My Type 2 Diabetes Is Forcing Me to Find a New Reason to Live

By Abby Hanna

April 21st, 2021 was when it finally happened. It was around 1:00 am and I was dozing off in bed. With the melatonin in my system and a good day behind me, I had no reason to be up any longer. My nights were usually long and painful due to my anxiety and lively thoughts, but that morning I had a good enough day to let me sleep peacefully. An exceptional day even. I had gotten my blood work from the day before back, and it looked like everything was stellar. My doctor emailed me that afternoon- “Hello Ms. Hanna, your labs look good overall.” I had carelessly overlooked the note she left about my low cholesterol (I’ll just eat more avocado toast or something) and went on with my day proud of how my body was taking care of itself without me ever having to intervene.

And then came that night. That was supposed to be a peaceful night. Me dozing off in bed. Melatonin in my system. And something told me to check my email. I decided why not, noone ever sends anything important at 1:00 am, it’ll be a quick scroll and then right to bed. I noticed another email from my doctor, more blood work results from the other day. I clicked on the message that revealed the results, and it was as if someone had replaced that sleepy pill in my system with Adderall. I’ve never sobered up so fast. I actually had a little bit of research to do from the information that she gave me. What I was looking at wasn’t an email explaining my labs, but the actual labs themselves. With a bit of research and decoding, I had confirmed what I thought was true. A cold chill ran through me as I stared at my labs. I rubbed my eyes to make sure I wasn’t dreaming. No, those labs are correct Abby. You have type 2 diabetes.

It was like finding out that your deepest fears were true. Like looking under the bed and seeing that the boogie man actually was there, or feeling the pain of pinching yourself when you thought that you were dreaming. Or looking behind you and realizing that someone is indeed following you, or getting a test back with a big fat F that you couldn’t afford to fail, or opening your bedroom blinds to reveal a dark figure is watching you, or hearing the sputtering of your car breaking down in the middle of nowhere, or reading your lab results in the middle of the night that say: You. Have. Diabetes. It was the end of my world. My body purged itself of any reason to sleep and immediately filled itself with anxiety and anguish. I did eventually end up going to sleep hours later, after learning every single thing on earth about diabetes.

I actually entered a state of bliss for the next few days. I had found out that my A1c (the number that tracks your blood sugar and how much excess sugar you have in your body) was relatively low when it came to the diabetic range. If your A1c is 6.5 or higher, you have diabetes, and mine was 6.6. I felt great about that, and although I aggressively changed my diet the next couple of days, I held dearly to my truth, which was that I wasn’t that much of a diabetic, only a little diabetic. A diet diabetic, if you will!

I knew that when I had a phone call with my doctor she would reassure me that everyone else’s diabetes was bad and that mine was just fine and that with a couple of smoothies, I’d be diabetes-free and back to normal like everyone else. So I waited a couple of days for my appointment. I set up MyFitnessPal. Ate a couple more vegetables, just for kicks, because I knew that when you have diabetes lite like me, you just have to add an order of apples to your McDonald’s meal instead of throwing it out all together.

Monday came around and we finally had the conversation. She told me everything I already knew about diabetes due to my extensive research days before. I told her that my worst habit is eating once a day. She sent a couple of informational videos about living with diabetes and told me that a nutritionist would be calling me soon. And then I posed the question. “So this is like a short-term thing, right? My A1c is pretty low for diabetes, so I just need to get it even lower and then I won’t have diabetes anymore, right?” And then she told me that this diagnosis was forever.

I started sobbing. And I sobbed through the rest of my conversation with her. I sobbed while telling my mom. I sobbed while on my walk. I sobbed in the grocery store while I picked up the “5 best foods to combat high blood sugar”. I sobbed while sitting in the car thinking about how I couldn’t flip this to be something that it’s not. I realized that this was the first thing that I couldn’t run from. I had successfully coped with everything in my life with the help of food. Food was my sidekick, my refuge, my safe space. And with this, I couldn’t run to food. I actually had to do the opposite. I had to run away from food because if I ran to it, it would be the very thing that kills me one day. It made me think about my relationship with myself and my body on a whole new level.

For as long as I can remember, food has been my safety blanket. It was my hobby. I had always loved cooking and wouldn’t mind taking the extra 20 minutes to turn top ramen into fine cuisine, or slow cooking something in the oven to make the taste richer. I loved the crinkly sounds of a takeout order, the squishy packets of soy sauce and ketchup, the red Thank You’s staring at me with gratitude as I opened the bag to reveal what treasure I ordered for that day. I loved the sizzling sound of a raw egg hitting a hot pan. The bubbling boil of a ripe stew slowly melding its flavors over a low fire. Everything about food was special to me, it was an experience, and I unabashedly leaned into it. Eating was my favorite thing to do and I would eat if I felt sad, if I was happy, to celebrate, to commemorate, to combat boredom. Everyone is supposed to eat, obviously, but I wouldn’t shy away from giving myself my favorite foods whenever I wanted them. These tendencies got a lot worse during the pandemic. I was already fighting my depression with cheeseburgers and my anxiety with brownies. The addition of a global catastrophe was scary, but it was no match for pad thai, mac and cheese, and crab rangoon. I felt justified giving myself whatever I wanted whenever I wanted. And why should I feel bad? I hate my life so I’m gonna enjoy my meals because it’s the only thing keeping me from killing myself!

Oops. Did I just say that?

The thought came tumbling to the forefront of my brain as I sat in the car thinking about this new life I would have to live with diabetes. I realized that the only thing keeping me alive was food. Literally. I hated everything else, my depression had taken everything from me but the sweet taste of lemonade or the spicy kick of kimchi. I realized that I hated my body and thus didn’t care what went into it. Growing up with body dysmorphia has made me distance myself from myself as much as physically possible. And mental illness has made me work towards quieting my brain and running from my problems in any way that I can. So, I don’t do my hair, I wear big chunky outfits to hide my body, I let the root of my fears hide in the crevices of my brain, and I revisit my good pal Caviar because it’s the only thing keeping me from ending it all. And now I am forced to take care of my body.

Learning about all the things that can contribute to high blood sugar was probably one of the wildest parts of the diagnosis. Anxiety, bad sleep habits, and stress are three things that I am too familiar with, and three things that also can raise blood sugar. Not eating enough and not getting enough exercise are also three things that can increase your blood sugar, or put it at alarmingly low rates.

Being diabetic means being confronted with my body’s health and well-being for the first time. It doesn’t just mean having more smoothies but it means sleeping at an appropriate time and making sure that I’m not stressing about all the worries of life. It means drinking enough water because my body deserves water, and it means going on a walk because my body deserves to feel the warmth of the sun and the coolness of the wind. This is hard for me. Because I want to sleep all day and I want to stress eat. I want my first time of the day leaving the house to be when I pick up my Ono Hawaiian from the delivery driver. I don’t want to have to think about loving myself and what that really means. But I have to. I have to make the decision to prioritize myself even though indulgence has felt like prioritizing me this whole time. It clearly wasn’t. Because this is where it got me. I don’t know what self-love is and I’m scared to find out, but I know that my security blanket has been ripped from me, and although it’s cold and painful, I hope there is something worth it on the other side.

 

Editor’s note: If you are struggling with mental health issues and diabetes, we urge you to seek professional help. The American Diabetes Association maintains a registry of mental health providers that have specially trained on caring for patients with diabetes.

Source: diabetesdaily.com

Using Smartphone Tracking to Identify Patients with Depression (ADA 2020)

At the American Diabetes Association (ADA) 80th scientific sessions last week, Dr. Ashutosh Subharwal, Department Chair and Director of Department of Electrical and Computer Engineering at Rice University, put together a compelling presentation that showed the benefits of using smartphone sensors to measure behavior-biology pathways and use those findings to assess, treat and improve healthcare outcomes for depressed patients living with diabetes.

Scaleable Health Labs believes that there should be a bio-behavioral sensing layer to healthcare using simultaneous, non-invasive and accurate measures to provide clinicians with data to better help their patients. They feel using quantitative data from a sensor-based automatic measurement will be more useful than asking patients questions and having their answers be based on their own perception. For example, when asking patients how often they exercise, their answer may vary drastically from the data from their sensor.

The presentation focused on 3 areas: Mobile bio-imaging, behavioral sensing, and data science for health.

Dr. Subharwal proposed two questions:

  1. Can we track depressive/anxiety states?
  2. Can we measure loneliness?

Can We Track Depressive/Anxiety States?

Depression is a common comorbidity of diabetes and is often undetected and untreated. A study explored this in adults and adolescents, using a tool called SOLVD: Smartphone and Online Usage as based eValuation for Depression, by way of a smartphone as a wearable for tracking depression.

The two clinical pilots for SOLVD consisted of the following:

  • Bi-weekly clinical visits.
  • Logging feelings in a MoodReminder Module.
  • The MobileLogger Module, which has the sensor logging social use (phone calls/texts), mobility (GPS/steps/accelerometer) and phone usage (screen time, screen light, etc.), all while being respectful to keep any conversations private.
  • A new parent app for the teenage pilot that used the parent’s feedback as a sensor to measure their children’s mental well-being.

Using this combinational sensor data allowed clinicians to track who, when and for how long the patient was speaking with or texting an individual. They were able to track where the patient was going and the duration of time spent at each location. There were also many other extracted features from the smartphones related to communications, mobility and sleep collected daily, as listed in the chart below.

Key Findings

This method proved to be a useful way to continuously track a patient’s mental state. The patients did not find it intrusive and were willing to be tracked. They saw a strong correlation between the daily self-reported moods and different diagnostic questionnaires in both teens and adults. Also, when patients had fewer phone calls/text messages and shorter frequency of these exchanges, it was predictive of higher depression symptoms. Additionally, as the number of steps walked decreased, there was an increase in the participant’s depressive state.

In both studies, there was a correlation between the data collected from the smartphone and the patient’s psychometric scores, and a noticeably stronger correlation in the moderate to severely depressed participants. The data indicate that the more depressed a patient was, the less mobile and social the person became. This information can help providers to better assess and treat their patients.

Can We Measure Loneliness?

Sociability is crucial to our overall well-being and lack of social encounters are indicators of loneliness. The traditional measures of sociability are often questionnaires, patient self-tracking, the UCLA loneliness scale but all of these require participant effort and many times the report lacks enough detail to draw any conclusions.

SocialSense, an in-person social network (IPSN) is able to track real-life, in-person interactions through audio data. This tracking device is able to detect conversations, detect social scenes and context as well as turn-taking behaviors, with no content analysis to respect participant’s privacy.

The Sociability Clinical Pilot at Baylor College of Medicine (emailed waiting for confirmation) spent 1 week audio-tracking their participants, using the daily smartphone app sensor features discussed above, along with patient baseline psychometric measures.

Key Findings

A decrease in sociability was seen among patients with depression, including fewer longer conversations and fewer social contacts. The SocialSense reports were consistent with the self-reports. SocialSense was also able to detect audio self-talk conversations amongst patients with psychosis.

Conclusions

  • Most patients are willing to be monitored via technology (>80% adherence).
  • These tracking studies are among the first of their kind to study adolescents and adults who suffer from depression. They are also the first to use the new tool for psychiatry, the parent app.
  • Data from the participant’s phone sensor and usage features correlated with symptoms of depression, which was even more pronounced in the moderate to severely depressed patients.
  • The data we can get from wearables can help better evaluate a patient’s mental well-being and develop the most appropriate solutions.

What are your thoughts on the subject? How would you feel about your activities being tracked for health purposes?

Source: diabetesdaily.com

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