Diabetes Diary: A Bagel Lover Who Finds Balance Through Meditation
Natalie Karabel was diagnosed with type 1 diabetes when she was six. People often don’t understand the difference between type 1 diabetes and type 2 diabetes, but there are some key nuances. Type 1 diabetes is an autoimmune condition that prevents your pancreas from making enough insulin to regulate your blood sugar. Type 2 diabetes happens when your body doesn’t use insulin very well and your pancreas can’t produce enough insulin to keep your blood sugar stable. Both forms of diabetes can cause high blood sugar that requires a treatment plan including dietary changes and medicine. People with type 2 diabetes generally modify their diet and take medication to help their bodies become more sensitive to insulin. People with type 1 diabetes, like Natalie, inject themselves with insulin several times a day to maintain stable blood sugar levels.
For many years, Natalie didn’t talk about her condition with others because she was worried people would judge her for having diabetes. After noticing how this affected her mental health and well-being, Natalie started talking to family and friends about her diabetes, which helped her gain self-acceptance. Then, when she was 34, Natalie developed an eye complication called diabetic retinopathy that can happen when high blood sugar levels damage blood vessels in the retina. After having chronic eye infections that continued for several months, Natalie’s retina became detached, requiring her to have eye surgery. Now she wants to normalize talking about diabetic complications by sharing her experience with others. She does this as a volunteer advocate for the American Diabetes Association and uses her own social media account to encourage others to practice self-acceptance.
We asked Natalie to document her life for one week to share what it can be like to live with type 1 diabetes. Here is her diary.
Name: Natalie Karabel
Occupation: Retail Strategist
Location: New York City
Health conditions: Type 1 diabetes
Day 1 (Sunday)
Mornings are the most challenging part of my day as I am not a morning person. This is also the hardest part of my day for diabetes management. My blood sugar typically spikes first thing in the morning, so I need to inject myself using an insulin pen soon after I wake up.
Eating a bagel on Sundays has been a family tradition for as long as I can remember. I prepare by giving myself what’s called a bolus dose of insulin about 40 minutes before I officially take a bite into my bagel to help keep my blood sugar stable. Determining the best time to take my pre-meal insulin requires some trial and error, but I’ve found that waiting 20 minutes before eating is usually best for me, but I need a little extra time with bagels.
Mindset work is a significant part of my diabetes management since it allows me to focus on the moment. When I don’t feel balanced, I can get more upset than normal if my blood sugar is too low or high during a reading, and I have a hard time making choices that help me get back on track. So every Sunday, I listen to an Emotional Freedom Technique Tapping (EFT) guided session using Zoom. This technique uses cognitive and physical techniques to alleviate stress. To do this, I think about a particular area I want to focus on while tapping different points on my body in a specific sequence.
Time for a workout! I’ve noticed that exercise really helps stabilize my blood sugar and makes me feel more energized. I like clear structure in my workouts, so I have a membership to an online training program that combines cardio, weights, and yoga.
Walking has become a part of my daily routine because it’s an easy way to integrate some movement and is a great way to explore my neighborhood. I try to walk 30 minutes daily, and I enjoy walking with a destination in mind, like Central Park.
I visit Trader Joe’s to pick up some food for the week. I get some of their grilled chicken as well as my new favorite snack combo (honey goat cheese and red chili crackers), plus I grab a few of their frozen meals. In the past, restricting what I eat caused me to have an unhealthy relationship with food, so I have worked with my medical team to find the right balance for me. In addition to carbs, I review the amount of cholesterol and protein on nutrition labels as advised by my medical team.
Tonight, I make an easy dinner with the grilled chicken from Trader Joe’s, mushrooms, and rice.
I always check my blood sugar right before going to bed. To do this I use Dexcom, a continuous glucose monitor (CGM), which involves having a sensor placed under my skin to measure my blood sugar levels every five minutes. I can see the results on my phone and watch. I also inject my basal insulin now, which is the baseline level of insulin I need to keep my blood sugars consistent throughout the day.
Day 2 (Monday)
I’ve noticed that working out and taking a long walk helps me wake up with my recommended blood sugar levels the next day. This is the perfect way to kick off the work week!
I write a gratitude list dedicated to grounding myself for a new week. In this list, I always include something I’m grateful for physically and mentally. I used to feel angry about having an autoimmune disease since my body literally attacks itself. But now I focus on feeling grateful toward all of the other things my body can do.
I had a lot of meetings today, so I grab a grilled chicken sandwich and an apple.
I pick up a chicken salad for dinner since I ate a late lunch and wasn’t very hungry.
I do my nightly blood sugar check and inject my basal insulin. Before this CGM device, I used to measure my blood sugar levels by pricking my finger multiple times a day, which left scars on my fingers and didn’t allow me to check my blood sugar levels as consistently.
Day 3 (Tuesday)
I wake up feeling groggy. My blood sugar levels are in a healthy range, and I do an insulin injection.
I was really busy with meetings, so I ate a quick tomato soup and Caesar salad.
On Tuesday nights I participate in two different classes and still need to find time for dinner, so this requires some planning. My first class is an online breathing and meditation session and then I do a virtual salsa dancing class. I give myself an insulin injection in the middle of the meditation class because it gives the insulin enough time to start working. Then, I eat between the two classes. If I give myself insulin too early, my sugar drops during the breathing class, which would not be relaxing. If I take the insulin too late, then my blood sugar spikes, and I don’t feel great during salsa.
And I did it! I learned some new salsa steps, and my blood sugar has been smooth sailing. I started salsa dancing a few months after I had a hemorrhage in my eye, and it was the first activity I immersed myself in after the retinopathy diagnosis. I check my blood sugar and give myself my basal insulin.
Day 4 (Wednesday)
On Wednesday mornings, I always wake up with great sugar levels since I am so active on Tuesdays. I have some coffee and get ready for my day.
I meet a friend for lunch. We split some tapas, and I calculate the amount of insulin I need. It’s a little tricky to do this accurately because I’m eating small bites of different types of food that I don’t know the nutrition information for. But I do a good job and my blood sugars remain stable.
I pick up my insulin prescription which I receive in three-month increments. I am so grateful I have insurance and fully recognize my privilege that I never had to ration insulin. I know that there are people who aren’t able to get the insulin they need due to cost. I recommend that people contact InsulinHelp.org if they need financial help.
I do a quick cardio workout before dinner. I may have a slight dip in blood sugar, but eating a good meal afterward helps stabilize that.
I’m craving ice cream, so I buy a kid’s size cone of mint chocolate chip ice cream on my walk home. I try not to eat late at night because it can cause changes in my blood sugar, which I would rather prevent. My sugar levels look stable when I check before bed, so I think they’ll be fine in the morning.
Day Five (Thursday)
Beeeeeeeep! I wake up to a blaring noise from my CGM alerting me that my blood sugar is dangerously low. When I was 10, I had a seizure from experiencing low blood sugar at night, so I always fear that it might happen again. When my blood sugar is too low, my doctor recommends eating about 15 grams of carbohydrates to see if that helps. Sometimes if it takes too long for my sugar to rise, I eat more, and then my blood sugar can become too high. I was tired and frustrated, so I ended up eating significantly more than 15 grams of carbs. I take a couple of units of insulin to hopefully balance it out.
The results are in—my sugar level is a little high but within a reasonable range. I take that victory and give myself my standard morning insulin plus a couple of extra units to balance my high sugar level.
After last night, I keep lunch super simple and choose one of my go-to meals: a sandwich and salad.
Every week, I visit a museum to satisfy my walking goal and curiosity. Today, I picked the Frick Museum, which showcases old paintings. I spend an hour wandering the halls but leave when I feel my sugar levels dropping, which is a signal that I should eat dinner.
Having low blood sugar at night can make me feel more tired the following day, which I’m definitely experiencing today. I have a frozen meal from Trader Joe’s since I don’t have the energy to make something more complicated. I watch some TV and there’s a joke that eating a particular food will give you type 2 diabetes. This really bothers me because it plays into a stigma that diabetes is self-inflicted, which can then make people feel unworthy.
Day 6 (Friday)
I overslept, quickly give myself some insulin, and rush to my first work meeting with an iced coffee.
I had a super intense and busy day, and I do a rowing workout class to release some energy.
Today, I’m physically meeting a group of friends who are in an online class with me for the first time. I used to hide my diabetes from everyone, so I feel like it’s a victory that I felt comfortable sharing this with my new friends. I feel relieved because I don’t have to explain why I am giving myself injections and can just enjoy my night out while making sure I manage my condition.
I had such a fun night out! I’m not always as aware of my blood sugar levels when I drink alcohol, so I double-check my blood sugar level before I go to bed.
Day 7 (Saturday)
I woke up with perfect morning blood sugar! I inject a couple of units of insulin, drink a cup of coffee, and get ready to leave for a workshop.
I have steak tartare and a cheese plate for lunch. My blood sugar levels are smooth sailing.
I grab drinks with a new friend for happy hour. My blood sugar keeps changing, so I monitor it closely and give myself a few units of insulin.
For dinner, I make some grilled chicken, mashed potatoes, and a watermelon and feta salad.
My blood sugars are looking good before bed. Writing down my decisions this week has been such an interesting experience. I’m so used to doing all of this, that I haven’t thought about all of the things I do to stay as healthy as possible. It’s helped me realize I don’t have to feel perfect at all times.
Condition diaries are meant to offer a glimpse into how different people live with different health conditions—not to provide medical advice or treatment.
1. National Institute of Diabetes and Digestive Kidney Diseases, Symptoms & Causes of Diabetes
2. American Academy of Ophthalmology, What is Diabetic Retinopathy?
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