I’ve lived with diabetes for 13 years. For the first six years after my initial diagnosis, I still produced my own insulin, I could manage the whole thing with yoga, diet and herbs. I never imagined I’d need insulin. But then I did.
I started slow.
First there was the daily shot of basal insulin. I restricted my diet, ate under 30 carbs a day, exercised fanatically, dragged myself up and down hills and ate a ketogenic diet. I sported flat lines and felt safe and confident with my management. That went on for 4 years. It worked, until it didn’t.
10 years after my diagnosis I took the plunge and started meal time insulin. My motto was, a little goes a long way. I used 1/2-unit syringes and eked out the doses. Learning from the low carb diabetes community that the less insulin I used the less likelihood of lows. It felt safe and doable. I could relax. Or so I thought…
Last year I started needing more insulin because I made a radical change. I wanted to go vegan for ethical and emotional reasons. I’ve talked a lot about the ‘why’ here on the blog. Suffice it to say changing from a strict low carb diet to a high carb low fat one has been no picnic. I’m nearly a year and a half in and it’s tough.
Don’t get me wrong. I am over the moon being plant based. I feel healthier, I’m more resilient and I love being creative in the kitchen again, but to be honest I’ve struggled with my mindset.
Right now, I’m dealing with Diabetes Burnout.
I though diabetes burnout would look like giving up on my management or feeling like things were hopeless. But Diabetes burnout is subtle. Mine was triggered by a severe low. I wrote about that on the blog too.
Since my low I’ve lost confidence with dosing. Even after meeting with my diabetes coach and fine-tuning things, I’m still afraid. As a result, I’ve been taking less than I should, or over treating a low and then not correcting when I go high. I’ve let my blood sugars run high over night. Been afraid to adjust my basal rate and tweaked and adjusted my bolus ratios up and down like a yoyo. Looking at my meter day after day and watching the peaks and valleys, I feel defeated. I keep asking myself where did I go wrong? I have all the right education, I know what I need to do, but when it comes to doing it, I don’t.
In Tandem with going plant based, I’ve been studying Mental health Aware Yoga. This involves being able to tailor a class to students dealing with any kind of mental health challenges like anxiety, depression, trauma and stress. One of the first things I learned was how to create a safe container. How to make my students feel safe no matter what.
Feeling safe goes hand and hand with gaining confidence. And if I’m really honest with myself, right now I feel the opposite. Out of my depth and worried I’ll never regain ground.
So how can I create a safe container for my life with diabetes? I don’t want to wrap myself in cotton wool, but I do need to feel safe when making decisions that often make me feel like I am teetering on the edge. It’s heart thumping, stomach churning scary stuff. Who wants to jump of a cliff ever?
There’s a Zen story:
“An honor student, frustrated with his life and with school, worried about what tomorrow may bring, approached his teacher asking for some guidance.
“The story goes,” says the teacher in response to his students request for help, “That a Buddhist Monk was walking through the mountains one day. Then, out of nowhere, a tiger appears, chasing the monk towards the edge of a cliff. The monk, in his quest to escape the tiger, runs to the edge of the cliff and climbs over the side, where he sees five other tigers 15 feet below him, waiting to eat him.
So, the monk is just hanging there, holding on to a vine on the side of the cliff, waiting there for the little chance he has to escape or for his imminent demise. Then, as the monk hangs there, exploring his options, he turns to the left and sees a strawberry.
He smiles, “Wow what a magnificent strawberry!” he says to himself. So, he picks it and eats it.
The student waited for his teacher to continue but it was clear that the teacher was done with the story. “That’s it? That’s the story? The monk is about to be eaten by tigers so he reaches out to pick and eat a strawberry?” the student exclaimed.
“What’s the point?” he added.
The teacher replied, “The lesson is to know and embrace the experience of being alive. You must be alive every second you are alive.”
The student responded, “But teacher, everyone is alive when they are alive.”
“No,” said the teacher. “It’s the experience of being alive in each moment, in each experience, good and bad. We must be alive every second we are alive and not simply exist and live out our days.”
The student, confused, questioned his teacher, asking, “But everyone alive is alive, aren’t they?” he insisted.
“No. Look at you now,” explained the teacher. “You are running around being chased by tigers, consumed with your thoughts of how it could be better, how you could be better if only things were different. Yet, you have shared with me over the past year several difficult situations, in addition to the circumstances that I have observed, how you were about to be eaten by tigers and how you have been saved in each situation. You can’t be alive if you are living in fear and if you’re living in fear you can’t see and experience life; the magnificence of your life that is right in front of you in each moment.” – Keith Rosen
The story is a powerful reminder for anyone who grapples with challenging circumstances. To be fully alive means feeling the fear and doing it anyway.
And that’s what I intend to do. Starting today…
with great respect…
When I was little I was convinced a monster lived under my bed. Every night just after brushing my teeth and getting into my P.J’s I’d make a bee line for the bed and hide under the covers. Spending the night terrified that if I moved or breathed the monster would get me. Even though at night I was frightened for my life, I woke up every morning refreshed and unafraid. Somehow, I knew the monster could never survive the light of day.
After years of yoga, personal reflection, and trauma work I now know why I was so afraid. Having lost my mother suddenly at the age of 10, I projected the shock and fear into an external threat. As an adult and the author of my thoughts, I understand that I can only ever be the source of anything I project. The monster wasn’t separate to me, it was a part of my psyche supporting me to make sense of the incomprehensible. Mothers aren’t supposed to die and leave their 10 year old daughters.
Being with fear and uncertainty is something I deal with every day as someone who lives with type 1 diabetes. I spend my whole day managing risk. Most of the time I get it right. But every now and then I don’t.
To describe the onset of a mild low is easy. There’s the feeling of ants crawling around my middle. The rushing to the loo, the increased heart rate. A kind of hyper vigilance and anger all at the same time. But when the low is severe? With no warning? That’s something that defies words.
Last night was just like any other. We’d gone for our afternoon walk and I decided to water the plants. I’d kept my CGM in my coat pocket, so I could keep an eye on my levels. Often around sunset I dip low as my long acting insulin wears off. As my numbers were more than steady I decided to do some weed pulling. No more than 10 minutes, knowing that any kind of gardening induces a low. Still, after checking my blood sugar I was in the clear. A nice steady 5.0 mmol.
I came inside, prepared my dinner and then decided to have a shower. I took my long acting shot for the evening ( I split my dose), checked my level, it was 5.3 and hopped in the shower. I checked again when I got out and due to my CGM getting damp it read 5.6 with an upward arrow. Great, I thought to myself, I’ll check again in five minutes when the heat from the shower dissipates. On my mat, I started my evening practice. After a few poses I felt a strange tingling around my middle. Knowing that that is one of my ‘tells’ for a low, I checked my CGM, it said 5.4… I decided to cross check with my glucometer just in case.
Thank GOD I did! It said 2.9!
I freaked, checked another finger, while at the same time trying to wrack my brain as to where my glucose tabs were. Once the other finger came back with the same number I ran upstairs, realised they were downstairs and ran to them and shoved four tabs in my mouth at once. My heart rate was through the roof, I had no idea if 12 carbs was enough. Everything went into soft focus. All I could do was feel my heart rate pounding, the sweat running from every pore, the thoughts in my mind jumbling with no coherence. While John went upstairs to get his phone (in case he had to call the ambulance) I ate another glucose tab thinking 15 carbs would be better than 12. Then suggested we get the hypo kit out of the fridge, unused, not even looked at since purchase.
I tried to read the instructions to John. “What is this for? “He asks, “Just in case I pass out.” I am trying to read the instructions and stuck on number 2, which says, slowly inject the water into the vial. I’m thinking but where is the water? Do we have to get the water from the tap and put it in? John is saying there are pictures of what to do on the inside lid of the kit. I don’t understand the pictures, I don’t understand the instructions, I’m sweating profusely now. I check my CGM it’s a straight down arrow
NOT GOOD! I down another three glucose tabs so that’s 15 + 9= OMG don’t even know how much I took. Was it too much? Not enough? I can’t set my timer to make sure its been 15 minutes since I took the tabs. I can’t do anything but try and explain that we only need the hypo kit if I am unconscious. “Whatever you do John, don’t put the needle in the vial we cant waste the kit.”
We hang in the balance, check my blood sugar with the meter which is much more reliable than my CGM at this point and see it’s the same number as it was five minutes ago. Not going down. Phew, but not going up.
I start to really feel the low now. I feel faint, sick to my stomach, weird as F…ck.
And then inch by inch it creeps up. John puts away the hypo kit. I sit in a stupor. Even though my blood sugar is back up past 4mmol (that’s a normal range) my brain is not online. It’s worse than the feeling after a panic attack. I’m literally numb. All the while my only thought is why?
Why did I drop in 20 minutes from 5.4 to 2.9? I knew it had to be something to do with the long acting Insulin, somehow it had absorbed too quickly. Maybe the shower and the heat? But how much was absorbed and how long would it last. Was there a danger of going low again? This had happened just before dinner and I had to inject meal time insulin for that. Would they interact? Was eating and injecting going to endanger me again? And why didn’t I know more about this? Where are the formulas and strategies for this unexpected scenario? Why can’t our HCP help us to be prepared for these kinds of situations? They send us home with the basics. Eat, inject, treat a low with 15 carbs. That’s it? Talk about flying blind.
Once I could properly operate machinery again I sent a message to some of my allies in the DOC (diabetes online community). Their response was so immediate that I cried.
One friend mentioned that I should split my meal time dose just to be safe. Take a unit at the start of the meal and maybe another one two hours later. Another friend assured me that at 2.6 mmol 24 carbs worth of glucose tabs was the right amount to treat the low and my levels would soon stabilise. She also mentioned taking less insulin for the meal and watching every 30 minutes to see what happens. If I saw my levels spiking, then that was a sign to take more insulin. After a ton of messages back and forth, she admitted she couldn’t ‘tell’ me what to do and that I would have to trust my intuition and decide. Everybody reacts differently to every food. She reminded me that I have diabetes, it’s okay to have high levels, better to be high than low.
I decided to dose 15 minutes after the meal when I saw the upward trend and took ½ a unit less than normal. My blood sugar spiked. I survived.
It’s morning now and the sun is shining. The monster firmly back in its cage. I am in awe of the women I reached out to and their instant support. I know they have had soul crushing lows and impossible highs and just like me make it through. Without those who have gone before us, how would we know the path to tread? How would we tame the monsters under the bed?
If there is one lesson, this low has taught me it’s to reach out and keep reaching out. Ask for help. Know you are not alone. Yes, ultimately, we have to make our own decisions when it comes to how to manage our diabetes. But for every potential choice there is a person with lived experience out there willing to support you, you need only ask.
With great respect…
When I first travelled to Japan to teach I would walk into my yoga classes and see some of the students wearing masks. My translator explained that the mask was worn when someone was feeling unwell, living with a condition that required them to avoid colds and flu or as an ounce of prevention. I remember being in awe of their ability to
a. put themselves and their health first and
b. think of others
When I was diagnosed with diabetes I realised straight away how important it was not to get sick. Being sick meant uncontrollable blood sugars for a sustained period of time. Add to that the stress, trauma and tension of feeling doubly unwell.
My job as a global yoga teacher required lots of air travel so I donned a mask while flying and where it was acceptable, wore my mask in public places. When someone was sick I wouldn’t come over to visit and when my partner fell ill I would do my best to bolster my immune system and keep my distance.
When Covid hit, the directions from the government felt sensible. As there was no vaccine, no understanding of the disease and a variety of outcomes from no symptoms to loss of life, why not wear a mask to
a. protect myself and
b. help others.
I assumed that everyone felt the same way. Nine months later I have come to the realisation that people don’t.
I am living in South Africa right now. I have been here for a year. I am unable to return to Australia for many reasons. I look with envy at my friends enjoying maskless beach walks, parties with friends, their latest bookstore purchase or whatever.
I have not been shopping, partying or socialising for nine months. The few times I have gone out it’s been for doctors visits, a quick trip to an almost empty beach or a drive through the countryside where I don’t even leave the car.
People might think I’m paranoid, overreacting or have been brainwashed. I mean why not just give up and get it? Isn’t freedom and the enjoyment of life and all it has to offer more important than my personal fears? What comes to mind is that ‘people’ have never lived with Type 1 diabetes.
From the moment I was diagnosed I knew that freedom would have to be a compromise. 24 hours a day, 7 days a week tethered to medication that has no definitive outcome. Each injection could be a life or death sentence. Traumatic to say the least, living a ‘normal free’ life with diabetes is possible, but at the same time impossible.
Every outing requires careful planning, supplies, contingencies, every meal requires math skills, and a thought-out strategy. Every walk, yoga practice, garden foray requires something different. There is no room for error or spontaneity and yet you see people living with diabetes seamlessly. Why? Because they don’t talk to you about what it’s really like. And why would they? You will never understand.
Just like how you can’t understand why a person living with chronic illness might expect you to consider them when you make the choice to either maskup or be an avid antimasker.
I won’t go into details, but the details matter. When I come across a person on the path to the beach or in the forest without their mask, in a known hotspot, where I have been told the cases have risen 41% in one day… I can’t help thinking,” Wouldn’t it be smart for them to wear a mask? Or even turn around and walk away?”
Nope, guess not…instead they happily pass me by even waving and almost breathing on me, looking at me a little funny and perhaps thinking to themselves ‘brainwashed moron’. While I, the chronically compromised mask wearer, walks past in fear of my life. Not quite able to shrug off the incident because
a. I know people who’ve had Covid and
b. they’ve died!
I can rant and rave all I want, I’m still going to have people tell me, ” it’s a conspiracy, they’re denying us our freedoms, you can’t catch it in the open air. If I don’t wear a mask and you want to fine that’s your choice. Lockdowns don’t work.”
Duh? They do!
Look at Australia and New Zealand. Almost no cases, people enjoying backyard barbies, in person yoga classes, toilet paper available everywhere!
The next time you tell me it’s about freedom and my basic human rights, remember even YOU are conditioned to believe in an ‘idea’ called freedom.
Living with diabetes has taught me to let go of my ideas and instead I have learned to
a. accept what is and
b.protect this absolute precious life.
with great respect…
I’ve been setting the timer on my phone to 15 minutes a lot lately. 15 minutes to pre-bolus, 15 minutes to wait out a hypo, 15 minutes of yoga and meditation practices no matter what.
Before I was diagnosed I absolutely hated time. I never wore a watch or even looked at my phone. Even as a kid I never wanted to learn to tell the time. Why be constrained by a limitation like that?
Everything had more validity to me when time wasn’t involved. Why does anything ever have to end? Like a yummy meal, or time with a beloved or friend, a day at the beach. Maybe my abhorrence of time has to do with losing my mother at a young age. Having to face endings for me was complicated and traumatic. Being forced to rush through something felt unnerving. As a dancer I was bound by time and timing, but it never bothered me, because the timing of the music, or the timing of the movements to the music uplifted me, reminding me that all creative endeavours are happening in the presence of timelessness. Not that I could put that into words when I was dancing. It was something that touched me and made me cry with inexplicable joy.
By the time I was nine my grandfather insisted I learn to tell the time. He bought me a Timex with a red strap. We went painstakingly through the details of the big hand and the little hand, what all the numbers meant and what each part of the day represented. My mum bought me a digital clock which rolled over numbers like cards. And then I got a clock radio, even cooler because I could wake up to music.
After I met and started traveling with my husband we would wander through international airports looking at expensive watches. He’d point out all the brands. I knew nothing about Panerai and Patek Philipe. I didn’t even know the difference between a Swatch and a Tissot. When I would badger my husband to tell me what time it was he would say, “you need a watch darling” and I’d reply, “my smartphone is good thanks.”
Then one day when I was stuck in an airport on my own, I decided to splurge. If I was going to buy a watch it would have to be the purchase of a lifetime. I decided on a gold Tissot with Roman numerals and a simple link band. I’ve only taken it off a handful of times since then. When I point at my watch to tell my husband, “it’s dinner time, lunch time, time to go, time to clean, time to ‘whatever’” he likes to chide and say, “I wish I’d never mentioned you needed a watch”.
Watches aside, time has changed my life.
Recently I’ve been navigating some soul crushing lows. Waiting for my blood sugar to come up sends me into a wild panic. What if it doesn’t come up? What if I run out of low snacks? What if…
Initially I set the timer on my phone to 15 minutes so that I would know when to check again. But when the lows are scarier, in the low 3’s (below 70 mg/dl) watching the minutes tick down is a lifeline. If I can stay focussed for just 15 minutes, I’ll be okay. If it levels out at the end of those 15 minutes I can relax. If it still goes down after those 15 minutes, I can take more glucose, dates etc and start again. As long as I can watch the clock I know eventually I’ll be back to compos mentis.
Knowing I have a tool to support me during a low blood sugar has absolutely changed everything. I have a deep-seated fear of lows. It’s why I insisted on sticking to a regimented low carb diet for 7 years. It’s why I timed every single part of my day to avoid any deviation, and I why I would restrict my social activities.
My goal for 2020 was all about opening up to life, food and freedom. It’s been interesting to be stuck in one place while I navigate this new perspective. Asking myself…what do I want to eat? What do I want to do today?
If I want to eat heaven in a bowl (a fruit smoothie bowl with crushed seeds and dates) I can. If I want to garden, go for a walk, do a strong yoga practice, I can. If I flub the ratios, don’t reduce my insulin enough or take too much, I’ll be okay.
15 minutes is easy. 15 minutes I can do.
with great respect…
I don’t think anyone expected to go through what we are going through right now. Who could imagine a situation so beyond our understanding and control. I have been holding back from writing anything here on the blog mainly because I have been spending the majority of my time getting grounded and taking practical steps to be able to self-isolate for an extended period of time.
As someone living with a compromised immune system it’s important that I look after myself. This is a hard one for me. I love ‘being there’ for others. I’ve been reminding myself that ‘being there’ doesn’t have to look how I think it should look. It could be as simple as reaching out to a friend to check in or sharing a positive post, cool recipe, fun activity or what I shared yesterday on Instagram and facebook, a dance on the beach.
Because yoga is my lifeline you can absolutely assume I have stepped up my personal asana practice and am spending even more time working with breathing and meditation. Taking time out to balance mind, body and immune system is essential.
I’ve seen many yoga teachers rushing online to teach yoga. For me it’s not about joining the fray. It’s about doing things that help me to slow down, breathe and be still. I can’t teach when I’m stressed out. I learned this the hard way.
The only comparable experience was when I was in 9/11. On that day and subsequent days, I was a bundle of nerves. The shock that ran through my body was worse than any anxiety I’d ever experienced before. Instead of being able to stop, rest and restore I dove straight back into teaching. I was quaking on the inside while appearing ‘strong’ for my students. Suppressing my fear, shock and many other feelings led to a collapse which affected my immune system, my digestion, my marriage and my ability to parent. It has taken me years to recover and integrate the lessons from that time. Now that humanity is being faced with its biggest challenge yet I’ve been asking myself; how do I want to show up? How can I last the distance? How can I be a leader?
Stop, rest, restore, get creative, take my time, dream, reach out for support. Find beauty in simplicity and make sure to play. Then when my cup runneth over teach and share.
So that’s what I’m doing. Being gentle with myself. Not pushing into anything. Not expecting anything of myself.
For anyone wanting a little glimpse into one of my daily practices, here’s a simple joint and mobility warm-up series I shared yesterday in our facebook group.
with great respect…
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My blood sugar hit 11.7 mmol today. It’s been a while. I mean a long while. Since starting Insulin in 2014 and simultaneously going low carb I’ve had excellent control. A high for me was about 9 mmol. In the last two years, even that was pretty rare.
The control I’ve had over my numbers has been directly related to a huge amount of food restriction. A.K.A living on eggs, non-starchy vegetables and avocados and olive oil for the last 6 years. When my husband would ask, “How is your dinner?” my standard reply was, “the same.” I could make breakfast, lunch or dinner in 15 minutes tops. Eating to live, and fine with that. Worth the sacrifice if it meant staying healthy.
Don’t get me wrong low carb works. It totally works. The question is… is it healthy and sustainable? I have been low carb for 6 years so it’s doable but healthy?Healthy is having a rainbow in your diet. Healthy is as much emotional satisfaction as physical satiation. Healthy is enjoying food, being social, being able to go out and pick something off the menu without guilt or fear. Healthy is putting the meal together and then trusting that what you inject will do the job. I’m not talking eat whatever you want and cover, rather eat whole foods that please the eye and the pallet. Know you are taking in life sustaining nutrients and that your body can take it in, digest it and distribute the energy accordingly.
This is the basis of a yoga practice, absorbing prana from food, the atmosphere, anything you consume. If our own energy is scattered, stuck or overly dogmatic, we can’t absorb prana which in turn builds Ojas, the basis of our immune system.
In Ayurveda diet should be mitahari, which means balanced. Eating whole grains, legumes, fruits, vegetables etc. Everything according to your type incorporating the six tastes of sour, salty, sweet, bitter, pungent and astringent.Before my diagnosis I was able to follow an Ayurvedic vegetarian diet ad infinitum. After diagnosis I found myself narrowing my diet according to what I felt sensitive to or what I thought wouldn’t cause a high blood sugar. Eventually I was so afraid of going low I stopped trying. I told myself I couldn’t have mung beans or quinoa because it was too confusing to dose for. I couldn’t have fruit because I would spike. My list of excuses was long. My openness and availability to try something new was zero.
In the last few years I’ve started each year with a diabetes goal. In 2018 it was braving meal time insulin (up until then I managed on a split dose of basal with severe carb restriction). In 2019 I worked on healing my gut. My 2020 goal came out of months of feeling helpless around the situation we are facing on the planet and watching two documentaries Cowspiracy and The Game Changers. Discovering that animal agriculture is one of the main contributing factors to climate change and seeing how athletes were able to maintain a vegan diet and increase their performance, made me question what I was eating and why.
To be honest wanting to go vegan was a total heart longing. I’ve never liked the feeling of eating animals (as a kid, I used to pretend to eat my pork chop and when no one was looking I’d push it into a napkin and then excuse myself and flush it down the toilet) so it made sense to stop.The big question for me was how. How could I make the transition from keto to vegan smoothly? Was it even possible? While I was mulling over the what and how, a T1D friend sent me a PM about a new program she was on which was high carb, low fat and and how successful it had been. She suggested I try it.
I balked at the idea. Then another T1D I follow on Instagram shared his story of going from keto to vegan. His story was inspiring and confronting. I had to ask myself, what was my excuse really? Was I going to be terrified of carbs and insulin for the rest of my life? What was holding me back?
Doing some deep soul searching around these fundamental questions forced me to take stock of the times in my life where I’d faced a seemingly insurmountable hurdle. I reflected on giving birth. That was terrifying, yet I did it. I thought about how I managed during 9/11. How when I thought I couldn’t handle the shock I actually rose above it and made it through. Even after my diagnosis I was able to eventually find a way to acceptance. I also thought about the beach. Here in South Africa the water is beyond cold. Going in takes a certain kind of bravado.That’s how I decided to approach this new and exciting chapter in my diabetes management. If I didn’t jump in, I might regret it. If I did, hopefully I’d feel refreshed and invigorated.
Five weeks on from transitioning to a plant-based diet. I’ve introduced a huge range of foods, with hardly a hitch in my digestion. The big challenge has been to experiment with insulin to carb ratios to find what works best when. I’ve also had way more highs and lows then before. I’ve had to be courageous while watching that straight down arrow on my freestyle libre. Patient when I see a spike.
My insulin needs have completely changed. I need less basal; more bolus and I am becoming more and more sensitive to insulin. I’ve also had to slowly build my daily carb intake working my way up to about 250 carbs per day. That’s been hard, but I’m getting there. I’ve also rekindled my passion for creating recipes. I’ve made hummus, nori rolls, veggie burgers. I’ve been eating heaven in a bowl for breakfast. Smoothie bowls with dates and figs, bananas and papaya. I now look forward to eating and cooking. I’m excited to try things like beets, leeks, peppers again. I feel like every meal is a party. One I get to have for myself.
The best side effect of my new diet is increased energy and decreased aches and pains. When I step on my mat I feel open, balanced and clean from the inside out. It feels like I’m back.If you’d like to find out more about a plant based whole food diet check out this brilliant new book, Mastering Diabetes
If you’d like to have more one on one support to make the transition I highly recommend Drew Harrisberg from www.drewsdailydose.com