As a doctor, it’s easy enough for me to think I understand a disease state, and then to know how to manage it with medication to be taken two or three times daily. I spent hours and hours studying that problem. I talked with patients who were diagnosed with that illness, and learned how it changed their lives. But it’s still not the same as having someone close to you diagnosed with it.
Diabetes has been like that for me. I learned a lot in medical school and residency. I continued to learn from my patients. But in the end, a friend taught me more about diabetes than anyone else. She became an expert because she had to: she was diagnosed with it when she was 9. She is a type 1 diabetic, which means that her pancreas doesn’t make any insulin at all. All the insulin that she uses comes from outside, via a pump or a needle.
D is absolutely expert at keeping her blood sugars normal. In fact, I wish everyone’s blood sugars were as good as hers. Over the years and decades since her diagnosis, she has learned to predict with virtual certainty which foods will cause her blood sugars to spike, and which ones will not. But she doesn’t leave anything to chance. There is no guesswork. She uses her glucometer to check her sugars all day long, before meals, after meals, before she takes a walk, or a drive, or a nap.
D is not into self-deprivation. She loves ice cream, cookies, and cake just like everyone else. But she knows they will cause her sugars to spike, and she doesn’t want that to happen. So she eats treats only when her sugars are too low. In other words, she treats them like medicine, like another tool in her arsenal, in order to keep her blood sugars normal. Once, when her blood sugar was low, I watched her eat a quarter of one of those gargantuan chocolate chip cookies from a fancy bakery. It was definitely an adequate single serving. It’s just that I had never seen anyone actually break one of those giant cookies into quarters. Halves, yes. But quarters, no. Not until D did it. But it worked, and her sugars normalized shortly. She put away the rest of the cookie for another time.
Of course, you should know that she never creates low blood sugars on purpose to give herself an excuse to eat a treat. She isn’t intentionally making opportunities for treats. But when her blood sugars drop, she treats them with treats. Maybe she’s caught a virus. Or maybe she misjudged how far she was going to walk. Or maybe she’s stressed for some other reason, like cramps, or sleep deprivation. All kinds of stressors can cause people’s blood sugars to move up or down. Also, if she exercises more on any given day, she will usually lower her insulin dose to keep her blood sugar from dropping too low. But if she misjudges even slightly, that might become a reason to slip a hand into her pocket for a jelly bean or two. Keeping her blood sugars normal requires her to constantly juggle a lot of variables, but the truth is that it’s become second nature to her.
Yes, there is a place in her diet for candy. But she doesn’t just load up on it whenever she feels like it. She carries individually-wrapped jelly beans and uses them as “medicine” when her blood sugars are dropping. She told me once that each jelly bean raises her blood sugar about 6 points. She knows this measurement exactly. So five jelly beans will increase her sugar from 50 to 80, as long as she’s sitting still. If she’s walking, her blood sugars become a moving target and it becomes a little trickier to get them back up into a normal range. On occasions like these, we have sat side by side on a bench or curb for a few minutes, waiting for things to stabilize.
She also has a deal with her family: It’s fine to have ice cream any time you want — you just have to be willing to walk to the ice cream store to get it. Of course, she is happy to go with you! She gets the sugar-free ice cream. But if you don’t feel like walking, then no ice cream. You have to earn it. This might seem drastic, or it might sound like the sanest approach to treats that you’ve ever heard. Before you decide which, remember that D’s blood sugars are perfectly normal. And that everyone in her family is active and comfortable with their weight.
I consider type 1 diabetes to be a “canary in the mine.” Long ago, miners carried caged canaries down into the tunnels with them. If poisonous gases (like methane and carbon monoxide) leaked into the mine-shaft, the canaries, more sensitive to the stress of the poison, would be affected (and die) before the miners began to experience symptoms themselves. The miners would then, at least theoretically, have time to escape.
We can use what D has learned to keep our own blood sugars normal today. We don’t have to wait until we start running out of insulin and we then get diagnosed with type 2 diabetes. We can take a page from D’s approach to blood sugar management to keep our own blood sugars in the normal range right now. Here is what D has taught me:
#1 Don’t feel guilty every time you feel like having a treat. Just “earn” it. That’s why it’s called a treat.
#2 Give each of your kids another jelly bean every time they pass one more block the next time you go on a family hike. Walk to the ice cream store.
#3 One serving is a slice of cake, or a cup of ice cream, or two small-medium cookies. One serving is enough.
#4 Ready for more drastic measures? Do you have two diabetic parents? Buy a glucometer and check your own blood sugar 60-90 minutes after you eat. If your blood sugar still hasn’t returned to the normal range (80-120), think back over what you ate, and see if you can figure out why. Over time, you will get better and better at predicting which particular item(s) caused your blood sugars to spike, while you simultaneously get better at preventing it from happening the next time.
This is how to keep your blood sugars normal. Why wait?