The most powerful tool to manage type-1 diabetes
Managing Type-1 diabetes can be a challenging task. To be frank, any diabetic know that it is a challenging task!
There are a plethora of factors that need to be considered, such as monitoring blood glucose levels, getting insulin doses right, following a healthy diet, tracking the intake macronutrients, engaging in physical activity, sleep, life stress and so on. Keeping track of all these factors can be overwhelming, especially when one has to sit down and do the math to figure out the next insulin shot at every meal (luckily, this can be automated!).
So yes, the process can become overwhelming and can be discouraging at times. Life can get busy, and despite of all our efforts to keep the right BG levels, sometimes we just lose control.
That is why I think that the most powerful tool that can help manage diabetes more effectively is one that forces you to keep track of what goes on in your life. That tool is journaling.
What is journaling
Journaling to me is as simple as “writing down your stuff somewhere”. The form can be that of a piece of paper or a document on your laptop. The content can be any area of your life you want to keep under scrutiny and ideally improve.
Journaling, and writing in general, has the immense benefit of forcing you to trap somewhere physical all the fuzziness of whatever goes on in your life and in your head. As soon as you have written some of that down, it is not a mere abstraction anymore. It is something you can touch and see and feel more concretely. If something is just wondering in your head, it can get lost in the midst of the millions of things that happen in a day. When you write it on paper, you have trapped it, you have seen it, and it is now much harder to ignore it.
How I journal
I have been journaling for a few years now. I keep journals for a few life areas I am trying to observe more closely and to improve:
one daily journal for personal stuff, where I write about how I feel, what I am grateful for, what I am proud of and not-so-proud of;
one weekly journal where I review my week from a higher standpoint, auditing my actions with respect to the goals I set out to achieve, and most importantly to the values that I abide to;
one for running, where before and after every run I note how my body feels, if I have pains or bothering sensations somewhere, how is my energy, how I handled nutrition and hydration leading to that run, etcetera.
It may sound complicate, but it is not. I won’t go into much detail of my journals for now, but suffice it to say that I do journal for five minutes as soon as I wake up, and for other five minutes at the end of the day.
At dawn, I take note of where I am at physically and mentally, and how I’d like my day to unfold. In the evening, I come back to my earlier entries and see if I was able to stick to my intentions and values. I also take a few notes about the food I ate, the exercise I did, and if there was any big problem with my diabetes management.
The whole thing does not take more than five minutes at once, and it is as simple as a few bullet points on a page.
The sole purpose of these entries is to help me keep a proper track of the evolution of my goals, my processes, my behaviours, successes and failures.
In these years, this practice has helped me spot behavioural and lifestyle patterns that were causing harm or holding me back, and the fact I had a place where all these information were stored made it much easier for me to find the fil rouge, connect the dots, figure out the causes and treat them.
Years of my life, paper format.
For instance, it was not until I wrote down for more than 30 times (i.e. more than 30 days) that I was not proud of the amount of food I was eating at dinner, that I finally one day I sat down and said
“Alright, 30 days of overeating is enough. I don’t like how I feel after, how it affects my sleep and my blood glucose, it may be the case to just stop this, ain't it?”.
I was also able to relate this pattern to some apparently unrelated life stress that was going on in that period. I say “apparently”, because had I not wrote that down the connection would have never been observable. Once I saw that stress was the issue, I focused on stress instead of eating: I was finally addressing the root of the problem instead of one of its consequences.
Once stress was under control again, overeating solved itself just as a logical consequence.
My journal for managing type-1 diabetes
In the past I was not that great at managing my type-1 diabetes. I had no clue why my BG was skyrocketing overnight, what types of foods were affecting my insulin sensitivity in this or that way, and how that all was affecting my daily life.
That is why I introduced journaling as my main tool to monitor my diabetes management.
I keep my diabetes journal very very simple, and as a complement to my “diabetometer”, where I automate the daily calculations of my carb-to-insulin ratio. At it’s core, I note down:
my daily activities and life events, like what is going on at work or in relationships or elsewhere. This is an important area to consider to spot potential stress factors;
what I eat, and how much, at every meal;
how much insulin I take;
my blood glucose levels before and after meals;
the type of physical activity I engage in.
By doing so, I can account for and relate many different factors all at once. The patterns and relationships I identify are not necessarily bulletproof from a scientific standpoint, but that is not the point of the exercise.
The point is to take a moment at the end of the day to go through the notes and say
“Ah, so this happened today at work and I notice I ended up with a higher BG after my lunch, even though I ate the same as yesterday and respected my carb/insulin ratio. Could it be that the stress at work contributed to the spike? Maybe! Let’s see how it plays out in the coming days, and figure out a solution in case.”
Again, not scientifically valid, but once one gathers enough evidence and experience, these anecdotes may unveil some hidden and unintuitive patterns that could have been lost. If you realise that your body reaction to work stress causes a spike in blood glucose, then you know that when stuff happens at the office you may have to inject a few more insulin units. Or perhaps the solution is not even strictly related to diabetes! Maybe breath work or mindfulness meditation are enough to calm your sympathetic nervous system, tame the release of cortisol and in turn the spike in BG.
Why journaling is crucial for managing type-1 diabetes
Let me stress this point once again: one of the most significant benefits of journaling is that it forces you to sit down and reflect on your experiences. It allows you to think through what went well and what did not go so well, and to identify the reasons behind it. By doing so, you can come up with a plan on how to increase the good and decrease the bad.
With journaling, you to spot patterns and you have a shot at fixing them. For me, this blog is just a big public journal! I write down things lie how diabetes and running interplay with each other, how eating high protein affected my BG levels, how intermittent fasting helped me thrive, how a high-carb whole food plant based diet has unlocked the wonders of 90% time in range, how mindful eating has improved my stress management and my blood glucose levels, and so on.
Sure, it takes time and effort, but at the end of the day being intentional and thoughtful about what we do is the single best way we have to ensure our actions, plans and values are all aligned, at least most of the time.
Sure, one could have a great memory and recall everything without the need of writing. I am not that person, but there could be some human out there with this ability. However, a thought is a thought: it passes and is quickly replaced by the next one in the natural flux of our minds.
Why you should start journaling for type- 1 diabetes
Writing, and taking notes of details in general, is just enough to free up some of our limited mental capacity. To think through our problems, to acknowledge our successes and to audit the causes of our failures. When something is on the page, you don’t need to store it in your mind anymore. You give it a physical dimension, you can see your “demons” and fight them. You can see your “angels” and hang out with them.
You are concretising your problems and getting to deal with them if you choose to: “This is the problem, and this is the next best action I can take to fix it”.
If you notice that your blood glucose levels are consistently high after eating a certain type of food, you can make a conscious effort to avoid that food or adjust your insulin dose accordingly.
Similarly, if you notice that your blood glucose levels are low after engaging in physical activity, you can adjust your insulin dose or snack intake to prevent hypoglycemia.
If, as in the previous example, you notice that work stress causes your blood glucose levels to rise, you know that when things get busy at the office you may have to fix your insulin dosage, and that some mindfulness may be of great help.
If you don’t know how or when to start, just take a small notebook and note down a few lines at the end of the day:
How was my BG today?
Did my insulin dosage vary from yesterday? Did I eat anything different?
Did something particular occur in my life?
If you feel like you’ll forget to do your entries, try set a reminder or change your routine to ensure you do not forget. Put your journal on your bed or on the countertop in the kitchen, so that it “gets in your way”. If it is visible, you will hardly miss it.
And yes, make some conscious effort to stick to it too. It may sound intimidating at the beginning, but just a few weeks will be enough to break that barrier.
In conclusion, journaling is a powerful tool for managing Type-1 diabetes. It helps you to reflect on your experiences, identify patterns, and adjust your management strategies accordingly. By keeping a record of your daily activities, you can monitor your diabetes more effectively and take control of your health. That is a small investment of time and energy that goes a very, very long way.
Some easy prompts to get started
If you feel inspired to start but don’t know how exactly, here are some journal prompts and questions I often use, and that you can consider introducing in your practice:
How was my blood glucose levels like today? Was there anything weird?
Did I sleep well last night?
What foods did I ate today? How much insulin did I need, and how did my BG react?
How much I exercise today? Were my blood glucose levels different from days when I exercises more, or less??
How was I emotionally? Was I stressed?
What challenges did I face today in managing my diabetes?
What successes can I celebrate?
