The Caring Diabetic

I'm so grateful for all of the comments I get on this blog, but I've always been partial to Al's. Why? Because he's not a diabetic. His son is and he reads my blog for insight into how to be a better parent. As a parent of two little riddles, myself, I soooo get that.

At any rate, Al posted a great comment last week:
"Have you always been so successful with controlling your bg levels? My son really does "care" about his diabetes, but struggles with roller coaster bgs. In your early 20's at college, were you as successful controlling your diabetes as you are now?

He adds: Right now he is very scared of lows and therefore runs high a lot."


Since going on the pump eight years ago, I haven't had an A1C over 7 that I can recall. Before that, I had tons of 7's with a smattering of 8's. During phases in my life where I didn't test as often, I'd rarely go beyond 8 but do recall a few 9's and one time (I think it was college) being over 10.

For me, the huge turning point was going on the pump. Prior to that I rode the NPH rollercoaster. Simply put, a diabetic with a big enough dose of NPH can get along OK - the NPH will usually bring you down within shouting distance of normal.

But when I went on the pump, it all made precision-like sense to me. Every meal, every dose could be calculated precisely. The "potential" negative to all of this, though, is that precision requires discipline. Unlike my roller coaster NPH shot, a pump patient at 300 is going to stay at 300 until they bolus extra. But I never minded, because it finally made sense.

Still, through all those years of testing once per day (or less), I was still generally in the 7's. Since being diagnosed 25 years ago, I've had only 2 ambulance rides for lows (and one additional ambulance visit) and none in the past 17 years.

I used the phrase "caring diabetic" in my last post and I think it's an important one, because I want to believe that diabetics who care about their diabetes stand a better chance of being complication-free. Here's what that phrase means to me:

1) A caring diabetic knows that there's always a reason for their blood sugar reading. My kids will tell you that nothing makes me angrier than when they do something dumb, I ask why, and they say, "I don't know." Give me a crappy reason, but there's always a reason. I have heard diabetics say "I was low/high and don't know why," and the same grumpy guy that yells at my kids tends to call bullshit on that. There's always a reason.

The "caring" diabetic makes a calculated guess to the reason - your infusion set was in too many days, you exercised too much/too little, you guessed your carbs wrong, etc. and goes with it, knowing they'll be smarter next time.

2) The caring diabetic corrects. This seems elementary to me, but I've known diabetics who don't correct highs. If you are high and you have no insulin on board and you're not going to be exercising, your blood sugar isn't coming down unless you care enough to bolus.

3) The caring diabetic tests. If you're on a pump, you test a lot. If you're not on a pump, you still test.

4) The caring diabetic doesn't worry about last week, last month or last year. The only blood sugar you can control is this one (and somewhat the next two hours). I don't understand diabetics who get down because they've had a bad week of blood sugars. Live here. Live now.

5) The caring diabetic analyzes last week, last month and last year. Notice I said you don't worry about it, but you do look at, study it and correct for it.

6) The caring diabetic looks for comrades but understands they're an island. I've seen soooo many diabetics succeed doing things that I couldn't or wouldn't do. Listening and learning from them is invaluable, but in the end how I respond to medicine, food and exercise is unique and always gets higher weight than anything anybody else has done. George Sheehan said, "We are all an experiment of one." He said it about running and I'd say it fits just as well for diabetes.

To this point, this shouldn't be taken as a universal post about what a "Caring Diabetic" is. It's only what it is to me. You might think a caring diabetic doesn't drink beer or eat candy, but I've never met a Peanut Butter Cup I didn't like and what's made Milwaukee famous helps me pass the hours. More than anything, I think what makes sense is to figure out what works for you and then make sure you stay on that path as much as possible.

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