Diabetes Self-Management Blog

I planned on writing today’s blog entry about a program I’ll be volunteering for at the University of Michigan Medical School. It’s called the Family Centered Experience (FCE)—which, by the way, was cofounded and is directed by my endocrinologist, Dr. Arno Kumagai. It’s a wonderful way for medical students to gain an understanding of illness from the patient’s point of view.

There’s a great article about it, “Into the Home, Into the Heart,” that you might check out if you’ve ever felt that your doctor doesn’t understand what you go through with your diabetes. Last week, I attended a reception to kick off the FCE and met Andrew and Megan, first-year med students who’ve been assigned me as their volunteer. You can be sure that I’ll write more about my involvement with FCE in the coming months.

But on to the reason for this post’s title…

Are you addicted to your self-management? Are you obsessed with it? Or maybe you’re too lax and don’t maintain the type of control you’d like. Which is it? I’m far from addicted or obsessed—my interest in journaling and reading and asking questions is first and foremost a desire to understand diabetes and do my best to ensure I remain complication-free. Still, a recent comment on my post “On Keeping a Diabetes Journal” as well as the responses to a survey sent out in last week’s e-mail newsletter by Web Editor Tara Dairman have made me curious about the way others deal with their diabetes. The comment was left by Burbot, and you can it read here by scrolling down.

What I kept returning to was the last sentence in Burbot’s comment: “Develop good habits toward your diabetes and get on with your life.” Did Burbot think I was paying too much attention to diabetes?

What do you think constitutes excessive self-management? I’m sure there is such a thing as overdoing it, but how do you judge another person’s dedication to maintaining tight control as over the top or not? Maybe my description of journaling seemed excessive to Burbot. Am I allowing diabetes too much up-front time in my life because I spend twenty minutes or so every few days writing about my emotions and feelings in relation to the condition? I see my doctors when I’m supposed to. I monitor my blood glucose as many times as my endocrinologist feels I should. And, as I noted in last week’s post, diabetes isn’t keeping me from doing anything I did before I was diagnosed. Still, I get defensive: Sometimes I do pay too much attention, but then a few hours later I may be worrying that I’m not doing enough. Take Monday: I woke up, all was well, and then I read the New York Times article “Looking Past Blood Sugar to Survive with Diabetes.” “I have to do more,” I thought. Soon, however, my worrying passed.

I’ve heard stories and read accounts of people with diabetes who chart absolutely everything: the carbs in the crumbs they scoop off their plate, the calories and fat content of each meal that passes their lips, how much their food weighs, as well as every finger stick and any little bit of exercise and anything—ANYTHING—that might affect their blood glucose. And, because literally anything can affect your blood glucose, we’re talking about a pretty dedicated group of self-management addicts here.

Are they getting on with their lives?

I don’t know how many people are reading this blog, but I have a question for those of you who don’t mind commenting: What are your goals in your diabetes management? Are you an addict? A lapsed tight-controller? Remember that I’m relatively new to the world of diabetes. Truth: I haven’t written down any management goals since I took my first diabetes education class in April. Back then it was to lower my HbA1c to 6.0% by September. Yesterday I had a physical and found out that my HbA1c was, yep, 6.0%. (It was a cause for a small celebration.) What do I shoot for next? I have a feeling that maintaining, or even lowering, my HbA1c beyond 6.0% is going to require the same if not more diligence and dedication than it did to lower it from 14.5% in March. I’m up for the challenge, regardless of what kind of self-management person it makes me!

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Comments
  1. The only person who would accuse someone of being “addicted to self management” like that was a BAD THING is someone who ISN’T going to suffer the consequences from what happens to those NOT addicted to tight control.

    I’d rather be obsessed than blind, thank you.

    I have run into doctors who tried to make me feel like I was being obsessive when I asked for their help with blood sugars going over 200 mg/dl at each meal. My “obsession” only pointed out their lack of knowledge about how to diagnose and treat diabetes. I got a new doctor who helped me out, but a lot of people don’t.

    Any doctor or other professional who discourages you from going for the tightest control possible is dangerous to you and your health!

    I’m in year 9 now, with great control (A1cs in the mid 5%) and no complications I didn’t have at diagnosis.

    Posted by Jenny |
  2. If there was a stage 3 that would be me.
    I was so close to being a stage 2 diabetic that had I continued my life-style as it was, I would be now. But my doctor scared the devil out of me and I have lost over 50 pounds and yes, I’m obcessed with glucose control, my diet, my frequent testing all reflect this and my friends think I’m crazy but I’m 75 years old so I don’t care what they think and neither should you.

    Posted by Penny |
  3. Congratulations on reaching your 6.0% target! I’ve found that having goals always helps motivate me, as long as those goals were something I cared about. It doesn’t have to be all about numbers - it could be anything in your life that’s important to you.

    I think self-management can become an obsession, and here’s how you’ll know — if it starts to get in the way of other things in your life that are more important to you than your health. But in practice, this is rare. Usually self-management improves your self-discipline and makes you feel better, so that you can do the other things even better!

    Thanks for your great blog. - David

    Posted by DavidSperoRN |
  4. I am fairly newly diagnosed also. Just six months ago. My Husband however has been a diabtic for several years. I think if you don’t keep some sort of track every day, then you become very lax and do nothing except twice yearly Dr. Visits. I check my fasting and then times if I think I am having a low blood sugar, such as afte execise. I try to journal my food once or twice a week because otherwise my portions get scope creep. LOL

    Posted by tekwriter |
  5. Hi Eric.

    I have had type 2 diabetes for 16 years. I have used insulin for 15 years, and an insulin pump for 8 years.

    At first I kept very detailed records. Then I settled into habits that work for me for blood glucose control. My A1Cs are usually in the mid-5’s. My blood pressure and lipids are good. I have no sign of complications.

    So I don’t keep any written records any more (although I could go through the history in my pump and get records if I wanted). If I am treating to goal in so many areas, I wonder what the purpose of those records would be? I don’t see any reason to write down my diabetes results if everything is going really well; and I do object to “busy work”, i.e., keeping records for the records’ sake alone.

    But if my A1C went above 6, or if I noticed several high postprandial readings in a row, or if my blood pressure or lipids went too high, I’d start keeping records again. They are a great problem-solving tool.

    Posted by Beth |
  6. I was a lot more obsessive at first. I think you have to be if you really want to know how your body reacts to various things (foods, activity, MEDS, etc)

    I’ve been diabetic 2 years now. I still test pretty regularly, but I’ve gotten lax at writing it down. My last A1c was 5.8% so I guess its working for me :-)

    I actually had to loosen up on my carb intake this month… My sweat started having an “ammonia” smell. I looked that up. It is caused by the body using amino acids for energy. 3 reasons for rhat…
    1) not enough water .. i drink about 10 glasses a day.
    2) Excessive exercise, like marathon runners… I’m 3 times a week at Curves.
    3) Not enough carb intake. .. that fits, I eat a lot of protein and low-carb stuff. I’ve doubled my fruits, increased my veggies, allowed a little more in the grains.
    The odor has gone away
    My blood sugars are still in good ramges.
    BUT I’m have a flare-up of Neuropathy symptoms. How do we WIN?

    Posted by Ephrenia |
  7. been doing this for about 18 months. learned what I know thru books and errors. DRs. seem of little value. Read two books. both touted lo carb and the easiest one seemed to be the Atkins diabetic revolution. The ADA diet recommended 170+ gr of carbs/day for my weight. At 310 + lbs that did not work. Kept carb count and tested in AM and before bed/ Did not weigh just dieted to meet sugar goal. lost 70 lbs. as a byproduct. now don’t log carbs but very observant. sugar = about 120 avg and still losing weight. good luck

    Posted by bigd |
  8. I am a new type 1.5 LADA heading toward Type 1. Every day I pay attention to what I eat, how much exercise I get and the characteristics of my BG for that day. But I don’t think of myself as a Diabetic. I HAVE diabetes and I deal with it. I am a marketing guy, a writer, a husband, a friend, a photographer, the guy who makes you laugh or gives you work or eats lunch with you. But what takes the most time is figuring out what type 1 diabetes is. Endocrinologists don’t know. How many type 1s are sent to immune system experts? Or checked out neurologically? Specialists are like guys with only a hammer. They see every problem as a nail. My “diabetic time” is spent spanning the gaps.

    Posted by Peter Mead |
  9. Just wanted to let readers of this blog and website know, in case they’re interested, that I do read your comments, even if I’m not adding my own comments immediately following. I really appreciate the feedback, and, in truth, I read the comments many times each.

    There’s a wonderful range of commentary by both those who’ve had diabetes for a long time and those who are more recently diagnosed. You guys are adding to a conversation and addressing issues that I was looking to read more about when I was diagnosed. You’re bringing up topics that you don’t necessarily find in too many places, or at least I had difficulty finding.

    And that’s why I wanted to write a blog for Diabetes Self-Management. You’re helping people out. You’re helping me, for sure.

    Also, let me know through a comment what living-with-diabetes topics you’re interested in. Who knows, it just might be the thing that kickstarts a future blog entry.

    Thanks to all!

    Eric

    Posted by Eric Lagergren |
  10. Eric, you raise an interesting question. I am neither an addict or a lapsed tight-controller, just another person trying to keep good control to prevent the nasty complications of diabetes. This involves the goal of weight loss which seems to be forever on going. When I attended my diabetes education class the goal I had was to have the jeans I was wearing fit loosley and I have reached that goal. Now I want these jeans to fall off. Baby steps and perhaps a silly goal, but it seams atainable to me. My serious goal is to maintain an A1C of 5.5. My average over the past few years has been 5.9 and is now coming down.

    Sometimes my goal has been just to maintain what I have achieved.

    Posted by Rosalind |
  11. I hope your goal can be to always find an Rx that works. I’ve tried about everything, including Januvia which really messed with my allergies big time: ER and Rx,

    I am down to Metformin combo with Glyburide, and Byetta. If I could take it TID I would do better, but insurance will not pay for that extra shot per day.

    It is progressive and I hope the day comes if -when Metformin stops working, there will be something else. Only Actos kept me at 5.8% and since it quit, I can’t get below 6.5% .

    Knowledge is POWER so learn all you can. Since switching to One Touch Ultra with software, I no longer keep a paper log book. How about you?

    Posted by Marcia |

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