Guest Post, David Mapletoft, Diabetes Educator
I often liken having diabetes to driving a car: learn how to drive, follow the road rules, maintain the cars safety features: these action will reduce your risk of an ‘accident’ – a diabetes related health problem.
Today I found something I think is a lot less simplistic, more realistic as an analogy.
A skier I have never been. At the age of 54 I have now skied twice in the past 12 months in an area of France known as the Jura – mountains similar to that of the Australian Alps, not the higher French or Swiss type of Alps.
I hope my words that follow can match my thoughts as I was skiing along the track in the French Jura, adrenaline pumping, having little idea of what I was doing, or where I was going. Fear high on the list on my emotions.
Communication – speaking your language
Its extremely rare for a French person NOT to stop whatever they are doing at noon and eat – for up to 2 hours. Not gorge themselves, but eat a nourishing simple meal with friends, family or work colleagues. French school teachers are even legislated to have a minimum 90 minute lunch break!
At 10am today I heard: ‘lets go for a ski, then eat’. Great, some exercise, a short break out in the sun, and then food!
At 2pm, enjoying the exercise but curious to what the ‘plan’ was, I asked: how long is this ski run? – “18km – we have done 6km”
One of the disempowering things about being in a country that is non-English speaking is not being able to communicate effectively.
For people with diabetes this communication with their healthcare team is essential. Being able not only to ask your questions, but having an answer in a ‘language’ that you can actually make sense of and build into your self management plan.
Often I hear clients of mine coming to me saying: “I saw the …. and I came out even more confused than when I went in!
Direction: do you have a map?
Exploring any new area in Australia I would have a map to explore with, have some idea of what direction to take.
Today in the French Jura I trusted my friend – who comes here every year to ski – to lead. Today I followed: unusual for me, I’m usually the leader. Not having a map in my hand was a situation of disempowerment for me.
Knowing the distance I was nervous, disturbed that towards the end my legs would not hold me safely and I’d fall and break something.
As a newbie skier I had no idea of the state and difficulty of the tracks my friend was going to take me on. I had no idea what I could and couldn’t manage.
With the diagnosis of diabetes it’s often overlooked by the health care team to provide you with a ‘map’ of where you are headed. Support in all areas required to find your way safely, securely, and effectively.
The first map given often has warnings of hypos, hypers, and what might happen if you are not in ‘control’ are frequent. What about work, school, …..life?
Has the newly diagnosed diabetic been given a ‘map’, something to follow over time, something that has with some life skills to find their way both short and long term?
Did you feel that you had some direction, apart from the BGL targets, when you were first diagnosed? Do you feel like you have some direction today?
Goal to work towards?
Now out skiing and being told I have another 12km to ski, I have to change my strategies. I decide to change my pace, find my rhythm. The goal has become clearer, I know not what to do, but I also not to go hard. The goal is to make 18km!
Having a specific goal gives the person with diabetes somewhere to head, some direction, something to aim for. Often when I meet clients for the first time I am the first person to ask them: ‘what is your goal?’
What is your goal?
‘Balance’ or ‘Control’
Today I thought about the diabetic life every time something challenging came along and spoilt my rhythm. Wet snow, icy snow, down-hills / up-hills that appeared to steep for me to ski, tracks that disappeared without warning, to name a few.
Isn’t this our lives most days: unexpected events that throw us out of rhythm?
Isn’t this the life of somebody with diabetes? Only more difficult because they are running their body’s insulin production system on ‘manual’ rather than ‘automatic’ where the body adjusts to different outside events by itself?
As I skied along I was thinking ‘balance’.
Here in this new and challenging environment – snow – I have no control of conditions; I have no control of what’s around the next bend; I have no control over the weather conditions; I have no control over how the blazing sun changes the snow texture. I have power only of what is in my mind and how I can use it and my body find the balance within my means to stay upright and make the distance. Reach my goal.
Finding the balance is how we can manage those challenges. When we become off balance we find the strength and determination to press on. We gain knowledge from experience. We seek support and guidance from our team, family, and partners. We find some sense of who we are.
Is it possible to change that word – control – in so many minds of people who have diabetes, and people associated in the care, education and management of people with diabetes? Change that word to – balance?
Dave B – “ a diabetic drives his/her body on manual. We have to count the numbers, feel the rhythm of our bodies and adjust our insulin in response to these messages. Most of the time we get it right but sometimes it’s a catastrophe! Say when you have been drinking and your thoughts don’t always match your reality, an unexpected high when your meeting goes longer than expected or running out of insulin, or your diabetic response to stress or to prolonged exercise – just to name a random view.”
Adrenaline = Stress, Stress = Adrenaline
Dave B “ …. don’t forget the tight turns and carving it up, dry mouth, eye popping moments in. Skiing knocks out racing car drivers to!”
Yes, positive stress can effect your BGL. When you ‘take a tight turn’ – try something new and exciting, or participate in sports – your body responds by pumping adrenaline to your muscles. This adrenaline also stimulates the liver to release glucose to fuel those stimulated muscles. Therefore your BGL will rise. The fuel (glucose) is in transit. Of course negative stress can also have the same effect of causing your BGL to rise – in this situation you are not going to burn it up with the exercise though.
Falling Is Normal
And as I fell for the – (I’ve lost count now) – time into a meter of soft snow at the end of the 18km run I thought “that was a challenge, how lucky I am to only have this frightening experience for 4 hours.”
Dave B: “Can you fall? Sure but I don’t know many committed sport people who plan to fail but I do know many sport people who prepare to prevent falling and recognise they can train for that too”.
So, my new analogy in a nutshell:
Diabetes is like a cross-country ski run. You can find the strength and balance within you to reach your destination – your health goals, your life goals. Every now and then the world throws up something unexpected, you get thrown off balance, you fall. Falling is normal (watch the winter Olympics – even the best fall).
Dave B: “As an analogy, I think the longer you ski with your diabetes the more you learn to not sweat the small stuff. You focus on maintaining “balance” by tooling up more often; regular blood tests, exercise and visits to your clinical team. When diabetes becomes a part of your life, not something that you deal with on the side of your desk, then at this time you are familiar with the ski run that is your diabetes. You understand it’s obstacles and soft spots and if anything you speed up and assault the slop, carving turns and enjoying the confidence of being in command of your run and the style that you ski it in.”
I’m still learning. I’m happy for any arguments for or against this analogy. Or anything you might like to write to add to this analogy.
And the final word to one who is much more of an outdoorsman than myself, a person living day to day with the challenges of type 1 diabetes:
Dave B: “The ultimate is standing on-top of that slop, uninterrupted, listening to the hills and smelling the clean air. You are free and alive. That has taken practice, lots of thrills and spills to achieve but at that moment you are in control of your destiny and the ski run to come. It is mine! From that moment I launch off again without hesitation. Swooooshhh”
Safe Travels, swoooooooosh!
David – Diabetes Educator