The dark side of normality

Have you ever felt like you didn’t “measure up”, didn’t quite “cut the grade”? Perhaps you felt “not good enough” or inadequate or worthless? Maybe a sense you just didn’t have it “all together” as you would like, or you dropped the bundle? This is how Michael White, the founder of Narrative Therapy, once described the way that people may feel if affected by a sense of “personal failure” ….

The idea of “normality” is fairly new. It is also very powerful. It provides us with the criteria check lists by which we measure and compare ourselves and our “success” in life. Normality can sometimes work for us and sometimes, against us. Ideas about what is “normal” can isolate people and groups of people and give power to those who live their lives within this idea of “normality”. It also leads to us picking up invitations to feel like “failures”. Guilt gets a big part to play as well when we feel we “should” be, act, think, a certain way “or else”.

These ideas can also be used to diminish people on the basis of cultural or spiritual practices, sexuality and physical and mental health and ability.

The idea of “normality” can be interesting to consider in the light of living with something like diabetes. What is a “normal diabetic”? How do we (and others) judge ourselves and the way we manage and sometimes don’t manage our diabetes. Sometimes it is just too hard so no wonder.

The word “normal” actually comes from the Latin or French word for the carpenter’s square, or normal angle! So we may ask ,what has that got to do with us? It was only in the 19th century that the word “normal” began to be used to in relation to people and their actions, rather than just to angles.

In recent times the idea of what is “normal” is applied to just about anything !- we are judged on our height, weight, clothes, body shape, child rearing, house and garden, time taken to grieve or adjust to something like diabetes, how angy and happy we are etc etc etc

There are many places in public arena such as our popular media for example, where ideas are created which are tempting for us to measure ourselves against. Just pick up any women’s magazine; home rennoavtion mag, or watch all the advertisements on tv.

Lists about what is “normal” also abound!

The idea of what is normal is also constantly changing – we have developed so many ways of measuring our “normality” and we then equate this to what we are worth – it means we are “worthwhile” or “worthless” depending on how “well” we are doing against all of these “lists”.

For example

1. finished school (oh and went to the right school)

2. got a good job and/or went to uni

3. got married

4. had kids

5. built a house

6. got a 4 wheel drive!

7. have lots of family holidays

8. Have an HbA1c of 6 % all the time and no diabetes complications

8. have a tidy house

9. kept my figure and regularly go to the gym

This may be one person’s list by which they measure their worth…and what a list!

This leads to a sense of not being “good enough” or being a “failure” being very easy to fall into – if not fitting into what is expected, we can be overwhelmed by what can be called the “normalising gaze”.

So have a think about what lists and ideas are in your life that may actually lead you to feeling bad about yourself and falling into the trap of “failure” –

In my mind – there is NO normal – we are all beautiful and all unique

appreciate the beauty around you and your own beauty and uniqueness
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Diabetes and eating disorders – overcoming the dangerous beast

We speak to lots of people living with body image problems and eating disorders – both type 1 and type 2 diabetes. Many people with type 2 diabetes struggle with binge eating and body image issues; people with type 1 diabetes have double the rates of eating disorders and find that the issues of weight management and control of their diabetes get intertwined – a dangerous mix.

Below is a story from one of our members about her journey with these issues.

http://www.diabetescounselling.com.au/communicate/your_stories/story2.html

“I have had diabetes for 19 years now, since the age of 8. When I was 14, I trialled the newest insulin pen which allowed the injection of short acting insulin just prior to each meal, thus mimicking a normal bodies response to food intake. Because of the flexibility this gave me, I gained a lot of weight eating the things I had never before been allowed to eat. When year 12 rolled around, and I had lost the weight that I had gained two years earlier, I was unable to stop dieting. My weight reached 28 kilos and I made my way through university at that level, interspersed by lots of hospitalisations.

I suffered severe anorexia for 5 years. Life was hell. I was always freezing cold, had a fine coat of downy hair on my body, stopped menstruating (not that it was something I missed!!), my hair fell out and my skin and finger nails were dry and brittle. When I was admitted to the Children’s Hospital at 17, I hadn’t eaten properly for nearly 6 months. I was taking no short acting insulin and was surviving on less than half my “normal” dose of long acting. I was also constantly hypo, hovering around 2, 24 hours a day.

The doctor decided to put me onto a dextrose drip and this caused me no end of trauma thinking they were force-feeding me. It took quite a lot to calm me down. After 5 years, something made me turn around and I began eating again but this time I would purge after bingeing: bulimia . My weight ballooned to 90 kilos and with it came depression. Bulimia was much harder to cure because no one knew you had a problem. I began stil life modelling.

Although my weight had dropped to 80 kilos, I still felt pretty uncomfortable with myself but my friend assured me that artists enjoyed curvy figures, not stick thin people whose ribs were showing. And thus started a beautiful thing. My self esteem rose as I realised it didn’t matter what size you were, you are still beautiful. Those artists made me look like the Reubens models – curvaceous, glowing and happy. At times it was confronting to see how different people saw me, and men always painted me larger than what the women did, but it also allowed me to become strong in the knowledge that what they saw was neither judgmental nor critical.

While I was anorexic, although my HbA1c was very low at around 5, I suffered some of the problems that are more often associated with higher HbA1cs. I experienced some retinopathy, which was frightening for someone only 22 years of age. This didn’t repair during my bulimia either. But since I have been fully recovered, the ophthalmologist can see absolutely no evidence of it left. It is pretty amazing what the human body can suffer and still come good again.

The only problems that remained were my reflux, which had to be fixed with surgery to create an artificial valve to prevent the stomach acids rising; some tooth decay, because the stomach acids eroded the teeth when I was vomiting; and my hair is not as thick as it used to be. My weight has dropped to 68 kilos – spot on the recommended weight range – and I still get plenty of work modelling. It allows me to meditate and I thoroughly enjoy the classes. And do you know, men are easier to model for than women!!!

I now consider myself fully recovered and enjoy a healthy diet and exercise regime. The women who counselled me through the difficult time were my GP and Friend, Dr Jenny Thomas (thanks Jenny) and Vonnie Coopman who runs a very successful clinic at the Blackwood Hospital in Adelaide . Vonnie has suffered with both anorexia and bulimia also and her own experiences have helped many sufferers. Even with the knowledge of what can happen to the body, I am not sure it would have stopped me from going through these eating disorders. Anorexia was my way of asserting my authority and control over a life that I felt I had no control over – my life was being run by well-meaning parents who controlled my food intake and insulin as best they could.

Our relationship between food and the human body and its psyche is amazing. The amount of research going into this is mind boggling.”

There are organisations that provide support for people affected by eating disorders throughout Australia: Queensland – 07 3876 2500 Victoria – 03 9885 0318 NSW – 02 9412 4499 SA – 08 8212 1644 WA – 08 9221 0488 Tasmania – 03 6222 7222

EdTalk is an email discussion group for people affected by eating disorders. You can find it at http://www.uq.net.au/eda

Eating Disorders Australia has a website at http://www.eatingdisorders.org.au

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Diabetes problem solving

Here is an excerpt from our current newsletter http://www.diabetescounselling.com.au/communicate/newsletter.html

We get many people contacting us for personal counselling and support. Often people have similar concerns and stories. We will share some of these with you each edition. We welcome your feedback and comments which we will also publish in the newsletter.

QUESTION “I have had type 2 diabetes for the past 3 years and am struggling with my weight. I know what to do, but putting it into action is so hard, especially when I am also dealing with depression. Because I’ve lost some weight I start to think “I deserve a treat, everyone else can have one”. This then turns into a real binge & then I hate myself and feel like there is no point going on with it now. I just get so down and it seems all too hard…..”

RESPONSE -” This is a common problem. Many people struggle with their weight and when you have type 2 diabetes it can be even harder. However it is entirely possible to lose weight and you have done really well in the weight loss you have achieved so far. Depression can make weight management harder and they are connected. What we want to aim for is long term weight management in a healthy way. Even a 5% weight loss can have a big impact on your health. It might be possible for you to include some built in treats, so you do not feel like you are missing out – this works for some people. Others say once they start a certain food they can not stop. Losing “black and white” thinking and learning to think in more “shades of gray” can help. Many people take an “all or nothing” approach, which leads to a cycle of starting and stopping with their weight management and to then lowered wellbeing. Learning “grey thinking” and how to be gentle on yourself can help. By doing this, you lessen the guilt which helps to stop the cycle of depression and binge eating.”

QUESTION – “My partner has type 1 diabetes and su ers with anxiety about hypos. This means he keeps his blood glucose levels high, to avoid a hypo. I am really worried about the impact this is having on him and our chances of having children. He has never spoken or met anyone else with type 1 diabetes before. I have tried to talk to him about this problem, but he just says it is his diabetes and how could I understand what it is like to have a hypo? He works in a high pressure job and I am so worried that this problem is leading to me also su ering with anxiety. I have been sick a lot and have not been able to sleep lately. Please help.”

RESPONSE “Anxiety about hypos is a common problem. The symptoms of a hypo can be very distressing and di£ cult to manage. It is hard to explain to someone who has not had a hypo, what it really feels like. Keeping the blood glucose levels higher on the odd occasion is not a problem, but you are right in that an extended period of high levels could lead to diabetes complications and it is important to manage this problem. Watching someone you care about struggling is very stressful but as he is an adult you can not force him to make changes, or seek help. I think it might be really helpful for him to talk to someone else with diabetes as a starting point, so he can see he is not the only person to feel this way. Developing strategies for managing his diabetes at work to avoid a hypo, whilst still maintaining healthy blood glucose levels is important. There are a range of things he can do, such as looking at his current management regime and seeking a review of this. Learning anxiety management techniques such as relaxation and breathing cycles, can really help. If he is open to this, I suggest you refer him to our website so he can chat with other people with diabetes. You can also access this support for yourself.”

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How do you have babies when your pancreas is missing in action?

Imagine a 12 year old girl, on the edge of adolesence, growing up, waiting for boyfriends, dreams, plans and ideals. Imagine a 12 year old girl who loves babies, who really wants babies and a family, as part of those dreams. Enter type 1 diabetes. Idyllic childhood shattered.

Imagine a 12 year old girl told that she is probably going to have her legs amputated, lose her vision, have her kidneys conk out and the ultimate tragedy for her – will probably NEVER have a healthy baby….that women with diabetes if they do manage to get pregnant and carry to term will have either dangerously large, or dangerously small babies; that they can be deformed and in particular develop without their ears (not sure why that one was highlightd!); and the cruncher – that still birth is very common……Oh and add to that the stress to her own body (think the movie “Steel Magnolias” and you get the picture).

All of these stories and worries pile upon pile, until the teenage years become a whirlpool of grief, sadness, confusion and anxt. Not that life is all horrid in any way, but this background of grief looms large as this girl grows up.

Flick to 1993 and this now 26 year old, having succeeded in her life despite diabetes and all of these worries and all of this grief (a high achiever as all young people with diabetes seem to be!) – falls pregnant, unplanned and without “perfect” control. She is delighted!

Yes this pregnancy WAS tough, it was hard and yes, the baby did have hypoglycemia when born and he sure was big! But he had all of his parts (even the ears) and he is now a thriving 6 foot 16 year old young man!

A lot of the reason diabetic control was not so great during this pregnancy was due to just terrible management options – Protophane and Actrapid Insulin were not a good combination for tight control and thus, it was not really within the realms of possibility no matter what….

Carrying on with the story, things with this bub’s dad took a wrong turn and when he is 9 months old, this young woman becomes a single mum, with diabetes and she gets on with it and does a good job of managing a child, a job and her diabetes. (there is that high achiever again)

5 years later in 1999, now with her new husband, (and after suriving depression and panic attacks) she again falls pregnant, again unplanned (well not that soon after getting married in any case!) and she has her second son, also a tough (actually with the depression and anxiety, a tougher) pregnancy; and guess what, yes he was REALLY big and had some problems for a few days after birth – but again he is now a perfectly normal, healthy 11 year old boy.

Now, the real cherry on this wonderful, sweet story – is this young (well not so young now!) woman’s third pregnancy – this time planned but taking 7 years to come along! – this time with advancing years came maturity and an Insulin Pump!! This miracle of invention provided the possibilty to manage diabetes so well that a HbA1C of 5% was maintained and the baby was stunningly healthy. This pregnancy while not easy, was wonderful, a delight, a joy and unlike the other two, not ONE hospital admission until the time for birth. Technology had opened the door.

So now, imagine a woman waiting to have her baby, her last baby. Imagine this woman going into hospital a week before the planned C-section to reduce her insulin doses and manage things so that at birth, diabetes will stay well controlled. Imagine her waking on the morning of the birth to a wild storm, grey skies, rain and a blustery wind so strong it blows all the leaves from outside into the halls of the hospital so that as she is wheeled to theatre she can see some of the outside world, the trees, on the floors as she floats across them. She is shaking she is so excited and nervous. She tells the doctor this baby will be fine (he reminds her that even with an HbA1C so tight, babies in the “diabetic environment” can have issues) – she knows better.

The baby is born and to the delight of all, is the smallest of all her 3 babies, a healthy 9 pounds which is just right for her family history; he is perfect; he is brought to the breast for a try at a breastfeed (which to her after many breastfeeding problems in the past and not having this with the other 2, is the ultimate joy). The doctor can not hide his surprise and, his own joy.

A couple of hours later the nurse says ” I will be bringing Maxwell in a minute”. “For a feed she asks?”. “No, to stay!” beams the nurse. She can not believe this is real. This time, bub has NO problems, is totally unaffected by her diabetes. And she knows the many reasons why, including the pump and her increased knowledge about her diabetes – and she is just, glad. There is just joy and a complete lack of ability to be separated from this little miracle.

The story is just starting really and Maxwell, now 18 months, still breastfeeding and the light in our lives, completes our family and puts to rest a lot of grief from the past.

So I ask you – diabetic women not able to have healthy babies?  

I don’t think so!


The miracles of birth and an insulin pump!
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Can you eat that and other guilt laden moments

“But you don’t look like a diabetic” (and what exactly would a diabetic look LIKE??); “Can you eat that?” (well can YOU, or more to the point SHOULD you?); “Oh you must have the bad diabetes” (Is there a GOOD kind???); “oh you are being very naughty having that cake/biscuit/chocolate/treat” (what would YOU know?); “If you just ate better and lost weight your diabetes would go away” ( I WISH)……

These are all genuine comments us people with diabetes get from those without diabetes, time and time again. You would think with all the media attention on diabetes, how we are the fattest nation in the world, how diabetes is set to be the biggest health problem ever faced, that our hospitals will be stuffed with obese people, with diabetes, ruined kidneys, heart failure and their legs cut off (no joke I can see it now) – that people would know better. But herin lies the problem, the media is often misinformed, uniformed and just downright dumb when it comes to diabetes and no wonder. We used to have it sorted, there was Insulin Dependent Diabetes or IDDM and Non Insulin Dependent Diabetes or NIDDM. So you either were on insulin (the REALLY BAD diabetes) or you weren’t (the diabetes that was all your own fault and happened to old people).

We now know that diabetes is much more complex, we have type 1 and type 2, but we also have gestational (arguably just the start of type 2 diabetes in some women and the natural insulin resistance of pregnancy in others); type 1.5 or LADA which is an autoimmune form of type 1 diabetes in adults and a range of other less common forms and reasons for the pancreas going on the blink.

We also know that age is no barrier in deciding which type you have – kids are sadly getting type 2 and adults can get type 1. Further all forms of diabetes are on the increase, suggesting that environment has a part to play in all forms – not just type 2.

People working in diabetes get confused and people living with diabetes are confused, so no wonder the media and general person in the street do not understand diabetes in all its forms. That said, education is vital and something we as people living with diabetes, can offer to the world.

Guilt is not helpful so don;t accept it when offered – you know what is ok to do in your own life and you can choose to manage how you wish. So next time someone asks “Can you eat that”, instead of getting angry or defensive, say “well yes actually people with diabetes can eat anything you know” and give them some information – tell them “you never know” they may end up as one of those diabetic statistics themselves one day – as after all diabetes (surprise surprise) is not choosy in who it decides to visit….

stories from the diabetes counselling web
stories from the diabetes counselling web
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