Tag Archives: diabetes

When Eating Disorders Meet Eating Requirements

Debbie says:

For a person who doesn’t have diabetes, I know a fair amount about it. My partner has Type II diabetes, and so do a number of my close friends. For myself, I have been “pre-diabetic” (a term defined by your blood sugar numbers) for over eight years now, which makes the “pre” a little suspicious. My best friend for part of grade school was a Type 1 diabetic.

What I know about eating disorders is more academic. Although I have occasionally indulged in what people might call “binge” eating, I have never been anorexic, or bulimic. I’ve never been a serious dieter, though I’ve done a reasonably good job of controlling my carbohydrate intake since my blood sugar numbers started to go up in 2007. At the same time, the work I’ve done with Laurie both for our books and here at Body Impolitic has made me very aware of eating disorders, both from the personal story and the scientific data perspectives.

So I was struck by Bryce Covert’s excellent essay, “I Thought I Was Over My Body Issues, until I Got Diabetes.”

When I found out I had Type 1 diabetes, I had just finished eating a slice of pound cake. I still had powdered sugar stuck to my fingertips when the phone rang.

In the months before that phone call, I had become insatiably hungry. I would finish eating an entire meal — something as filling as pad Thai or Indian curry — and instantly want to eat the same thing all over again. This unending hunger would have brought me guilt and pain if it had struck in my teenage years or early 20s. I would have wrestled it into the back of my mind and denied it what it called out for. But by 30, I had ended that battle and agreed to give my body what it told me it wanted. And it had lately been telling me it wanted everything.

Almost without exception, this is how stories of getting over eating disorders and food-related body dysphoria end. “I gave my body what it told me it wanted.” Covert is clearly living in the culture’s body/mind division, which I theoretically believe is not the best for us, and which I find myself falling into all the time. More to the point, she had figured out that what she ate wasn’t a war, or a contest, or a secret test: it was just food.

Then there’s a quick medical stereotyping story. Despite extreme thirst, atypical hunger, and inexplicable weight loss,

… the doctor told me unequivocally that I didn’t have diabetes, despite a nurse’s suspicions. You’re too old, she said. You’re not sick enough. You’re not overweight.

“Too old” refers to Type 1 diabetes, which is generally diagnosed before a person is 20. As a quick oversimplified distinction, Type 1 is primarily about the body’s inability to produce its own insulin, and Type 2 is primarily about the body’s resistance to its own insulin. I know someone who was diagnosed with Type 1 diabetes in her early 30s, which is “too young” to expect a Type 2 diagnosis (which shows up in your 40s or beyond). She wasn’t thin, which perhaps made it take longer to confirm that she really had Type 1. These things happen; doctors should probably not be unequivocal, and yet it’s easy for doctors, like the rest of us, to confuse stereotypes with certainties.

Covert’s relationship with dieting started when she was 12, and her belly began to bulge.

I wanted to have power over what my body looked like. I found that power in strictly controlling what went inside it. It was often, if not always, misinformed. I decided the best way to eat fewer calories was to eat less food. I would deny myself whatever I thought I shouldn’t have with the discipline of a monk. I spent one memorable day holed up in my bedroom abstaining from everything — from the moment I woke up until dinnertime — so that I could eat the unknown calories in the Chinese takeout my family ordered every Friday evening guilt-free. But the delivery that night came hours late, at which point I was close to fainting. … What I lost in strength (and pounds — the only other time I’ve been below 100 was one particularly austere summer during high school) I felt I gained in control. I didn’t care about giving my body what it needed. I cared about making my body look the way I needed it to.

That’s the key to eating disorders as I understand them; they are about control. The calorie intake, the size of the stomach, the curve under the chin–those are the outward manifestations. But in the life of a young girl with so many pressures on her to look, act and feel certain ways, and so few areas where she can make her own choices, control is irresistible. If our culture venerated size, these same girls would be counting calories with a view toward increasing them as much as possible.

So Covert worked for over a decade on this control, and then worked at least equally hard to let go, eat what she wanted, with the most valuable kind of success there is.

I began to feel something akin to what I felt as a kid: that my body was a means to an end and not the end itself.

Then, diagnosis.

… a Type 1 diabetic has to become her own pancreas. I’ve marched into another full-on struggle against myself, assuming the job of an organ that can no longer function because my body is trying to destroy it. This requires dictatorial discipline. For every given amount of carbohydrates I eat — which can be found in foods ranging from sugar to bread to beans to even milk, and which then turns to sugar in the body — I inject myself with a corresponding dose of insulin. I compute in quantities of 15: For every 15 grams of carbohydrate, I need one dose of insulin.

Aside from her own story, which is still unresolved, Covert connects the dots: girls and diets, women and auto-immune disorders, body hatred and the desire for control.

The whole thing leaves me wondering: if girls and women weren’t judged by our looks to such an extreme extent, would we have the same auto-immune disorder numbers that men do? Is there some kind of subtle, unexplored link between our pre-pubescent focus on our bodies and our adult risks? Covert doesn’t take her musing this far, but I suspect she’s asking herself the same questions.

Resurfacing

Debbie says: Have you missed Lynne’s voice around these parts? Laurie and I certainly have

Lynne Murray says:

I am starting to come back from several months of sickness. I had to seek out medical care even though a house-call doctor visit took a big dent out of what was once my savings.

I’ve been without medical insurance more often than not in my life and now I can’t afford more than Medicare, Part A–so, no coverage for doctors, tests, etc. That was not a problem so long as I wasn’t in intolerable pain. Only in spring of this past year did that situation arise. I had wounds that were not healing and pain that kept me up at night.The doctor was helpful and open to collaboration and experimenting with different strategies to improve my health. He didn’t say that the slow healing might be due to diabetes, but he took my blood and the test result was that I do indeed have diabetes.

I would say that we don’t have a history of diabetes in our family, but we don’t have a history of regular medical care in our family, so who knows? Anyone I might ask is dead already.

As a fat person who already deals with some disabilities, I felt like the diabetes diagnosis was an indictment. The doctor agreed that I would work on lowering my blood sugar first without medication.

I looked for resources. I didn’t want to talk to people I knew or met about diabetes. I didn’t want any advice, I wanted facts, but some people nonetheless shared strange suggestions with me, like it or not. One woman, who was terrified that she would develop diabetes after watching her mother’s horrible death from it told me her doctor advised her to lose 40 pounds through calorie restriction (a soup diet!) and walking. The doctor told her to stay away from the gym until she had lost the weight because the increased muscle mass would get in the way of her weight loss goals. This incredibly stupid prescription ranks very high on my list of least helpful doctor’s advice of all time.

After looking at and discarding several books, I found Jenny Ruhl’s website and her book, and they really resonated with me.* She writes:

I was diagnosed with diabetes in 1998. Since then I’ve kept my A1cs in the 5.0-6.0% range using the techniques you’ll find explained at [the website], where you’ll also find extensive discussion of the peer-reviewed research that backs up the statements you read here. …

While people with diabetes often are seriously overweight, there is accumulating evidence that their overweight is a symptom, not the cause of the process that leads to Type 2 Diabetes.

Even so, it is likely that you’ve been told that you caused your diabetes by letting yourself get fat and that your response to this toxic myth is damaging your health.

Blaming you for your condition causes guilt and hopelessness. Even worse, the belief that people with diabetes have brought their disease on themselves inclines doctors to give people with diabetes abysmal care. They assume that since you did nothing to prevent your disease, you won’t make the effort to control it. So they ignore your high blood sugars until they have lasted long enough to cause complications and then they prescribe the newest, most expensive, potentially dangerous but heavily marketed drugs, though the drug-maker’s own Prescribing Information makes it clear that these drugs cannot lower your blood sugar to the levels that reverse or prevent complications.

Ruhl examines all the scientific literature with a clear eye and demonstrates a viewpoint close enough to my own Health at Every Size philosophy to make sense to me. She demonstrated to me that such approaches to lowering blood sugar have been around on the internet for some time:

The advice you will find below is an edited, updated version of the excellent advice written by a lady named Jennifer, which she posted for many years on the alt.support.diabetes newsgroup. It has helped thousands of people bring their blood sugars down to the level that gives an A1c test result in the 5% range. Note: The Jennifer who wrote the advice is not the Jenny Ruhl who maintains these pages. (Home/How to Lower Your Blood Sugar)

Her suggested method of lowering blood sugar included beginning by eliminating most carbohydrates, and adding them back, testing your blood sugar with a meter one then two hours later, and adding back the ones that have the least effect on you personally.

Ironically, all my early years of dieting proved useful during the first part of severely limiting carbohydrates. I reached back through the decades to all the times when I had changed my eating patterns overnight. Easily done.

A week later I finally got my hands on a blood sugar meter and test strips and started testing. The numbers were low and they’ve gotten lower, so I am hopeful to be able to manage without medication. The stakes are high enough that so far I am motivated to do it.

Ruhl writes:

Almost everyone diagnosed with Type 2 diabetes has a long history of trying to diet off weight and failing miserably. If you believe that your health depends on even more dieting, it is easy to give up hope.

But it turns out that a diabetes diet is very different from a weight loss diet of the sort you can see illustrated in the photo above. The point of a diabetes diet is not to lose weight. The point of a diabetes diet is to bring your very high post-meal blood sugars down into the normal range. You can eat as much food as you want on a diabetes diet, as long as the food you eat is food that doesn’t raise your blood sugar. (Diets/A Diabetes Diet is Different from and Easier than a Weight Loss Diet)

After the initial “get rid of the usual carbo suspects” purge, I called upon my post-dieting years of learning to respect, listen to and nurture my body. The challenges were unexpected–e.g., figuring out how to get enough fiber without the standard carbohydrates. Health food web sites offered some strategies (high-fiber-low-carb crackers, ground flax seed, etc.).

I was too sick with the infections that I’ve been battling to develop any cravings. Around the same time I was figuring out what to eat, I started on a particularly aggressive antibiotic, so low carb eating was only one goal–the other was to get through the day without throwing up.

For most of the past year I haven’t able to think or engage with ideas very effectively. Even reading posts on Facebook was sometimes too much.

In the past few weeks, my mind seems to be clearing! I could tell that my energy was coming back when I encountered a woman who came to my house to get a household item I was giving away on Craigslist. She showed up unable to lift the 22-pound spin dryer and demanded rope. I managed to get some thick string and helped to tie it to the wheeled suitcase she proposed to use to haul it home on the bus. I helped her because clearly, getting her out of my space without the free item she had come for would be more difficult. During the time I helped her, she produced a grubby piece of candy and offered it to me for some unknown reason. I made the mistake of telling her I was diabetic and she unleashed a torrent of fat-shaming remarks until I lost my temper and told her that my body was none of her fucking business. in those exact words and a rather loud voice. She looked around (the door was open to the hallway) and said something about neighbors. I told her I was cutting the string and she should tie the last damn knot and go on her merry way.

I was still angry for a long time after she left. Then, somehow, I managed to switch my mind onto another track. For the first time in months, I started to ponder some plot problems in a manuscript that had seemed just too much to pick up for the better part of a year. Surprisingly (to me anyway) I thought of a solution and I went ahead and started writing it.

Doing that reminded me why I write fiction. It takes me into another life even more powerfully than reading (which is pretty powerful). I was afraid that writing might not come back, but it has!

So here I am, still wounded, and not back 100%, but starting to surface.

* Jenny Ruhl doesn’t have separate URLs for the different essays on her sites. The name in parentheses after her quotations tell you where to find the context on bloodsugar101.com)