How I Fixed My Diabetes Crisis
Last week I was very explicit about the big diabetes mess I had carefully created for myself. To recap, for a period of ten days circa, my blood glucose was an absolute obscenity, and my time in range, my insulin to carb ratio and my general well being followed suit.
I was in range 60% of the time with huge spikes (up to 350) every night, I was chasing my meals with randomly guestimated boluses, the variability of my glycemic index was extremely high.
As a consequence my levels of energy were coming and going (going, for the most part!), runs were partially affected and my peace of mind was somewhere else too.
While there had been rare and stressful life circumstances that threw me out of my “as usual”, and I am certain that was the small initial snowball that was thrown at me, I am quite as certain that the responsibility for allowing that snowball to turn into an avalanche is on me.
My beloved green light foods (whole plant based foods that are naturally rich in carbohydrates and low in fats, like fruits, vegs and whole grains) were largely replaced by yellow lights (baked products with added fats, breads, peanut butters and the likes).
I stopped tracking what I was eating: my ratios and my dosing became random. A sort of “let me eat this random thing and I’ll figure out the bolus later. And I’ll cross my fingers it’s right”. And it was never right of course.
In my previous article you can read what this led to. I didn’t like the place I had reached: bad in the immediate term due to the strain on my body, on my mind and on my brain performance; bad in the long term, considering the health implications of prolonged states of insulin resistance and of chronically elevated blood sugar levels.
Facing The Problem And Taking Action
I started with a piece of paper and listed down all the things that were not quite right, and their consequences, in painstaking details. I wanted to have a tangible, material view on the damage my actions were producing right in front of me.
Something like:
I just ate half a bag of bread and I feel sleepy, and my BG is skyrocketing. I know that this will shoot my BG to the moon tonight while I sleep, and that my sleep quality will be compromised.
Another day has passed and I’ve not logged one single food item on my decision tree. The rapid insulin I’ve just injected is a random dose. This is going to either send blood sugar high, or too low. Either way, I am not going to be able to keep my focus at work this afternoon.
I have a long run tomorrow and I don’t know my ratios. I don’t know whether I’ve fueled up correctly or not, either. I hope I won’t bonk, and that my glycemic index will stay stable. If that happens, it’s going to be pure luck rather than me being intentional and careful in my dosing.
Once I recognized all the issues, and their detailed set of consequences, I had some very good reasons to came back to my process for getting out of hell.
Reshaping The Environment
I began by moving all the things I needed from the shadows back to plain sight. My decision tree, the diabetes journal, was either on my desk with a pen on it or in my pocket. My food logging app was one of the three apps that made it to my phone’s home screen.
Green Light Foods - those plant based whole foods that are naturally rich in carbohydrates and low in fats such as Fruits, vegetables and whole grains - regained their 90% share of my shelf and fridge space, the remaining 10% being left to strategic yellow light foods that I use for long distance running, such as some pieces of packaged bread with some oil, soy milk, dates and chocolate.
At the center of the table
Equally, I removed any unnecessary processed food from sight. I didn’t buy another jar of peanut butter, nor did I buy more bread than the two or three pieces I had planned to eat before my long run. If I felt like snacking, carrots would be the only thing I could reach for.
At the center of the fridge.
And I printed on a big sheet of paper the area of life that is most important to me (long term health), my values and three daily actions to ensure I live up to that vision. That sheet is on my fridge, on my desk, in front of my bad and on the bathroom mirror. It’s also a bookmark on my laptop and phone. In this phase, I just need to see it everywhere and remember why I do what I do as frequently as I can.
The sheet / wallpapers is structured more or less like this:
AREA: HEALTH
VISION: “I want to spend my life in range at least 90% of the time and run a marathon at 100 years old”
DAILY ACTIONS TO REALIZE THAT VISION
“In order to be in range 90% of the time for the rest of my life, I, Giovanni, must eat green light foods to improve my insulin sensitivity.”
“In order to be in range 90% of the time for the rest of my life, I, Giovanni, must keep track of everything I eat, the ratio and the insulin I need to inject.”
“In order to be in range 90% of the time for the rest of my life, I, Giovanni, must recognize when a craving arises, and question three times wether eating that less healthy food makes sense.”
…
And I let these list of actions be within sight all day long. And in turn, inspire and guide me.
If my visions for the future sound too ambitious, that’s exactly the point. They force me to aim high and strive for the best possible outcome. I do really have the intention of running a marathon at 100 years old, because that simple act will be the result of many good choices made all throughout my life. It will mean that: I have reached 100 years, I had no major health complication related to diabetes or else, that my lifestyle has been health promoting, that I’ve eaten well, that I’ve ran and trained well and sustainably, that I have had a good emotional and social life, and so on, day after day after day, etc etc.
Should I fall short on these targets and run that marathon at 90 years old, well, it doesn’t really sound like a loss to me anyway.
Not Smooth, But Effective
Don’t get me wrong, I still crave all those tasty treats. I still resist or forget to log and track everything on my decision tree journal. But as long as I am doing it nine out of ten times, then it’s ok. And tomorrow I’ll have the opportunity and motivation to do it ten out of ten times. It’s all about building momentum and staying locked into the process. And believing, and having a vision.
I still did many mistakes. But every day I tried to do one less than the day before, and when I felt lazy or too weak, I could always deploy the Goggins approach: just shut up and do it. Brute force. That worked wonders when I caught myself into that good old loop of excuses and victimhood. I had a year-long list of reasons to rationalise why I wanted to eat that pizza on Wednesday night, or attack that sugary granola for breakfast. Then I remembered that doing these things would throw me right back into the loop I was trying to escape. Every cell in my body wanted to eat it, but I said no. And walked away from the pizza. It sucked, but it was effective.
I am now out of that, for the most part. My blood glucose has once again found its regularity and stability. My runs are not ruined by the issues of type one diabetes. My mental clarity and performance is back, and my sense of frustration is mostly gone.
One fruit bowl at a time, one page of my journal, one breath after the other, I am back in charge.
Speaking about time in range and blood glucose control, here’s the more disciplined version of me sharing my experience as a T1D endurance runner in an interview on the Mastering Diabetes Youtube Channel!
