just randomly avoiding food. If my BG is in range and has been for a while, I might find myself thinking "oh well I won't eat that because it will ruin my BG". I know it's wrong, I know I need to eat and I know I need insulin but sometimes the thought of staying 'within range' outweighs those thoughts. exercise and weight.Since the age of probably 13, something which has always gotten me down is having to consume calories after purposely burning calories during exercise. This is still something I really struggle with now. I was a pretty chubby kid... teenager... and adult. I've always been very self-conscious about the way I look. Being a larger than average teenage girl in the 00's will lead you down that path. Adding fuel to the fire, the stigma regarding being overweight and diabetic. As a 12 year old, I knew full well that being chubby had absolutely nothing to do with my diagnosis (I was diagnosed before I was even 2 years old). Even so, that didn't stop me feeling like shit when my classmates all thought I was diabetic because I was fat. I became obsessed with wanting to lose weight. I was doing it the right way, I was reducing insulin before exercise or having a snack etc. We all know, sometimes the maths doesn't add up. Maybe you work out a little harder than expected. Maybe your BG rises instead of falls. As a teenager, I would throw an absolute tantrum if I had a hypo after exercising, tears included. As a teen, I remember ranting to my mum about "never losing weight even though I exercise". Meaning nothing of it, she passed a comment which translated as "it's probably all of the orange juice you need afterwards". I used OJ to treat hypos because it's a natural source of sugar and in my head, seemed healthier than using jelly babies or other alternatives. Until she said that. And then even OJ became a bad thing in my mind. Now, I'm 27, I enjoy being fit, healthy, going for walks, doing pilates etc. I feel the most confident I have in myself and my body. Inevitably, there are still times where the maths is wrong. If I end up with a high blood sugar after exercise, I'm in a foul mood and you'd better not talk to me for a few hours. If I end up having a hypo, I will try to avoid treating it by eating, I'll sip minimal OJ until it comes up just enough and on a really day I'll over-indulge, leading me down a different path of self-hatred. treating hypos after eating.Rolling into the next category with a vey similar outlook... hypos after eating. I started this blog by discussing the maths behind food because it does take up... probably 40% of my brain space. The maths can be (and quite often is) wrong. There is no worse feeling than stuffing your face full of delicious food, only for your BG to drop shortly after because you've injected too much insulin. Bruce Bogtrotter is an absolute hero for smashing that cake in Matilda but let me tell you, in real life, with a full stomach and a head full of insecurities, eating after eating is up there with the worst parts of my trauma. I knew this part was getting bad when I'd stop treating hypos and instead I'd reduce my insulin and wait for it to climb up. shame and guilt.Earlier I said achieving BG results looking like a muggle was unrealistic but it is within reach of achievable. This is what makes it so much harder to stay in a positive place mentally, you constantly feel like you could be doing better. Truth is, you have good days and bad days but we all know it's so much easier to focus on those bad days. I will never forget being in town with my friends after turning 18. My best friend was incredibly supportive but like most people, still hadn't really got a clue what being diabetic is like. We'd been drinking, having a good time, I always kept my BG monitor on me and tested my blood. I was 18mmol/L. To be honest, at that point, I expected it. It also wasn't the first time we'd drank. I knew full well my BG would come down later as a result of the alcohol and the dancing. My friend was disgusted and pretty much spat out "Oh my god! You need to look after yourself better." I was ashamed but also incredibly angry. I look after myself 24/7, I was enjoying a night of being 18 and out in a club with my friends and dirty reality hit me smack in the face. From that point onwards, I've kept my BG results as secret as possible. I will literally scan my arm and close my phone to look at it later if someone is peering over my shoulder. If my BG rises over 12mmol/L, I feel shit about it. Which is ridiculous! Of course we're going to have fluctuations in our BG, we're human! Writing this blog has made me realise that I'm currently sat on the edge of a disorder. I never considered myself to have one because regardless of what I've mentioned, I do have a good relationship with food. I enjoy cooking and baking. I love travelling and learning new recipes. As a young teen, I remember telling my nan "the one thing you don't have to worry about with me, is food" and she laughed. I'm an absolute foodie. But my problem isn't with food, granted it plays a part in it, my problem is... mostly diabetes related. These things I've mentioned, plus others I haven't, are quite common feelings for someone living with Type One Diabetes. I'm currently at a place where I recognise certain things I'm doing are wrong and stop myself. Taking the time to focus on these feelings for a blog, plus doing research on Diabulima and other disorders, has made me realise just how easy it can be to take this too far. "Experts estimate 40% of people who have Type 1 diabetes engage in behaviours that are consistent with diabulimia"Firstly, I noticed this quote is for 'behaviours consistent with diabulimia'. Diabulimia is when someone stops taking insulin to lose weight. However, there are so many areas regarding diabetes and mental health. ED-DMT1 is the term used for other eating disorders and diabetes. But who has ever heard of that? Google it, there isn't much out there. The media constantly refers to any diabetes ED as diabulimia, is that why a lot of these other behaviours go unnoticed? I know what I'm doing is wrong but is it defined by anything? Is it any wonder the percentage is so high when people living with diabetes have to dedicate so much of their lives to numbers and food? It's almost as if we do teach ourselves to have an eating disorder. However, the counting, the calculations, the guestimates, the hard-work isn't the problem. The problem is our constant strive for perfection. Perfection which not only ourselves but our GP's, our DSN's and our society plough into us on a daily basis. We set goals which on on the surface are within our reach, which makes it so much harder when we don't achieve them. Goals that we strive for 24/7. No down days, no breaks, not even a cheeky kit-kat.
Both healthcare professionals and patients need to remember that “good enough” diabetes management is the goal, not “perfect” control. The quest for perfection can lead to burnout and boost those feelings which help develop an eating disorder. symptoms.It's important to spot the early signs and symptoms, this might be within yourself or in someone you know, such as:
Consequences.We strive for perfection to avoid the following but remember, 'good-enough' diabetes management is enough. A very small part of our body doesn't work like it should, which leaves a massive job for us to and we can only do our best. Sometimes we need the cold, hard facts about our actions to realise just how much of an impact it can make.
TREATMENT.The first step to recovery is acknowledging the problem and that first time you ask for help is the hardest. Talking to your DSN and dietician would be a great place to start recovery, as they can understand the diabetes element of the disorder. GP's and Diabetes Specialists are becoming more aware of the mental health impacts of T1D. There are now dedicated recovery programmes within the UK. NICE guidelines now state that children and young people who show signs of eating disorders need to be treated as a priority and urgently referred on to specialist services that can more closely monitor their safety. We are entitled to annual mental health checks due to our condition but I have never had that opportunity. This is something I strive to push for across the UK. It is so important for people to have access to support for their mental health and diabetes. Whether it's burnout, eating disorders, anxiety, depression, the list goes on. Diabetes is a bitch to live with and it takes a toll on more than just our pancreas. support.If you're reading this and feel the same way, I urge you to reach out to someone. I didn't quite realise the extent of what I was doing until I started this blog. I am surrounded by supportive friends and family who have always looked after me but even they don't know some of the things I do. If you open up, it's easier for people to spot what you're doing and help you. I know we don't always want help but sometimes we need it.
If you don't feel comfortable opening up to a friend or a stranger who writes blogs on the internet, you can reach out for help on the following:
Mental Health and diabetes is such a big subject and it was hard to know where to draw the line with this blog, I could talk forever. Let's consider this a part one. As always, my inbox is open for those who have questions, comments and stories.
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