This month, we feature an article that addresses the dilemma we all face: How can we achieve perfect control? Or can we? And is it worth it (in the sense that we have other things going on in our lives besides diabetes)?
What is the definition of “perfect control” anyway? If goals are defined as blood-glucose levels between 90 and 130 mg/dl before meals, is that perfect control? What if your numbers drop down too low? Or go up above 130 mg/dl two hours after a meal? Would that be defined as imperfect control?
Healthcare practitioners look at A1Cs as a measure of control. What’s a “perfect” A1C? Is it 6%? What does that 6% really mean? What if it’s a see-saw between 30 and 300 mg/dl?
Our editor Jan Chait, who has type 2, says she had “perfect control” when she first went on insulin in 1995. The problem was, she was obsessed with control and frightened of going over 120 mg/dl. She read everything she could get her hands on about diabetes, couldn’t seem to talk about anything but diabetes and kept to a very strict schedule. She also became extremely depressed.
Now Jan says she tests and corrects often, lives her life the way she wants to and feels much better emotionally.
Do you maintain “perfect control” if you don’t stay between the “magic” numbers of 90 and 130 mg/dl, but don’t have hypoglycemia? Besides not being fun, hypoglycemia can range from the dangerous-such as having a car accident-to the frustrating-such as not knowing how to eat a barbecue sandwich because it’s on a long, narrow bun instead of a round one.
What about hyperglycemia? How about if we don’t go over 200 and immediately correct back down to 100 or so? We don’t want to run high so much that it puts us at higher risk for complications. But how much is too much?
Some people can maintain control more easily than others. Does that make those who have trouble staying in control imperfect? Should we insist that they devote their lives to controlling their diabetes?
Maybe the answer for all of us is that we do the best we can as often as we can and still live our lives in a way that is most comfortable for us. Controlling diabetes, after all, is not a science; it’s an art. Sometimes we do everything right and it still seems that everything goes wrong. We’re stressed, or other hormones are acting up, or we’ve miscalculated what we’ve eaten or how much energy that walk or bicycle ride took. Or maybe the planets realigned themselves while we weren’t paying attention (which is sometimes as good an explanation as any).
All we can do is just take it one day at a time and strive to have the best control possible.