Whittling It Down

The thing most elusive to people without diabetes is how much constant work it is, I find. When others see me using a lancet or pushing buttons on my pump and react with that ooh! look, I feel like shouting: “It’s no big deal, I do this more than a dozen times a day! Every day of my life!!” So why isn’t my @#$! glucose control perfect?

As recently noted, there are just too many things we need to do “perfectly”: food, exercise, dosing, timing of dosing, logging results, more food issues, scheduling lab tests, obtaining the results, extracting meaning from the results, acting on the results… Ugh. Where to start?

So I was lamenting about all this work in a recent telephone interview with the newly elected president of the American Association of Diabetes Educators, Amparo Gonzalez — a lovely Columbia (South America) native now based in Atlanta, GA. She does a lot of work with diabetes patients in Mexico, where care is often low-quality and hard to come by. How the heck do they manage their blood sugars without all the devices and support available here, I wonder? Still, I was having the audacity to feel sorry for myself that day.

Simplify And then, somewhere in middle of our interview, Amparo said something really simple and really smart. And really helpful. She said: “I do an assessment of all my patients’ behaviors, and then we select TWO THINGS in the way that person lives to change. We take it step-by-step… you have to be ready to change, but don’t try to work on more than two things at a time.

I myself am working on two things right now: flossing my teeth*, and exercise. I’m going to focus on those until I get them right. And this is what every person with diabetes should be doing,” Amparo added. “You should always be working on something. There’s always something you can improve.

Right! In fact, I wrote a lot about the “step-by-step approach” in our book last year, but clearly reporting and writing do not always translate directly into DOING.

So after our interview, I thought it over good and hard.

Here are my Two Things for the time being:

1) testing BGs more diligently post-meals, and

2) dosing more aggressively for every speck of carb I ingest.

My only fear is, if I focus on these two things until I get them right, I may never move on. Ugh! These are my pain points. I may be be chasing these goals when I’m 90 (if I’m lucky to live so long). Sigh.

Still, it’s quite comforting to have a clear & simple strategy for the weeks ahead.

[*Editor's note: flossing teeth is a bigger deal than you might think, given PWDs' tendency to develop periodontitis.]

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14 Responses

  1. Stu Davidson
    Stu Davidson February 18, 2008 at 7:32 am | | Reply

    Excellent blog post.

  2. chris
    chris February 18, 2008 at 8:12 am | | Reply

    ehhh…sorry to be all persnickety, but is Gonzalez a native of Columbia the planned community of over 100k residents in MD that also happens to be my place of residence, or that other Columbia in SC, or, Colombia the country in South America?

    here are my two things:

    1. keep better records (ive been working on that for years)

    2. throw away insulin when it expires/follow the proper guidelines for storing insulin (I often have a few half empty bottles collecting in my fridge/glove box/back pack)

  3. Heather
    Heather February 18, 2008 at 8:20 am | | Reply

    Thanks for this post.

    I’m a complete slacker, compared to you, in managing my diabetes. And my A1Cs show it. I keep *wanting* to be better about it, but find it so overwhelming that I throw my hands up and give up.

    I feel like this post just gave me permission to focus on ONLY two things at a time. I don’t have to get it ALL right right away in order to rightfully or truthfully claim progress.

    Phew!

    Thanks again.

  4. cindy
    cindy February 18, 2008 at 8:26 am | | Reply

    I’m in Heather’s slacker club….most of the time I just throw up my hands and say why bother (although I DO know the answer to that).

    Baby steps are definitely the way to go. So is starting right in where I am whenever I fall off the “good diabetic” wagon and not berating myself for not doing everything a “good diabetic” should do all the time. This week I’m going to wear the 3 day, 24/7 monitor so maybe we can figure out why I can’t get below the 7 A1c I’ve had for the past year. Then I’ll pick out 2 things to work on.

  5. Naomi
    Naomi February 18, 2008 at 8:33 am | | Reply

    Since my in-house diabetic is a teenager, I might just push for ONE thing!

  6. Hannah
    Hannah February 18, 2008 at 8:37 am | | Reply

    Thanks, Amy, for this post. It was nice to read first-thing in my day, providing me a little inspirational direction for my week.

  7. riva
    riva February 18, 2008 at 8:50 am | | Reply

    Amy, go back and read letters ‘P’ – don’t expect perfection, ‘S’ – small changes create big results, ‘A’ – appreciate what you do do and have, ‘J’ – create a space for joy. Heck, go back and re-read my whole book – “The ABCs of loving yourself with diabetes.” All those golden rules are in it. And don’t forget ‘D’ which you do everyday – contribute your talent to help others in the world of diabetes. (Book available on Amazon for the rest of you.)

    The 24/7 toll of diabetes makes it an emotional labor as well as medical. Focus on what you’re doing right and well and do a random act of kindness on yourself while you’re getting better at your game. You’ll go further, more easily over time. But i know it’s hard for you Type As :)

    riva

  8. sorina
    sorina February 18, 2008 at 9:50 am | | Reply

    You have a very nice blog, good post…keep up the good job

  9. M
    M February 18, 2008 at 1:02 pm | | Reply

    Spot on, Amy!
    I think the best thing about this method is that it gives us something positive – a sense of achievement.

    When we simplify our efforts and concentrate on one or two things at a time it gives us clear aims and a much better chance of success.

    Also, for anyone doing this, remember that your BG result is just a number – don’t let yourself see it as failure (or even success!), see it as a *tool* to achieve your aim… BG results will not always be good no matter how hard we try, we know that don’t we? And yet we still feel like we’ve failed if see a number out of range. Concentrate on the big picture – success is feeling good and being healthy (or whatever your end result aims to be), not *one* BG result at any one time in one day!

  10. Jillian
    Jillian February 18, 2008 at 3:13 pm | | Reply

    I do the 2 things with tasks that are not diabetes related. Like putting my clothes away as soon as the laundry is clean and getting up before 8 on weekdays (I’m home schooled). I think managing and improving other aspects of my life helps the diabetes woes and burdens lessen.

  11. Seonaid
    Seonaid February 18, 2008 at 7:53 pm | | Reply

    sounds like a good idea to me.. i’ve got a lot to improve on, so I think i’ll try this out.

  12. Challenge Diabetes
    Challenge Diabetes February 19, 2008 at 3:24 am | | Reply

    The Road to Less Than Optimal Blood Sugar Control is Paved with Good Intentions

    Managing your diabetes takes a lot of work. It can take less work however depending on which tools you use and how often you use them.
    Should I do shots or a pump? Doesnt matter if you are looking for easier. They b…

  13. Boyd
    Boyd February 19, 2008 at 4:43 am | | Reply

    I’m new to this site and fairly new to type 1 diabetes … going on 3 years. I’m 41 now. Amy, I commend you for your work on this site.

    One thing that I don’t understand is why do diabetics think keeping your sugar level is such a hassle and difficult? Why complain about all the ‘equipment’ you have to hall around? Why complain about counting carbs? I say this because I don’t think that way. Yes, I take shots before every meal and test 3-4 times a day. My A1C is 6.5 and has never been higher than 7.2 … it was 13.7 when diagnosed. I do everything that I did as a non-diabetic. I don’t carry my monitor around everywhere I go but I carry my insulin pen in case I’m going to eat. I watch what I eat but I don’t count carbs to the exact amount. I eat everything I want to eat both the good and the bad food. Maybe if we just have the attitude that this is a way of life now and don’t look at it as a negative, establish a routine and stick to it. If you forget or your sugar goes high or low ..don’t fret. Your sugar will go back to normal and remember what you did that caused the sugar reaction so you don’t do it again.

    If anyone wants to discuss this further, please feel free to contact me … maybe I’m missing something here?

  14. Karen
    Karen February 19, 2008 at 4:54 pm | | Reply

    Boyd,

    I do understand what you are saying as I pretty much eat whatever I want as well and I always have for the past 41 years. I guess I have regrets because in the dark ages there was no testing of bgs and now that I know that all my sluggish days, which were in the 1000′s,it was the fact that my bgs were high so I just wonder if I grew up in this age of diabetes and knew what my bgs was all the time, I might have been able to add a few years on to my life to spend with my family, which keeps growing with two baby nieces. It is the outcome of carb counting and shooting up that disturbs me a lot, as I suffer from hypoglycemic unawareness, and therefore, I can never ride a bike or go golfing with complete abandoment.

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