Diabetes Numbers, Diabetes Burnout

I finally did it. After 23 years of treating my Type 1 diabetes with MDI (multiple daily injections), I made the switch to an insulin pump. A few things prompted the change. First, my insurance finally responded with a classification and copayment that I can afford. I actually attempted to switch to the pump three years ago, but at the time the copayments were simply prohibitive for me. That was with a different manufacturer, and perhaps the approval this time is the result of a better relationship between my insurance and a more established company. Who knows. The other thing that really prompted this is that insulin pump/continuous glucose monitor (CGM) closed-loop systems will be the norm in another three to four years. My pump, in fact, will be software upgradeable to a closed-loop system in early 2018.

But as anyone who has made this switch knows, it can be overwhelming! Translating ratios and basal rates from MDI to a pump is no simple 1:1 operation. Carbohydrate ratios change a bit because of the pump’s slightly more efficient use of insulin, and of course I now have the option to use very precisely controlled extended boluses, a feature I am still learning how to use effectively. The basal rate, which was formerly a simple twice-daily shot of long-acting insulin, is now a constant drip of fast-acting insulin given by the pump. This is, of course, a much more flexible approach, as it allows me to change my basal rate throughout the day rather than being stuck with one level for 24 hours. But that also means it’s a much more data-intensive approach, and again requires readjusting and recalculating all of my old numbers!

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To give everyone an idea of the data collection and calculating of the past week, here’s a photo of my actual sheet:

Coulter data sheet

I’m starting to feel like all I’m really EVER doing is calculating my blood sugar. Sure, I might technically be teaching a music lesson, playing a show, going out to dinner with friends, or practicing piano. But what I’m REALLY doing, all the time, is calculating, tabulating, and planning. It’s exhausting! In fact, while I love the pump and I am supremely confident that once these ratios are worked out it will change my life for the better, it’s currently giving me some serious burnout! And when I say burnout, I mean the kind of burnout I haven’t felt since my first year of living with diabetes. So let’s talk about burnout a little bit.

The usual suggestions won’t always work for us
A lot of the common strategies for managing stress fall short for diabetes burnout. One of the most common strategies is to “just take a break from [whatever is causing you the stress]”. If it’s work, people will remind you that it will still be there in a few days and maybe it’s time to use a personal day. If it’s a relationship, you can take some time apart and revisit the issues with cooler heads. But we can’t really do that with diabetes. It demands our attention 24 hours a day, without exception! And even if we decide to “ease up” for a few days and drop the habit of watching our numbers like a hawk, we can’t simply ignore them entirely. And we can’t escape the implications of those numbers, either. They’re not abstract numbers, but very real indicators of our health!

Another classic bit of advice is to “stop giving [whatever is causing you the stress] power over your mood.” Now, this is actually good advice — the art of meditation aims to help us build up the capacity to detach our mood from the world of events as we understand on deeper and deeper levels the truth of impermanence. But it’s much easier said than done, and when the thing causing stress is diabetes, the ante is upped considerably. Because with diabetes, we could literally lose a foot if we don’t manage it well. The consequences are not abstract. They are very, very real.

So how can we manage our stress while still managing our diabetes? The two can feel mutually exclusive sometimes. But we do have options.

Manage expectations
I have found that one of the most useful things I can do is to remind myself that diabetes simply IS (and always will be) kind of stressful. I know that sounds counterintuitive, managing stress by reminding myself that the thing causing me stress really IS stressful and will always be that way, but here’s the logic: A whole lot of stress comes from our desire for things to be different than how they are. The dissonance between reality and what we WANT TO BE true can create some real tension. And so sometimes it can be helpful to simply remember that what we’re dealing with IS a serious, often stressful disease, and that’s just how it is. It lets us at least stop fighting against our own experience.

Don’t chase “perfect”
This is an important point to remember. When our life is so consumed by numerical results, it’s easy to fixate. It’s easy to focus on the outliers, the high numbers, and the “bad” results instead of keeping the focus on the bigger picture. And it’s easy to fall into the trap of expecting every single meal to yield a perfect, in-target blood sugar. But that’s simply never going to happen, no matter HOW well controlled we are. High numbers happen. Lows happen. We will never achieve “non-diabetic” blood sugars 24 hours a day. As long as diabetes is incurable, perfection is not something we can achieve. And that’s OK.

Keep on keepin’ on
So there you have it. We live in a sea of stress-inducing numbers. We can’t avoid them, and we have to pay attention to them. But we can manage. And I can manage. I might need to re-read my own blog entry a few times this week, but I can manage. And so can you. We’ll all just keep on keepin’ on!

A short-term low-carb diet is slightly more effective at causing weight loss than a low-fat diet, says a new study from the Mayo Clinic in Arizona. Bookmark DiabetesSelfManagement.com and tune in tomorrow to learn more.