I spent every day of the past week at the Joslin Diabetes Center in Boston. I'm a pretty decent diabetic in the sense that my A1C is in control (well under 7%) but I had lost the health gains I made a few years ago. My weight crept back up, I had become mostly sedentary and my diet sucked (how did I still manage a decent A1C-that's what we call feeding our insulin or maybe in my case insulining my food). I wasn't happy. My arthritis was aggravated, I am 5 years older so have more general aches and pains anyway and being overweight and unhealthy wasn't helping. I had personal, family and work drama that contributed to the malaise and so there I was a few months ago, visiting my endocrinologist and asking if the Joslin had a program that might help me turn this stuff around.
They kind of literally did. The program is called You-Turn. I signed up for the June session and it just finished. It was exactly what I needed to snap me out of my ennui.
First though, I did my homework and I gave myself the best chance of making this succeed by getting a physical, discussing some real issues with my primary care physician and making the very difficult choice to go on an anti-depressant medication. I knew that a large part of my disinterest in my own health stemmed from depression but was in denial as to how much it had taken over my day-to-day life. I realized that without getting my head a little less fuzzy I couldn't expect to be able to do what I needed to to make a program like the one I just did work and certainly not make it work long term. I had to let go of a lot of negative self-talk and allow myself to try the drug and see if it helped me. It did. I'm almost embarrassed to admit how bad things had gotten and how long it took me to realize this. Years and years. Look-anti-depressants aren't happy pills. They don't make me more motivated or paint the world in a sunny, rainbow washed glow of unicorns and fairies, they simply cleared away some of the gloom and fog that had become my daily baseline and were keeping me down.
So. Monday I arrived in Boston at 7:30am. By 9a, I had had labs done, an exam and was taken off almost every one of my diabetes medications and insulins and placed on a new regimen that started right then. I was told to stop symlin, an injection I took with meals to increase the amylin in my body ( a hormone that tells you you are full) and to replace it with a once a week injection that does something similar. I was shown how to mix and inject that at 9:30a and injected my first dose right then. I was taken off Lantus and placed on Levemir (an injection of long acting insulin you take at bed time) and I was told to take a twice daily oral medication and most scary of all to decrease my rapid insulin (the insulin I inject with meals) to almost nothing (eventually it will be nothing if the other meds work well and I can be stimulated to use my own insulins better). I discovered that I am still making some insulin although my body is highly resistant to it. I was placed on a strict diet of 1800 calories a day, that consists of 30% protein, 30% fat and 40% carbs but of course not bad fats (in fact, all week I habe eaten closer to 1200 calories and have been reminded to include my snacks). I was made to exercise. This last is amazing because I figured that given my lack of exercise and all my aches and pains I would not be able to do more than a few minutes. I have exercised over at least 30 minutes and usually over an hour every day this week. By the end of the day Monday I had basically had my entire lifestyle in regards to food, exercise and diabetes switched up.
The rest of the week we had classes with behaviorists, nutritionists, nurses and sessions of exercise. We ate out as a group and figured out how to make healthy choices when out. We discussed our concerns. We all met privately with the doctor and his team every day to fine tune our individual plans. We shared our hopes and also our concerns about how all this will play out in our lives when we were done. It was a lot to take in and it will be a lot to work on going forward but....I feel better this week than I have in ages. I have slept better. My glucose numbers will be a little wonky for a week or two as things kick in, but overall they are better and I am using far less insulin.
Why do I care? The question a friend or two has asked is why make it so hard for myself when insulin will make it possible for me to have a good A1C and eat, maybe less, but the foods I most like. Well, for me, it's a problem. I can't speak for others, but food and I have never had a healthy relationship. Insulin makes that relationship more toxic. Insulin causes weight gain. Then you have more tissue which of course needs more insulin. It's a cycle and for my health and well-being it needs stopping. Sure, the easy answer would be to try and eat better and exercise but just stick to the old insulin regimen and cover my meals. I need something different. I need to reduce the insulins overall, to get rid of those that are more likely to induce weight gain and to drastically change how and what I eat. I need to exercise everyday for at least an hour and I need to make sure some of that exercise includes strength training to maintain my muscles.
It won't be easy and I was blunt with the team and asked how to manage those times when I might want to eat certain beloved foods. I have a plan for that.
At the end of the week, I felt better, I lost 5lbs and I felt like I could do this. I'm lucky in that I have support at home, which not everyone has. I am asking my friends to try not to derail my efforts with their own agendas. I know this plan isn't for everyone and I know not everyone agrees with the philosophy behind it but I believe it will give me the best chance at a healthier and longer life and want to try and make it work. Walk with me, meet me at the pool, bike or kayak with me, don't make fun of me when we eat out and I have to take extra time to figure out my meals, don't tempt me with your food choices and tell me "its ok just this once", just support my choices and be my friend.
Well,Time to eat a healthy lunch and then exercise. Kayaking tomorrow.