Sheri Colberg, PhD
What Does Success with Diabetes Management Really Mean?
What does it mean to be successful when it comes to managing your diabetes? That seems like a simple question that should have an equally straight-forward answer, but nothing could be farther from the truth when it comes to diabetes.
The focus of successful diabetes management is usually on blood glucose. How low can you get your A1C? What is your “time in range” if you use a continuous glucose monitor? How many lows are you experiencing, and how many highs? While some of these questions are relevant to your short- and long-term health with diabetes, there is a lot more to consider than just how close to optimal your glucose numbers are or aren’t.
For example, consider how diabetes is affecting your daily life. A measure of success for me is keeping my diabetes management to a dull, background noise—something that I’m aware of from time to time but that does not command my full attention most of the day. You likely have to think about your blood glucose when you’re choosing what to eat or remembering to take your medications or picking doses. The rest of the time, you are experiencing success when it’s not interfering much in your life. Of course, we all have bad days when diabetes management takes up more time or more of our focus, but having as few of those days as possible is definitely a measure of success.
Personally, I consider myself successful when I have a good night’s sleep. Anyone with diabetes knows that sleeping well can be a challenge for multiple reasons. Having your glucose go low during the night interferes with good sleep (and, for me, makes it hard to fall back to sleep after I treat it). Having it go too high can make you have to go to the bathroom a lot at night, which also can interfere with sleep. Aging itself has the potential to interfere with good sleep, so it is not just diabetes that you may have to manage. These days when I manage to sleep three to four hours at a time between waking up and have stable blood glucose levels overnight, I consider myself as being successful managing it.
Avoiding health complications associated with diabetes is also a measure of success to many, but not a goal that is entirely within most people’s control. It’s possible to have health issues come up that have nothing to do with diabetes, and even people with the most stringent blood glucose management can develop health problems over time. Unfortunately, the tools and medications that are available to treat diabetes are less than perfect. For instance, if you have to take insulin, there is no way currently to deliver it where it would normally be released in the circulation leading to your liver. So, at best, your metabolism of the insulin you take is altered because you have to inject, pump, or inhale it. While doing the best with the tools you have available is a measure of success, do yourself a favor and stop expecting perfection. It’s really not possible at this point in time due to limitations outside our control.
Enjoying your life as much as possible despite having diabetes is a true measure of success. It’s easy to develop “diabetes burnout” or “diabetes distress” when dealing with it 24/7 starts to wear you down. At times like those, just take a deep breath and consider the alternative (that is, not being alive) and seek out emotional support from others if you need to. Sometimes it helps to just be able to vent your frustrations to someone else who understands and sympathizes with what you’re having to deal with every day. Lose the stress and the guilt over not being perfect with your blood glucose levels.
Finally, on days I would like to take a vacation from diabetes, I remember my grandfather’s uncle and that uncle’s two sons, all of whom died from type 1 diabetes in the 1910s before insulin was discovered in 1921. On those days, I simply try to be grateful that I have had even imperfect tools that have allowed me to live over 54 years with type 1 diabetes already. I’m also healthier than most people I know without diabetes, so living well is a success in my book!