The triple D problem: Diabetes, Depression & Diet

I’m really not one for blogging, but over the last couple of weeks I’ve listened to and watched things that have brought thoughts that have been bouncing around my head for years into slightly sharper focus. Hopefully focused enough I can get it down and out of my head!

I will try my best to get the wording right, but may mess up and say something problematic – do tell me so I can fix it and hopefully not make the same mistake again! I will warn you that this piece specifically deals with eating disorders and mental health issues, including problems with suicidal ideation – if that’s problematic for you feel free to give this a miss or come back another time when you feel you’re able to read it – the last thing I want to do is put anyone else in a bad place.

For some background on what kicked off my thinking here are some links to the material I’ve been listening to and watching:

  • The BBC’s documentary about ‘Diabulimia’,
  • This MOHpod episode with Richard Osman dealing with eating issues
  • ‘999: What’s your emergency?’ series 5, episode 4. I can’t link to that episode at the moment as it’s not been made available, but it deals with the issue of our horrendously overstretched mental health services. Definitely needs a warning before watching as I nearly had to stop half-way through as it was putting my head back in dodgy territory. The BBC’s ‘Ambulance’ had a similar episode on mental health services, but I did have to stop before the end for similar reasons.


Now we’ve got the admin out of the way…

I’ve had type-1 diabetes for nearly 10 years. To start with it wasn’t too bad. I had a pretty good honeymoon period (where my pancreas was still pumping some insulin out before my islets of Langerhans gave up entirely) and my active lifestyle (cycling or walking pretty much everywhere, including about 12 miles walking in one day when viewing rooms for my move to Bristol!) helped a lot afterwards. That said, I started struggling more and more, as my ever increasing average glucose (HbA1c) showed. I started working towards getting an insulin pump as I thought my brain would deal better with a reduction in the constant calculations a diabetic needs to make.

“So that sandwich is two slices of white bread, which are usually about 18g of carbs per slice… so that’s 36g for the bread… the filling is just ham and salad, so I can ignore that. My insulin to carb ratio is 1u to 7g at lunchtime so that’s… *grabs calculator*… 5.14 units of insulin. My blood glucose is 13mmol/L so with my correction dose of 1u/2mmol that’s around another 3u. So a total shot of… 8u.”

You can get .5u pens now, though I only got one of those in the last couple of years before – spoiler alert – I got my pump. Don’t forget that your insulin sensitivity changes throughout the day, so at breakfast you might be 1u/5g and dinner 1u/10g, and your glucose changes (obviously), and if you do a different amount of exercise than expected you can have wildly varying glucose.

The beauty of a pump is that you don’t need to do a lot of the calculations yourself – once it’s programmed right you just tell it the carbs you’re eating and your blood sugar level and it works it out itself – joy! Of course, getting it programmed in the first place isn’t easy.

Since pretty much the start of being diabetic I had a pretty cavalier attitude, and (surprisingly, in retrospect) quickly started using my diabetes as – what I now recognise as – a form of self-harm. I couldn’t control whether I *had* diabetes or not, but I could control my, well, control. My tendency used to always be excessive control – dosing too much and running dangerously low. This got to the point where a nurse commented I was running my diabetes like I already had a pump, which was causing some of my problems, as pens don’t work the same.

Basically my stomach was being used as an increasingly flabby pin-cushion. I would do things like say to myself ‘you’ve been crap at control all week this week, let’s make up for that now‘ before going to the top end of all my doses until I started hypo-ing (low blood sugar) like mad, leading to pigging out on delicious hypo-snacks. So on top of comfort eating, I could comfort eat *and* ensure I would be comfort eating in a couple of hours as well! What’s not to like, right?! I was also blessed with the kind of metabolism that lets you get away with this kinda nonsense without anyone being any the wiser, especially with all the exercise.

It’s no real surprise that when my work got busy, at the same time as me and my then partner got 2 rescue dogs and my little sister moved in with us – all within a month of each other – that I started struggling to cope. Due to me being a typical bloke and not talking enough to anyone about anything that mattered, my mental health inevitably started to suffer. Due to various combinations of factors I kept heading downwards until I hit breaking point about a year later and I was finally signed off work and starting taking antidepressants. This was also one of two periods where I was having some serious suicidal ideation, the only thing keeping me around was my inability to think of a good plan to make sure that my dogs were looked after (me and my partner of 3+ years being in the process of splitting up).

So yeah. I hit what was pretty much the bottom. Certainly closer to the bottom than I want to go again. On my way back up (I’m not there yet, but better than I was, for sure) I’ve learned lots about myself and mental health in general. I’ve also been through several phases of more typical self-harm, the learning I did after I started harming revealed that I’ve had a tendency towards it for a long time, just never before so obvious in purpose. All the over-controlling my diabetes, my tendency to push myself physically to the limit – often not feeling like a run or cycle or walk was ‘worth it’ unless I was exhausted at the end and barely able to get home. While not ‘proper’ self-harm, knowing my thought processes in those moments I can now see how clearly those actions were a pre-cursor to the ‘real’ self-harm that came later.

I’ve found the way in which I abuse my diabetes has changed as well. From ‘punishing’ with extreme over-control, I have rocked back to the other extreme. Eat too much, don’t put much effort into getting the shots right, avoiding doing anything to improve my control. Quietly ignoring the long term side effects because I don’t really believe I’ll be around when that stuff is an issue. Also, delicious cake now > future eyesight, right?!

I’ve also experienced the other side of mental health problems through people I care about going through their own issues, and my inability to help and be there for them. Especially when it comes to mental health provision. This is why the ‘Ambulance’ and ‘999: WYE’ episodes hit me so hard. I’ve found it very difficult to see other people in difficulty because I recognise the feelings they’re experiencing at the low points. I know the feeling that everything is hopeless and no-one can say anything to help. To see people in that place, their mood bottomed out and in desperate need of help and getting nothing. When they’ve actually *tried* to get help in that state and been turned away. I just can’t express it. It’s heartbreaking and infuriating and, and… I don’t have the words.

The diabulimia programme hit oddly close to home as well. Even though I’m not on the same scale as the poor girls in the programme, I recognise the triggers and behaviours that sent them down the path. I’ve done the opposite, and the same, just – touch wood – on a much smaller scale. So far. But that weight of responsibility for your own well-being at a level that shouldn’t be conscious can get pretty heavy.

That’s all I’ve got, I think. Not entirely sure what my point with this piece was. Partly to re-iterate the importance of maintaining good mental health, and educating people about how to do that. I think with a better attitude and education I might have caught myself earlier and avoided the super deep plunge. Partly just to acknowledge this is how I’ve felt, what I’ve done, am doing, am feeling? Maybe adding another small voice to the ‘we need to fix *everybody’s* attitude to food’ movement? Maybe I’ll come back and add something more, or re-write it completely, or write a sequel. Or forget about it. Maybe just delete it.

Feel free to add your thoughts on all aspects of this, ask questions, whatever. Like I say, I’m not used to this. I don’t think I’ve written this much on one topic since college, and that was very dry engineering content!

Oh, and if you’re interested you can hear my usual method of getting this stuff out of my head here and if you’re feeling flush you can even tip me by buying a copy of my EP here.

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