2012-09-17

Not Doublespeak: Flexibility Through Routine

At long last! Today marks the beginning (okay, technically the second day) of a return to my precious daily routine.

Things have been busy in my neck of the woods, which is always rough on a person's routine. Now that they have finally settled down, and I'm back in a stable environment, I find that my blood sugar has almost immediately gone from being always slightly high to being in complete control. I feel like a new man.

Now, the internet is replete with personal accounts of type 1 diabetes, and I don't want this post to get lost in the fray. If you're reading this, and you're a newly diagnosed type 1 diabetic, here's what you need to know.

Some Basic Information About Routines
For diabetics, a daily routine is not a source of boredom or plainness, it is a source of comfort and stability. This is not because diabetics are obsessive compulsive, but rather because the only way to maintain tight control of a diabetic's blood sugar is to adhere to a strict and healthy pattern of predictable behavior.

The reasons predictable routines work so well are as follows:
  • It eliminates guess-work with the mealtime insulin bolus.
  • It allows peaks and valleys in blood sugar to be easily predicted (because you can always count on what happens next).
  • Thanks to the above, it allows for predictable impacts from minor routine changes, such as a one-off exceptional meal or a particularly hefty bout of exercise.
  • If things start getting out of control, it allows one to quickly regain that control.
To put it concisely, managing your blood sugar is a matter of always keeping track of a long list of variables, and making small adjustments so that you mimick in behavior what other people can do with their pancreas.

Getting it perfect is, simply stated, never going to happen. You'll have occasional lows, you'll run high from time to time. What the routine does is it takes the most common and important things you do on a regular basis, and holds them in place, so that you don't have to worry about unpredictability every time you, say, eat breakfast.

A Few Personal Anecdotes
I'm a pretty healthy guy. I like being healthy. Maybe you've noticed. Anyway, it is important for people who like being healthy to get a good and varied diet, but variety is difficult for diabetics to achieve. Furthermore, certain important foodstuffs don't lend themselves well to blood sugar control. Case in point: fruit. I love fruit, and it is an important source of nutrients, but it is also high in sugar and has a big impact on blood glucose levels. It's tough to just "add a fruit" to lunch, especially if that lunch includes other healthy foodstuffs like sandwiches or lentils.

Through routine, though, I can ensure that every breakfast I eat a piece of fruit - typically a banana - which I can vary in order to get a wider variety of dietary nutrients. I can replace my daily banana with an apple or an orange, or add some blueberries to my oatmeal instead of eating a piece of stand-alone fruit.

What's important here is that I only have this kind of flexibility with my breakfast fruit intake because the other aspects of my routine remain intact: I eat a bowl of oatmeal, some fruit, and two cups of milk, every day, at about the same time in the morning. These things never change; the fruit can be varied.

Alternatively, I can swap-out the oatmeal for some toast, grits, buckwheat pancakes, whatever. But only if the other aspects of the routine remain the same. See how that works?

What you want to avoid is switching something different every day. In other words, don't swap out your fruit one day, your carb the next day, your protein the third day, etc. etc. Then you'll start getting out of control.

How about exercise? I do cardio (ahem, running) every day. Every other day, I do some sort of strength training or plyometric routine. This happens every single day, unless I need to take a rest day or something. I can easily swap out the strength training for a particularly long and grueling session of housework or yard work. I can forego the cardio in exchange for a long day of walking around at the zoo or something.

But again: I can only do this if my core routine remains the same. I cannot go to bed at widely varying times, take multiple rest days, never get the same type of exercise two days in a row, etc. I cannot simply vary everything all the time, without losing control of my blood sugar.

Conclusion
As counter-intuitive as it may seem, we diabetics actually have more flexibility when we adhere to a strict routine than we otherwise would have.

Were I to do-away with my routine, I would have to hound my blood sugar constantly. I would have to test five times a day or more. I would have to give myself a correction bolus at every meal, and perhaps at other times of day, as well. I would wake up in the middle of the night all the time. My immune system would be compromised, and I would fall ill more frequently. My eyesight would deteriorate noticeably. Simply stated, I'd always be thinking about my diabetes.

So, amazingly, I can enjoy a great and refreshing level of variety and flexibility when I keep tight control of my daily routine. This is the kind of thing non-diabetics will never understand, but it is nonetheless very true.