Your T1 Diabetes Strategies Failed Again. But…Are You Even Trying?
If I want to be healthy as a diabetic, why am I falling short? Am I doomed?
A self examination that turned into an article.
Hope it helps you as it helped me!
Whenever I set a goal for myself or I declare a change I want to make in my life, one of the first things I do is to lay out the Google Doc where I have listed all my Guiding Principles and read them over and over again.
Doing so helps me prime my brain and moves these Principles to the front of my brain, readying them to stand behind me and fuel my actions.
I find it useful to reread them often due to my tacit tendency to slide back into my old habits, and this is a quick and effective solution to stay locked in and catch myself in time. Whatever it is I am trying to do, having clear Principles keeps me focused and helps me find the path again when I get lost.
You might wonder What does this have to do with diabetes?
Soon told. It’s trivial to say the principles one holds dear operate in the background of pretty much everything one’s does. Principles are the fil rouge that inspires our behaviors in any area and circumstances: running, work, relationships and yes, health too.
Setting Goals, Falling Short
If you’re a human being just like me, you might be familiar with that awful feeling of knowing you should be working towards something, but for some reason you’re not quite getting there.
Say you want to find your fitness again, because Health is one of those big areas you want to prioritize. You commit to the habit of working out, execute for a while and then lose momentum. Perhaps the environment around you is not making this habit accessible enough (i.e.: the mat or the weights are in the backroom instead of the center of your living room), or the day is simply not designed to facilitate a workout (i.e. I am too busy today oh god this workout will have to be postponed). Perhaps you’re so into the busyness of things that you can’t even find time to go for a walk. The habit doesn’t stick.
Or you commit to stay away from distractions while working and studying because doing focused work is what moves the needle for you, you want to be a person who does stuff well. So you block your phone and leave it in the other room. Works for a few amazing days, and you feel pumped because you see how much you’re doing. Then, one way or the other, the phone and all its notifications make their way back on your desk, right on the side of the laptop where you should be working with your full focus, which is now mostly gone again. Then you feel the pull of a Youtube video or a Netflix show. And focus is interrupted again.
Or you decide you want your blood glucose to be and stay in range and your insulin sensitivity to be at its best. You are aware that elevated blood glucose and insulin resistance are a big problem for your health, and since your Health is a top priority having some Principles and behaviors around health and diabetes is important for you. You commit to eat (or not eat) certain foods, to limit sweets to some occasions, to diligently track food and insulin and do all the necessary things you know will get you there. You get there, pat on the back. Then you loosen yourself: you have it under control now, so perhaps you allow a few too many indulgences at the dining table, or you only occasionally keep track of things. Sure enough, before you know it you’re right back doing things as before, with the results you had before.
In all these cases, you knew what the ideal situation was, you had identified some factors and behaviors that were getting you there, you executed for a while and then lost momentum. Perhaps you had forced aggressive changes that were not sustainable for too long, or simply did not create the right conditions for those habits to stick after the initial spark. Or perhaps you didn’t really grasped the reason why these changes were important, and the lack of a clear reason to sustain your efforts resulted in you abandoning the venture.
And in one blink of an eye you’re back several squares. You still know the path and that you should stay on it, but the cost of inaction is hidden: still active but not really in shape, still “working” but not really getting anything done, still “managing” type 1 diabetes but those ups and downs occur a little bit too often. Feels like you’re kinda on it, so a few slips here and there are acceptable.
And because you don’t really feel the pain or face any consequences in the immediate term, those few slips become a lot of slips: you’re slowly losing it without you knowing.
You know what you need to do but you don’t do it right. You’re not 100% committed. As Tony Robbins would say, you have not made a clear decision to make that change and stick to it. No wander that belly fat is still there, or that it still takes twice as long to get a task done or that your blood glucose still has those random spikes.
You know exactly what to do. The question is: are you actually doing it?
You Know Exactly What To Do. So Why Aren’t You Doing It?
If this article sounded paternalistic so far because I’ve used the word “You”, that was a pure rhetoric exercise.
I am the one under scrutiny first.
Should I be surprised that I am not really getting the results I wanted?
Am I even trying? No.
Am I doing things properly or only halfway? Only halfway.
The reason I am writing this article is because I don’t want to escape from this question. This is a self examination. Let me focus on diabetes.
My declared life goal is to achieve maximum insulin sensitivity and get my time in range above 90% all the time, two conditions that automatically set me up for almost nondiabetic HbA1c.
It’s an ambitious aim, but those who aim for the stars will reach the moon, so if reaching the moon means 89% time in range instead of reaching the star (above 90%), so be it, it’s still a great result! I know this is absolutely possible, because there are many people doing it out there. I also know that this is only obtainable through certain lifestyle choices that are absolutely natural but are not considered normal in the modern era.
Simple things such as not eating refined carbohydrates and refined foods in general were the norm until seventy years ago, but today they are ubiquitous in our surroundings, and they make their way into our mouth every day, often multiple times a day. White bread, pastas, pizzas, fast foods servings full of processed oils of all kinds are the norm, they screw our metabolism big time, and for a person living with diabetes, this translates into a nightmarish blood glucose management. (No need to trust me on this, I surely study a lot but I have no credentials. Here’s a few scientists explaining you why).
I am not immune to this yet, but I am getting there. Over time I have become almost insensitive to the processed junk that was once irresistible, but I still have some way to go. I still have cravings for foods that are fine but aren’t great in big quantities (whole breads, dried fruits, processed soy products). It doesn’t make sense to pretend those cravings do not exist - that would put an immense mental toll on me every time I walk by a handful of dates or a freshly piece of baked whole bread). I still enjoy them occasionally, but my problem comes with availability: if I have large quantities at my disposal, I just get out of control.
In those moments, I must come back to my Guiding Principle: LONG-TERM HEALTH FIRST. When I am primed to it, the decision to let the craving go is as automatic as it is immediate. The craving just ceases to exist because I am onto something bigger. I want my blood glucose to have been in range 90% of the time by the day I turn 100 years old, and that achievement starts today, now, as those slices of bread talk to me “eat us, we’re tasty!!!”, but I kindly tell them “I know, but I am ok for today, I can always come back tomorrow!”.
Noting my cravings is a choice of mindfulness. It gives me those few extra seconds to bring my Guiding Principles on top of my head and let them drive the right actions: I eat certain way because I want to be in good health, so I won’t eat that slice of bread today even if I really like it, and If I want it I can prepare a delicious lunch with it tomorrow, planning my meal and setting up the conditions for my blood glucose to stay smooth and flat.
It takes some effort at first but then it gets easier and becomes second nature. The only problem is that we are often too quick to surrender to the power of the old habits we’re trying to eradicate, and without our being intentional about our actions we’ll collect a bunch of actions contrary to the new direction we’ve set for ourselves, a bunch of regrets, and probably some frustration.
Do You Want To Be Right Or Do You Want To Be Healthy?
Despite knowing all of this, last month I was in range 80% of the time, and my carb-to-insulin ratios were actually quite low, much lower than usual.
Trust me when I say I’ve come up with many explanations and ways to rationalize: the weather has changed, some stress at work, some trouble sleeping, “I know this bread is not ideal and it’s the third day in a row I am eating it, but haven’t had time to cook lately you know…”, and thousands of others.
Guess what? That the weather always changes, work issues will come up for everyone all the time, sleep is not always be perfect for everyone all the time, and not everyone has time to cook the perfect meal all the time. That’s just part of a normal life and everyone experiences them just like I do, also the people that live with time in range above 90% .
And indeed, here’s what really happened: I didn’t follow my own guiding principles. I didn’t translate them into the behaviors that would lead me closer to the outcomes I envisioned. And I came up with excuses to rationalize myself indulging in my favorite junk(ish) food.
I ate plenty more processed foods than usual just out of convenience or laziness (hummus with oil, soy yogurts and other soy products, some processed carbohydrates, etc); I kind of knew my ratios but wasn’t really updating them, so my insulin doses were not really correct and my blood gluose fluctuations reflected my lack of precision; I ate most of my meals in a rush, and even when I had time to eat I just slammed down food as if I was competing against someone, increasing the likelihood of post-meal spikes.
I know what’s required to succeed: eat whole plant-based as much as possible, cut the junk, track carbs, adjust ratios, calculate insulin, time injections correctly, eat slowly, move (I dedicated an article to the topic, and put the framework into a free PDF which you can download).
You Can Get There. Just Do What’s Required
No conspiracy, I was not getting the results I had set to achieve simply because I was not following my principles, my process. I cannot complain about an 80% time in range and irregular blood glucose through days and nights if I am eating foods that by definition lead to insulin resistance and the endless cycle of hyperglycemia-rage bolus-hypoglycemia. It’s very simple: there is a clear set of things I must do to reach my goal of >90% time in range. Am I sticking to the plan with a 100% commitment? No, I simply crave foods out of…I don’t know, some old habit? And then come up with explanations to justify why it is right for me to eat them.
The question I have started to ask myself is: do you want to be right, or do you want to be healthy?
If I want to be right (it’s right for me to eat this bagel because bla bla bla), I should not be sad or frustrated when my TIR is at 80% instead of 90%. That is the pure logical consequence of eating a poor diet. If I want to be healthy (and health is my top priority), then that bread will stay on the shelf and I will lean on a piece of fruit. Easy. And my time in range, over time, will improve just like my insulin sensitivity.
Decide which game you want to play: if tracking carbs and adjusting ratios feels like chores, if those pizzas and sweets are too irresistible, and if you’re ok with a blood glucose of 70%, then fine! That’s what you’ll get.
There’s no magic trick to succeed, it just comes down do doing the work that nobody, not even myself sometimes, wants to do. What gets measured gets managed. That’s why we need C:I ratios! We must know the carbs and the insulin, and we must sit there to understand what goes on and how to make it better.
We often ignore these things because they feel like a pain and we just want to “enjoy life”. I don’t see being enslaved to oscillations and being interrupted by unpredictable blood glucose at any time of day and night as “enjoying life” anymore, though.
It is a constant work of self improvement and growth, an act of self responsibility and ownership for me, for you and for anybody else. But only a few people do that consistently, and perhaps that’s exactly why only a bunch of people get the results. I want to be among those people. Do you?
I will leave you with a sentence from James Clear which in my opinion summarizes the message of this article very nicely:
"When you choose the benefits of an action, you also choose the drawbacks.
If you want to be an author, you can't only choose the finished novel and book signings. You are also choosing months of lonely typing. If you want to be a bodybuilder, you can't only choose the fit body and attention. You are also choosing the boring meals and calorie counting.
You have to want the lifestyle, not just the outcomes. Otherwise, it doesn't make any sense being jealous. The results of success are usually public and highly visible, but the process behind success is often private and hidden from view. It's easy to want the public rewards, but also have to want the hidden costs."
A few days after writing this article. No magic: just choosing to do the right thing over and over and over again.
