There’s a saying: the barber with the worst looking hair gives the best haircuts. Presumably, since he can’t cut his own hair, he must go to the next best barber in town. I have no idea where that saying came from. And given that I haven’t been to a barber in years (one look at my photo and you’ll understand why), I have no way to verify it. But it does make sense.
Maybe the same can be said for blood sugar control. I think my practice (Integrated Diabetes Services) does a pretty good job helping people to meet their diabetes management goals. But quite frankly, my control stinks. My A1c has crept up to nearly 8%, and despite using a pump and CGM religiously, I still experience more than my fair share of lows. There are plenty of possible reasons:
Travel – For years I’ve been called upon to lecture and present all over the US and overseas, but this year has been busier than ever. Since receiving the 2014 Diabetes Educator of the Year Award, I’ve been on the road an average of two or three times a month. In fact, I’m writing this blog on a flight from Philadelphia to Spokane, WA (via Chicago and Seattle) to do a talk on insulin pump management. Traveling makes blood sugar control difficult for a number of reasons: time zone changes, mystery meals, long stretches of sitting in one position, and changes to one’s workout routine just to name a few.
Stress – Emotional stress can wreak havoc on blood sugar levels. Even “good” stress – like trying to manage a growing practice – can have its effects. This year, my wife and I have kids in four different schools (college, high school, middle school and elementary), and each participates in multiple activities. Figuring out the schedule is mind-numbing! We’ve also suffered through the rigors of a particularly rough winter (including two separate power outages totaling 8 days). The blood sugar implications have been significant to say the least.
Exercise – If I’ve had one mainstay in my diabetes management program, it’s exercise. No matter where I am or how busy things get, I find a way to work out just about every day. But that doesn’t mean its effects on my blood sugar are consistent. The time of day and nature of the activities vary quite a bit: Morning or evening basketball, afternoon yardwork, post-dinner runs or cycling, midday weight lifting, and so on. What it all amounts to is a lot of variability in terms of insulin sensitivity and blood sugar patterns throughout the day and night.
Dietary Discipline – Like many people with type-1 diabetes, I have an appetite that just won’t quit. Perhaps it’s genetic, or maybe the lack of the amylin hormone really does make a difference. Regardless, I’ve always struggled to avoid munching between my usual meals and snacks, and I tend to overeat – especially when faced with hypoglycemia. I’ve taken to using liraglutide (Victoza) on a daily basis to help curb the hunger, but I still often find a way to eat myself into trouble.
BURNOUT? – This is something most people with diabetes can relate to. But here’s where my situation is a bit unique. My job involves teaching, motivating and coaching people with diabetes for eight to ten hours a day, day in and day out. The last thing I want to do when I’m not helping a client is think about my own diabetes. This makes me a bit lazy when it comes to counting my carbs, taking insulin at the right times, and making adjustments for lifestyle activities. I’m like a chef who prefers to order takeout. A maid who leaves their own house a mess. A writer who would rather talk on the phone than send letters or e-mails.
I’m not sure why I’m telling you all this. Maybe this will help.
A few years back, I was presenting at a CWD (Children With Diabetes) conference in Cincinnati. Anyone who has a child with diabetes should get to know this organization. Anyway, a physician with type-1 diabetes showed how he managed to keep his glucose levels remarkably steady. We’re not talking decent control. We’re talking impeccable control. Rarely a reading above 150 mg/dl (8 mmol/l) or below 70 mg/dl (4 mmol/l). While I stood there feeling horribly guilty about my own numbers, I saw most of the parents in the room shaking their heads in disgust, and heard many commenting to eachother: ‘Is this guy kidding? What planet does he come from?’ I could tell that they tuned him out completely, which is a shame because he had some really useful and practical things to say. When I presented later that day, I made a point of sharing the ups and downs of my blood sugars during that particular trip. The audience smiled, nodded their heads, and warmed up to me almost instantly.
Apparently there is something good about “keeping it real”. None of us is perfect when it comes to diabetes management. We all have our challenges and obstacles to overcome, and I’m certainly no exception. And while I’ve learned how very important it is to accept ourselves for who we are, it is even more important to not stop trying. I, for one, am committing to cover my irregular eating with matched doses of insulin, and to be more aggressive at bolusing for highs as early as possible. I’m also going to make a serious effort to treat my lows with less than the usual 12,000 grams of carbohydrate. Interestingly, none of this changes the way I teach and manage my clients. But it certainly gives me a stronger appreciation for what many are going through.
So welcome to my little barber shop of diabetes management. My haircut may not be the best, but I promise to give you the best-looking “do” in town.
BTW, if you'd like to see my (and my colleagues') other blog posts, click here.