"By George, I think I've got it!" shouted a friend of mine, who had been diagnosed with type 1 diabetes. "I'm living in the middle of a triangle."
Over 30 years of living with type 1, I've often heard glucose control referred to as a fine balance. The image of an old-fashioned brass scale would appear in my head. Yet my friend's revelation got me mentally sketching a new image. She was right: Managing diabetes is like living in a triangle of food, insulin, and physical activity level. There's more to balance than the two sides of a scale. Yet are there really only three sides?
I grew up in a family of quirky, creative thinkers. I recall a childhood afternoon sitting around trying to label everyone we knew as a piece of fruit. "Naw, she's not a grapefruit—how 'bout a kiwi?" Or, "That little girl, she is an absolute blueberry!" While the challenge of finding the perfect fruit to typify diabetes didn't speak to me, assigning a shape to diabetes did. And the steady triangle just didn't cut it.
My first memories of taking responsibility for controlling my diabetes date back to high school. Perhaps a triangle is indeed the most apt shape for those teen years. After school, I dashed to my locker to grab a snack before volleyball practice. My NPH was in full force by that time of the day, so I had to balance insulin with carbs to prevent hypos while exercising. The general three-sided geometry remained constant day after day—insulin, food, and activity. My control wasn't stupendous, but the triangle stood stable, never teetering on a point.
College years changed everything. That time period was a big wheel, with diabetes in perpetual motion. There were loops of erratic variables: Insulin ran after food, sleepless nights chased insulin, activity chased glucose levels, inactivity pushed sugars higher, and unpredictable schedules tried to catch carbs. I'm sure I could've stomped on the brakes and wrested control. But at 19 years old, who wanted to do that?
And then I got married. Another soul stepped into the picture, and I had someone else's needs to factor into the geometry. The wheel slowed down. Insulin, food, activity, and dear husband each took a side, and my circle morphed into a square. We aimed for a fixed schedule and happy stability. This worked well for a bit, until the birth of our first child combusted the square. The sides flew out of control and floated weightless for a while until I got a grip: Life with diabetes became a proud pentagon.
Identifying the shape of my diabetes granted me a valuable perspective. The way I see it, diabetes control is indeed a balance–yet the details of what needs to be balanced are highly individual. This is something that everyone needs to take into consideration in order to support long-term, good control.
The shape-reformation process has occurred many times since my diabetes was a pentagon. We now have seven amazing children (right), and with steady, well-controlled steps, my 11-sided diabetes struts happily in the shape of a hendecagon.
Debbie Burack lives in Beitar, Israel.
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