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Trying to Control the Uncontrollable
November 7, 2006
“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:
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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