Sarah’s pretty, petite, and fast. She’s over forty, but looks much younger. She’s a physician from Virginia with T1. She wears an insulin pump, and is a mom to four. She’s optimistic and takes care of her diabetes in a matter-of-fact way. And she runs seven-minute miles. She defines wellness as, “being able to enjoy my family, work out in a relaxed way, and to help those that I can help.”
Ginny’s [not her real name] is in her forties, and my patient; she works in healthcare and is bright, literate, and witty. Her multiple health problems, include T1, and complications have significantly stolen her energy for years. Ginny’s physician referred her. Her goal is to “get back on track with diabetes, and get my energy back so I can do the things I used to do.” Once Ginny started in treatment, she recaptured her energy, and worked on de-cluttering her apartment, and began to spend more time with friends.
Gary’s tall, lean, and funny. He’s dad for three and lives near St. Louis. He’s a computer programmer, has T1, and has completed a full Ironman, three half-Ironmans, three half-marathons, and six marathons, plus six 200-mile relays. Gary’s good at planning. He plans for the regular aspects of endurance events—training schedules, and gear for running, biking, and swimming. And Gary also plans for what T1 imposes at these events—he needs to ensure he has a takes a meter, strips, extra fuel, pump supplies, checks his BG several times during events, and even wears a CGS. With diabetes and endurance events there’s always one more thing to check. Gary says wellness means, “staying in control, not necessarily with perfect BG numbers, but knowing that I’m doing as well as I can and staying healthy doing it.”
The National Wellness Institute defines wellness as, “…a conscious, self-directed, evolving process of achieving full potential…encompassing lifestyle, mental and spiritual well-being…and is positive and affirming.” And Wikipedia defines wellness to include aspects of…mental and physical activity, nutrition, fiscal responsibility…and evenemergency preparedness…” It’s “an active process of becoming aware of and making choices toward a more successful existence…” Except for that “full potential” part, these ideas about wellness sound a lot like people living and coping with T1!
My personal view of “wellness” is that it’s sort of a buzzword. Since I’m a clinical psychologist, some might tag me as “new-agey.” But I don’t think like that. I prefer pragmatic definitions, and rely on treatments with evidence to approach people and their problems. People with T1 can’t indulge in esoteric long-term health discussion. They need to decide what is the best course of action, in each moment.
Every T1 I see or know always needs to balance the physical, emotional, and metabolic into their social, occupational, and even spiritual lives. Wellness for a person with diabetes means maturing into a more sophisticated view of diabetes. Into a person who sometimes struggles, sometimes succeeds, and always tries to do what’s necessary to live a long and healthy life.
My ideas about wellness are less poetic than practical. For me wellness is in the eye of the beholder. Your definition of what it means to thrive and be well may not be how I define it. Some people carefully track all their carbohydrates, eat completely organically, practice ideal stress relief techniques, exercise at their optimal VO2 max, eat no gluten, but have an A1c of 8.3. Some might eat fast food every day, exercise only when chased by animals, and use TV for stress relief, but have an A1c of 5.9. Which is the more well, wellness path?
My working definition of wellness is living well and taking control of what’s possible with diabetes, and letting go of those parts that aren’t controllable. My wellness journey includes making and maintaining strong personal relationships, making diabetes convenient, learning new diabetes information when I must, and challenge my own diabetes worldview regularly. T1 wellness should be more like an icon on your computer screen, running in the background, but not filling the entire screen.
Sometimes of course, diabetes forces it way in the front door like a pop-up virus—low BG, sickness, forgetting to refill insulin prescriptions—and it takes your complete attention and fills your entire screen. A friend of mine, T1 for over thirty years, is usually in tight control. But one day as he went through a TSA line, he woke up abruptly in an ambulance, after a nasty low. Diabetes filled the screen that day.
Sarah, Ginny, and Gary are all on wellness journeys; journeys they didn’t intend to start. Their journey may not be like yours at all, or might be similar. Each of them took control of diabetes on their wellness journeys. I believe everyone with T1 diabetes can be viewed as being on a wellness journey, no matter how far along, or where started. Everyone with T1 is compelled to integrate diabetes management into lives.
When you have T1, your wellness journey is like running a super-marathon, except the journey never ends. The road is not a paved super highway, and can feel lonely, bumpy, and like traveling in the backwoods—with no map. But when you take control of your wellness journey, it will lead you to a destination only you will envision.
It’s always your choice whether and how to take control of your wellness path. Some T1s don’t take control of their lives or well-being. But if you tell me you want to get your BG in line, and feel better each day, that is, in my mind, your definition of wellness. After you reach that goal, you will find another. One other thing I’m certain about. Whether you’re already the most wellness oriented T1, or tussle with only vague intentions to make changes with your diabetes, and move closer to your vision of wellness, your road always begins at the same place, your first small step. The only place to start is where you’re at, and after your first step, you will be enacting your own form of wellness.
If you have ideas about personal wellness for T1s, write your ideas and forward them to me below.
 National Wellness Institute http://www.nationalwellness.org/?page=Six_Dimensions