87. 理解二型糖尿病与身体形象

你会建议他们减肥吗？

Would you tell them to lose weight?

不会。

No.

那么第二个选择是什么？

So what would option two be?

他们会接受哪些其他的健康教育？

What other education would they receive?

是的。

Yeah.

而且我认为，即使在这个例子中，我也想明确一点：当你提到所谓促进健康的行为，比如吃蔬菜、锻炼，这些你希望做、也希望多做的行为，可能会带来体重减轻，也可能改善糖化血红蛋白水平，但这并不是唯一的目标。

And I think too, like, you know, even in that example, and again, I'm wanting to be clear When when you're saying that, like, doing what we call health promoting behaviors, eating vegetables and exercising, the things that you want to do and you want to do more of may result in weight loss and may result in an improved a one c, but that it is not, like, the only thing that

可以，不行。

can No.

不行。

No.

我的项目里有很多女性，她们的体重一直保持不变，甚至还有所增加。

And I I mean, women have been in my programs and stayed with stayed the same weight, gained weight.

你知道的吧？

You know?

我的意思是，因为我从不关注体重，所以我从不问她们这个问题。

I mean, because I don't focus on weight, that's never a question I ask them.

有时候，是她们主动跟我分享这些情况。

So sometimes that's things that they share with me.

说实话，我刚当营养师时，在一家非常注重体重的诊所工作，医生们会让我频繁地给病人称体重。

And, know, I can honestly say that, like, I worked in a very weight centered clinic when I when I first started working as a dietitian, where the doctors would have me weigh people very regularly.

那里的重点完全放在体重上。

It was very, very weight focused.

我在那里工作时看到了很多情况：有些人减重了，但他们的糖化血红蛋白水平却完全没有变化。

And I mean, I saw so much when I worked there, I saw people lose weight in their A1C say exactly the same.

然后医生们又感到困惑，说：‘哦，他们减重了。’

And then again, the doctors are dumbfounded, like, Oh, well, they lost weight.

但我觉得糖尿病这个问题其实非常复杂。

But I think like there's just so much nuance when it comes to diabetes.

如果真的只是减掉体重，血糖指标就会下降那么简单的话。

And if it were as simple as lose weight, your numbers will come down.

那我们看到的情况就完全是另一回事了。

That's exactly what we would see.

如果只是减重就能解决一切问题，就不会有这么多人患有糖尿病了。

We wouldn't have an epidemic of people living with diabetes if it were just as simple as lose weight, everything will be fine.

没错。

Correct.

而且你知道，我能感觉到自己的身体有些变化，主要是衣服穿起来感觉不一样了，但我从不在医生那里称体重，因为他们不需要这些数据。

And, you know, I I know that my body has changed some just based off of the way that my clothes feel, but I don't weigh myself at the doctors because they don't need it.

我拒绝称重。

They I refuse.

我可以说，你可以在我的病历上写‘拒绝’。

I I will say, like, you can write decline in my chart.

他们现在甚至都不再问我了。

They don't really even ask me at this point anymore.

但我的想法是，如果我被称体重，然后我的糖化血红蛋白突然变好了，他们会不会认为是因为你减了体重？

But my thought is that if I'm being weighed and all of a sudden my a one c is better, is the contribution gonna be like, oh, well, you lost weight.

所以你的糖化血红蛋白才改善了。

That's why your a one c has improved.

而不是因为你每天开始服用一小粒药，这才带来了改变。

Not you started taking a tiny little pill every day, and it's it's created that change.

所以对我来说，这迫使他们真正履行自己的职责。

So it's just for it's for me, it's forcing them to actually do their job.

嗯。

Mhmm.

是的。

Yeah.

而且，我曾经和一些非常优秀的医生合作过，他们确实非常关注减重，但我并不喜欢这一点。

And, you know, I I I've worked with some really great doctors who did really they really focused on weight loss, And so I didn't love that aspect.

但我也知道他们会把人推荐给我，他们会直接告诉病人：我对营养学了解不够。

But I also know that they would refer people to me, they would literally tell patients like, I don't have enough nutrition knowledge.

所以呢，我对这个主题的了解也不够。

And so I'm, you know, I don't have enough knowledge around this subject.

我很喜欢当人们能清楚认识到自己的界限和能力时。

And I love when people know their own boundaries and their own capacities.

当医生能坦率地对患者说，即使他们希望对方减重，这也是他们自己的判断。

And when doctors can openly say to someone like, you know, even if they if they want someone to lose weight, that that's, you know, their own prerogative.

但我特别欣赏医生能说：这不是我的专长，我建议你去看营养师或糖尿病教育师，让你专注于营养方面该做什么，或者运动方面，或者其他任何相关因素，因为营养师通常擅长把人当作整体来看待，我从来不会只问别人‘你吃什么’。

But I love when a doctor can say like, this isn't my area, and I want you to see a dietitian or diabetes educator, and I want this to I want you to hone in on like, what nutritionally needs to happen or you know, maybe you know, exercise wise or whatever it is, because dietitians are usually really good at looking at people as whole people, not just like, I'm never just asking someone what do you eat?

当然，我也会问他们吃什么。

Like, I do ask them that.

但我还会问他们的压力水平、睡眠情况，所有这些可能影响他们指标的其他因素。

But I'm also asking them like about their stress level, their sleep, all these other things that could be impacting their numbers.

所以这也是为什么我喜欢自己创业，因为我不必专注于那些让我感觉不舒服、却要让客户关注的事情，而体重只是其中之一。

And so I that's why I also love being in my own business because I don't have to focus on the things that don't make me feel good to help my clients focus on and weight is just one of those things.

我翻看了自己过去十年的血液检查报告，我的糖化血红蛋白值一直在某个数值到某个数值之间波动。

I was looking through my own, you know, blood work, over the last ten years, and my A1C has varied from, you know, one number to one number.

无论我是否在减肥，它都这样波动。

And it did that when I was losing weight, and it did that even when I wasn't trying to lose weight.

这让我意识到，这是遗传倾向的问题。

And so that's what tells me that it's the genetic predisposition.

卡罗琳·科斯廷在她关于饮食失调的书中提到：遗传装上了枪，但环境扣动了扳机。

Carolyn Costin says in her book, about eating disorders, genetics loads the gun, but environment pulls the trigger.

所以我认为，是的，遗传因素早就已经奠定了基础。

And so I think that, yeah, like this, the genetics were already loaded.

我本来就对这个问题有遗传倾向。

I already have a predisposition to this.

我常听到客户说，他们有一年没去看医生，结果突然间糖化血红蛋白值飙升，还确诊了糖尿病。

And I'll hear stories from clients that's like, they didn't go to the doctor for one year and then all of a sudden, A1C is off the charts and they developed diabetes.

但这并不是在那一年里突然发生的。

It didn't happen in that year.

在一年内吃的东西或运动量很少，不可能导致这种情况。

There's nothing that you could have eaten in one year or exercised little in one year that was going to contribute to that.

这听起来就像枪已经上膛了。

That sounds to me like the gun was already loaded.

是的。

Yeah.

对。

Yeah.

而且我认为，过了35岁之后，每个人都应该每年接受一次糖尿病筛查，无论是否有家族史、无论体型如何、无论其他任何因素。

And it depends on I mean, after age 35, everybody should be being tested for diabetes every single year, regardless of a family history, regardless of your body size, regardless of anything.

我不认识多少35、36、37岁的人每年都会做体检，除非他们已经有某种疾病，经常看医生。

And I don't know a lot of 35, 36, 37 year olds that are getting yearly tested for anything unless they already have a condition where they're seeing a doctor often.

所以，比如我哥哥，他今年34岁，胆固醇非常高，还有其他一些问题，但总的来说，他是个很健康的人，没有任何慢性健康问题。

And so, you know, like, my brother, he I mean, well, he's 34, but he has super high cholesterol and other I mean, quote unquote, he's pretty like a healthy individual, like he doesn't have any chronic health conditions.

他住在旧金山，走路去任何地方。

He lives in San Francisco, he walks everywhere.

他只是很困惑，为什么自己的胆固醇会这么高。

And he's just like, it's he's like dumbfounded why his cholesterol is high.

我觉得高胆固醇在我们家族里是遗传的。

And I'm like, I think high cholesterol like totally runs in our family.

他说他认为是因为自己吃太多鸡蛋了。

And he's like, I think it's because I eat too much eggs.

这是我医生告诉我的。

And that's what my doctor told me.

我说，不，我们得实事求是，你不可能仅仅因为吃太多鸡蛋，胆固醇就会升高。

I'm like, no, like, let's just really get down to the fact that you could not eat just too much eggs, and your cholesterol is going to be elevated.

但那就是他脑子里的想法。

But like, that's what he has in his head.

因为他觉得，其他任何解释都说不通。

Cause he's like, nothing else makes sense.

因为他是个会计，思维非常逻辑化。

Because he's like a very he like works in accounting, his brain thinks very like logically.

所以我认为他无法理解基因在你高胆固醇问题中扮演着如此重要的角色。

So I don't think he can wrap his head around like genetics playing this huge component in you having high cholesterol.

是的，意识到我吃什么都真的不重要，这对我而言是一种极大的疗愈。

Yeah, it's been very healing for me to like realize that like, it really doesn't matter what I eat.

当我深陷饮食失调时，曾试图控制饮食，总想成为那种‘我想吃沙拉，但我却不想吃’，或者‘我想运动，但我却不想动’的人。

And when I was trying to control my food back in the depths of eating disorder, wanting to be the person that's like, I want to want a salad, but I don't, or I want to want to move my body.

而现在，我开始信任我的身体，拥有这种自主权——我知道现在真正想吃的是沙拉。

And so to now have trust in my body and have that autonomy of like, you know what would sound really good right now would be a salad.

这种感觉真的很有力量。

Like that that feels really empowering.

但这正是因为我在饮食上获得了自由，并且能够信任我的身体。

But it is because I have freedom with food and I have the ability to trust my body.

要信任一个你认为正在辜负你的身体，是很难的。

It is hard to trust a body that you think is failing you.

是的。

Yeah.

我经常从我的客户那里听到这一点，特别是因为我教授的是‘所有食物都适合’的理念，我们会讨论吃甜甜圈以及糖尿病患者如何最好地吃甜甜圈，因为你知道，最近我一个小组里的女性告诉我，她只是想吃任何她想吃的东西。

That's something I hear a lot from my clients is, you know, especially because I do teach, like, an all foods fit approach, and we talk about eating a donut and, like, how to best eat a donut when you have diabetes because, know, I, you know, I know that something that a woman in my group told me recently, she's like, I just want to eat whatever I want.

但我不能那样做，这让我非常困扰。

And it really bothers me that I can't do that.

她说，真正让我困扰的是，如果我吃了一个甜甜圈，我就会看到血糖水平的反应。

You know, she's like, it really bothers me that I, if I eat a donut, I'm going to see the repercussions repercussions of of my my blood blood sugars.

血糖会升高，我会看到我的数值飙升。

Sugars, I'm I'm going going to to see see my numbers go up.

所以我们聊了聊，我告诉她，单独吃一个甜甜圈对任何人来说其实都不是特别好。

And, you know, so we were kinda talking, and I was telling her, like, eating a doughnut on its own really isn't super great for anybody.

我们所有人吃完甜甜圈后都会感到饿。

Like, all of us are feeling hungry after a doughnut.

我们从甜甜圈里根本得不到任何纤维。

None of us are getting any fiber from a doughnut.

如果仔细分析，每个人都应该均衡饮食，因为足够的蛋白质和纤维才能让我们更长时间保持饱腹感。

Like, if we really break it down, everyone should be eating balanced because enough protein and enough fiber is what's going to keep us fuller longer.

这有助于保持我们的血糖稳定，也不会让我们感到极度饥饿。

It's going to help keep our numbers stable, and it's not going to make us feel ravenous.

比如，我吃一个甜甜圈，三十分钟后就会饿得不行，因为里面没有蛋白质或纤维来帮助我们维持饱腹感。

Like, I eat a donut, I am ravenous, like thirty minutes later, because there is no protein or fiber to help keep us full.

所以，我知道糖尿病患者可能会觉得，哦，我必须吃得特别讲究。

And so, you know, I understand that people with diabetes might think that like, oh, I have to eat this really specific way.

但事实上，我教糖尿病患者怎么吃，和我教任何人怎么吃是一样的，也是我自己即使没有糖尿病也在践行的饮食方式。

But really, in reality, how I teach someone to eat with diabetes is really how I would teach anyone to eat like and how I try and eat and I don't have diabetes.

我真的很努力地确保摄入足够的蛋白质和纤维，并把这些放在重要位置，尽管我也会尊重自己想吃的东西。

I really try and, like, eat enough protein and eat enough fiber and really make those things important, even though I honor what I want to eat as well.

很多时候，人们会抱怨，他们总是得把食物搭配着吃，这让他们感到非常沮丧。

You know, a lot of times people will say, like, how frustrated they feel that they always have to quote unquote, Pair their food.

我会说，你其实不一定非得这么做。

And I'm like, you don't necessarily have to.

但为了尊重自己和你的血糖数值，在合适的时候搭配食物是有意义的，因为你会感觉更好。

But it is out of like respect for yourself and your numbers to pair your food when it works the best because you're gonna feel better.

不仅仅是关于数字。

Not just about the numbers.

更重要的是，我常对人们说，问问自己两个问题。

It's also like what I tell people, I'm like, ask yourself two questions.

餐后两小时，你的血糖在目标范围内吗？

Are your numbers within Target two hours after your meal?

是或否？

Yes or no?

餐后两小时，你仍然感到满足吗？

And are you still satisfied two hours after your meal?

如果答案是否定的，即使你的血糖正常，但你并不满足，那这顿饭对你来说就不够。

If the answer is no, even if your blood sugars are normal, you're not satisfied, that meal was not enough for you.

我们需要再稍微优化一下这顿饭。

We have to optimize that meal a little bit more.

我觉得，你也知道，我总是用这样一个例子：你还记得小时候吗？有个代课老师，等原来的老师回来后说：我对你们中的一些人真的很失望，而你心里想：我觉得我表现得不错啊。

I think too, you know, I always use this example of like, do you remember when we were kids and you you there was a substitute teacher and the teacher comes back and is like, you know, I'm really disappointed with some of you and you're like, I thought I did good.

就像她说根本没在跟你说话一样。

It's like, babe, she's not talking to you.

是的。

Yeah.

你根本不是在跟你说难听的话。

You were not you were not hard talking to you.

我觉得我大多数客户都有这种感觉，好像这些信息都是冲着他们来的。

And I feel like that's what most of my clients feel like of like these these and this information is being directed at them.

前几天我有个客户说，唉，我真希望我能吃上煎饼。

And, you know, I had a client the other day who said, you know, like, ugh, I just wish I could, know, eat the pancakes.

我问她，那你为什么不能吃呢？

And I'm like, why can't you?

她说，可是我得搭配着吃。

It's like, well, but I have to to pair it.

我说，你现在因为搭配食物而承受的压力和羞耻感，本身就是一种节食。

And I'm like, the amount of stress and shame you are now making about pairing your food is a diet.

你现在是在自我羞辱，逼着自己以最‘正确’的方式进食，而不是说，嘿。

You are now shaming yourself into eating the best way as opposed to, hey.

理想情况下，我知道如果我搭配一些蛋白质，我会感觉更好。

Optimally, I know I'm gonna feel better if I pair it with a piece of of protein.

但如果此刻这样做不现实，那就干脆吃那该死的煎饼吧。

But if it it's not realistic in this moment, have the fucking pancakes.

是的。

Yeah.

对。

Yeah.

我刚才正好在聊这个，因为我的小组里有个女人说，你知道，那是我和我们小组才进行到第三周。

I was just having this conversation because this that woman in my group, she's like, you know, it was my and we're only on week three of my group.

所以，所有这些关于搭配食物、理解这些概念，对他们来说都还非常新。

So all of this, like, pairing their foods and, like, understanding that is, like, very, very new to them still.

她说，我女儿过生日的时候，我觉得必须把生日蛋糕和别的东西搭配，这让我承受了很大的压力。

She's like, it was my daughter's birthday, and I felt like I had to pair the birthday cake with something that caused me a lot of stress.

我就说，我们在学习这些东西时必须要有辨别力，因为你觉得在女儿生日时，真的需要想‘我该把这块蛋糕和什么搭配’吗？

And I'm like, okay, we have to use discernment when we're learning these things because do I think that if it's your daughter's birthday, you need to be like, okay, what can I pair this piece of cake with?

我该怎么优化它？

How do I optimize this?

答案肯定是不用，因为即使作为营养师，我也不会这么做。

The answer is going to be no, because even as a dietitian, I wouldn't do that.

如果你去商店买了一块蛋糕当甜点，而且你能更好地掌控它，你觉得在那一刻搭配食物有意义吗？

If you go to the store and you buy a piece of cake to have for dessert and you have more control over it, do I think pairing in that moment makes sense?

有。

Yes.

因为这是事先计划好的。

Because it's preplanned.

你可以先吃一顿非常均衡的晚餐，然后再吃那块蛋糕。

You can eat, like, a really balanced dinner and then eat the piece of cake afterwards.

你必须学会辨别什么时候这样做有意义，什么时候没有意义，总会有一些时候这样做并不合适。

You have to use that discernment of like when that makes sense and when it doesn't, and there's gonna be times where it doesn't make sense to do that.

而这归根结底是关于你对身体的信任。

And this is where it comes down to the trust of your body.

我发现很多客户都不信任自己的身体。

And I find that a lot of clients do not trust their body.

所以他们更愿意相信数字。

So And they wanna trust the numbers.

他们想相信那个系统、那个公式。

They wanna trust, you know, like, the system, the formula.

归根结底，你可以做所有正确的事情。

And at the end of the day, it's like, you can do all of the right things.

但这些并不能让你免于疾病、虚弱，最终也无法避免死亡。

And that will not protect you from ailment, infirmary, and ultimately death.

我们谁也无法活着离开这个世界。

Like we will not leave this earth alive.

所以，吃蛋糕吧，吃蛋糕吧，保持觉知，好吗？

And so like eat the cake, eat the cake, be mindful, right?

比如，要逐步建立对自身感受和数值变化的觉察。

Like there's a build objective awareness around how you feel, what your numbers are doing.

如果你有糖尿病，我其实也想问一下这个问题。

If you have diabetes, actually wanted to ask this too.

我注意到越来越多没有糖尿病的人也在使用连续血糖监测仪。

I've seen an uptick in people using CGM monitors when they do not have diabetes.

是的，我们来聊聊这个。

Yeah, let's talk about that.

我们能聊聊这个吗？

Can we talk about that?

所以这有点有趣，因为我所有的一切都基于护理标准。

I so it it's kind of funny because, like so the standards of care is what I base everything off of.

我的意思是，任何人都可以去谷歌搜索护理标准。

And I mean, anyone can Google the standards of care.

这并不是只有我才能看到的什么东西。

It's not something that, like, only I can see or anything.

但当你查看护理标准时，它实际上指出，除非被诊断为二型糖尿病，甚至包括糖尿病前期，否则任何人都不应该使用连续血糖监测仪。

But when you look at the standards of care, it actually says that nobody should be using a CGM unless they have a type two diabetes diagnosis, even pre diabetes.

不过，在我看来，这一点我与护理标准略有不同。

Now, in my opinion, though, that's something I go a little bit against the standards of care.

我认为糖尿病前期患者佩戴连续血糖监测仪确实很有用，因为我们可以发现一些模式，比如：你总是在早餐后血糖升高，那我们就来看看早晨发生了什么。

I do think that people with pre diabetes wearing a CGM can be really useful because we can kind of we can spot patterns like, okay, you're always elevated after breakfast, let's look at what's happening in the morning.

所以我认为，对于糖尿病前期来说，连续血糖监测仪能提供非常有用的数据，而这与护理标准的说法不符。

So I do think it can provide data that's very, very useful in prediabetes, which is not what the standards of care say.

他们说，根本没人需要这个。

They say like, no one needs that.

我对此持不同意见。

I that I differ for that.

如果你没有糖尿病或糖尿病前期，佩戴连续血糖监测仪只会给你带来压力和焦虑。

If you do not have diabetes or pre diabetes, wearing a CGM is just going to cause you stress and anxiety.

对于没有糖尿病或糖尿病前期的人来说，根本没有理由佩戴连续血糖监测仪，因为我们的血糖水平上升和下降是正常的代谢过程。

There really is no reason for someone who doesn't have diabetes or pre diabetes to be wearing a CGM because our numbers going up and coming down is a normal metabolic process.

我们不希望对此过度关注。

We don't want to really hyper vigilize on that.

当我从事临床工作时，我戴过CGM。

And I wore a CGM when I was working in clinical.

首先，我想了解如何使用它，以及佩戴在手臂上的感觉如何。

One, I wanted to understand how to use it, how it felt going to my arm.

我只是想亲身体验一下。

Like I just wanted to like experience it.

所以当我向别人演示如何使用时，我能感同身受。

So when I was showing people how to use one, I was aware of it.

因此我戴了一个。

And so I wore one.

它大概四天后就掉了，我当时就想，这真是太烦人了。

It fell off after, like, four days, and I'm like, this is so annoying.

现在我终于明白为什么人们会对这些东西这么烦了。

Now I know why people get so annoyed with these things.

我非常保护它，但它还是从我胳膊上掉了下来。

I was very, like, protective of it, and it still fell off of my arm.

但我要说的是，在我佩戴的72小时以上的时间里，它给我带来了压力，而我既没有糖尿病也没有前期糖尿病，我的血糖值却上升了，我就想，为什么会上升？

But what I will say is in that the 72 plus hours that I wore it, it caused me stress, and I do not have diabetes or prediabetes, and my number would go up, and I'm like, why is this going up?

我记得我吃了一顿非常均衡的晚餐，但我的血糖值却明显升高了。

Like, why is it so I remember I ate, like a very well balanced dinner and my number like went pretty elevated.

如果我没戴这个监测仪，我会觉得这顿饭很均衡，感觉很棒。

And if I wasn't wearing that monitor, I would have been like, this was a balanced dinner and I like, it was great.

就是随便吃吃而已。

It was whatever.

但因为我的血糖值上升了，我就开始想，我哪里做错了？

But because my number went up, I started looking at like, what am I doing wrong?

为什么会这样？

Why was that?

我是不是该把这东西戒掉？

Do I need to be cutting this out?

我的大脑开始拼命试图理解这个正常的代谢过程。

Like, my brain started to really try and like make sense of this like normal metabolic process.

即使作为一名营养师，我了解这一点，但我还是对此变得过度警惕。

And even as a dietitian, I know that but I still was getting hyper vigilant on it.

关键在于，我知道一些其他营养师也在用它作为减害策略，来帮助我的客户。

And that's the piece is like, I you know, and I have other, you know, dietitians who are working with clients of mine where we're using it as like a harm reduction approach.

如果你对数字变得强迫症，而且你有前期糖尿病，那么这些信息现在实际上对你没有帮助。

If you are becoming obsessive about the number and you have prediabetes, information is not actually helping you right now.

是的。

No.

对。

Yeah.

我认为有一种特定的人群，连续血糖监测仪对他们非常有效。

And I think there's a very specific person where a CGM works well.

我有一些客户，我觉得他们根本不应该使用连续血糖监测仪。

And I have some clients where I'm like, this person should not have a CGM.

我会告诉他们这一点。

And I will tell them that.

他们说：如果我能戴CGM，我该戴吗？

They're like, if I can wear a CGM, should I?

我说：不。

I'm like, no.

我觉得这对你没有帮助。

I don't think it'd be helpful for you.

我认为这会给你带来压力和焦虑，因为适合使用CGM的人和不适合的人是截然不同的，关键在于你是否能将这些数据仅视为信息，并在适当的时候据此做出调整，是否能以非常中立的态度看待它？

I think it would cause you stress and anxiety, because you know, there's a right person for a CGM, and there's there is a wrong person for a CGM, and it really depends on can people take the information as information and use it to make changes where appropriate, and can they look at it from a really neutral standpoint?

如果答案是否定的，那么CGM对你来说就没什么用。

If the answer is no, then that CGM is not gonna be useful for them.

我想顺便分享一个个人经历，就在这段录音录制的时候。

And I I just wanna share this anecdotally, I mean, at the the time of this recording.

现在是2025年。

So it's 2025.

这是我成年后第一次渴望在运动与我的关系中保持一致性，而且这种渴望并非源于我内化的反肥胖观念。

And for the first time in my adult life, I am craving consistency around my relationship with movement, and it is not motivated by my internalized anti fatness.

也不是源于我不愿行动不便的内化能力歧视。

It is not motivated by my internalized ableism of not wanting to be immobile.

对我来说，这关乎我曾问过我的身体哀悼者：你知道吗，如果你要描述你身体当前所处的阶段，会怎么说？

It to me, it it is about, like, I I was I asked my body grievers, you know, if you could describe the era that your body is in right now.

你现在处于哪个阶段？

What era are you in?

你即将进入哪个阶段？

And then what era are you going into?

而我希望我身体的下一个阶段是进入一个被接纳的阶段。

And what I want for my next era of my body is to be in my held era.

我知道，对我而言，这包括休息，甚至是彻底的休息。

And I know that for me, that includes rest and like a radical rest.

这还包括快乐、睡眠，以及管理疼痛。

That includes joy, sleep, managing pain.

我已经在健康方面做了优化，并且有意识地规划，但现在我想专注于生活本身。

I already have optimized and have been intentional about the health piece, but now I wanna focus on the living piece.

我知道对我来说，疼痛管理会非常重要，但管理好疼痛并不会让我成为一个更好的人。

And I know for me, the pain management is gonna be huge, but I'm not a better person if I manage my pain.

当你不再将它与道德评判挂钩时，你就知道你已经准备好了。

That is how you know that when you are ready is when it is detached from a moralization.

如果你因为没去上普拉提课而感到羞愧，那么在那一刻，有意识的运动练习可能反而对你有害。

And if you are gonna feel shame because you don't go to a Pilates class, then the intentional movement practice might actually be harmful for you in that moment.

如果你是那种知道为了管理糖尿病需要锻炼，但又不想动的人，我们能来看看这是怎么回事吗？

If you are somebody who's like, I know that I need to exercise for my diabetes management and you don't want to, can we look at that?

是什么在困扰着你？

Like what is coming up?

你为什么不想活动？

Why don't you wanna move?

对我所见到的大多数人，包括我自己在内，很可能是因为精疲力尽了。

There's a possibility that what I see for most people and what was true for me is they're burned out.

他们工作太累了，每天下班回家后，只想瘫倒休息。

They are so tired from work that when they come home from the end of the day, all they wanna do is collapse.

这是你的身体在向你发出信号。

That is your body speaking to you.

这对你来说并不比强迫自己锻炼更好。

That's not any better for you than forcing yourself to exercise.

问题依然存在：你仍然处于压力之中。

The problem still exists is that you're stressed.

是的。

Yeah.

是的。

Yeah.

我教授营养师、治疗师和运动专业人士如何更有效地管理糖尿病。

I teach a whole I teach dietitians, therapists, exercise professionals how to be more proficient in diabetes management.

我们总是会讨论的一点是：作为健康专业人士，无论我们的专业领域是什么——无论是治疗师、营养师、医生还是药剂师——我们都在要求糖尿病患者做很多事情。

And one conversation that always have is we have to remember as health professionals, no matter our niche, no matter we're a therapist, we're a dietitian, we're a doctor, we're a pharmacist, we are asking people with diabetes to do a lot.

我们基本上是在要求他们彻底改变自己的整个生活。

We are asking them to literally overhaul their whole life for the most part.

这不仅仅是饮食问题。

And it's not just nutrition.

这不仅仅是关注于，我们要求糖尿病患者服用药物。

It's not just focusing on We're asking people with diabetes to take medication.

有时是注射剂。

Sometimes they're injectables.

有时是胰岛素。

Sometimes it's insulin.

有时是口服药。

Sometimes it's oral.

我们要求他们坚持执行这些措施。

We're asking them to be consistent with that.

我们要求他们锻炼身体，每三个月看一次医生，每三个月做一次实验室检查。

We're asking them to move their body, we're asking them to see a doctor every three months, right and go get lab work every three months.

我们要求他们承担其中一些费用，这些费用基本上都要自费。

We're asking them to pay some of this stuff is like completely out of pocket.

有时候保险能报销，有时候则不行。

Sometimes insurance is covered, sometimes they don't.

我们要求人们关注自己的压力和睡眠，因为我们在日常生活中所做的几乎所有事情都会影响血糖水平。

We're asking people to focus on their stress on their sleep, because almost everything we do on a day to day basis affects our blood sugar numbers.

所以我们要求人们真正做到的事情太多了。

So we're asking people to literally do so much.

即使他们的饮食控制得很好，但如果压力极大，无法应对焦虑，他们的血糖数值也可能非常高。

And even if their nutrition is on point, but they're super stressed, they're not handling anxiety, their numbers could be very elevated.

所以我们要求他们去应对这些问题。

So then we're asking them to tackle that.

我经常告诉医护人员，我们必须记住，我们要求人们做的事情实在太多了，而倦怠是真实存在的，尤其是当他们付出了这么多努力，却感觉血糖数值依然停滞不前时。

And so something I tell providers all the time is like, we have to remember, like, we are asking people to do so much and that burnout is very real, especially if they're doing so much and they feel like their numbers are staying stuck or they're not going anywhere.

于是人们就会想：既然如此，那还为什么要努力呢？

Then people are like, well, why do anything anyways?

我要去拿。

I'm going to get.

对。

Right.

照护疲劳。

The care fatigue.

我们来谈谈GLP-1类药物。

Let's talk about GLP-1s.

再给我讲讲，就像我五岁一样。

Again, explain to me like I'm five.

GLP-1是什么？

What is a GLP-1s?

GLP-1类药物，人们以为它们是新东西。

GLP-1s people One thing is that people think that GLP-1s are new.

其实它们并不新。

They are not new.

GLP-1类药物已经存在很长时间了，实际上对二型糖尿病非常有效。

GLP-1s have been around for a very, very long time and are actually a very effective medication in type two diabetes.

我非常支持使用GLP-1类药物。

I am a huge proponent for GLP-1s.

我们会谈到这一点，因为这里面也有不少细节。

Well, we'll talk about that because there's nuance there too.

我喜欢把GLP-1类药物想象成一种辅助帮手。

So what I love to think of is that GLP-1s can act like almost like a helper.

它能做几件事。

So it does a couple of things.

它帮助你的身体释放胰岛素，但只在血液中存在葡萄糖时才起作用，这一点我很喜欢。

It helps your body release insulin, but only when there's glucose present in your bloodstream, which I love that.

我之所以喜欢这一点，是因为当你不吃东西时，你的胰腺就像在休息，但当你进食时，GLP-1就会刺激胰腺说：嘿，帮帮忙吧。

The reason why I love that is because your pancreas is kind of like taking a back seat when you're not eating, but then when you do eat, that GLP-one is stimulating your pancreas like, oh, hey, help her out.

她吃东西了。

She ate.

让我们帮助把她在进食后摄入的糖分转运到细胞中加以利用。

Let's help cover and pull some of that sugar from what she ate into the cells to be utilized.

我喜欢这一点，因为它不会导致低血糖的风险。

So I love that because it doesn't have a hypoglycemia risk.

比如，如果我给自己注射胰岛素，无论我有没有进食它都会起作用。

So for instance, like if I'm giving myself insulin, it works whether or not I've eaten.

因此，低血糖的风险非常高。

So the hypoglycemia risk is really, really high.

但GLP-1的情况并非如此。

But with the GLP-one, that's not what's happening.

因此，对于老年人或有低血糖风险的人群来说，它可能非常有用。

So it can be really useful for those who maybe are older or who have like a hypoglycemia risk.

GLP-1还会告诉肝脏停止制造糖分。

A GLP-one also tells your liver to stop making sugar.

大多数人不知道这一点，但无论你是否进食，肝脏都会储存并产生糖分。

Most people don't know this, but whether you eat or not, your liver stores and produces sugar.

所以GLP-1会告诉你的肝脏：你不需要做这件事了。

And so a GLP-one tells your liver like, you don't need to do that.

退到一边去，或者少生产一点。

Take a backseat or produce less.

这对那些血糖偶尔偏高却不知原因的人来说非常有帮助。

So that can be really helpful for people who have like random high blood sugars and they don't know why.

它还能减少食欲。

It also reduces your appetite.

它通过作用于我们大脑和胃中的GLP-1激素，让食欲稍微降低。

It works with the GLP-one hormone that is in our brain and our stomach and makes our appetite a little bit less.

很多人说，那种对食物的执念消失了。

And a lot of people say that the food noise goes away.

很多客户向我解释过，尤其是当你长期处于节食状态、总是想着食物时，使用GLP-1能帮助平息这种念头，我觉得这对很多人来说太棒了。

Now, I a lot of clients have explained this to me that especially when you're in a a season of just dieting all the time, and you're used to always thinking about food, that being on a GLP-one helps quiet that, which I think is amazing for people.

如果真的如此——一个人几十年来一直反复想着食物、下一口吃什么、有多少热量，极度关注这些细节，而现在这种念头减轻了，那这岂不是一种绝佳的方式，能让人腾出更多心理空间去做别的事？

Like if that is true, that if someone's been thinking about food and what's going in their mouth next and how many calories it is and just being so hyper aware of that for literally decades, and now that seems lower, What an amazing way to have more mental capacity for something else.

就像人们告诉我的那样。

Like, that's just what people have told me.

它起作用的另一种方式是减缓食物离开小肠的速度，对吧？

One other way that it works is it, slows how quickly food is leaving your small intestine, right?

进入你的小肠。

Going to your small intestine.

所以食欲下降是因为食物在胃里停留的时间更长了一些。

And so that that's why there's a reduced appetite because the food is sitting in your stomach a little bit longer.

总的来说，当我们看这一点时，我还想指出，这些药物并不是减肥药，它们仅被批准用于治疗糖尿病；唯一被批准用于减肥的GLP-1药物叫做Wegovy。

So overall, when we're looking at one thing I also just want to note is that these are not weight loss medications, they are only approved for diabetes, The only medication that's approved for weight loss that's a GLP-one is called Wegovy.

其他所有药物，如Mounjaro和Ozempic，都仅被批准用于治疗2型糖尿病。

All of the other medications, Mounjaro, Ozempic, they are only approved for type two diabetes.

因此，减肥是这些药物的副作用，就像我们都知道二甲双胍的副作用是胃肠道问题一样。

So weight loss is a side effect of these medications, just like most of us know that a side effect of metformin is like GI issues.

是的。

Yeah.

并不是每个人都会出现胃肠道问题，但这是一个副作用。

It doesn't mean everybody has GI issues, but it is a side effect.

同样地，GLP-1的副作用之一是减重。

So same with the GLP-one is a side effect is weight loss.

但并不是每个人都会经历。

Now, not everybody experiences.

我目前有两个客户都在使用GLP-1，但他们都没有减重。

I have two clients right now who are both on a GLP-one who are not losing any weight.

他们其实并没有减重的目标。

They don't have a weight loss goal really.

所以他们对这件事都持中立态度。

So both of them are pretty neutral about it.

他们只是希望更好地控制糖尿病。

They want their diabetes to be better managed.

但他们俩都说：‘天啊，我不明白别人为什么说用GLP-1能减那么多体重，我一磅都没掉。’

But both of them are like, wow, don't know what people are talking about losing all this weight on a GLP-one because I haven't lost a pound.

所以重要的是要看看，这种药物是如何帮助控制血糖的？

And so it's important to like, look at, okay, how does that medication work for blood sugar management?

如果有人有减重目标，那很好。

And if someone has a weight loss goal, great.

如果他们既有控制血糖的目标，又有减重的目标，这些药物会非常有效。

Like if they also have a blood sugar goal and a weight loss goal, these medications are going to be wonderful.

但如果他们只是为了减重而使用这种药，那并不是每个人都会有效果。

But if they're on it for weight loss specifically, that doesn't happen for every single person.

是的。

Yeah.

我也想指出，从食物噪音的角度来看，饮食自由也能带来同样的效果。

And I wanna also just acknowledge too that from the food noise piece, food freedom can also offer that as well.

所以GLP-1可能暂时压制了这种噪音，但这意味着你可能需要终身服用。

And so maybe the GLP-one will mute it for now, but then that means you need to be on this for the rest of your life.

否则，食物噪音会重新回来。

Otherwise, that food noise is gonna come back.

是的。

Yeah.

抱歉，这个问题我经常被问到。

And sorry, that is a question I get asked often.

比如，我必须一直服用这个药吗？

Like, do I have to be on this forever?

这就像是，你必须终身服用降压药吗？

And it's like, would you have to be on a blood pressure medication forever?

大概吧。

Probably.

所以药物本身其实并没有哪种是只用于短期治疗的。

So medications are really there really isn't a medication out there that's only meant for a short period of time.

大多数情况下，如果我们正在服用精神健康类药物，通常是需要长期服用的。

Most of us, if we're on mental health medication, usually it's it's indefinite.

当然，有些情况下你可以停药，但GLP-1类药物的设计初衷就是长期服用的，而这一点很多人并不愿意听到。

I mean, of course, there are instances where you come off of medication, but GLP-1s are meant to be a forever medication, which people really don't like to hear that either.

我们之前提到过，似乎有一种叙事或羞耻感围绕着需要服药这一点。

And we had mentioned this earlier, I think there's this narrative or this shame that comes up around needing to take medication.

好像需要吃药就意味着你失败了。

That somehow needing to take meds means that you have failed.

就像高血压一样，对吧？

Like even with like high blood pressure, right?

我不想吃高血压药，因为我本该能自己控制住的。

Of I don't wanna have to take high blood pressure medication because I should just be able to control it.

至于我的甲状腺，无论饮食文化如何试图说服我，我都无法让甲状腺恢复正常功能。

And it's like my thyroid, there's nothing I can do to make my thyroid function in the way that it needs to, no matter how much diet culture tries to convince me of that.

每天吃一颗小小的药片，已经为我的身体带来了巨大改善。

And taking one little baby pill a day has done wonders for my body.

那么，告诉我现在GLP-1被用于减肥的情况吧。

So tell me about GLP-1s being prescribed now for weight loss.

是的，它们确实被开给减肥患者，但几乎没有保险会覆盖这笔费用。

Yeah, I mean, they're being prescribed for weight loss, but no insurance is really covering it.

我知道像Mounjaro这种药，保险公司至少要求你有二型糖尿病的诊断才会考虑报销。

I know Mounjaro, for example, you have to have a type two diabetes diagnosis for insurance to even think of covering it.

但这并不意味着他们一定会报销。

And doesn't mean that they will cover it.

所以如果这些药是开给减肥用的，很多人只能自费购买这些药物。

So if it's being prescribed for weight loss, a lot of people are getting, you know, they're paying out of pocket for these medications.

Wegovy如果用于减肥，一些保险公司会部分报销，因为它已被FDA批准用于减肥。

Wegovy, if it's prescribed for weight loss, some insurances will cover some of it because it is an FDA approved medication for weight loss.

但事实上，我们看到的是，很多人为了减肥而自费承担这些药物的高昂费用。

But really what we're seeing is people paying a lot out of pocket to be on these medications for weight loss.

是的，我也想回到你之前提到的，你小组里的那些客户，他们说：‘我在吃这些药，但我并没有减肥目标。’

Yeah, I also wanted to go back to you had mentioned the clients in your group who are like, oh, I'm taking these meds and, you know, I don't have a weight loss goal.

我有太多客户来找我，说：‘我正在考虑使用GLP-1，但我根本不在乎体重。’

I have so many clients that will come to me and be like, I'm thinking about taking a GLP-one and I don't care about my weight.

我会说：好的。

And I will say, okay.

所以三个月后，如果你的体重没有变化，但血糖改善了，这对你来说足够了吗？

So in three months from now, if your weight does not change, but your blood sugars improve, will that be enough for you?

每次都是这样，是的，绝对如此，Bri。

And every time, yeah, absolutely, Bri.

但到了三个月后，他们会说：但我还没瘦下来。

But then when we get to three months down the road, they're like, but I'm not losing weight.

所以我们需要重新提出来，说明这对你确实很重要。

And so that's when we need to bring it back up and say, then it does matter to you.

如果你要服用这种药物，我们需要了解这些信息。

And we need that information if you're going to be taking this medication.

你依然拥有身体自主权，你依然可以决定使用，但你是不是在欺骗自己，认为这仅仅关乎数字？

You still have the right to body autonomy, you still get to do it, but are you trying to gaslight yourself that it's just about the the numbers?

是的。

Yeah.

为了控制血糖？

For blood sugar?

嗯。

Mhmm.

你提到过关于药物的羞耻感，我想就此展开聊聊。

One thing that you mentioned that I would just wanted to kind of like riff on was you mentioned shame around medication.

天啊，我太理解了。

And boy, I see that.

我每天都能看到这种情况。

I see that every day.

有些人会直接对我说：我不想吃药。

And I have people literally say to me like, I don't want to be on medication.

我宁愿做任何事也不愿意吃药。

I will do anything to not be on medication.

所以我想就这一点说两点。

So two things I kinda wanna say to that.

第一，我有个客户，她的糖化血红蛋白正好是5.7。

One, I had a client who her a one c was, like, right at 5.7.

她不想服用二甲双胍，于是做了各种努力来控制血糖，甚至不惜以焦虑为代价——只要吃了一点‘不均衡’的食物，她就会担心血糖升高，从而被迫开始服用二甲双胍。

She didn't wanna be on metformin, and so she was doing all these things to keep her numbers low at the risk of she would be so anxious if she ate, quote, unquote, off balance because she was worried that that was gonna make her A1C go up, she's gonna have be on metformin.

她非常自律。

She was so diligent.

她有两个孩子，我们不得不进行一次严肃而坦诚的对话：你真的能一直这样下去吗？

She has two kids, and we really had to have a really serious and honest conversation about, can you do this forever?

你现在的警惕程度有多高？你有多害怕？你连计划之外的任何食物都不敢吃，这样的生活对你来说真的值得吗？

Like how vigilant you're being, how how scared you are, how, you know, you're you're scared to eat outside of like anything that you have planned, like, is that worth it to you?

如果这是你想要的，我会支持你，我们就继续朝这个方向走。

If it is, I will support you in that, and we will keep moving that direction.

但我看到的是大量的恐惧和焦虑，这些情绪实际上正在影响她作为母亲、作为妻子的生活。

But what I'm seeing is a lot of fear and anxiety that honestly is like, it's impacting her life as a mom, as a wife, etc.

所有这些，都源于不愿服用药物的代价。

So having that type of a conversation, all out of expense of like not being on medication.

在我上一个小组里，也有一个客户告诉我：我的糖化血红蛋白是7.4。

I also had a client in my last group tell me, my A1c is at 7.4.

我的医生开了药，但我没吃，因为我害怕一旦吃了就会依赖它。

My doctor prescribed medication, and I'm not taking it because I'm scared that I will then be reliant on it.

而且我得一辈子吃药。

And I will have to be on medication forever.

我会坦诚直接地和别人交流，尤其是关于我非常了解的事情，糖尿病就是其中之一。

And an open and honest conversation, I'm very, very forward with people, especially like things that I know a lot about, and diabetes is one of those things.

所以我跟她说，你现在的糖化血红蛋白偏高。

And so something I said to her, I said, right now, your A1C is elevated.

所以你在努力避免吃药。

And so you are trying to stay away from medication.

但你这样做的风险是会增加糖尿病并发症的可能性，因为我们知道，糖化血红蛋白高于7%会显著增加并发症风险，而这一切都是为了不服用药物。

And what you're doing is you're putting yourself at risk for diabetes complications, because we know an a1c above seven puts us at a higher risk of diabetes complications all out of the name of not being on medication.

所以我当时非常直接地跟她说了。

And I so I was very, like, forward with her.

你知道你不想吃这种药，但你不吃药又在冒什么风险呢？

You know, you don't want to be on this medication, but what are you risking by not being on medication?

你的数值偏高。

Your number is elevated.

你正在失去无法挽回的时间。

You are losing time you can't get back.

你正在让自己面临并发症的风险。

Are putting yourself at risk for complications.

这些只是真实对话中的一些例子，因为人们太过害怕药物，以至于宁愿让血糖保持在高位，也只是为了避免服药。

And those are just some of the real conversations because people fear medication so much that they're willing to keep their numbers elevated basically to out of the fear of being on the medication.

作为医疗提供者，我们需要向人们解释，这种做法在背后可能带来的影响，这些影响可能并不明显，或者他们目前还不了解。

And, you know, think as providers, it's important for us to explain to people what that could be doing behind the scenes that might not be very prevalent or, you know, they may not understand right now.

是的。

Yeah.

我也想说，类似代课老师和遵守规则的情况。

And I also wanna say too that, like, sort of in a similar vein of, like, the substitute teacher and, like, following the rules.

有好几年我都只是按照医生的建议服药，他们告诉我这是该做的，而我根本没有进一步思考过：我需要去了解这种药物的作用是什么。

There were years that I just went on a medication because my doctor told me that this is what they would And there wasn't really like a secondary thought of like, I need to explore and understand what this medication is for.

我被开了二甲双胍，我的糖化血红蛋白显著下降了，但我每天都会拉裤子。

I was prescribed Metformin and we saw my A1C drop significantly, but I shit my pants every single day of my life.

我因为二甲双胍出现了严重的胃肠道不适。

Like I had really bad GI distress from the Metformin.

当我回去找医生说‘我有胃肠道反应’时，没有一个人提到‘你正在服用二甲双胍’。

And when I would go back to the doctors and be like, I'm having GI distress, not a single person was like, well, you're on Metformin.

这可能是导致症状的原因。于是我自行停了药，这时我才意识到，这其实是一个众所周知的副作用，但没人关心我经历的这些不良反应。

That could be being contributed from And so I went off of the medication myself and that's when I realized, Wow, this is a well known side effect and nobody cared about the side effects I was experiencing.

这让我下定决心，我必须对自己的用药更加谨慎。

And so that made me say, I need to be more vigilant in my own medication care.

在GLP-1还没流行的时候，我就被开了这种药。

And so I was prescribed a GLP-one before it was popular.

当时医生开给我的目的是减重。

I was being prescribed for weight loss.

当我问医生‘这药会有什么效果？’

And when I asked the doctor, what will this do?

我怎么知道它有效呢？

How do I know it's working?

她说：你会知道的，就是能感觉到。

She said, you're gonna, you just know.

她向我推销的其实是，这会让我减肥，然后我的各项指标也会随之大幅改善。

And what that told me was, what she was selling me was that this was gonna make me lose weight, and then that was exponentially gonna change my numbers.

但我选择不吃，因为我并不认为体重是我的问题。

And I opted not to take it because I said, I do not believe my weight is the problem.

如果你想把体重当作症状来看，那当然，超重的身体可能是多囊卵巢综合征、胰岛素抵抗或其他任何问题的表现。

If you wanna use weight as symptomology that, like, sure, living in a super fat body could, be a symptom of PCOS, of insulin resistance, of whatever, fill in the blank.

但减轻体重并不能解决胰岛素抵抗。

Fixing the weight does not fix the insulin resistance.

嗯。

Mhmm.

对，对。

Yeah, yeah.

我特别喜欢讲解关于药物的内容，因为大多数来找我的人并不了解他们的药物是如何起作用的。

And one thing I love teaching on is about medication because most people come to me and they don't know how their medication is working.

他们不明白药物的副作用。

They don't understand the side effects.

市面上有很多种糖尿病药物。

And there are lots of diabetes medications out there.

大多数人以为只有二甲双胍和GLP-1类药物，但实际上有七种不同类别口服药物。

Most people think it's like metformin and like GLP-1s, but there's like seven different types of oral medications that are in different classes.

还有胰岛素、GLP-1类药物等。

And then there's insulin, there's GLP-1s.

需要了解的东西太多了。

There's so much to know.

我特别喜欢问客户是否理解自己的药物、药物的作用机制、是否有副作用，以及这些药物在营养方面需要注意什么。

And one thing I love doing is asking clients like if they understand their medications, how their medications are working, any side effects, or any nutrition considerations with these medications.

这是我最喜欢讲解的内容之一，因为大多数人确实被开了药，被告知‘这能降低你的糖化血红蛋白，能起到这个作用’，然后就直接开始服用，人们也就说：‘好吧。’

It's one of my favorite things to teach on because most people, yes, are given a medication told, this will lower your A one C, this will do this, be on it and so people are like, okay.

我在胆固醇药物方面也经常看到这种情况。

So, I see this a lot with cholesterol medication too.

胆固醇药物的一个主要副作用是严重的关节疼痛。

So, a big side effect of cholesterol medication is severe joint pain.

大多数人并不知道这一点。

Most people don't know that.

很多人服用这些胆固醇药物，有些人可能只是轻微不适，但有些人会经历严重的关节疼痛，甚至难以行走。

So people are on these like cholesterol medications having and I mean, like some people who they might experience a little bit, but I mean, some people experience such severe joint pain that they like have a hard time walking.

如果没人告诉过你，突然之间，比如我没被提醒过，却突然出现严重的关节疼痛，我一定会被吓坏。

If it's not told to someone and all of a sudden, I mean, if no one told me that and all of a sudden I had severe joint pain, would scare the hell out of me.

我会想，我的身体到底怎么了？

I'd be like, what is happening to my body?

所以，关于药物和帮助患者，其中有很多细微之处。

So yeah, there's so much nuance around medication and helping people.

我认为我最大的目标就是帮助人们感到自己得到了充分的信息。

I think my biggest goal is just like helping people feel informed.

我希望人们去看医生时，能对自己所服用的药物有充分的了解，知道哪些有效、哪些无效。

I want people to go to the doctor and feel informed about the medications that they're on, what's working for them, what's not working for them.

我不在乎一个人是否服用了十二种治疗糖尿病的药物，目标是把血糖指标控制在目标范围内。

I don't care if someone's on 12 medications for diabetes, the goal is to get their numbers to target.

然后我们会评估哪些药物其实并不需要继续服用。

And then we look at what medications don't need to exist here.

我们能否通过优化你的其他生活方面和生活方式，来减少对药物的依赖？

And can we optimize other areas of your life and your lifestyle choices so we can be on less medication?

因为我知道，大多数人的目标都是尽量不服用任何药物。

Because I know most people's goal is to not be on any medication.

如果我要非常非常坦诚地说，对于糖尿病患者来说，完全不服用任何药物是一个非常不切实际的目标。

And if I'm being super, super transparent, that is a very unrealistic goal with diabetes to just be on no medication at all.

这非常不现实，因为之前我们谈到过，胰腺无法高效运作，对吧？

It's very unrealistic because earlier we were talking about the pancreas not working efficiently, right?

所以，认为我们能仅靠生活方式就完全不用药物来应对糖尿病，是极不可能的。

So to think that we can just live our life with diabetes on no medication is very, very unlikely.

我只是想邀请你客观地去探索这一点。

And I just wanna invite you to like explore that objectively.

我在看电视剧《外乡人》，有一集讲一个人因为糖尿病去世了，而那时他们甚至没有能力诊断这种病。

Like, and I'm watching Outlander on TV and there's like an episode where a person dies from diabetes and they didn't even have a way of diagnosing it.

所以说，我们现在有药物可以确保你不会因为水痘之类的小病就死去，这其实真的很了不起。

It's like, hey, it's pretty cool that we have a medication now that we can make sure that you don't just die from chickenpox or, you know, like the medication is actually really cool.

而且，如果使用得当，这些药物能带来惊人的效果。

And when used properly, it can do amazing things.

我认为，首先我们要审视那种对医疗诊断的恐惧和羞耻感为何如此强烈。

I think one, we wanna look at the urgency around the fear and the shame of your medical diagnosis of like why it feels so bad.

我会向医疗提供者描述糖尿病。

Like I will describe diabetes to providers.

当一个胖人，或者体型较大的人被问及他们最害怕患上什么疾病时，几乎所有人都会说糖尿病。

Like, when a when a fat person if you ask a fat person or a person in a larger body what they are afraid of of what sickness they're afraid of in being in a fat body, what are they most afraid of, everybody says diabetes.

糖尿病是胖人或大码人群心中的‘怪物’。

It is the boogeyman of the fat person or the plus size person.

这真是非常成功的营销。

And that is really good marketing.

我想就此打住，没错，我们被灌输的就是这种观念：只要减肥、更有自制力，就能单枪匹马地阻止糖尿病。

And I wanna just leave it at that, yes, that is what we are marketed, that we can single handedly stop diabetes if we were to just lose weight and be more self disciplined.

我最近的一个小组里有个女性告诉我，她八岁时就和妈妈一起去珍妮·克雷格减肥中心，当时她要在一群年龄足以当她妈妈或奶奶的女性面前称体重。

I had a woman in my most recent group, and she told me that she used to go to Jenny Craig with her mom when she was eight, And she was weighed in front of all of these women old enough to be her mom and her grandma's.

对吧？

Right?

她说她记得秤就放在圆圈的正中央。

And she's like, I remember the scale was in the middle of this circle.

我们所有人都得站起来，上秤称重。

We all had to get up, get weighed on the scale.

那里有太多太多需要梳理的东西了。

And she just has there's so much so much to unpack there.

但她告诉我一件事，她妈妈在她八岁时对她说：‘我们来这里，是因为我不想让你得糖尿病。’

But so one thing that she told me was that her mom told her at age eight, We are here because I do not want you to develop diabetes.

对你健康来说最糟糕的事情就是患上糖尿病。

And the worst thing that can happen to your health is to develop diabetes.

所以，这个八岁孩子的头脑正在吸收这些信息。

So this, you know, little eight year old brain is like taking in that information.

一个八岁的孩子根本不知道糖尿病是什么，对吧？

An eight year old doesn't even know what diabetes is, right?

然后她妈妈最终管它叫减肥营。

And then her mom ended up, she called it fat camp.

她就是这么叫的。

That's what she called it.

她说，我十二岁时妈妈送我去减肥营，我去了好几年。

She's like, my mom sent me to fat camp then when I was 12, and I went to fat camp for years.

所以这么多年来，她妈妈一直说：我这么做是因为我不希望你得糖尿病。

So all of this time her mom is saying, I'm doing this because I don't want you to have diabetes.

总之，这位客户现在29岁，刚刚确诊了糖尿病。

Anyways, this client is now 29 and just developed diabetes.

所以她坐在我小组里，说：我 literally 就得了我妈妈一直告诉我可能是对我最糟糕的事情。

So she's sitting in my group and she's like, I literally developed what my mom told me was like the worst thing that can happen to me.

这简直是一种心理上的折磨，对那个天真的八岁孩子是这样，对现在这个29岁、已经患上这种疾病的人来说也是如此——她这一生的二十年里，都被灌输着一种观念：如果你得了这个病，你就彻底失败了。

And it like, you know, it just the mind fuck that that does for this like sweet little eight year old, but also like this not 29 year old too, that's now has this condition that basically was told for two decades of her life, like, if you have this, you have pretty much failed.

我经常听到类似的故事：大多数女性在很小的时候就开始节食，最终却得了糖尿病，而这被称作‘最糟糕的事情’。

And that's a very common story I hear is most women are dieting at a very young age, end up with diabetes, and it's quote unquote, the worst thing that could happen to them.

是的，我认为我们真正需要做的是建立对自身信念的客观认知。

Yeah, I think that what we really need to do is build that objective awareness around our beliefs.

没人会因为得2型糖尿病而坐牢。

Know, like nobody goes to jail for getting type two diabetes.

你知道，你不是罪犯，也不是坏人。

Like, you know, you're not a criminal, you're not a bad person.

如果你认识的其他人得到这个诊断，你会怎么对待他们？

And how would you show up for somebody else who got this diagnosis?

你会像这样责备他们吗？

Would you shame them in the same way?

如果答案是否定的，那我们就需要审视你对自己说话的方式。

And if the answer is no, then we have to look at the way you're speaking to yourself and about yourself.

我想象，如果你的糖化血红蛋白偏高或已被诊断为糖尿病，你很可能已经非常警惕了，而更多的警惕未必是必需的，我认为更需要的是减少自我评判，增加对身体的信任。

I imagine that if you are a person who has an elevated one a one c or a diagnosis of diabetes, you are probably already super fucking vigilant that more vigilance isn't necessarily what is needed, but I think less judgment and and more body trust.

要信任一个你感觉正在失败的身体，这很难。

And it's hard to trust a body that you feel like is failing.

但我喜欢对我的身体说：谢谢你为生存所做的一切。

But I like to say to my body, thank you for doing what you need to do to survive.

你正在以我唯一知道的方式拯救我的生命。

You are saving my life in the only way that I know how.

以你唯一知道的方式。

The only way that you know how.

如果有人正在为糖化血红蛋白偏高或因糖尿病诊断而感到羞愧，你会给他们什么建议？

And so what is like something that you would leave folks with if they are struggling with having an elevated A1C or feeling shame about a diagnosis of diabetes?

你希望他们明白什么？

What would you want them to know?

我的意思是，我会告诉人们要充分利用自己的资源，因为有时候我觉得，羞耻感之所以存在，是因为人们太过于羞耻，以至于根本不去寻求帮助。

I mean, one thing that I tell people is like, really tap into your resources, because sometimes I feel like shame exists where we're not Shame exists so much so that people sometimes don't seek help.

他们不去获取本应提供给他们的信息。

They don't seek the information that should be given to them.

他们不去寻求支持，因为羞耻感太强烈了。

They don't seek the support because there's so much shame.

他们会觉得：‘哦，我本该懂这些的。’

They're like, Oh, like, I should know all of this.

而我知道，羞耻感让人深陷其中，难以自拔。

And I, you know, there's just that shame keeps people so stuck.

羞耻感让人深陷其中，难以自拔。

It keeps people so stuck.

因此，应该通过人们的保险提供相应的资源，让他们能够去获取。

And so there should be resources through people's insurances that they should be able to go to.

如果你得不到想要的答案，就要主动去争取。

And if you're not getting the answers you want, like demand them.

如果你的医生无法给你一个明确的答案，那就要求转诊给营养师，或者转诊给糖尿病教育者。

If you know, if your doctor cannot give you a straight answer, ask for a referral to a dietitian, ask for a referral to a diabetes educator.

许多医院提供免费的糖尿病课程，你可以去参加，好好吸收这些知识，因为一旦确诊糖尿病，你就得终身与之相伴。

A lot of hospitals provide like free diabetes classes that you can go attend and like, just soak in the knowledge because once you have diabetes, you do have it forever.

即使你只是前期糖尿病，未来你也需要在某种程度上终身管理自己的血糖。

Even if you have prediabetes, you're going to be managing your blood sugars the rest of your life to some degree.

因此，了解并掌握这些信息，是你能做的最好的事情之一。

And so understanding and being so informed is one of the best best things you can do.

而且，你值得拥有这些。

And like you're you deserve that.

这并不是说因为你可能本可以预防这种情况，就不配得到这些。

It's not like you don't deserve it because this could have possibly been prevented.

无论是否本可预防，你都更应该拥有这些。

You deserve it more than anything, regardless if it could have been prevented or not.

无论你能获得什么样的知识或教育，你都值得享有知情的医疗保健，也值得在看医生前做好充分准备。

Like any knowledge, any education that you can receive, you deserve to have informed health care, and you deserve to go into your doctor's appointments totally informed.

当然。

Absolutely.

所以，如果你已经确诊为糖尿病，我们先承认这个诊断。

So if you are a person who already has a diagnosis of diabetes, let's just acknowledge you have this diagnosis.

现在，让我们来确定接下来最好的步骤。

Now let's figure out what are the best next steps.

我们该如何以最佳方式照顾你？

How can we care for you in the best possible way?

如果你担心自己会患上糖尿病，或者你的糖化血红蛋白偏高让你感到害怕，首先，我想和你一起评估一下，从1到10分，想到得糖尿病这件事有多让你焦虑？

If you are somebody who is afraid of developing diabetes or has an elevated A1C and that scares you, one, I wanna sit with on a scale of one to 10, low, medium, high, how distressful is the idea of getting diabetes?

其次，你的下一步最佳行动是什么？

And two, of what are your next best steps?

因为我敢保证，更多的信息或更多的行动，未必就是最好的下一步，也许更重要的是，去探索你如何与自己以及自己的身体对话。

Because I guarantee you more information, more doing may not even be the very best next thing, but maybe just an exploration of how you're speaking to and about yourself and about your body.

克里斯蒂，我觉得和你聊多久都不够，所以我们今天就先到这里吧。

Kristie, I feel like I could talk to you forever, so I'm gonna I'm gonna wrap us up here.

介绍一下你的团体。

Tell people about your group.

告诉我们如何找到你，以及如何从你那里了解更多。

Tell us where we can find you and how we can learn more from you.

是的。

Yeah.

我运营两个不同的团体。

So I run two different groups.

如果你是一名希望在血糖管理领域获得更多技能的医疗从业者。

If you're a provider wanting to be a little bit more equipped in the blood sugar management space.

如果你是营养师或治疗师，正在为糖尿病患者提供服务，我运营一个名为《血糖商业》的团体，还能获得15个继续教育学分，非常不错。

If you are a dietitian, a therapist, seeing people with diabetes, I run a group called Business of Blood Sugars, also worth 15 CEUs, which is really great.

我觉得，作为医疗从业者，我们都知道糖尿病不会消失。

And I feel like, you know, as providers, we know diabetes is really not going anywhere.

随着GLP-1和连续血糖监测设备的普及，现在比以往任何时候都更需要理解这些细节，以便更好地服务我们的客户。

And with the uprise in GLP-1s and CGMs, I think it's really important more now now than ever to understand all of that nuance for our for our clients.

如果你是糖尿病患者，我运营一个为期十二周的实时团体辅导项目，名为《平衡血糖法》，我们会深入探讨所有这些内容。

If you are someone living with diabetes, I run a twelve week group coaching live program called Balanced Blood Sugar Method, where we talk about all of this.

布里是该项目的特邀教练，她会谈论身体形象，以及如何理解糖尿病对身体的影响，并接纳你认为正在辜负你的身体。

Bri is a guest coach in there talking about body image and understanding your body with diabetes and coming to terms with a body that you feel like is failing you.

当然，我们还会涉及营养、压力、睡眠、焦虑，以及这些因素如何影响你的血糖管理，同时你还会加入一个由女性组成的互助群体，她们的目标与你完全一致——以最不干扰生活的方式管理血糖。

Of course, we go into nutrition, stress, sleep, anxiety, how all of that plays a role in your blood sugar management, plus having a supportive group of women who all have the exact same goal, which is to manage their blood sugars in the least obstructive way possible.

我学到的一点是，我们大多数人希望在不彻底改变生活的情况下管理好自己的健康。

Something I've learned is that what most of us want to do is manage our health without impacting our entire life without overhauling our whole life.

我认为，团体辅导做得特别好的一点就是：不改变对你有效的部分，而是优化那些对你无效的部分。

And I think that's one thing that we do really well in group coaching is don't change what's working for you, and then let's optimize the things that are not working for you.

所以，这就是我运营的两个不同项目，我可以在Instagram上找到，账号是type2diabetes.nutritionist。

So those are two different groups I run, and, I can be found on Instagram at type2diabetes.nutritionist.

我们会在节目笔记中附上所有这些链接，克里斯蒂，如果你觉得还有其他对听众有帮助的资源，也请一定发给我们。

And we will link all of that in the show notes And any other resources, Kristie, that you think would be beneficial for folks who are here, please definitely send our way.

非常感谢你来到这里，并分享你所有的专业知识。

Thank you so much for being here and for all of your knowledge.

谢谢。

Thank you.

嘿，朋友。

Hey, friend.

非常感谢您收听《身体哀悼者俱乐部》这一集播客。

Thank you so much for listening to this episode of The Body Grievers Club.

和所有我们的播客朋友一样，我们恳请您点赞、订阅并分享本集给认为需要听到它的人。

Like all of our podcasting friends, we ask that you like, subscribe, and share this episode with someone who you think needs to hear it.

我知道身体哀悼很艰难，但我希望这一集能让你感觉不那么孤单。

I know that body grief is tough, but I hope this episode helped you to feel less alone.

要了解如何将身体哀悼转变为彻底的身体接纳，请务必查看我免费的七步指南，它旨在帮助你揭示如何转变你的身体形象故事。

To learn more about how you can shift your body grief to radical body acceptance, be sure to check out my free seven step guide designed to help highlight how you can transform your body image story.

你还可以了解如何通过我的

You can also learn how to work with me inside of the

节目说明。

show notes.

记住啊，朋友们，

Remember my friends,

你的身体哀伤是痛苦而真实的，但你从不孤单，尤其是当你属于身体哀伤者俱乐部时。

your body grief is painful and real, but you are never alone, especially when you're part of The Body Grievers Club.

感谢收听，我们下次再见。

Thank you for listening, and until next time.