This content material initially appeared on diaTribe. Republished with permission.
By Riva Greenberg
No individual with diabetes, irrespective of what number of years they’ve had it, has achieved absolute management of their blood sugar. The truth is, I might argue that “management” is just not doable in any respect.
It has to do with the phrase management itself, however extra on that later.
Even individuals who use the newest applied sciences – together with insulin pumps, steady glucose screens (CGM), sensible insulin pens, and hybrid closed loops – gained’t have good ranges each day. Most will see an enchancment of their time in vary, however not management.
I noticed this firsthand on the 2023 EASD convention in Hamburg, Germany, the place a lot of my fellow diabetes advocates sporting hybrid methods had their alarms go off steadily.
It could really feel disheartening, however understanding that “full management” over blood sugar ranges is just not doable could be liberating and empowering. If you happen to consider it as a means of managing with the aim of enchancment, it may well free you from chasing the not possible aim of perfection, easing the stress, frustration, disappointment, guilt, and self-blame that may come from feeling such as you failed.
I’ll clarify under how you can higher work with the fixed fluctuations of blood sugar and share a few of my practices for navigating (versus controlling) it.
The complicated science behind blood sugar administration
Our heartbeat, blood stress, intestine and mind signaling, digestion, liver processes, nervous system, and extra all work together and affect blood sugar ranges. So does residing in an unpredictable world.
Personally, each morning I take care of the “daybreak impact.” I have to take 1 unit of rapid-acting insulin instantly or I’ll go up 30 factors in minutes. The stress of presenting at a convention, though I really feel relaxed, releases hormones that elevate my blood sugar.
Adam Brown’s 42 Elements that Have an effect on Blood Glucose is all the time price sharing to remind us what number of components, organic and environmental, influence blood sugar.
As an alternative of utilizing the verb “management,” I choose “handle.” To handle comes from the Italian maneggiare, which means to deal with and practice horses. It suggests a mutual adapting to, respecting, and evolving between two complicated entities: the horse and rider. Or, on this case, the complicated dance between people, the atmosphere, and blood sugars.
Even after residing with kind 1 diabetes for 51 years, I can’t, for instance, see 142 mg/dL on my CGM, resolve I wish to be 102 mg/dL, and make it occur. Sure, I’ll take some insulin or go on a stroll, however I can’t assure precisely the place my blood sugar will settle.
This was a lot to the chagrin of my husband who early in our marriage thought there should be a number of root causes I may manipulate and the impact can be absolute management. However one night, quarter-hour after I’d ordered my meal in a restaurant and pre-bolused, the waiter got here again to say, “There’s been an accident within the kitchen, your meal will take one other 20 minutes.”
That’s when the husband noticed that managing blood sugar is just not a cause-and-effect job however a posh one which depends on fixed sensemaking. Sensemaking is the act of making an attempt one thing and seeing what occurs. We do it on a regular basis however we don’t acknowledge it.
Chances are you’ll assume what I’m saying is apparent, however the phrase “management” is used so usually within the language of diabetes that on some stage we’ve got absorbed it as true and doable. We maintain ourselves liable for our numbers considering we ought to be judged on them. This causes numerous pointless struggling.
Why will we imagine we are able to ‘management’ blood sugar?
Through the industrial and scientific revolutions, the thought of machine effectivity was introduced into medication. The human physique was extensively seen as a machine. This may be helpful for acute care however fails miserably for continual care, as is the case for managing diabetes.
However machine considering seeped into diabetes care with control-like, statistical formulation: insulin-to-carb ratio, insulin-on-board, pump algorithms, and carb-counting. Don’t get me improper: these are enormously useful, however they don’t flip us into machines.
Enhancing time in vary
Success in managing blood sugar and spending extra time in vary is realizing how you can affect your numbers and sensing what to do with any blood sugar quantity you see.
This requires you to have a common information of how issues have an effect on your blood sugar and a familiarity along with your patterns. That stated, as a result of so many variables are concerned, any motion could take some trial and error.
Listed below are steps that assist me spend, on common, 90% time in vary.
Influencing your blood sugar
- Put on a CGM: I like to recommend sporting a CGM to anybody with diabetes, notably in case you use insulin. You want to have the ability to see your numbers to know the place you’re and the place you’re going. A CGM can also be a straightforward option to see your patterns: verify your blood sugar earlier than and two hours after a meal or bodily exercise to see its influence in your blood sugar. If you happen to don’t use a CGM, you’ll be able to verify for patterns utilizing a meter. Whereas the 2-hour verify is a mechanical rule, it provides you with a way.
- Routine: I eat the identical breakfast of plain Greek yogurt, a spoonful of tahini and almond butter, and a slice of a flaxseed muffin each morning after I’m house. My lunches and dinners are comparable daily in amount and carbs, and I comply with a low-carb food regimen. Consuming and exercising constantly additionally helps my numbers be extra comparable daily.
Nudging: small pushes again into vary
I comply with Dr. Richard Bernstein’s “regulation of small numbers.” If I’m too excessive, I take a small quantity of insulin to nudge my numbers down, wait, watch, and repeat if vital.
After I want to lift my blood sugar, if it’s not dangerously low, I’ve discovered to take one or two glucose tablets and watch what occurs slightly than eat all the pieces within the fridge like I used to.
Training persistence and forgiveness
Managing blood sugar takes vigilance. You’ll have extra vitality to do it if you circulation along with your numbers, slightly than combat them. Meaning staying calm and seeing the massive image. It means realizing that many variables, not simply your choices, have an effect on blood sugar.
That stated, I’m removed from good. I actually have instances I really feel overwhelmed or annoyed by my numbers and my thoughts shouts, “How may I let that occur once more? Why didn’t I wait earlier than I took that further shot?”
However the temptation to assume why didn’t I do that as a substitute of that’s ineffective since I can solely know which determination was higher in hindsight.
To assist my nervous system keep calm, I follow this easy train – generally in the course of the day or after I’m tempted to rage bolus.
I stand with my knees unlocked, really feel my toes on the ground, let my arms relaxation by my facet or maintain them over my chest, and sluggish my respiratory. I acknowledge this quantity is just not my fault. My actions alone didn’t trigger it. Then I mirror as greatest I can on what may need created it so I would do higher sooner or later. I feel, what do I do now, and do it; I don’t dwell on the quantity.
In closing
It’s necessary to say that managing diabetes is just not straightforward. If it was, greater than 50-60% of individuals with diabetes would attain the time in vary advice, which is 70% of the time (the equal of 17 hours a day).
This previous summer time at Camp Nejeda I offered this fantasy of “management” to adults who’ve been residing with kind 1 diabetes for many years. All of them knew it instinctively, however listening to somebody say it precipitated one lady to sob, releasing years of blame she had been carrying.
It’s time we understand that it’s extra correct and useful to inform individuals to “handle” their blood sugar as a substitute of “management” it. Our numbers emerge from dozens of things, some inside our sphere of affect, many not. As such, we’re liable for our efforts however not our final result.
Relaxation on this understanding and see if giving up the thought of good numbers helps you spend extra time in vary with much less stress.
