Diabetes Self-Management Blog

Last week in part 1 of this two-part blog entry, I told you that over the summer I’ve adopted an attitude where I’ve taught myself to not worry so much and let my blood glucose numbers run slightly higher. Not too much higher, but a bit. This week I’ll tell you why.

Would you believe me if I said the reason I’m letting my HbA1c go up is that I just don’t care anymore? Or said I’ve decided I’m going to enjoy life and stop keeping close watch on my diabetes? What if I said life’s too short to spend time worrying about all those blood glucose checks, all those boluses, and all of the other (too many) things I have to do for this stupid illness?

Of course you wouldn’t believe me.

Get this, though: the genesis of my attitude shift is related to that “I don’t care any more” attitude.

After a spring in which I spent months recovering from thyroid cancer surgery and dealing with the lethargy of hypothyroidism, in which I didn’t gain weight but felt sluggish and out of shape, I wanted to return to exercise (not just walking, but cardio and weightlifting kind of exercise). Getting back to feeling like me wasn’t something I’d achieve only through pharmaceuticals. So when June arrived and I found myself feeling better than I’d felt in half a year, I decided to get back to the gym.

The problem with returning to the gym? Since my diagnosis with Type 1 diabetes, my exercise and gym time has been intermittent at best. Two or three months here, two or three there, and then bam, I’d get off track. It never failed. I’d miss a day or two, then a week or two, and then all of a sudden I hadn’t gone in months.

I thought about why, and I realized I was worrying too much about each visit to the gym, about each time I’d exercise. I worried because of diabetes.

My concerns, valid though they may have been, took up too much space in my brain. My concerns caused me anxiety on the mornings of the days I’d go work out; they’d follow me all day; they’d be there during my late-afternoon workout; they’d continue to nag that night.

For example:

What do I need to remember to take in my gym bag in case I go low? What sport drink should I pack? Do I have a pre-gym snack? Have I packed it? Crap, have I set the temporary rate on my insulin pump low enough so that I don’t go low? It’s too late now, so I might as well not go because what if I go hypoglycemic? Should I work out without my insulin pump attached or keep it on? How much sports drink should I sip during my workout, because I don’t want to go low? Is the way I feel because I’m having a hypoglycemic episode or because I’m simply tired and I’m having a good, hard workout (a hard workout feels good!)? I need to be careful I don’t have a low in my sleep so I need to be extra vigilant before bed to ensure my blood glucose is OK. Is my blood glucose OK? That’s a good number, but am I trending down? What about the second low, which happens to people within 24 hours after a workout?

These (and many, many more) thoughts quickly made going to the gym a burden. All too soon I’d use these (valid) diabetes concerns as an excuse to avoid the gym altogether.

Yet I never really thought, until just this year, “Hey, Eric, let your average glucose run a bit higher and see what happens.”

So I did. I made a contract with my psyche to let new thinking happen, to tell myself that, yes, I may be making a tradeoff in my HbA1c, but the long-term damage is negligible, and the present-time benefits wonderful.

What this shift in thinking has done is allowed me to shove aside a large portion of the gym worry and anxiety that I used to carry. Granted, I still carry carbs to the gym, I still prep for going to the gym as someone with diabetes. But am I a stickler about my blood glucose during the workout (I try to stay between 150 and 200 mg/dl when working out)? Nope. When it’s slightly higher to begin with (for me, at least), I find I don’t dip into those 70s, 80s, and 90s during the workouts, or after!

I’ve really enjoyed the last two months at the gym. I look forward to the days I work out. Maybe I could have learned to love exercise again without my self-inflicted A1C attitude adjustment. Every now and then, however, a mental crutch, some scaffolding around the weaker parts of my attitude, really helps get me headed the way I want to go.

I’m pretty certain my current practice regarding my blood glucose will result in a higher HbA1c reading when I visit my doctor at the end of September. But you know what? I don’t really care anymore.

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Learning to Love a Slightly Higher HbA1c (Part 1 of 2)
Learning to Love a Slightly Higher HbA1c (Part 2 of 2)


Comments
  1. I think this is probably a common issue (or at least one manifestation of one), that being: in the case of two health concerns, which should I prioritize? Would I rather be in shape with a 6.5, or out of shape with a 6.0? Would I rather go low carb to keep my blood sugar low, or go for a more balanced diet with a higher blood sugar but less fears about ketones, kidney problems (from higher protein) etc. In life, everything’s a trade-off, but with diabetes, everything’s REALLY a trade-off. I think, for the most part, people tend to prioritize for which they can most accurately predict the results. You know for sure what the short term benefits will be for you if you have a consistent exercise program. None of us really know what a .5 or even 1 point difference in our A1c (over a few months or a few years) will actually make in terms of practical health consequences. We know studies and percentages, but we don’t know what it will really mean for us. I think if anything, what all this has done is reduce your stress and make you feel better about your control overall (and look at control in a more holistic way) and that, to me, sounds like a healthy decision.

    -sisiay http://www.dontfeardiabetes.com

    Posted by sisiay |
  2. Like the new picture!

    I, too, have an “I don’t care attitude” but that works against me.In the last 3 yrs,the lowest my A1c was 9.2. Average: 10.5.
    Be glad of your low numbers.

    Posted by misskitty3 |
  3. I really enjoyed this post, especially since I read it after I got back from a great workout at the gym and tested 196. It gave me a new perspective, which I blogged about at
    http://www.thebigprick.squarespace.com

    Posted by jb |
  4. I’m now 59 and have been diabetic for 50 years. You’re right too much worry about numbers can drive you crazy. I can go low without knowing it until I’m about to black out. So not being so viligant has only taken me to an A1C of 8. Hang in there you’ll make it.

    Posted by Gail B Miles |
  5. Very interesting article and proves some interesting points. I am type 2 on insulin and metformin.
    23 units once in am of humolog and 10 units lantos at night.

    as indicated, i am large person 6tft 2 in and currently 300 lbs working down. when bs is 150 to 190, situation as previos writer indicates is manageable. under 120 bs can vaporize to 70 to 90 in heart beat and i have to watch every 15 minutes, no exception.

    any less, i get emergency sugar dump - now reading at 245 or more - not funny.

    my body is not sparrow fart 80 lb 4 ft jockey with small demand.

    As long as I only want to be picture on wall motionless, leaving bs at 120 or less is unmanageable. Cannot do anything mch less barely breath.

    out and about 140 to 180
    in house resting - sub 140 and i manage to push sub 140,
    one can burn through 50 strips in nder 2days.

    Posted by james snell |
  6. I am on metformin, glipizide and 50 units of insulin in the am and a sliding scale in the pm. and still can’t keep my numbers good. I can take a two mile walk and come home to a good 80. I can take the same walk on a different day and come home to 300. I watch what I eat I watch what I do and life is sailing right by because I am so consumed with how I eat and what I do that the enjoyment is gone. When I eat like the diatitian tells me my bs is in the 3 and 4 hundred range. The only way I can come close to the numbers I need is to not eat ANY carbs, which is almost impossible. Even fruit and veggies have carbs. The doctor wants me to keep my bs below 100, this is when the migraines set in for me. I feel fantastic when it’s between 120 and 200. I don’t think our numbers can really be a one number fits all. A friend my husband works with ends up in the hospital every time he goes below 200. I have read so much stuff and talked to so many people getting different stories of what is right and wrong. It’s confusing as all get out. I am one with the don’t care attitude anymore. As long as I feel good and can enjoy my family I am happy.

    Posted by Eyvonne |
  7. I completely relate to what you are saying . . . anxiety at the gym, dealing with post-exercise lows that make the work out seem hardly worth it. Also the decision to just run higher, daily life is so much easier. However I’ve been on Dexcom three months now, and I have learned a great deal and it has taken away the fear of all those lows. Life is much easier, much less anxiety and obsessing, I can make better decisions based on the direction of the glucose trend arrow, etc., etc. I feel more comfortable exercising hard with Dexcom. Really enjoyed your column. Thanks.

    Posted by Susan Shaw |
  8. Eric, you have a lot of points and sparked some great responses. Sounds like all of us are obsessive with the bs thing - and sometimes I feel like it really is BS!

    It’s summer. I am eating all of the fruits I can because that is what I love most. It satisfies my cravings for sweets, so I am losing weight. It keeps my bs up so I can take that long walk. That in turn is keeping my head on straight. I have stopped worrying what I eat WHEN I eat, the tradeoff being I eat a BIG breakfast with lots of fruit and no lunch. Bs when I get up is around 80, is probably high for a good portion of the day and then is about 90 at dinner. A good dinner and I’m feeling great. I take it on occasion during the day, but if I am feeling good and am not hungry, why bother? That speaks to your point, Eric: shifting attitude is working for me.

    By contrast, my husband, also a diabetic, eats all the time. He gets shaky when he goes under 110, then heads to the Snickers big bars to get it up again. Peach? YES! Snickers? NO!

    Posted by Cathy A, |
  9. Posted by Eyvonne | Aug 25, 2010 at 10:25 pm

    SOme comments from another layman.

    Regarding high numbers, are you sure you are not getting emergency liver add sugar because bs went too low and you did not see that happen.

    When my bs gets under 130 I need to watch every 15
    minutes when i do anything with some exercise.
    ie taking bath - bs start is 165 finish bath bs is 116 and heading lower.

    low glycemic diet works great but when on insulin you need to be sure to add small amounts of starch to be sure you have some glucose. My insulin bit me bad one day whene I was not watching close enough and doing all low glycemic diet.

    This lay person also uses metformin but notes for mre that I take 500 mg dose - 5:00am; 12:00 pm noon; 5:00 dinner ; 10:00 pm and 12:00 am midnight.

    Large dose once a day do not work for me are waste of time. Always check all changes with doctor and do not meddle with yourself.

    Posted by jim snell |
  10. I was diagnosed back in 2002 and have been on metformin since then, with doses increasing over time. For the last few years I’ve been on 2000 mg per day (1000 in a.m. and 1000 in p.m.)

    Thought it has varied some, for a few years my a1c stayed around 7.0. My weight is stable and I am a fit athlete with good health reports on everything BUT blood sugar.

    In the last year or two, though, my a1c has swung around much more. 7.0 to 7.6, back down to 7.0, back up to 7.7, etc. Last time was 8.2, the highest ever.

    I find it strange that I have NEVER read anything about possible effects of undergoing menopause! But that is the big change I can identify in this time frame. I’m still going through it. One would think that since menopause is a hormonal change, it might have effects on metabolism and therefore blood sugar functions. Yet I have read not even one sentence on this subject.

    I too am sick of feeling like a guinea pig. My doctor wants me to add another med to the metformin and he told me to see him once a week while monitoring BS 3x/day to see what dosage of new drug to take. He was talking about lowering a1c only a few tenths of a percent! Meanwhile, I feel the same as before this latest bad a1c result.

    Seems like we’re constantly barraged by reports that later are tossed out. Remember when butter was BAAAAAAD and we were told to use margarine instead? How about polyunsaturated oils as health savior–now we’re told that monounsaturated is best? Caffeine bad, caffeine bad. Milk harmful, milk healthful.

    I will continue to exercise, and I will eat to fuel that activity. While avoiding overeating at all costs, the rest is debateable!

    Posted by Patty |
  11. I am a 30-year veteran of type 1, and do not have health insurance. I, therefore, do not have a general physician, either. I found your blog and all the related posts most interesting, because your attitude is how I have managed my diabetes for decades.

    I do not believe in tight control for daily living, because the consequences are not worth the good numbers. Too many bs lows and too unpredictable to live a normal life. Diabetes takes a lot of thought, every day, to stay healthy and in control. Yay! Let’s hear it for bs readings 140 - 200, and a1Hcs at 7 - 8.

    I have NEVER found a doctor who would be satisfied with those numbers, so I stay away from well-meaning physycians and diabetes experts, and I stay smart about my diabetes and listen to what my body tells me. One thing doctors don’t know about is losing 20 - 30 minutes of your active life every time your bs drops, and you have to stop, eat, and wait. If you are trying for tight control (and I did try it), every time I ran downstairs to get the laundry my bs plummets and I lost another 30 min. for a sugar boost. This is no way to live a life. It’s touted by the experts, this tight control, but they don’t live in our day-to-day world.

    When I DO have to go to the doctor for some reason, they take their tests and then they say, “you’ve had diabetes for HOW LONG?”

    Listening to your body’s needs and not your doctor’s desire for low numbers will keep you healthier longer, imo!

    Posted by Deb |
  12. I have known about my diabetes ,it will be 3 yrs in may i’m on 2000 met am /pm and 20 glip am /pm and eat very little crabs and have not been able to keep my numbers under 200 ,have no insurance,so its hard for me to go to the doctor all the time,any ideals

    Posted by deanna |

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