My friends, this is quite a thorny thicket of a topic, is it not? I suspect that my regular readers, friends, and supporters will approach this post with an open mind and with trust and faith in my thoughts and feelings and discoveries. There will be many, I am sure, who will lean immediately and heavily on pre-conceived notions of wellness and how that relates to fatness (and perceived slothfulness and gluttony). I am not writing for those in the latter category, and I would invite those people to take a long relaxing walk in the sunshine and leave me to my contemplation and my physical and mental healing.
In fact, I am writing primarily for myself, but also for those curious about my feelings on being a self-proclaimed Fat Vegan and advocate for fat positivity, as well as a recent Type 2 Diabetes diagnosee. If you are approaching with an open heart and mind and the spirit of curiosity, then please read on! I am particularly keen that my fat and/or sick/ill/disabled friends read these words as I hope they will provide comfort and reassurance and -perhaps most importantly- community.
This story begins about twenty-ish years ago, and then again about two years ago…..and then it picks up once more around two weeks ago. Maybe the story begins when my late Mother (a former paralympian athelete) was diagnosed with Type 2 Diabetes in her forties. Being the ignorant pre-teen oik that I was, I’m ashamed to say I took little active interest in her diagnosis or treatment. I was impressed by the glucometer and the frequent finger pricks. I was further (smugly) impressed by my own perfect blood glucose levels whenever we were allowed a go (new lancet, obvs). With typical irreverence I noted that the evidence pointed to my own genetic susceptibility to the condition (rather than disease – more notes on terminology here) and then proceeded to spend ~15 years doing precisely nothing about it.
Let’s fast forward to 2017. My Mum was in hospital for much of the summer of that year. It was an intensely difficult time for her and for the family. I was also battling continuing stress in my own life: relationship breakdowns, work difficulties, a diagnosis of CFS/ME, and my ongoing mental health problems. In September of 2017 my Mum passed away in intensive care. Perhaps naively, I wasn’t expecting to be holding her hand as she slipped away aged 64. My Grandfather and Grandmother both had diabetes. In fact, my Nana was alive and in her eighties when my Mum died. On the one hand, longevity seems to be in the genes. On the other, my health story seems to be following a similar trajectory to that of my Mum, which is maddening, saddening, and terrifying in equal measure.
Let’s fast forward again to around two weeks ago. After three blood tests (one of which was mislaid), which were at my own request, I was told I am in the diagnostic range for full blown Type 2 Diabetes. They performed a test called the HbA1c. This is a very clever little test that measures the amount of glucose sticking to blood cells when it should be processed and used up by your body with the aid of insulin. Red blood cells are active for 2-3 months and that’s how it gives a magical retrospective view of your blood glucose levels.
The diagnostic cusp is 48mmol/mol (6.5%). My result was confirmed at 52mmol/mol. Here’s a handy chart from diabetes.co.uk:
I am just pipping the cusp between “pre-diabetes” and Type 2 diabetes as you can see. I’ve been told that it’s still theoretically possible for me to put it ‘in remission’ at this stage – if I seize control of my whole entire disaster of a life and demonstrate that I actually care enough to salvage my own physical existence, yanno? No pressure. But the fact my result is at the much lower end should, in theory, be of comfort. So I suppose that it is.
My first official ‘Welcome to Diabetestown’ appointment with my GP practice nurse was a disaster. A huge and horrible disaster. I left her office in floods of tears saying these very words: “I’m really not getting the support that I need“. You can read a bit more about it here.
A summary of what I was given by the nurse, as she peered at me sternly over her glasses:
- A huge telling-off.
- One print-off of NHS info about retinopathy.
- One print-off of NHS info about foot care.
- A prescription for metformin.
- High blood pressure.
Here’s what I wasn’t given:
- Any education about Type 2 Diabetes: current accepted knowledge on its causes, conventional treatments, outlook, diet/lifestyle changes or recommendations of any kind other than “lose weight“.
- Any acknowledgement of my complex medical history and/or the fact I have recently experienced the single most horribly stressful two years of my entire life. (See: effect of sustained high levels of cortisol on blood glucose levels and blood pressure, and my BPD diagnosis and associated poor distress-tolerance skills and a tendency to binge eat, alongside the NHS’s refusal to provide DBT to aid me in developing better and healthier coping mechanisms.)
- Any guidance or advice on a proven-to-be-effective LONG TERM plan for sustained, healthy weight loss.
- A glucometer or prescription for test strips.
- Any support in any way whatsoever.
And so that was not a great day, friends. Luckily for me, I got a call from the GP the following day to confirm my blood test results were good enough for me to begin a course of Ramipril for high blood pressure. I cried again (hello I am 37 years old) and told him I felt hopeless about turning things around where the diabetes was concerned. I told him I despaired at simply being given a prescription for metformin and no education, guidance, or support on how I can OWN this diagnosis and try to make good and healthy decisions about how to live my life.
(N.B. I have since learned that metformin should only be prescribed when your cells are no longer sensitive to insulin, as it is a medication intended to treat insulin resistance and not necessarily diabetes or pre-diabetes. Without a Glucose Tolerance Test, you cannot know for sure if you are insulin resistant and in need of metformin. To my knowledge a Glucose Intolerance Test was not carried out.)
The GP told me that the nurse should have referred me to an education programme, a support group, and a free weight loss advisory programme. The GP made all three referrals and reassured me that I could try to tackle my blood sugar levels through diet/exercise alone in the first instance, and so I stopped taking the metformin and I started to educate myself.
Whose ‘fault’ is it?
For me, the truth about who’s to ‘blame’ for my T2 Diabetes diagnosis is entirely moot at this point. My levels are what they are, and I am the one with the control of my body and what I put in it and do with it. Blame is unhelpful. Sure, it may be useful in predicting and possibly even preventing diabetes, but that’s not the situation I’m in. The assumption that T2 Diabetes is a ‘fat disease’ is not entirely correct. For multiple links to scientific studies, papers, and meta-analyses see this link. What I do know is that stigma (both of fatness and T2 Diabetes) is extremely harmful and, ultimately, entirely unhelpful.
For the record, here’s what I think caused my own diagnosis:
- A genetic predisposition.
- On and off years of sustained stress and anxiety.
- Dieting and related weight cycling over the years.
- My BPD/EUPD and the related poor distress tolerance skills and a tendency to binge eat buckets of highly processed fatty/sugary/carby foods during periods of stress and poor mental health. This coupled with a two year period in which I lost my Mother, my Nana, my Uncle, and experienced two house moves, a relationship breakdown, and a long period of absence from work as my workplace harasser was investigated and ultimately referred to disciplinary proceedings.
So, yes, sure, I’ve managed my physical health terribly. But the odds were stacked against me in a number of ways, and so I see no benefit in shaming myself (or allowing others to shame me). What I want to focus on from now on is the following:
- Seeking support to develop distress tolerance skills and healthy coping strategies.
- Educating myself about my condition and the science behind it.
- Seeking support and advice from fellow T2 Diabetics who have lived many long years with the condition.
- Educating myself about my own body and how it reacts to different foods – i.e. OWNING the diagnosis and figuring out what the healthy choices for me are.
- Advocating for myself in healthcare settings with the knowledge that fatphobia is rife within the medical community.
What’s most important to me? HEALING is most important to me. Allow me to drop this excellent quote from Stacy Bias here, which is very relevant to me and my situation:
(I am sorry that I do not have a non-image version of this quote. If someone is able to type it out and email it to me I will add it.)
To me, the physical and mental healing are inextricably linked. (See this excellent post by Jes Baker: If you want to talk about physical health, we’re probably going to talk about mental health first.)
I want to learn how to make better choices, holistically, for my body and my well-being. I don’t have to. But I want to! And I need help with that. I need education and support. And I’m seeking it out, and in some cases I am fighting my own National Health Service for it. Which sucks.
But broadly my plan is this:
- Follow -for the majority of the time- a whole foods plant-based diet.
- Pursue intuitive eating.
- Actively practise mindfulness and meditation, and continue talks with my employer’s Occupational Health team regarding workload and stress levels. (I’m also now diagnosed with high blood pressure though the reading was taken immediately after the nurse shamed me for a solid 30 minutes.)
- Seek effective treatment for my BPD and associated symptoms.
- Self-test my blood glucose regularly and figure out which foods work best for my body.
- Figure out how to get my body moving more and to do this in a way that doesn’t compromise my CFS/ME which I manage well through pacing.
- Endeavour to keep my blood glucose levels in a healthy range through all of the above.
- Allow myself delicious treats occasionally even though they will raise my BG levels. Punishing abstinence is unsustainable.
- Focus on the numbers on my blood glucose monitor and blood pressure machine above all other numbers.
And sure, I would love to be held accountable for the most part. But at the end of the day this is my body and my journey. I don’t actually owe my ‘good health’ (physical or mental) to anyone, except maybe myself because that’s what I want.
I am likely to lose weight in the process, and research does suggest that’s helpful in the short term (and only in the short term) so it’s fine. But, whatever, I’m not counting. And I know from experience that I’ll still be fairly fat regardless. Again, whatever! Fat is not inherently bad and that’s as true today for me as it was two or twenty years ago.
And all of the above is in perfect synergy with body positivity and fat positivity <3
It’s early days, but this is some of the stuff that’s already in my toolkit, and has been helpful for me so far. Not all is vegan-friendly, but it’s still helpful.
- On intuitive eating: Just Eat It (Laura Thomas PhD)
- Intuitive eating for Type 2 Diabetes (Linda Bacon): Enjoy your food, respect your body
- Diabetes UK forum: Useful links for the newly diagnosed
- Testing on a budget and Alan Shipley’s book, What On Earth Can I Eat?
- Diabetes UK website in general
And some of the tools and technologies I’m using to get a grip on my blood sugar levels (more in my life stack):
- SD Biosensor Codefree glucometer and test strips.
- This snazzy pill box for my now multiple medications.
- MyFitnessPal paid subscription for tracking everything I eat, and nutritional values.
- OneDrop app to log blood glucose readings, carbs, meds, exercise.
- Strava and Apple Watch + Health app so cumulatively I log everything.
- Dr. Neal Barnard’s Cookbook for Reversing Diabetes
- Forks Over Knives cookbook
- How Not To Die cookbook
And so, that’s that for now my friends. This is a journey and I’m feeling my way. Questions are welcome, unsolicited lifestyle advice less so! Unless you can read science papers and are willing to summarise a few for me (here’s my collection so far) I’m good with what I have and what I’m learning! I’m always interested in new sources of support or community, or your favourite books or blogs for whole food, plant based recipes ^_^
(If you’re interested. I post my ‘healthy’ dinners on Instagram stories most nights, and then report back on my blood sugar levels.)
Header image is from Pixabay. Thanks Pixabay!
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