Diabetes Self-Management Blog

“OK,” my endocrinologist—or endo—said at my July visit when he read the results of my HbA1c test, “What do we need to change?”

My HbA1c (a measure of blood glucose control over the past 2–3 months), which had hovered close to 6% seemingly forever, had gone up into the 9th percentile, been wrestled down into the 7th percentile, and had popped back up to 8.4% for that visit. I hadn’t bothered to have my labs done, I hadn’t written down a list of my medicines, and I didn’t have any kind of blood glucose log with me.

“My attitude?” I asked.

I tired of having diabetes a long time ago. After an initial burst of perfection—possibly driven by fear, possibly by depression, or more likely, by a combination of the two—I slipped back into complacency.

Or was it diabetes burnout?

In a presentation given at the American Association of Diabetes Educators’ (AADE) Annual Meeting in San Antonio, Texas, on September 22, 1982, and printed in the Fall 1983 edition of the AADE’s official journal The Diabetes Educator, Joan Williams Hoover addressed “Patient Burnout and Other Reasons for Noncompliance.”

“From the moment a person develops diabetes,” she wrote, “for 24 hours a day, 365 days a year, for the rest of his life, he is responsible for managing the unmanageable, controlling the uncontrollable, and coping with the incurable—his diabetes.”

But the usual recommendations for dealing with burnout, she notes, are not applicable to somebody with diabetes. The “usual recommendations,” Hoover writes, are:

  • Cut back on the stressful tasks.
  • Lessen the care and concern.
  • Avoid the people who are causing the stress (perhaps a health-care professional).
  • Take a vacation from the work.

As we all are aware, those recommendations for avoiding stress just won’t work if you’re trying to control your blood glucose.

Luckily, I have a few things going in my favor. I have very good educators, a love of reading and research that has led me to study diabetes in an almost obsessive-compulsive manner, and a knowledge of food that stems from a love of cooking. That combination allows me to run on automatic pilot much of the time.

What throws me for a loop is when I get into a situation where nothing seems to work. It’s then that the hopelessness sets in. If you try and try and try and don’t see results, the incentive to keep trying disappears.

The hopelessness happened when I was taking oral diabetes medicines. The solution was to take the step to insulin. When I still couldn’t get it right, the next step was to see an endocrinologist and to get diabetes education.

It happened again when, as it turned out, I wasn’t taking enough basal—or background—insulin and my insulin-to-carbohydrate ratios and correction factors were incorrect. No matter how much I weighed and measured and calculated how much insulin I needed, no matter how many times I corrected highs, my blood glucose was still too high. My solution was to go to a clinic that uses continuous glucose monitors to help adjust doses. When this move made it possible for me to control my blood glucose levels, it made me want to maintain that control.

Most recently, thanks to my use of a continuous glucose monitor, the ability to see which way my blood glucose levels are going and apply the proper correction before it gets out of hand has helped me want to work to maintain control.

Last week, I saw my endo again. This time, my HbA1c was 6.8%—much better than the previous 8.4%—my labs were done and all in good ranges, and I had the ultimate blood glucose log: graphs from my continuous glucose monitor. Doc made a point of saying that he had changed my coding to controlled Type 2 diabetes.

I can live with that.

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Comments
  1. Congratulations, Jan! What a great improvement for someone who was feeling burned out.

    Like you, I usually have pretty good A1Cs and other labs. But for me, when I slack off on blood glucose control, I feel so much worse that I get my BGs back in control quickly.

    I find it much harder to maintain control of heart risk factors. I have to be really rigorous about saturated fats to have good triglyceride levels and high HDL with low LDL. I don’t feel bad when these are not in a good range. So when I’m feeling burned out, that’s where it shows up for me.

    Posted by Ann |
  2. Thanks, Jan, for thoughts I have not been able to put into words. The emotions were there, but I wasn’t sure exactly what was happening. We never do get a day off from this disease, do we? And it sure is hard to do everything “right” and have the old meter tell us we’re doing something drastically wrong. My solution to everthing has been to get outside and WALK. That helps the blood sugar (commonly called the BS by me) as well as the attitude I get. It also helps to know I’m not the only one who is tired of this.

    Posted by Cathy |
  3. Glad to see that you are back in controll.
    I too am suffering from the burn out and I find it so hard to get back on tract keep up the good work.

    Posted by Pixie Doodle |
  4. I’m happy to see that someone was able to grab the bull by the horns and take control…I have been fighting with the “idea” of having Type 2 Diabetes for the last 2 yrs. It has been pure H.E double hockey sticks! I cut back on the starches, the carbs, the calories only to gain more weight and sink into a deeper depression. I’m too young for this but in this day & age diseases do not discriminate. I’m tired, I’ve tried working out, the classes, changing doctors - my old doctor would tell me I’m going to die - every visit that became too stressful. I don’t know what to do but…I hope to be just like you one day!!!

    Posted by Gray Girl 504 |
  5. Sometimes what works for me is to just get something under control. People with diabetes are more prone to depression. I’ve taken an anti-depressant for years. At first, I thought it was weakness on my part until a doctor explained that (to put it simply) just as my body needs supplemental insulin, my brain needs supplemental “happy” chemicals. My brain outputs enough for X amount of stress. Over that, and I need help. And trying to take care of diabetes is certainly stressful, especially on top of everything else.

    I wish that docs would present diabetes care in a more positive way, understand that you can’t do everything at once, and send you to a good educator.

    I wish they would tell you that getting blood glucose under control can lead to weight gain - as do most diabetes drugs - instead of: “Here. Take this (drug that can cause weight gain). Oh, and lose weight.”

    Please see what can be done about your depression. It’ll make it easier to handle the rest.

    Posted by Jan Chait |
  6. I am a recently diagnosed Type II diabetic. Why live when all every waking moment revolves around diabetes? Why even try “controlling” it when it truly can’t be controlled. All the health “professionals” dance around how horrible this disease is. I’ve been reading alot about it. Good God, if there is a good god any more. Tell me where the quality of life is.

    Posted by Patrick |
  7. Hi Patrick

    It’s a lot to take in all at once, isn’t it? I remember feeling like you do. All of a sudden, I learned I had this terrible disease that would cause a long list of complications and I had make two hundred million changes RIGHT NOW! Well, that lasted about two weeks.

    Nine years later, when I got to a group with an endocrinologist and certified diabetes educators who understood that I was a person first, my attitude began to change. They found out what was important to me and taught me how to fit diabetes into my lifestyle. Luckily, I have good genes, so the intervening 9 years didn’t do too much damage. (By the way, my A1C at that point was 17.4%. Try not to do that. You feel like crap.)

    You can’t do everthing all at once, so don’t even try. Take it one step at a time. Try something easy first. When you conquer that, go on to the next thing.

    Can you find educators who will work with you? Can you find solutions to things you need to do to take care of your diabetes without interferring too much with your lifestyle? Is there a support group where you live or can you find a group online that you are comfortable with? The ADA has one - go to to find it.

    I found that my control got better with knowledge about the factors that affect diabetes. If I know why something is happening, I can usually figured out how to “fix” it. It didn’t come overnight, however - it takes time.

    Good luck to you. I hope it gets better for you.

    Jan

    Posted by Jan Chait |
  8. I have been an insulin-dependent diabetic for 45 years. It has NEVER been under control no matter what I do or don’t do. This has affected my heart which just adds to the control issue. I have had an insulin pump for 4 years and that doesn’t seem to help with control. I am no longer able to exercise as I should. I am beginning to believe there is to be no control for me and maybe many more.
    Thank you for allowing me to vent.

    Posted by Kathy |
  9. I have been on shots for 2 years…now I ‘m on shots and metformin sustained release. I can’t take as much metformin as I’m supposed to take, and when I first started the metformin , it was working..but that didn’t last long. Now my sugar is back up to nearly 300. I’ve had diabetes for 13 years…i took the pills on and off and I certainly didn’t control my diet and I drank like a fish. Funny thing is…when I decided to control my diet…etc..nothing really changed. Now I just feel deprived. I’m so sick of the whole thing…I can’t get the weight off. I don’t know what to do. I go to the VA…and they will do NOTHING except hand me a syringe and a vial of insulin..no pins, no pumps..n0ope//But I am thankful to have the VA anyway.

    Posted by Sue |
  10. I had diabetes for two years now and each time I visit the doctor my AlC is out of control as well as the keytones levels being high in my urine. I have change my diet, take my readings and take the prescribed medications. 70/30 insulin, 500 metformin 500 ml two times a day. I still doesn’t know exactly what I am doing wrong for my sugar levels to stay above the 400 levels. When I was first diagnose the doctor prescribed metformin and Lantus. Due to my diabetes still being in the 400-500 range, I was given the 70/30 two times a day. I feel like there is nothing that can help me control this disease and put me in better health. I feel drain, muscle spasms, urinating excessively and losing weight. I go to my doctor and she saids that i need to just keep taking my medication along with diet and excersise. That is fine but how do I really control this monster that is taking hold of my life and possibly my mine.

    Posted by kathrine |
  11. I hear each and every one of you. My sugar levels are high 2-300 my last A1c was 11.9. I was on Januvia at that time, but instead of going down, it kept going up. I finally stopped it myself, just went on metformin extended release and the sugars are still high 318. after investingating, i am going to try cinnamon capsules, supposed to stabilize the blood sugar, also regular red and white onion has a lot of chromium in it, stay away from the sweet red and white onions, different variety, lots of sugar in those.

    will let you know the results. Also i have a very high stressful job, medical transcription and i wish i knew then what i know today, horrible job, exorbitant stress always.

    take care everyone, we all need to get this under control, we need to remember God loves us and yes there is a God

    Posted by Carol |
  12. I have had diabetes since 1999. I had the pump for a couple of years and then I literally stopped eating (went through a breakup) and it was hard, even with changing the amount of insulin to control my diabetes. My diabetes has always been uncontrollable. My AC1 has always been high. I have had neurophy in my feet ever since I was diagnosed. I have recently had some in my fingers and hands. I agree with Barbara, it has taken over my life with trying to control the uncontrollable, managing the unmanageable and dealing with an incurable disease. Diabetes was never diagnosed as a disease in my family.

    I can drink an 8 oz glass of skim milk and my blood sugar will jump to 400. So it not just not eating high carbohrates or sugars but everything.

    Posted by Gail |
  13. This is a heartbreaker column and comments.

    One cannot control diabetes and at best manage it as best as possible. The medical industry is kind to ascribe an A1C between 6 and 7 as “under control”.

    Its when you get diagnosis; it tends to be:

    ” Abandon hope all yee who enter here.”

    From my short reading of this struggling for last three years in specific and 40 odd years in generalas type 2 diabetic, the lack of a display meter front panel of your starship Enterprise/ symptons of what your internals are doing, glucose etc, a doctor who is is forced to process patients at a 3 to 10 minute clip, test equipment for home use is a disgrace, inaccurate and misleading in various ways. The instruction manuals written by lawyers wearing boxing gloves and a sock in their mouths. It is truly frustrating.

    Diabetes takes day’s of data observance, diet, exercise to get anything a Doctor can process in 5 minutes or less to help one.

    That said, many do a great job.

    Good attitude is key and especially positive and upbeat. This disease would test and wearout the Gods! Never mind mere mortals.

    I am hopeful today after catching my darn liver sugaring me up so that now diet, exercise and meds work their miracles.

    Before getting liver caged on metformin, a1c was 13.3 and now 6.9 and more important eyes, legs and rest of body back healing.

    If this was just a fork and knife disease, this problem would have been solved years ago. I was on my diet for 3 years unable to lose a pound till liver caged.

    We need a fresh new attitude towards treating this monster and the food and fat police aint it. 70 dollar barrell of 50 strips at pharmacy for $ 70 is a disgrace and unhelpful. Medicare refuses to pay for a CGM and only allows 4 test strips a day
    for those on insulin. WHo in hades is that helping.

    We have too many people treating the lightly sick and down and too few treating the actual disease and its core and type 2 diabetics with serious issues and liver signalling faults. This is why diabetes is exploding out of control. WE are looking for a single 30 second Eureka moment - success in a disease requioring a complex quilt of diet, exercise, meds and glucose monitoring to get even close.

    Posted by jim snell |
  14. Hello all and thanks for helping me know im not alone. Type II since 2000, pretty well controlled till this March…got E. Coli resistant strain …nearly shut down my kidneys and BS went nuts…hangs daily at 600 No matter what. Hoping if my kidneys recover this will pass. Pretty discouraged…3 months very ill now…I try to be thankful its not something worse like paralyzed or Lou Gerigs┬┤etc….etc…. Good luck to you all…thanks.. Kim

    Posted by Kim Alvarez |
  15. I’m 57 years old, a male and im having uncontrollable diabetes.five years ago i had my first pancreatic attack and there after i got two more pancreatic attacks, now it has settled down.Presently i am taking insulin which is mixtard 30/70 and morning 50 and evening 50 and in between i take two shots of actrepid 20 each.
    Average blood sugar level is as follows
    :-morning(fasting):70-150
    :-afternoon:200-300
    :-night:300-380
    Doctors suspected that insulin what i take was getting destroyed and they sent a sample to singapore and they found out that there was nothing wrong and now i was told by doctors that i have a disease named diabetes neuropathy, which contains the following symptoms: numbness on the feet, burning sensation on the feet and sever pain in the legs.If you have anything that will help me out please respond.

    Posted by Vimal |
  16. I’m not a Doctor but if me, I would check my liver carefully to ensure it is not adding tons of glucose by liver dumps.

    I would need to watch this much more closly and possibly a cgms may provide more clues to my doctor. i would be concerned about 70/30 as that insulin has two peaks - one of the super fast insulin and then the longer reach of the slower insulin part.

    You may be getting low later in time period causing liver to do super dump shooting numbers sky high.

    You need an expert to assist you on this.

    Posted by jim snell |
  17. Hi All, I have tried EVERYTHING to get diabetes under control and nothing works. Pills, insulin, diet, RouyenY, and still 8 or 9 on a1c. Hdl and ldl out of control, can anyone please help me.

    Posted by carolyn |

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Living With Diabetes
Diabetes Transition Experiences Study (09/30/14)
Share What It's Like to Live With Diabetes: Walk With D (09/15/14)
What Is Hope? (09/18/14)
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High Blood Glucose
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Lower Your Blood Sugar — Eat Slower (07/16/14)
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Controlling the Dawn Phenomenon (12/04/13)

Emotional Health
What Is Depression? (09/10/14)
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Diabetes Distress and Depression (07/09/14)

 

 

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