A man who has been married for 15 years suddenly begins losing weight and buying new clothes. He starts staying late at work and taking weekend business trips, unusual behaviors for him. His wife thinks he is having an affair. Why?
A usually happy teenager turns sullen. Her grades drop, she withdraws from activities that she’s always loved, and she spends almost all of her free time in her room. Her parents think she is depressed or on drugs. Why?
A 40-year-old patient who has been coming to the same doctor for 12 years complains to him that she has recently been experiencing sudden weight loss, lingering thirst, increased night visits to the bathroom, and tingling in her feet. The doctor immediately has her tested for type 2 diabetes. Why?
The answer to each question is “patterns.” The wife, the parents, and the doctor have all noted a change in a usual pattern and its replacement by a new one. It doesn’t matter that the patterns are almost clichés-after all, spouses usually stray in typical ways and teens often act predictably when they disengage. What matters is the pattern for this person in this instance.
The ability to detect patterns is one of the things that sets us apart from other creatures. We see the whole rather than isolated parts. A cow sees a truck that comes weekly and takes some of her companions away-none of whom ever return. Although she notices the truck’s visit every week, she does not see the pattern or understand its implication for her.
So, what does all of this have to do with diabetes? Very simple: Although diabetes is fairly easy to detect and define, it expresses itself differently in each person who has it. For you to best deal with it, you must learn the pattern it takes with you. Once you recognize that pattern, you can achieve the maximum possible control over diabetes.
What Does Diabetes Do to You?
Most of us who have been diagnosed with either type of diabetes are pretty familiar with its symptoms and effects. The bottom line for us, of course, is that uncontrolled blood sugar, too high or two low, can cause long-term organ damage or even unconsciousness, coma, and death.
Yet each of us uses a different set of benchmarks to tell us how severe our symptoms are. Professional surfer Scott Dunton, whom we profiled in Diabetes Health last year, will not work out or compete unless his BG is at least 140 mg/dl. In a non-diabetic person, that BG level would set off medical alarms. Even in a type 1 like Scott, it’s not considered a good level by any stretch.
But Scott has “learned” his disease, and he knows that a high BG level fuels the intense two- or three-hour workouts that he requires to stay competitive. It’s a compromise that kills two birds with one stone: After he finishes a workout, his BG levels are close to normal, and he has kept his edge. If Scott decided to follow the conventional pattern of giving himself a strong dose of insulin whenever his BGs reached 140 mg/dl, the world would be minus both a talented surfer and a happy young man.
When I was diagnosed with type 2 in 2003, the first thing I had to learn in dealing with it was to control my impatience. It was impatience that made me try to force the disease into submission by battering at it with everything I could think of: really vigorous exercise-more than I had done in years-combined with a stringent low-fat, low-calorie diet from which I exiled most of my favorite foods and daily doses of the sulfonylurea my doctor had prescribed.
At first my progress was gratifying. My A1c dropped to 5.6% within two months of diagnosis, and my fasting blood glucose level was often in the 120s-not ideal, but pretty good. I even began flirting with hypoglycemia, coming back from brisk five-mile walks with readings in the high 60s or low 70s. I quickly learned to keep a tube of glucose tablets in my pocket “just in case.” But what I hadn’t yet learned is that no trend is permanent and that the pattern I had established was far from being the only one I’d ever establish or need.
One day, months after my diagnosis, I took a particularly strenuous walk that had me breathing hard most of the way. When I came home and took my blood sugar reading it was just over 200. When I saw that reading, I think I came the closest I ever have to outright despair. I pricked myself again to double check, and the number came up almost the same. I couldn’t believe that after having been a good boy for all those months and establishing a high level of control over my disease, my body would betray me so dramatically.
But one dismaying BG reading doth not a disaster make. After my initial shock and indulgence in a “why me?” moment wore off, I realized that I had made the mistake of assuming that all progress is permanent and that my body was like a rescue pet that, if properly fed, medicated, and stimulated, would fall into the routine I had set for it.
That’s when I decided to take a step back and be a little more patient and methodical about monitoring my condition. I realized that having diabetes was not a straight-line affair. Just when I thought it was, the line would veer off in a wild direction or turn back on itself. So I had to figure out a way to account for those crazy departures from my expectations. Here’s what I learned about how to find your pattern.
Set up a monitoring routine and stick to it. Typically you’ll start with at least four daily readings: pre-breakfast; two post-meal (lunch and dinner); and pre-bedtime. You may want to add additional readings to monitor your pre- and post-exercise levels.
You should stick to this routine for a few weeks so that you can see what pattern emerges. For example, just after you’ve been diagnosed and have begun taking medicine and making lifestyle changes, your readings throughout the day might show:
- Fasting: 180 mg/dl
- 2 hours after lunch: 150 mg/dl
- 2 hours after dinner 165 mg/dl
- Before bed: 140 mg/dl
Two months later, those same readings might consistently show:
- Fasting: 115 mg/dl
- 2 hours after lunch: 120 mg/dl
- 2 hours after dinner 125 mg/dl
- Before bed: 120 mg/dl
Now you can begin experimenting to see what you can do to drop those numbers even 1ower:
- Add certain foods to your diet, or delete certain foods. If you have eliminated cereal from your breakfast routine, now would be a good time to see how a low-carb cereal, such as puffed rice, affects your post-breakfast reading.
- If you have been doing one kind of exercise, such as walking or bike riding, you can experiment with adding resistance exercises or weight training to the mix and see how it affects both your daily and your weekly readings.
- Alter your sleep habits to see if a change in the number of hours you sleep affects your fasting BG levels. Too much sleep (more than eight hours) can backfire on people with diabetes, leading to higher BG levels. Too little sleep (fewer than seven hours) can lead to daytime naps, a habit that researchers increasingly suspect plays havoc with BG levels (and can even be a sign of pre-diabetes).
- With your doctor’s permission, see what happens if you scale back on your diabetes drug dosage or even stop taking it. This is not that radical a step-many diabetes researchers are saying that doctors are too quick to prescribe drugs to newly diagnosed diabetes patients. They advise that treatment with diet and exercise alone should precede the introduction of drugs.
Patience allows you to track the larger pattern. By taking time to methodically work through all the “what ifs” of your diabetes, you can see your larger pattern. Take each of the above steps one at a time and then wait to see what, if any, effect it has on your readings. If you do them all at once and you see a drop in your numbers, how do you know which of them is responsible?
Yes, being this methodical takes time-several weeks or months. But fortunately, diabetes is not a disease that gives you only months to live after diagnosis. You’ve already begun making lifestyle changes to slow its progression, so putting in some time now to find out your own ideal combination of food, sleep, exercise, and medication will pay off handsomely.
Expect anomalies and learn how to deal with them. Who knows why people who have been diligently doing the right things suddenly experience dramatic spikes in their blood sugar readings? Who knows why you can run six miles one day and come home with a 90 mg/dl BG reading, and then run the same distance two days later and come back with 210 mg/dl?
Bodies are not machines that never vary their output if you just keep delivering the right fuel and maintenance. They can react to stress by upping their production of glucose in response to exercise, and they may react to the onset of another condition, like a cold or allergy, by doing something that pushes your carefully built routine out of whack.
But chances are pretty good that occasional anomalies won’t become a persistent pattern. Your ability to wait them out, by patiently tracking how often they appear and noting what you were doing when they did, will do much for your peace of mind.
Expect your pattern to change over time. Remember, diabetes is a progressive disease-not in the political or social sense of things getting endlessly better, but in the sense that damage from it is cumulative. You are experiencing a disease that can be managed, but for now cannot be cured. Managing it means that you can stalemate it for a very long time by keeping your blood sugars in control and thwarting its ability to create organ-destroying inflammation.
But bodies and metabolisms change. The effects of diabetes, though gradual, will eventually force a reappraisal of the medications you’re taking, your diet, and your levels of exercise. But by then you’ll have had years of practice at finding and knowing your pattern. You’ll have the attitude and experience that will allow you to track your responses to a new set of circumstances and make the necessary changes in how you manage your disease.
Don’t complicate things. If you’re newly diagnosed with diabetes, the temptation is to learn everything you can as quickly as you can about the disease. The problem with that approach is that there is far more to know about the disease than any one person could ever master, and the attempt to learn it all can be overwhelming.
How do you know what’s good information and what isn’t? How do you reconcile conflicting information? Which theories and scientific studies are authentic insights into diabetes and which are dead ends? The answer is that it all comes back to being patient and methodical. Give yourself time to observe and experiment so that you can build an accurate map of the disease’s effects on you and your best responses to it.