(long suggestion. I think that THIS is the post you’re looking for.)
Anna, I think that you should aggressively pursue a particular kind of psychotherapy: “Cognitive Behavioral Therapy”. Ask for it by name! What should happen is: Instead of a lot of general “fishing around” about how you feel, the therapist should do something like this:
THP: “OK, you’re afraid of going high, even a little bit. Now suppose that you did, right now, screw up and measure 250 mg/dL – what’s the WORST thing which could happen?”
Your turn: You’ll probably explain that you’re gonna get REALLY upset, angry at having made a huge mistake, angry that it’ll cause your A1c to go up, and you’d do a bolus fix-up shot, but you’ll be pissed off for the next 3 hours because the bolus will take that long to work. You HATE being abnormal, even if no one else sees it. You can FEEL your high bG, you’re not thinking as clearly, and you’re even running to the bathroom to ■■■■ away some excess sugar, it’s such a mess that even your kidneys are trying to clean up this GD mess you’ve made (or something like that…)
THP should then investigate EVERY SINGLE ONE of these “the worst that could possibly happen” items. For example, starting with the first one:
THP: “Now tell me about how you’re getting upset. What exactly are you going to do in the most UPSET ABOUT THIS state you can imagine, what’s the WORST THING which could happen, exactly how are you feeling infuriated, and what are you saying to yourself RIGHT NOW…”
Then he should follow each one of those things, as far as they go, and investigate THE WORST THAT COULD HAPPEN for every single one of them.
in a few sessions of actually following all of these “worst thing that can possibly happen” alternatives, and seeing that they basically lead to nothing seriously bad at all, you will probably rationally conclude, YOURSELF, without lectures from know-it-all’s like me, that ALL the “worst things which could possibly happen” from running a bit too high for a few hours a week aren’t really so bad. In fact, they’re way better than the things you go through now. :))
A skilled therapist will ask questions which get to the heart of the matter quickly, helping you expose fears which you might not be willing to present to yourself without help. This is why CBT doesn’t really work from just reading a book and trying to do it on yourself, you need someone ELSE to challenge your ego.
For a large number of major and minor psychiatric diagnoses, CBT has been shown highly effective. You’re obviously an expert on the medical part already, and you already realize that it’s a psychological problem-- so don’t waste time and copays with diabetes MDs re-instructing you, for about the 50th time, on insulin dosage calculations and testing protocols, that appears to have NOTHING to do with your behaviors. I’m a CGMS user myself, but I think you need CBT, not CGMS. I need both. :))
I hope that what I’ve said rings true. If so, go after it! I’m guessing that guilt about “misbehaving”, of which you’ve already got MORE than enough, probably strengthens your deep-seated fears of relaxing your sugar a bit: When your Doctor called you, you went into a irrational tizzy about being “bad”, but nearly everything you’ve EVER read about misbehaving T2s and teenagers in the popular press says “I was bad, my A1c was 13.9, it needed to come down, it was an emergency…” And your condition confuses the one badness with the other, even though you rationally know what you should be doing, you keep responding backwards (trying to push your A1c lower, lower, lower, at any cost).
You need to have this confusion challenged and exposed for what it is-- a lot of baggage from long ago, fearing a set of “terrible” outcomes which, when actually reviewed, will be much less bad than what happens now. Your target is an A1c of five and half, not thirteen. But your mind treats any attempt at relaxing your target of “always below 100” as this:
“I’m headed straight for an A1c of eighteen, I’ll go blind, then they’ll have to chop off my gangrenous legs, and I won’t even be able to read my meter anymore, I’ll get even worse, my A1c will reach twenty-five, then I’ll have a massive coronary from all the sugary dreck clogging my arteries and die a miserable death, and everyone at my funeral will say IT WAS HER OWN FAULT, SHE KEPT BREAKING THE RULES AND LET HER A1C FLY WILD…”
That’s what’s going on. really. BTW, I don’t think you’re getting stupid, you seem to be suddenly getting a lot smarter in a different way. Thanks for the post, it’s REALLY inspiring to me personally, I’m still doing the same thing as you are. (I’ve got more lows than highs too, and just like you, I get MORE angry at the highs. It doesn’t make sense, the lows are really much worse for me and everyone/everything in the vicinity, and for my work.)
So I’m gonna think about this post myself, and maybe ask DW to challenge me with some good CBT this weekend. (She’s Board-Certified MD in that area, more focused on drugs than therapy, but really good on both sides.)
