A Bliss Point for Diabetes?

Laddie_Head SquareWhen it comes to junk food, the “Bliss Point” is the “just right” amount of sugar, salt, and/or fat that optimizes our taste and cravings for that food.  If you have doubts about whether the manufacturers of junk food have invested tons of money in the science of addiction, read the 2013 New York Times Magazine article titled The Extraordinary Science of Addictive Junk Food.

In economics, the “Bliss Point” of consumption is that point where any further increase in consumption would make the consumer less satisfied rather than more satisfied.  Maybe owning ten cars makes me deliriously happy while adding an eleventh overburdens me with the worry of  driving and maintaining so many vehicles.

The notion of a bliss point assumes that there is a point of optimization for many of the decisions that we make on a daily basis. My bliss point on salt might differ from yours and you may like your food sweeter than I do. But studies by marketing researcher and psychophysicist Howard Moskowitz have shown that large populations can be sorted into preference groups and products marketed to them accordingly.

I think that it makes sense to think about a bliss point when it comes to diabetes care. On one hand we like to think that we have total power of choice when it comes to consumer products. Therefore it is a stretch to compare the purchase of potato chips to the daily minutiae of diabetes.  After all, none of us invited diabetes into our lives and we often feel that we lack choice in how we deal with this unwelcome intruder. However, I believe that each one of us with diabetes could probably describe an optimization point of self-care where our daily BG numbers, A1c results, and risks of complications are balanced by somewhat acceptable levels of diabetes intrusion into our lives.

Now I am not beginning to suggest that it is easy to hit the bullseye of this hypothetical bliss point.  Diabetes is hard and some days we are dealt a losing hand in controlling the huge numbers of factors that influence blood sugar.  (In the August 2014 issue of Diatribe, Adam Brown listed 22 things that affect blood glucose and admitted that it was an incomplete list.)  But in general I am happiest when my A1c, range of low/high BG readings, and number of chocolate-covered donuts are in a certain range.  It is a balance of working hard while accepting my daily transgressions along with the uncontrollable BG excursions that come with Type 1.  I know that I could probably get a better A1c, but I think that I have hit the point where a better A1c might not be worth the disruptions and sacrifices in my life that it would require.  So maybe I am living close to my diabetes bliss point.

Because the bliss point differs for each of us, I might feel satisfied with test results that are higher than yours because my goals are different that yours.  I might be thrilled to have an average BG of 175 over the last 60 days because six months ago my average was 235.  I might be appalled at an A1c of 6.0% because my last one was 5.5% while you might rejoice at a 6.5% because it is the best result that you have ever had. You might find it acceptable to eat low carb a lot of the time and I am unwilling to give up favorite foods and the social aspects of restaurant eating.  I think that we could all agree that we neither want an A1c of 10.0% nor do we want to spend 100% of our life thinking about diabetes.  Somewhere between those extremes is a spot where we have settled. Maybe it is a good spot or maybe we want to change it.

Bliss Point Graphic

My best days with diabetes are when it lives quietly in the background. I don’t ignore it and I certainly take my insulin and test my BG.  Every so often I have a magical morning playing golf when I don’t hear a peep from my Dexcom for several hours. It’s not that I choose not to look at the CGM, but I feel so incredibly good that I totally forget about diabetes. What is interesting to me is that a retrospective look at my Dex for those rare mornings indicates that my BG usually hovers around 110-125 and it definitely stays within my programmed 70-140 range.  My perfect golf mornings start making me think that my bliss point might be somewhere around 120 and make me question whether my current daily goals are too tight. Having had Type 1 for 38 years, I have no illusions that an increase or decrease of 0.5% in my A1c will make a difference in my health. So this is definite food for thought. (Of course I have never been able to figure out why some golf mornings are perfect, others leave me munching an entire tube of glucose tabs, and others require multiple boluses to keep my readings out of the stratosphere….)

One reason that I have been thinking about optimal diabetes targets is wondering how an artificial pancreas would influence my life.  Many trial results for the bionic pancreas have mentioned that average BG levels for trial participants seem to cluster around 130-140 which approximate A1c’s of 6.2-6.5%. Those numbers are a long ways from the normal BG of 83 (A1c of 4.6%) that Dr. Bernstein espouses. However for the vast number of people with Type 1 diabetes, those numbers would be a huge improvement with the added bonus that hypoglycemia and high/low swings are greatly reduced.

But there are others (myself included) for whom this would result in a worsening of average BG numbers and A1c’s.  This is where the idea of a bliss point comes into play.  What is it worth in worsening BG numbers to eliminate most of the mental and daily-task burden of diabetes? Also, would my health actually be better if most lows and Himalayan BG swings were eliminated despite having a somewhat higher A1c? Interesting questions for sure.

Since one definition of “bliss” is “supreme happiness”, I think it is accurate to say that the only true bliss point for diabetes will be The Cure.  I don’t expect to see that in my lifetime.  At 2.5 years away from Medicare, I don’t even expect to benefit from encapsulated beta cells or an artificial pancreas.  But I think you younger Type 1’s will and that is exciting.  My hope for my old lady years is that Medicare will begin covering CGMS for seniors and that I will remain in good enough health to be the decision-maker for everything related to my diabetes for a long, long time.