Discipline
How Relentless Routines Empower a Full Life with Type-1 Diabetes
Discipline means everything to me. In every aspect of life, discipline leads me to hyper-focus and powers my mission to become my absolute best self. I eat the same breakfast every morning. I train an intense workout regime every single day. While I include active recovery days, in my mind, there is no such thing as a “day off.” I can constantly be doing something that improves my physical or mental state. I have the same variation of dinner every night. Vegetables, meat, and whole grain. At least twice during my three week training blocks, I visit the mountains. I have been sober from alcohol for over one and a half years.
Managing my T1D… it’s become subconscious at this point when piecing it together with all of my other routines. T1D is no different than taking care of oneself. Why? Because I must in order to stay alive and to drive optimal performance. I am not flaunting, but I am proud to say that my A1C is 5.6. I use pens. Some may think I am constantly concerned, yet I’d state that I am just constantly monitoring. I monitor my hydration intake. I monitor my work hours and family life. I monitor my sleep. Why not intensely monitor T1D?
When I was first diagnosed, I was told that this would be easy. This misguided advice continued: Count carbs and give the allotted amount of insulin. This is far from the truth. T1D is not easy. And the message I often heard was: just keep a cool, calm life, so you’ll be able to live normally. Pardon my French, but what the fuck does normally mean?
Life would be easy as a T1D as long as you give your insulin to carbs and stay lightly active. Don’t push too hard or you’ll go beyond the boundaries of what you can safely do. This is far from the truth.
On the day of my diagnosis, I was told that it’d take a year or more for me to complete any major hike. Less than three months later, I was standing on top of the Rocky Mountains. I was told that I can never adventure on my much beloved solo backcountry trips. Not only have I summited Mount Whitney (the tallest mountain in the lower 48 states) alone, not only have I experienced minus 40 degrees alone, not only do I continue to train overnight trips in the backcountry in all four seasons alone, but I conduct these expeditions in a safe manner monitoring and managing my dangers.
I am not blindly or stupidly getting myself into trouble. I am respectfully and successfully accomplishing these journeys alone as a T1D. Why? Because when I was told that I couldn’t, I told myself that was not an option. I told myself that I must learn how to do this with intelligence. Not just for my own purpose, but to now put it out there to show that other T1Ds can have full trust in themselves during moments when it counts.
Let’s talk about some of my disciplines related to T1D.
First of which is the timer I keep during my bolus insulin half life and full life. I acknowledge that this trend may react differently for those using pumps or other methods. I appreciate the pen for the finite insulin bump I receive. In three and a half hours, I know *for me* my bolus has expired unless I gave following boluses, which I often do, mimicking the constant flow of insulin seen in a pump.
I set my timer as such:
Timer 1: 15min, post injection (before eating carbs)
When those 15min are up, I know my bolus is now in effect and I can eat my allotted carbs.
Timer 2: 1hr30min, rest of half life
When those 1hr30min are up, I know I’ve reached the half life of my bolus, so I can make adjustments on either eating more carbs, taking more insulin, or staying as is, depending on my blood glucose readings.
Timer 3: 1hr45min, second half life
Upon the ring of this timer, I know the full life of that bolus has ended. I keep these timers on my watch.
This also helps me keep track of all my boluses if I decide to give multiple boluses within the total 3hr30min span of one bolus life *for me*. At evening before sleeping, I give my basal dose. I like the idea of constantly having insulin in me, especially during my backcountry trips, to prevent the chance of ketones dangerously building up.
When I was on a glacier in Alaska, my blood glucose numbers hovered higher for multiple days, but I always had basal insulin in me. When testing my ketones from day one of the trip to day seven, I actually went from 0.2mmol down to 0.1mmol. This is a minute difference, and anecdata that begins and ends with me, but it is worth noting that basal insulin may have helped contribute to the prevention of ketones rising. I’d love to seek further studies on this concept. Please comment if you know of any.
One of my other T1D disciplines…
Keeping a similar carb count to every day or based off the next day’s activity.
I eat in a range of 130-180 carbs per day depending on my needs. On days before an endurance run, I eat closer to 180 carbs. On days before weightlifting or active recovery sessions, I eat closer to 130 carbs. On days when I am away from my home, and more apt to be in an uncontrolled societal environment (social functions, family visits, etc.) I tend to eat less carbs to minimize any complications.
The types of carbs I eat are similar. From whole grain cereal in the morning, to nuts at lunch, to whole grains with my dinner, I eat the same variation of carbs every single day.
Some of these are:
Cheerios, Peanuts, Brazil Nuts, Other Mixed Nuts, Farro, Bulgar, Teff, etc.
Before endurance runs or to treat lows, I eat:
Kiwis, Mangos, Apples, Grapes, Blueberries, Bananas, and yes… Chocolate
The most important T1D discipline, which I have been alluding to this entire time, is routines.
I am constantly in an athlete’s mindset.
No matter where I am on the face of the planet, or in my life, I try my fucking hardest to keep consistent routines. Even when the day doesn’t call for it (a work trip, a life event, etc.), I do what I can to maintain my routine to keep as much consistency as possible.
I exercise at similar times every day. I eat breakfast, lunch, and dinner at similar times every day. I go to sleep within the same timeframe every night. I drink caffeine at the same time every morning (and throughout the day). At the moment, I am attempting to start two businesses at once, am planning for a wedding this year, and have a 6-month old puppy. I feel as though time slips away from my grasp every day, but I still follow my routines. This is why I am proud of my 5.6 A1C.
I put my health above all else because it helps me feel great and motivated to get after every other aspect of my life. We only have one life. The way I enjoy it is by grinding. I don’t find enjoyment in going to amusement parks or parties. I find fulfillment in pushing myself during a run, training for a greater climb. I find purpose in pursuing a platform that will one day hopefully serve as inspiration and education to millions. Dream big. As Stephen Covey advocates, Begin with the end in mind.
I argue to do this in all aspects of your life, including T1D. Begin with the thought of what it would be like to reach the end of your life with T1D. This condition will not be my downfall. The end I have in mind is to live a full life, and something else (I hope old age) will knock me out, but not T1D.
I hope this helps. Stay strong. Stay determined. T1Determined.
written by Joseph Anthony Marcello
