By: Cathy Feste
Intensive Management? Tight control? Those words are pretty daunting. I don’t think you have to be a teenager to rebel against the idea of tight control.
Sure, I want my diabetes to be well-managed. But intensive management and tight control sound so overwhelming. As much as I want good health and overall well-being I’m not sure that I’m willing to pay the price.
For many of us with insulin-dependent diabetes, studies proving that tight control prevents complications have raised questions about how we can balance tight control with our hopes and dreams for enjoying life. How can well-managed diabetes be compatible with an enjoyable life?
Prior to self-monitoring of blood glucose, of course, all we had was urine testing. Diagnosed in 1957, I was still urine testing through my pregnancy in 1976. Shortly thereafter I was introduced to blood glucose monitoring.
At first, it was almost a love-hate sort of thing. The positive side was that I knew what my blood sugar was before and after exercise, before driving, before planning my daily schedule. I could make decisions based upon information instead of guess work. Ironically, the downside of blood glucose monitoring was that I knew what my blood sugar was. I hadn’t realized before that I had actually felt comfortable not knowing my blood glucose levels (BGs). Ignorance had been bliss. I felt that I was doing the best I could… given the limitations of urine testing for my daily decision-making. Now, with blood glucose monitoring I could go beyond these limitations. It would be possible to manage blood glucose more closely… if I was willing to do BG monitoring.
I chose to manage my diabetes the best I could using the new technology and the new advice of multiple injections. That choice has not been easy.
One of the first hurdles I encountered was compulsiveness. Now that I could actually know my blood sugar, I tested constantly. I tested hourly some days until my fingers were so sore I couldn’t dial a phone. I don’t know which came first, our touch-tone phone or my increasingly relaxed attitude. But, eventually, I tested less.
Then, the next hurdle. I decreased my monitoring to an occasional status. I even asked my doctor (it is embarrassing to admit this) if I could test every Tuesday. He was so patient in his response and so careful to explain that people with insulin-dependent diabetes had such widely fluctuating blood glucose that I might be really compromising my health if I did not monitor seven days a week. Before each injection of insulin, every meal and all exercise, you need information about the current status of blood glucose.
I sat down and looked at my life and how diabetes management fit into it. Using the system credited to Ben Franklin, I placed a minus and a plus on a piece of paper. Under the minus, I listed ways in which I found diabetes management conflicted with my life. Under the plus, I listed the ways I felt diabetes management was compatible with my life.
As I looked at my list, I could see a plus to balance the first minus: dietary restrictions. The plus of dietary restriction is that it helps me to keep my weight where I want it. I thought carefully about the second minus: diabetes management robs me of spontaneity. Being honest with myself, I had to admit that unmanaged diabetes would make spontaneity even more difficult. If I didn’t know where my BG was it could be anywhere from uncomfortable to downright dangerous to engage in activity spontaneously. I began to view diabetes management as the foundation for spontaneity.
As I continued this process I became aware of some of the reasons behind my reluctance to monitor. One of my stumbling blocks was in viewing BG results as a judgment about me instead of purely a bit of information to help me make choices. As if age, weight, income and IQ weren’t enough ways to judge people… BG monitoring now provided yet another set of numbers by which we could judge ourselves. It took me years, but I did finally come to terms with the “numbers game.” My nonjudgmental healthcare team showed me how to respond appropriately to BG results: objectively. Perhaps my greatest struggle has been to use the information I get from blood glucose monitoring to change my behavior.
I am a believer in the benefits of well-managed diabetes. But, in order to work daily at the management of my diabetes, I have had to also become a believer that the “costs” are not such a big deal. Good nutrition has meant not only weight management, it has also meant that my family has benefited – thus reinforcing an important value for me as a wife and mother. Regular exercise has (slowly… this took years, too) become a part of my life. And, when I want to use exercise specifically to bring down a pre-breakfast BG, then I make it convenient for myself by having a stationary bicycle already set up. Taking insulin is no big deal to me. And, managing stress not only benefits my diabetes it enhances the quality of my life.
So, I’m not into tight control. And, I don’t practice intensive management. I manage my diabetes well. It’s just another aspect of my life of which I want to be in control so that I can have as enjoyable a life as I can.