Tight Control Pitfalls

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Diabetes Tight Control

In 1970, NASA launched the ill-fated Apollo 13 mission. Roughly 56 hours into their flight an explosion crippled their ship, and what had started as a mission to land on the moon became a frantic mission to return the ship and the astronauts safely to Earth. Problem after problem arose, and with each new wrinkle old plans had to be scrapped while some of the most brilliant minds on the planet scrambled to create solutions before time ran out. In the end, the ship successfully returned to Earth (against most odds).

There was one particular news segment from this period that I have always remembered. I should say I saw this clip as part of the actual historical news footage shown in the Hollywood movie about the mission (as I was born eight years after all of this unfolded), but the clip was real and from the time of the incident. Describing reentry, a correspondent held up a basketball, a baseball, and a piece of paper. He explained that the crew had to aim for a reentry corridor into Earth’s atmosphere that was extraordinarily tight. If the baseball were the moon, the basketball was the Earth, and the two were placed 14 feet apart, the crew was aiming for a reentry target no thicker than the piece of paper. Too low, and the ship would burn to nothing entering the atmosphere, too high, and the ship would simply “bounce off the atmosphere like a flat stone skipping off the water surface of a pond.”


Tight window, tight control
That segment could have been describing diabetes “tight control.” If you recall, the crew in that situation had lost any kind of guidance computer. They were aiming for the unbelievably tight corridor with nothing but piloting skill and sightlines to guide them. We’ve certainly lost our guidance computer, all of those beta cells that used to produce insulin for us without us ever having to think about it or calculate our food. Nope, we too are forced to live with what my mother always called “manual control” of one of the most important physiological systems of the human body. It takes a tremendous amount of skill, focus, and ingenuity. And it can feel just as perilous as that ill-fated space flight.

It often feels like the corridor we’re aiming for has equally disastrous consequences for coming in “too low” or “too high.” Come in too low and we’re confronted with severe hypoglycemia, and all of the serious problems it comes with. We can develop unawareness, something I have struggled with in recent years and am trying my best to reverse. We can literally slip into a coma in the middle of the night. That’s terrifying — for us, for our spouses, for our families, for everyone involved. On several occasions, I have had severe hypoglycemia in the morning that required my wife to pour juice down my throat while I lay there barely conscious.

The perils of aiming “too high” are well known to anyone living with diabetes — amputations, kidney damage, nerve damage, heart disease, stroke, blindness, impotence. These are all real complications that can come about from too many high blood sugars. They’re all scary and they’re all painful.

Grace under pressure
Given all of the terrifying consequences of mismanagement, given all of the challenges and frustrations we face dealing with this often unpredictable disease day-to-day, the question becomes: How do we live with diabetes gracefully, and how do we aim for “tight control” without losing our sanity? It’s so easy to freak out over every high number, to fill with anxiety over every hypoglycemic event. But in the end the anxiety doesn’t help us. Corrective action should always be taken, but how do we keep ourselves sane?

Let me once again return to the crew of Apollo 13. If you haven’t listened to it, hunt down the recording of the commander, Jack Swigert, telling Houston “we’ve had a problem.” His voice is amazingly calm considering he’s telling them this immediately after his ship has suffered an explosion more than 200,000 miles from Earth. It’s pretty impressive. And it’s not a calm borne out of ignorance. This is a NASA astronaut we’re talking about — NASA tends to be pretty good about thoroughly training their people. What he did was simply stay present and meet each new obstacle as it came, working with it as best he could, and then moving forward to the next challenge. That’s something we can certainly emulate. We can greet each blood sugar reading in a straightforward way, record it, correct it if it needs correcting, and move forward. We can stay in the present, aiming for our tight control target but not freaking out every time we drift off course. We can take command, literally — not by thinking we can control every little thing, but by doing our best with each new challenge, and then meeting the next one…and the next one…and the next one.

Fish oil may be able to reverse some of the nerve damage of diabetic neuropathy, according to new research. Bookmark and tune in tomorrow to learn more.

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