“I can do this,” I thought as I listened to the doctor explain how our daughter, Erin, had just been diagnosed with type 1 diabetes. My mother had T1D. Yes, there had been a lot of advances in technology since her passing 15 years before, but the basics were still the same. It was all about numbers – measuring food, counting carbohydrates, blood glucose levels, insulin dosages, body weight, hours of activity, hours of sleep, etc. What I didn’t understand at the time was the mental and emotional toll this focus on numbers can have on a person, especially someone predisposed to an eating disorder.
Every three months we went to the endocrinologist, and every visit felt like sitting for an exam. Her blood sugar log would be checked, her HbA1c measured (a blood test that indicates your average blood glucose for the last three months), her weight taken. She would be quizzed on how and what she was eating, how and when she was exercising. She would then receive an evaluation from each of three “examiners”: the doctor, the nurse and the dietitian. How well she performed would determine whether or not she was sent to the diabetes educator which always felt like being sent to the principal’s office. These appointments also determined how I felt and behaved over the next three months. If they went well, I was a good mother and could relax a little. If they did not, I was a bad mother and had to double down on my efforts the next three months. For Erin, this probably felt like being sent to boot camp.
I remember clearly the appointment that should have been our first red flag. Erin’s weight had gone down significantly, but her A1c had gone up. The doctor commended her on her weight loss, lectured her on her A1c, and sent us home. I knew enough about the biology of T1D that I should have been able to put the pieces together, yet there was no mention of the connection between the two. When a person doesn’t take enough insulin, their body can’t utilize the food they are eating. The glucose stays in their bloodstream causing their blood sugars to run high until they literally pee out the calories. And since the person isn’t getting any energy from their food, their body starts to eat itself. Unfortunately, without insulin the body still can’t utilize this energy resulting in continued high blood sugars and an accumulation of ketones.
Every three months we went to the endocrinologist, and every visit felt like sitting for an exam. Her blood sugar log would be checked, her HbA1c measured (a blood test that indicates your average blood glucose for the last three months), her weight taken. She would be quizzed on how and what she was eating, how and when she was exercising. She would then receive an evaluation from each of three “examiners”: the doctor, the nurse and the dietitian. How well she performed would determine whether or not she was sent to the diabetes educator which always felt like being sent to the principal’s office. These appointments also determined how I felt and behaved over the next three months. If they went well, I was a good mother and could relax a little. If they did not, I was a bad mother and had to double down on my efforts the next three months. For Erin, this probably felt like being sent to boot camp.
I remember clearly the appointment that should have been our first red flag. Erin’s weight had gone down significantly, but her A1c had gone up. The doctor commended her on her weight loss, lectured her on her A1c, and sent us home. I knew enough about the biology of T1D that I should have been able to put the pieces together, yet there was no mention of the connection between the two. When a person doesn’t take enough insulin, their body can’t utilize the food they are eating. The glucose stays in their bloodstream causing their blood sugars to run high until they literally pee out the calories. And since the person isn’t getting any energy from their food, their body starts to eat itself. Unfortunately, without insulin the body still can’t utilize this energy resulting in continued high blood sugars and an accumulation of ketones.
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