Laddie: Today’s blogpost was submitted by my Arizona D-friend David Bernstein. David was diagnosed with diabetes nine years ago. After four years of frustration and ineffective treatments, David learned that original Type 2 diagnosis was a mistake and he was correctly diagnosed as Type 1. In recent years David’s pump and CGM have provided him with better tools to manage his diabetes but like many of us more experienced Type 1’s, he has discovered that the math of diabetes is only a starting point for managing blood sugar.
David: As a Type 1 diabetic, I’ve ridden the sometimes wild and seemingly unpredictable highs and lows of the glucose roller-coaster.
Those of us who depend on insulin do our utmost to match insulin to sugars. This match-up, after all, is the essence of diabetes management. Yet the process can be so frustrating! How many times are we surprised by the results of our efforts? How many times do we feel like fools? How many times do we scold ourselves for missing the mark?
We have been taught to administer our insulin according to empirical information. For example, if your food to insulin ratio is 10 to 1, and you’re about to ingest 40 carbs of food, you need four units of insulin to handle the load. Similarly, if your “adjustment” ratio is 30 to 1, you need one unit of insulin for every thirty points to bring you down to your glucose goal.
Math is handy, for sure, in diabetes management. We need the guidelines to get a sense of how much to dose. From the various mathematical paradigms we’ve learned, we do lots of calculating and then come up with a number that determines how much insulin we take.
The system usually works, and most often gets us close to our goals. But how many times are we surprised to find that a given dose is just not getting the job done? How many times have we had sugars that go sky-high or nose-dive after lots of careful calculations?
Most of us have come to learn, and accept, that not every effort at managing our diabetes will be successful. There will be times when our sugars seem so out of sync that we simply cannot fathom why! It’s truly daunting to learn that dosing the same insulin for the same meal may not create the same results from one day to the next.
It’s common knowledge that various factors beyond insulin and glucose affect our glucose levels. These include exercise, stress, sleep, pain, and more. If we have a headache or some other physical discomfort, our sugars can be unpredictable. If we are extremely worried and anxious, our sugars can vary widely.
Given the difficulty to maintain perfect control over sugars, many of us end up annoyed and confused. Why did my glucose readings soar to 350? How come I was steady all day and tonight my sugars dipped into dangerous hypoglycemic territory?
Should we blame the fates? Is this thing called “management” of diabetes a fantasy? Will we ever understand the inconsistencies in glucose levels? Will we ever figure out the “perfect” dose for a given meal? Tough questions indeed.
I would offer a way to deal with the seemingly crazy process. I call it “zen” management. Back in the 60s, a very popular book was published called Zen and the Art of Motorcycle Maintenance. Subtitled an “inquiry into values,” the book explored our feelings about life and human interaction.
Among the many sayings in the book that became popular, one stood out in my mind: “First get the feeling, then figure out why.” Isn’t that one way to approach our diabetes? Should we strive to be more intuitive and less number-based about our insulin control?
“Zen” management of diabetes places more emphasis on our feelings at a given moment in time. When it is time to dose, what factors other than numbers of carbs and insulin units should we consider? Are we tired? Sick? Happy? Sad? Hassled? Serene?
Since it is common knowledge that many factors affect insulin and glucose, it is important to look beyond plain and simple math. We need to look inward. We need to get a second sense about our dosing before we dose.
Before I take insulin, I sometimes do the math and then sit back with a cup of coffee (less milk, of course, in order not to begin the carb load!), and think.
Okay, yesterday the meal I’m about to have was perfectly covered with four units of insulin. But today, things are different. My readings have been on the high side since I got up. I had a lousy night’s sleep. I feel like I’m getting a cold. I “feel” like five units will do a better job this time.
Such “zen” thinking flies in the face of the experts who would have us dose units with precision according to the quantity and quality of carbs we take. But science alone does not always provide the complete picture.
If you’re tired of missing on the high or low side after dosing, try a broader thinking approach. Take into consideration emotional factors in your life. Consider not only “thinking like a pancreas”, but also thinking like an individual.
Hopefully you will have more success reaching your goals.
This article was originally published in 2018 as a commentary in the Diabetes Management Open Access Journal.
Bio: David has a Ph.D. degree in French literature and a history of teaching French at university and secondary levels. After a career in education, he went into business with his son. They created an educational video company that sold to schools throughout the U.S. After retirement, he took up bluegrass banjo, wood bowl turning, and fused glass artwork. He is a passionate reader, writer, and TV watcher. He has been diabetic for nine years. He strives to learn more about type 1 so he can share his learning with fellow diabetics.