“Tight” Diabetes Control Without Tension

I’m writing this week’s blog to myself, really. I’m a world-class worrier in a lot of ways — I worry about home repairs, I worry about my blood sugar, I worry about my standing among fellow musicians, I worry about what other people think of me — I’m just very good at worrying! I’m not sure where it comes from — the mystery of personality is longstanding and deep. Is it experience that molds who we are, or do we come into this world with inherent traits? If it’s a mixture (which I think it most certainly is), what’s the ratio? Why are some people able to go through stress and pain without it impacting their long-term outlook while others seem to be sponges for every negative incident that comes their way?

Unfortunately, this is a mystery we Diabetians need to solve, at least partially. You see, while I do worry about plenty of things, I have spent a great deal of time working with how I respond to diabetes-specific stress. I’ve done this because I understand how the cycle of stress can take one negative experience and turn it into an ongoing, self-sustaining negative pattern. With diabetes, it goes like this:

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1. Stress over a string of high numbers or other medical issue.

2. Stress response hormones impact the body’s ability to manage said numbers or medical issue, making the initial condition that CAUSED the stress worse as it RESPONDS to the stress.

3. More stress because of the impact of the first stress, leading to more prolonged high numbers, or worsening medical issue.

4. Repeat…

Of course, I do this same thing with other things, and the feedback loop is equally futile, but with most other things I’m at least not messing with issues of long-term health and major complications.

There’s something often-overlooked, but very important, that I think has historically added to the special tension of diabetes, and that is our terminology. In fact, shifting the terminology has been something that’s helped me a great deal. One of the big ones is the term “tight control.” Just hearing that phrase makes me literally want to “tighten up”! It’s the kind of phrase that sounds daunting, unforgiving, and without any room for error. Of course, that’s not what the term really entails. Go to the ADA’s website, and they say as much. But I’ve always wondered why we hold on to this term like we do when it feels so counterproductive to me!

The truth is that feeling “tight” in our emotional state tends to lead to poor outcomes. This has been shown in a number of studies on the effects of mindfulness and relaxation practices — inevitably people exhibit better control with practices that mellow us out, ease tension, and relax us into accepting the moment without expectations or judgments. And so I’ve always preferred the term “optimal” to “tight control.” Because even under “tight control” guidelines, blood sugar isn’t expected to remain in some “perfect middle” all the time — blood sugars will swing up after meals, and that’s OK. Sometimes they’ll swing a little higher than we want — that’s OK, too. In fact, the main point of “tight control” is that we actively monitor ourselves throughout the day, that we test often, and we make our best effort to bring blood sugars “close to normal most of the time.” Of course the goal is minimizing excessive high blood sugars, but perfection is not a requirement.

Even the simple term “control” can be a little troublesome. I sometimes wonder if maybe “optimal management” is the best term. Because (and bear with me — I know I’m getting a little picky here) even the term “control” denotes a certain authoritative relationship that we all know isn’t possible with diabetes. No matter how good we all are about what we eat, how often we monitor, how much we exercise, and how often we check our blood sugar, we know that it’s not always going to respond to every command we give it. An old piano teacher once said to me, “I don’t want to ‘master’ jazz piano — that’s impossible; I want a two-way RELATIONSHIP with the piano — a dialogue between the instrument and me.” I’ve often remembered that when I’m struggling with diabetes. And managing something feels much more like a relationship than “controlling” something.

Conclusion
Even though this may sound like inconsequential stuff, terminology is important. How we define our world has a major impact on how we FEEL about it, how we feel about ourselves, and how we work with stress. And given how important stress management is to diabetes care, it’s something we shouldn’t overlook.