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. In actual fact, I might argue that “management” isn’t 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), good insulin pens, and hybrid closed loops – gained’t have excellent ranges day by 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 lots of my fellow diabetes advocates carrying hybrid programs had their alarms go off incessantly.
It could really feel disheartening, however understanding that “full management” over blood sugar ranges isn’t doable might be liberating and empowering. If you happen to consider it as a strategy of managing with the objective of enchancment, it may possibly free you from chasing the unimaginable objective of perfection, easing the stress, frustration, disappointment, guilt, and self-blame that may come from feeling such as you failed.
I’ll clarify under the way to 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 dwelling 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 Components that Have an effect on Blood Glucose is at all times value sharing to remind us what number of elements, organic and environmental, influence blood sugar.
As an alternative of utilizing the verb “management,” I favor “handle.” To handle comes from the Italian maneggiare, that 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 surroundings, and blood sugars.
Even after dwelling with sort 1 diabetes for 51 years, I can’t, for instance, see 142 mg/dL on my CGM, determine I need 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 just a few root causes I might manipulate and the impact could 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 isn’t a cause-and-effect job however a fancy one which depends on fixed sensemaking. Sensemaking is the act of attempting one thing and seeing what occurs. We do it on a regular basis however we don’t acknowledge it.
You might suppose what I’m saying is apparent, however the phrase “management” is used so typically within the language of diabetes that on some stage we have now absorbed it as true and doable. We maintain ourselves accountable for our numbers pondering we must be judged on them. This causes numerous pointless struggling.
Why will we imagine we will ‘management’ blood sugar?
Throughout the industrial and scientific revolutions, the concept of machine effectivity was introduced into drugs. The human physique was broadly considered 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 pondering 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 flawed: 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 the way to affect your numbers and sensing what to do with any blood sugar quantity you see.
This requires you to have a basic data of how issues have an effect on your blood sugar and a familiarity together with your patterns. That stated, as a result of so many variables are concerned, any motion might 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 carrying a CGM to anybody with diabetes, notably should 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 be a simple solution to see your patterns: test 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 test for patterns utilizing a meter. Whereas the 2-hour test is a mechanical rule, it offers you 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 once I’m dwelling. My lunches and dinners are comparable daily in amount and carbs, and I observe a low-carb weight loss program. Consuming and exercising constantly additionally helps my numbers be extra comparable daily.
Nudging: small pushes again into vary
I observe 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 realized to take one or two glucose tablets and watch what occurs quite than eat all the pieces within the fridge like I used to.
Working towards endurance and forgiveness
Managing blood sugar takes vigilance. You’ll have extra power to do it if you movement together with your numbers, quite than battle them. Which means 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 excellent. I actually have occasions I really feel overwhelmed or annoyed by my numbers and my thoughts shouts, “How might I let that occur once more? Why didn’t I wait earlier than I took that additional shot?”
However the temptation to suppose 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 observe this easy train – typically throughout the day or once 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 aspect or maintain them over my chest, and gradual my respiratory. I acknowledge this quantity isn’t my fault. My actions alone didn’t trigger it. Then I mirror as finest 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 essential to say that managing diabetes isn’t straightforward. If it was, greater than 50-60% of individuals with diabetes would attain the time in vary suggestion, which is 70% of the time (the equal of 17 hours a day).
This previous summer time at Camp Nejeda I introduced this fantasy of “management” to adults who’ve been dwelling with sort 1 diabetes for many years. All of them knew it instinctively, however listening to somebody say it precipitated one girl 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 accountable for our efforts however not our final result.
Relaxation on this understanding and see if giving up the concept of excellent numbers helps you spend extra time in vary with much less stress.
