Life Changes and so does Diabetes

I almost forgot that this is a blog about diabetes and the games we play in our mind to manage it.

Well, if you`ve read my last post my life has changed, and for a while so did my ability or motivation to manage my diabetes. Put simply I just didn`t care. Still don`t some days.

I go to my doctor and they always comment on my A1C, oh, it has climbed, and I usually reply that the reason is my mood has declined, sort of an inverse relationship I guess.

I always tell folks with diabetes, that if the stress part of your life isn`t well managed then your diabetes will never be adequately controlled. Who am I to preach. I know.

When my depression gets a grip, you know, barely brush my teeth, dragging my self to work, those joyless, overwhelming sad feelings, my diabetes is the last thing on my to do list. In actual fact it likely compounds my mood as I make poorer food choices cause I just don`t care.

When you feel worthless, and ineffective in your daily life, one way to abuse yourself is through not taking care of yourself. People use alcohol and drugs, I have used diabetes, knowing full well that eating 3 bowels of sugary cereal is not exactly in a good diet plan.

Point is I need to focus on the mood first, sooth the soul, talk , write, exercise, try to find joy and purpose, which I find in my kids and work.

Well, that's all I can think of for now.

Trev

Self Experiment - Does Diet Effect Your Mood?



"Me Fired Up!"

 Good Day All! Boy do I have something I want to share!!!  I have not been this fired up in a long time. No I am not manic. This is some really revolutionary stuff. I didn't invent but check it out!!!

Not sure if I mentioned this,  but my last A1C was 8.4 % which, in my opinion for myself, pretty much sucks!!!

So I took a hard look at my current diabetes regime and self management.  By hard I mean honest, like; can I do more, am I measuring, trending, tracking, counting, am I consistent. To answer myself; as to whether I've been a well behaved PWD. I'd have to say, NO. I haven't been consistent in doing any of the above.

The result,  a shitty A1C.  Time to do something radical. Time to make a plan, and stick with it. Time to smarten up, and as you all know, I have 90 days.  At which time I will repeat my A1C and have a check-up with my physician.

Over the past four days, I know, not long, but I have to share this, I have been doing the following:

-Off my Pump, back on the Multiple Daily Doses.

-Re-Read Dr Bernstein's Diabetes Solution , for the second time in 4 months(This time I took notes)

-I have been eating the following portions daily:
Breakfast:  6 grams Carb and 3 oz Protein(Measured using a scale)
Lunch: 12 grams Carb and 4 oz Protein(Pre-made the evening before)
Dinner: 12 grams Carb and 6 oz Protein

-I have been taking the following insulin:
AM: Levemir 15 Units (split into 3 separate injections as per Dr B's Suggestion)
AM: Apidra 5.5 Units
Lunch: 4.5 Units
Dinner: 6 Units
Bedtime: Levemir 5 Units

Broken Down:

Correction Factor = 1 Unit will drop my BG by 2 mmol
1 gram of Carb increases my BG by approximately .3 mmol
1 unit of insulin for 1.5 oz of protein
1 unit of insulin for 6 grams of Carb
2 units to cover the Dawn Phenomenon (2 hrs after waking)

-I write everything down
-I tested every 2-3 hours for the first 3 days
-I discovered Sugar Stats a website that allows you to log your numbers, graph them, and so much more. Get this! If I am out, away from my computer I email my blood glucose reading using my phone to the site and review the numbers later. It really is awesome!(No I am not an affiliate, so I don't get anything if you visit the site)

Okay, so what?! 

I am going to tell you, the first day sucked!  I felt low(hypoglycemic) because I wasn't used to having sugars in the normal range. I felt hungry, I had a massive headache. Day two, still feeling headachy, but slightly better. Day three, better. 

Today, I feel fantastic!!!  I have no headache. I have no post meal spikes, my range yesterday and today has been close to that of a non-diabetic.  I never in my 28 years of being a Type 1 have seen numbers, I mean stable, steady. 

My mood and my mind is clearer then I ever thought possible. I am not exaggerating. I post my numbers publicly on Sugar Stats if you want to check them.  It's really encouraging to eat a meal or take a shot and knowing exactly what the outcome will be.  I admit I was really hesitant to take 1 unit for 1.5 oz of protein. But seriouly, it's totally possible!

The only downfall is it is a rigid regime,  but I feel great and that is motivation. I don't feel edgy, like I am on an emotional roller coaster that I would get with spikes and drops in my blood sugar.

Stable numbers (Stable Carb and Protein + Stable Insulin = Stable mood ) 

That is my conclusion thus far.  I know it is only day four but I am onto something life changing. I just feel it!

Trev

Diabetes - Entwined

It is time to discuss being all grown up with diabetes.

I have had Type 1 diabetes since the eighties, yes the Big Hair, Glam, Dancing on The Ceiling era.

 I was nine when diagnosed, so I was dancing to thriller with my cousin not realising what a life with diabetes would entail.

When you are a young person your view of the world is idealistic not to generalize, but this is what my view of the world was. You dream, you picture what your life will be like when you are all grown up.

You envision a life full, happy, stress free.  You over hear discussions about money, mortgages, but this to you as a child sounds like another language, because it doesn`t apply to you. 

You go where your parents go, take your insulin, eat whats prepared for you and play, imagine and enjoy life, not thinking about diabetes.

You celebrate numerous birthdays, and with each passing birthday, the awareness starts to gradually manifest itself. The awareness that this diabetes thing is here to stay. You fight, deny, then hopefully accept, or at least allow it to sink in fleetingly through-out your youth.

You complete your elementary, middle and high school. You make some big decisions like, what am I going to do with my life now? 

You fall in love, finish more education or choose a field to pursue. Life goes on, and diabetes is always present.

You marry, and have children or not.

You work, save, buy your first home, apartment or condo or not.

You have many more birthdays. You reach middle age. You reflect, and all this time diabetes lingers; you need to renew your drivers licence, have regular check-ups, finger pokes, infusion sets, injections, pens, new devices, promises about cures and transplants, yet, diabetes is still entwined as part of you.

You look back, at chapter one, you look forward to chapter two.  What`s in store; will I avoid complications, will there be a cure, will they close the loop?

Then I think, will my children with type 1 diabetes have to endure the same life journey with diabetes that I have?

They are being entwined as I was with diabetes, I pray and hope they endure.

Trev





  

What's up with SAD?!

We are nearing the end of March and my view remains dark, cloudy and with a chance of flurries.  Obviously talking about the office window view, and not my mood, but there is a link.

I do believe it(the weather or season) is a barrier to staying upbeat, positive. I also believe it gives those ANTS the upper hand.

SAD, great acronym, as this is how a lot of people get during the long winter months. My self included.  Oh, I am referring to the depressive disorder called Seasonal Affective Disorder. I am certain this was a contributing factor in derailing my mind  earlier this month. When you combine multiple situational stressors and no sunlight, grey skies, it is a recipe for a bad day.

Definition By Mayo Clinic staff

Seasonal affective disorder (also called SAD) is a type of depression that occurs at the same time every year. If you're like most people with seasonal affective disorder, your symptoms start in the fall and may continue into the winter months, sapping your energy and making you feel moody. Less often, seasonal affective disorder causes depression in the spring or early summer.

Don't brush off that yearly feeling as simply a case of the "winter blues" or a seasonal funk that you have to tough out on your own — you may have seasonal affective disorder. Treatment for seasonal affective disorder includes light therapy (phototherapy), psychotherapy and medications. Addressing the problem can help you keep your mood and motivation steady throughout the year.

Like the definition indicates, don't ignore it, but consider this as a cause to your "decreased mood" coupled with a long term chronic disease (I hate calling it a disease) like Diabetes this can throw you into a depression. 

I have never been formally diagnosed with SAD but I sure feel better with the sun peers through the clouds, and the days get longer and brighter.

I encourage, reaching out to a friend, talk to your family physician, they also sell full spectrum lights at most large chain pharmacies. Exercise , Meds what ever it takes.

Yours in Health!

Trev

Why so many whys?

Why?

Simple question right, well not all the time.

Why when you're tired do your kids seem to behave at their worst?

Why when you have planned a special meal your meter reads high?

Why is it when you have no money your car breaks down?

Why is when you want peace chaos ensues?

Why can't the sun shine more?

Why is it we know what to do but don't?

Why is when I wake up and say, I am going to be a better parent, friend, partner,
worker, I end up yelling at my kids, ignoring a friends call, and not listening to my partner?

Why don't mini vans have sound proof partitions like limos?

Why does it seem that when things are going really well things suddenly change?

Why do we have to live with diabetes?

Why does anyone have to endure pain and suffering?

Why are there so many whys?

My only answer thus far as that we are all imperfect, fallible, vulnerable, emotional, ever evolving humans.

The positive in all this is we have free will and the human ability to self reflect, change, and wake up tomorrow and try again.

Trev

Stress and Diabetes - Often Left out of the equation?

In my experience as a PWD  who helps  people diabetes on a daily basis I often question why stress isn't one of the priority discussions that should take place.

Health professionals  have their routine during diabetes visits that usually include: diet, blood glucose readings, BP, Wt, A1C, feet, kidney's, then the time is up and it's time for the next patient.

I propose stress and mental coping be added to this equation as part of the team's repertoire or interviewer's strategy in discussing diabetes during a visit.  You'd be amazed at the responses you get when you simply ask, "So, how are you feeling about your diabetes?"

I personally use a four legged approach to my discussions with PWD I am trying to help.  I call it my diabetic stool, so all the legs need to be stable for decent control. I discuss  Diet, Activity, Medication, and Stress.  If all these are in check the you tend to achieve fairly decent diabetes control.  This is my discussion strategy with PWD.  But the first question I ask is; "So, how are you feeling about your diabetes?" I know I am repeating myself, I heard once it's good for emphasis.

"Sorry about the image quality, it is word document that wouldn't paste"

After going through the above I flip it so the stress is on the top, to basically say, unless your stress and mental health is in check then all these other components are even harder to control, and you may indeed fall off your stool.  It is very visual and they usually ask to take it home with them as a visual reminder. 
Most folks have not been given a good explanation how stress may effect their diabetes.  They are  usually aware hat having a common cold or serious illness can effect control, but they don't realize that mental Health, Anxiety, and prolonged stress can seriously hamper diabetes control.

Why is this?  I suspect it is because where the mind goes the body will follow.  If you are mentally well you are going to physically take care of yourself.  But there is also the biology  to consider.

When you are experiencing stress, acutely, or prolonged, you are more resistant to insulin. Your body releases hormones that inhibit insulin from doing its job, that is, letting the glucose into the cells to be used appropriately for energy.  Some of the stress hormones are cortisol, and adrenaline. The body also starts producing more glucose from your liver, getting ready for the "Fight or Fight" response. This used to be handy thousands of years ago when extra sugar was needed to feed the muscles in case you needed to attack a woolly mammoth or flee from a saber tooth tiger, but not so good now. This extra glucose simply increases and floats around wreaking havoc and leading to complications if not corrected.

What I am getting at is patent's and PWD need to know that stress impacts there diabetes control just as much as food.  It needs to be brought up, discussed, dealt with.  But the problem is our health care system isn't designed for health care workers to spend an hour talking about how PWD are feeling about their chronic process they deal with 24/7/365, every second of every day. 

On a positive note, we as a system in Canada are moving toward Primary Health Care, where by Allied Health Professionals work with physicians to assist them in improving patient care.

I work in this area and as a result I spend an hour dealing with all aspects of an individuals chronic disease, including Stress and Diabetes.

Trev

Well guess what, we need to.

Peeling Back my Diabetic Brain

"My Diabetic Brain"

I was thinking about the movie Shrek when he makes reference to himself being complicated, with many layers like an onion, and donkey refuting this in a positive way, by saying more like a layered cake. 

My point is we are complicated, with many layers.

I,  at least feel like my brain is complicated lately.  Things that used to be clear, and simple are now questioned, judged, and not so clear. 

The cognitive behavior tricks or more respectfully stated "Techniques" do seem to work.  My wife notices a different "me" but what do I notice when I peel back the layers of my thoughts?

I'll tell you:

Those "ANTS"(For those who missed my previous post, ANTS = Automatic Negative Thoughts) are still pesky little buggers that are trying to penetrate my mind.  I am more watchful of them now, which may explain the changes on the outside. But it is still very trying to always keep on guard. It is like being on guard all the time with no one to replace you. A lot like having diabetes I guess. 24/7. 

As I am more aware, conscience, or whatever of my thoughts, it is apparent that these ANTs are plentiful.
More then I would have previously known if it weren't for the Jedi Training.

Now when an ANT makes its way into my stream of thoughts, I snatch the little bugger, stare at it, think about, and decide what to feel about it, and the result seems to be a more positive emotional response. Not as reactive, not like a run-away train. 

I realize now this is going to take a lot of practice, herbal tea, some meds, therapy, and more peeling of layers to deal with those nagging ants that are trapped in my layer brain. 

I know my post likely sounds pretty "out there" but these are my peeled back thoughts.  I am hoping soon to compare my brain to a layered cake. 

Trev

Exercise is better then Drugs!

"Me doing it!"

Okay, I am not suggesting we all stop taking our medication but I worked out today for the first time in like 2 months. Amazing! Totally amazing!!!

I promised, well announced on my blog The Diabetic Caveman that I would proceed with an exercise regime starting soon, which happened to be today.

I had to post about it.  After 40 minutes of moderate intensity circuit training and a bout of cool down cardio my mood instantly improved. I felt calmer, I felt that my thoughts were clearer and more positive which according to the cognitive behavior Jedi Mind Tricks  this leads to a more positive mood.

I willed my ass to the basement even though I did not want to at all. I dragged my sorry ass down stairs to the man cave and did it anyways.

I have not felt this clear, and positive in a very long time. I knew it had to be done, I knew the hormones that are released with activity which include, endorphins, testosterone, serotonin would directly improve my mood.

It is taking that first step that is the most difficult.  I took the first step, and tomorrow is another day and I know I will have to struggle with my mind, and will myself to repeat what I did today.

Trev

Jedi Mind Tricks to Battle ANTS?

"No Match For a Jedi!"

Yes - Apparently there are Mind Tricks available to fight the "ANTS"

I know, once again you are asking yourself, what in the hell is this guy talking about?

Well I had my first counselling session today. That's right, I am officially being counselled. Kind of like having my own personal adviser, like being president, or a king. 

She did some scales, or tools on me and said, you are definitely ranked as being off the charts in terms of being depressed.  I said, " I figured as much, now what?" 

She said it seems, "You are having a lot of negative thoughts and self talk". I replied, "Yup"

Then she said time is running short and she reiterated or validated what I was talking to her about, if you are wondering just read the last couple of posts. Then she told me she would email me some coping techniques called "Cognitive Behaviour Therapy" I said "sounds cool"

The conversation was concluded with a followup apt in 1 weeks time, and a safety plan in case I loose my marbles and desire to live again.  Apparently once you feel better you are actually more vulnerable to acting on your suicidal ideations. For the record, I am slowly seeing the rays of light.

I thought about "ANTS" no not the little irritating black bugs that march away with your picnic food, but the "Automatic Negative Thoughts" that can flood the brain when your guard is down.  Then I thought about the "Jedi Mind Tricks" or "Cognitive Behaviour Therapy"  Which is being emailed by my counsellor. But I am too impatient.  So I found the following on the net regarding "CBT" 

Here is an article written by By Dr Greg Mulhauser that decribes the basis for CBT titiled "An Introduction to Cognitive Therapy & Cognitive Behavior Approaches".  He states:

"Cognitive therapy (or cognitive behavioural therapy) helps the client to uncover and alter distortions of thought or perceptions which may be causing or prolonging psychological distress."

The following diagram taken from Dr Mulhauser's Article below sums up the usual process our brain follows:

I remember reading a book, a very long time ago called, "How to Keep People From Pushing Your Buttons"

It basically followed the same premise, we are stimulated by our environment, we think certain things, and then these thoughts are followed by emotions. Like if you are cut off while driving, you think "What an A-hole" or "Maybe he's in a rush" both thoughts will likely lead to two very different emotional responses, one likely in anger the other likely in understanding. 

So apparently, these Jedi Mind Tricks will assist me in dealing with my ANTS, as these little buggers are apparently directly effecting my emotional outlook on life. Too bad it wasn't as simple as using a spray can of raid.

Man, I am liking this personal adviser thing, too bad it's only temporary.

Trev

Mental Health Stigmas - Barrier to Seeking Help?

The stigma attached to mental health ailments is obvious in my opinion.  I call them Mental Health Ailments because it is no different then a broken arm.   I read recently that the medical profession equates Depression to the Common Cold. Intereseting....

I think it is important to mention the labels and stigmatization that is attached to coming forward with a mental issue.  Be it depression, feelings of suicide, ADD, ADHD, or any other illness that messes with our brains emotional regulation. 

Is the stigma society places on mental illness a barrier to seeking help? This is a question that I have pondered.

I have mentioned this slippery slope to falling off of the mental deep end. It didn't happen spontaneously, so why did I not seek help earlier. Answer....I didn't want to be labeled as a nut bar!  I didn't want to tarnish my professional reputation.  I told myself, I can handle it, I'm a man, men handle shit. They don't ask for help. Those were a sample of my rationalizations to not seeking help earlier on.

The most powerful barrier for me was the admission that I had a mental problem and the perceived judgement or stigma that I thought society would cast upon me.

This is a problem.  I know they  have mental awareness months. It just never appealed to me, until lately, for obvious reasons.

I have worked in the medical community for most of my adult life. I hear the judgments, thoughts and perceptions people have towards the mentally ill. It is revolting.  Your brain is an organ, and one of the most complex ones in the human body, so it makes sense that something can go haywire.

In terms of diabetes, I have said this before, it is often last on the agenda in the management of diabetes. It should be first, because where the brain goes, the body will follow.

So what do you think?  Does a stigma exist in society and if so does it impede the prompt pursuit of help from those in need?

Trev

Suicidal Ideation Prompts Blog - Read all about it!

This blog, is different from the others (Three 2 Treat & The Diabetic Caveman) that I author.

This blog will be solely devoted to diabetes and mental health. My current struggles with D, my struggles with my 2 type 1 kids, and hopefully some research and good techniques to manage the "Mind Game" that accompanies living with diabetes. 

I guess what prompted this new blog was a recent experience that is actually very fresh in my mind.  So raw I am dealing with it in my heart and soul as I type this, which will hopefully make it more real.

If you have had the chance to read my other blogs,  you will know my style is open, candid and real. Feel free to let me know if you feel I am straying from my blog writing principals.

I have had diabetes for 28 years, and for the most part  have successfully managed it. Nevertheless, it has  taken its toll on me mentally.

Last week it (Diabetes) finally beat me, at the mental game. I call it a game because it is, see my post on Three 2 Treat called, "A Diabetes Mind Game"  Well let's just say I felt like I was defeated and in check mate(which in chess means game over, no other moves, the end)  Ready to topple over my king in the game of life.

In my 38 years of being on this earth, this is the lowest I have ever felt. I have always been able to see a glimmer of light. Not this day.  I woke up, went to work, and didn't take my insulin. That's right, I did not take any insulin. For those with Type 1 DM you know this is not a good way to start the day. I picked my children up, dropped them off, and said my goodbye, I will always love you no matter what statements. WTF!  Who does that......

Now, a glimpse into my mind. Why was I in check mate. I had lost all desire to care. I was tired, so very tired, of diabetes, life, commitments, bills, debt, basically tired of living.  I decided my plan was to go into (DKA) Diabetic Ketoacidosis and slip away.  I know in retrospect it is an easy way out. But a way to never think about diabetes ever again.  So what happened?

Well, I posted a comment titled "Life Sucks!"on facebook.  Then went about my work day(pretending diabetes didn't exist). It is amazing how you can act normal, despite what you are truly feeling on the inside.

Later in the day, cramps started to set in, my brain got foggier, and I knew I was on my path to DKA, according to the plan.  I was thirsty but did not drink.  I wanted to be dehydrated, it would expedite the process and end result..

Then I received a call from my friend, who happened to be a very talented social worker. He said, "Hey buddy, wanna grab a burger after work today". I immediately started crying, it was like the flood gates busted, I was now swearing at him under my breath for making me cry at work. He made me promise to meet him, and I did.

I arrived at the restaurant before him.  Starting to feel abdominal cramps, and physically sick. I ordered a double burger, bacon, loaded, with onion rings, and a large coke.  I had know idea what my glucose was and didn't care.  Ryan arrived, sat down, and my phone rang. I answered it, "Hello, this is officer ------ may I speak to Trevor?" I replied,  "This is him, may I help you sir?"  He sated he wanted to talk to me as there was a concern about my safety.

I told him my location,  and informed him that  I had my friend here and handed Ryan the phone. Ryan told the Police officer that he would ensure I took my insulin and if not he would call the officer back.  Being a health care professional I knew that if I did not comply,  the police would apprehend me and lock me in a psych ward for the night or longer. Wow, was I fucked up.  I didn't care either way.  I also had to promise to make an apt with my physician ASAP. So what happened?

 I spent the night with Ryan. The next day I went home to my wife. I seen my physician. I am booked to see a counsellor to hopefully figure out what got me to this desperate state. Still not sure if I need to go to the hospital.  I know I want to live. I know there are options. I know my wife and children need me, and love me.  Like I said before what the hell is wrong with my brain!? 

Life can get pretty messed up.  Our minds are amazing things, our emotions are amazing things too, however, sometimes, emotions confuse the mind, self talk no longer works, and emotions are so overwhelming  that poor and often life threatening decisions and/or  actions are set into effect.

I used to hate facebook, but I fear what the outcome what have been if Ryan hadn't been perceptive to my post and called me. I'd either be dead, seriously ill, or locked up in a mental hospital.

But....Here I am. At work on Monday,  contemplating the last five days. Playing a serious game of mental chess with diabetes, who is relentless in his ability to take me down again.  I say the Mind-Game isn't over yet.  Let's reset the Chess Board and hopefully I can be more strategic this time around. 

Trev