It seems that I’ve been thinking more than writing lately. My thoughts are a little confusing and maybe a little contradictory - and a lot of the thinking is in the areas of diabetes, eating disorders and the lap-band.
Going back to our friend Scott and The Butter Compartment, it really is interesting, when you think about it, how much having diabetes exacerbates our food issues. In my case, the food issues came first, diabetes just complicated them. Perhaps for others, the diabetes came first and created these food issues.
I’ve been pondering the differences in the food issues between type one and type two. Scott and Ms. Thill write from a type one perspective and while I can imagine what some of those issues are like, I haven’t really experienced them. There are times that I have had insulin-envy. The thought of being able to correct for a poor food choice is sometimes very appealing. During the holiday discussions on Diabetes Mine there was a lot of what at the time felt like type two bashing to me. The message I kept hearing was “people with type two are stupid to think I can’t eat sugar, I can eat whatever I want I just correct for it.” Looking back, instead of focusing on the negativity I felt was there, I’m thinking those comments are indicative of the complex relationship people with type one have with food.
As someone with type two, I share some of the same food issues and I have some different food issues. I think we share the guilt of not eating perfectly, not managing our sugars perfectly, sometimes having to eat when we don’t want to eat, using the low to justify eating something perhaps we shouldn’t eat, and just generally being tired of having to deal with this all the time. Diabetes and it’s constant focus on what you eat and when gets into your head in a not-always-healthy way. I’m curious about the idea that diabetes (especially type one) may actually create an eating disorder.
I came into diabetes already eating disordered. In my life, I ran the gamut from anorexia to bulimia to compulsive eating. Of the three, compulsive eating is the hardest to define and the most likely to be seen as a weakness of character. This definitely plays a role in my diabetes care and not always a good one.
Ms. Thill wrote, “…in the end, there really is no one else to blame but me. I did it. I’m responsible. I’m the one who fucked up.” I react pretty strongly to this statement and I’ve spent the better part of a week thinking about why.
I have type 2 diabetes. I am (still) seriously overweight. I knew that diabetes was a risk and had even described myself as “diabetes waiting to happen.” The media is constantly telling me that I could have prevented my diabetes. This is all my fault.
I am all for personal responsibility but this is a bad headspace to be in. It’s a damn short journey from “This is all my fault” to “I’m an abject failure and don’t deserve anything better.” It’s a really difficult balancing act for me to take responsibility for my eating and diabetes care without constantly beating myself over the head with what a failure I am for every perceived imperfection.
Is it personality type? I know people on both sides of diabetes who are fighting that same balancing act. I think it may reflect the food issues/disordered eating we both are facing.
Complicating my life right now, food issues are fighting it out with the lap-band. For the past couple months I have been dancing around the issues. I am fucking up. Yes, sometimes it’s fairly minor and sometimes it’s a lot worse but it still comes down to I am making some really poor choices and don’t seem to be able to stop. Think of me as the alcoholic who is keeping it together most of the time and only gets drunk at night.
One of the first things I learned as someone with diabetes is how to over-eat and still keep my sugars in range. Even now, with nightly poor choices and/or binges, I think most diabetics would be happy with morning sugars between 95 and 105. “See,” I can tell myself, “it’s not that bad.” The same issues relate to the band. It’s not that difficult to eat around the band. Simply eating small extra amounts when I’m not hungry is probably my biggest band issue.
Which brings me back to the concept of “I can eat whatever I want so long as I take my insulin.” Isn’t it possible that that is disordered thinking, too? There has got to be a difference between occasionally eating something off your plan and covering it with insulin and consistently having to add insulin to cover your food choices. That is what scared me the most about the possibility I would need to go on full-time insulin. I know that I would be likely to use insulin to justify eating badly because I could correct for my choices.
I’m still losing weight, albeit more slowly, and I justify my bad choices. I say to myself, “Look at my blood sugars, look at my weight loss, I’m not doing that badly.” But I am doing that badly. There’s a difference for me, too, between occasionally eating off plan and consistently skating that line.
I don’t know how to get past this issue. The only thing that comes to mind is “just do it.” That sounds so easy. Just make good choices. Just stay on the plan. Just don’t eat when I’m not hungry.
But, says my head, there are times that I have to eat when I’m not hungry. I am rarely hungry in the morning but I have to eat because that’s what you’re supposed to do. Breakfast gets your body and metabolism started for the day. I have to eat after working out because my hands are shaking and I feel disconnected at a blood sugar between 61 and 71. I feel like I have to eat at certain times of day because if I wait until I’m really hungry, I will almost certainly make even worse food choices.
My rationalization skills are really very good.
There are issues with the band that some people have a lot of trouble with that I didn’t have that much trouble changing. I don’t drink with or before and after meals, for example. I am not having that much trouble with small portions most of the time - but I am having trouble with “wasting” food if I am full when half way through whatever I’m eating. I’m not having much of an issue with small bites and chewing thoroughly. THAT has a pretty immediate reinforcer built in with the band. I still eat too fast and don’t pay enough attention to what I’m eating while I’m eating it. My method for dealing with that is the small portions. My biggest roadblock right now for both the diabetes and the lap-band is grazing in the evening. All rationalizations aside, that has to stop.