Friday, 22 August 2008

Why some diabetics won't exercise

On a forum I'm sometimes in, I ran across this comment from someone in a class for exercise instructors. He's talking about these students discussing diabetics.

This is a class of people honed in to health, exercising, being fit. They couldn't comprehend the mentality of "I'd rather take some pills to sustain me for a little while and die horribly". I get it. People really are that lazy. They really are that resistant to change. "Exercise" and "diet" really are THAT much worse for them than a horrible death.

Which is to say, I understand THAT people choose that. I don't necessarily understand WHY.

I can partially explain it.

I'm insulin resistant, aka pre-diabetic. This is partly genetic, and partly a result of PCOS. So I know what it feels like to have insulin problems (though not full-blown diabetes) and try to change your diet.

A diabetic/insulin resistant person has blood sugar which seesaws violently unless externally controlled. The most obvious way to control it, and one which is easiest to develop independently, is to take frequent small sugar doses.

In other words, to keep a can of soda or a bag of lollies next to you, and take a sip or eat a lolly (candy? sweet?) every five to fifteen minutes.

This keeps your blood sugar kind of even. Rocky-even, but enough to keep you functional.

Take the candy or soda away from a person who's doing this, without replacing it with a proper low-glycaemic-index diet, and they feel AWFUL. Absolutely rotten, and effectively non-functional. Their blood sugar spikes after a meal, then within half an hour they're sluggish, they can't think, they can't focus, and their body is telling them they're starving.

And a single glass of Coke will make them feel good again.

Even converting to a low-glycaemic-index diet, under controlled circumstances, knowing what you're doing, feels ghastly. I've done it several times, and had to repeat it because the temptation to 'just have a small glass of soda, it can't hurt' is so strong.

A low GI diet works, and keeps you functional, but it feels very, very different to the lots-of-small-hits-of-sugar diet. And any time you forget to eat on time in a low GI diet, you know that peanut paste sandwich on multigrain bread will take at least ten minutes to kick in, but a small glass of soda or a couple of lollies would make you feel good almost instantly.

It takes a lot of willpower to keep to the proper diet. I can only do it with a bag of nuts or seeds kept close at hand at all times.

I can also only do it now that I've found foods that count as good AND satiate me - like dahl, or vietnamese rice paper rolls with a lean meat inside.

My first tries failed miserably because I couldn't figure out a low-GI diet that actually had enough protein and healthy fats to keep me functional; other than one which included a lot of meat. And whenever we had a lean time financially, I felt so guilty about dominating the food budget with meat that I'd try to stop eating it so often, and thus get all low-blood-sugar awful, and the cycle would resume.

As for the exercise: that feeling of new muscle developing, that I'm told is kind of pain and kind of not? To me, at least, that's painful. Okay, I have a pain disorder, so that doesn't necessarily correlate to everyone.

But it is a strange feeling to someone who's not used to it. On top of that, there's the fact that the novice is probably overextending themselves anyway and thus getting 'real' pain. Plus they don't know how to avoid chafing or blisters.

Plus there's probably no sweat-wicking clothing available in their size anywhere (except PERHAPS specialist shops that you athletes know about but we don't), and they may not have ever heard of sweat-wicking clothing anyway.

So exercise means pain, blisters, chafing, unpleasant sweating, probably fungal infections in the folds of their skin (they also probably don't know about the truly effective antiperspirants, only the supermarket ones), and no pleasant results that they can ever detect.

Noone ever teaches these people about proper effective blister preventions, or sweat-wicking clothing, or the truly effective antiperspirants, or effective anti-chafing and anti-fungal treatments. The only reason - ONLY reason - I ever learned about them was a friend who was into athletic things, and was horrified that I didn't know.

On top of that, exercise doesn't feel good for them. It's difficult and heavy and they don't get any feeling of accomplishment. If they're trying dance, they don't feel pretty. If they're trying to run or power walk or something, they don't feel fast. They don't feel strong in the gym, or skilled in 'fitness karate' or other 'skill' sports. You'll have to help them learn to feel pleasure in exercise, it doesn't come naturally for them.

So to you, the choice is serious medical problems, or fun exercise and yummy foods like Vietnamese rice paper rolls, dahl and saffron rice, and tofu or lean meat stir fries.

To them, the choice is serious medical problems, or serious medical problems aggravated by a life of torture (the exercise), and where they're denied the only foods they've found that make them feel anything near 'okay'.

It's not laziness. Okay, it's not necessarily laziness. It's actually a sensible quality-of-life decision when you really learn about it from their point of view.

If you really want to help a diabetic friend (of the 'doesn't exercise or eat well' type), try this:

1. Help them explore low-GI filling foods. Don't try to make them change their diet yet. Instead, help them find foods they enjoy, can afford on a long term basis, and will make for themselves (or can reliably find in the supermarket).

2. In the course of this, help them explore exercise. Go on a picnic and throw a frisbee with them, even for only two or three passes. Park a little further from the entrance to the supermarket. Or park at the same distance, but walk with them through one or two more shops than they'd normally walk. Have your coffee at a coffee shop rather than in their kitchen or yours.

Make it VERY small amounts of exercise at first. They need to learn what their body feels like when its moving, and to learn that it's okay.

3. Get them 2 litres worth of glass resealable bottles, and have them fill them with water every morning and empty them by the end of the day. They might need to squeeze some lemon into them, or have a water filter, or make some sort of tea, but anything like that's fine. Plain water tastes icky to some people.

4. Help them gradually swap high-GI regular meals for low-GI ones. Switch their evening meal from white-flour pizza or KFC to dahl and buryani or a home-made roast with all the (healthy) trimmings. Encourage them to make hummous from chickpeas and have it with chopped veg for lunch.

5. Continue the exercise. Expand it until they're the one suggesting you go fly a kite in the park. Keep an eye on them for signs of blisters, rashes, chafing, and other problems, and help them get those dealt with and prevented in future. Help them find affordable exercise-appropriate clothing in their size: that will be challenge enough for you, much less them.

6. Get them to keep nuts and seeds and other convenient but healthy & low-GI snacks on hand at all times.

7. Once they're comfortable with all of that, NOW you can take the soda and lollies away. Some of them will have dropped them already. If not, support them through the transition.
Let them know it's normal to feel awful, or just strange, during the transition, and be there for them while they go through withdrawal. It really is a kind of withdrawal.
Let them know that they can expect to feel different once it's completed - they're switching from one type of blood sugar control to another, and they're going to need to adapt to the new 'base metabolism'. But once they're used to it, they'll actually be more functional and more comfortable than with the old system.

8. And with the new base metabolism, they'll have more energy for exercise. Now you can introduce formal exercise.

I hope this explains it, and that you find this helpful.


Ken said...

As a type 1 diabetic (Adult Onset, age 48 when it hit) I can say that you are close to the mark. I spent 12 years active duty Army, I know what it is like to excerise. I HATE it. After excersing I am not only sweaty and tired, I am normally sick. Yes, excersing does make me sick, and no it is not psyco-simantic. I was tested while in the Army. It has to do with a reaction to a protien the muscles release.
Not every diabetic won't exercise becase they choose not too. I still go on long walks (wife calls them marches because of my pace) and do some light exercise. I still get sick, even if just mowing the lawn.
Most of your points are dead on. Never did find a deoderant that works and did not cause rashes.

The Scribe said...

Thank you - it's good to get the feedback!

And even better to get the confirmation that yes, others do feel the same way. :)