My Diabetes Confession

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.

I LOVE your confession, Gary! Very courageous of you. And frankly, if you said "I don't see what the big deal is. MY diabetes is EASY to manage!" I would be skeptical about the empathy you could show your patients. Keep it real!!

Gary, I am so glad you decided to post this over here, it's really good, helpful, and yes, REAL. Refreshing. While there are outliers who have managed to keep their a1c in perfect range, it's not what I see here on a daily basis, walking side by side with my PWD friends. Someday I'd like to see a bg meter being advertised with a number NOT between 104 and 107.

Gary: Its not a confession to most of us. I do not know a long term diabetic, especially me who has not fallen off the wagon. heck I fell off for over 20 years and probably am not back on yet and may never get there. What is not important is where you have been rather where you are going. When I traveled a lot there was no way I oculd possibly stay even close to on diet,, on track, on anything. In those days Id dose and go and hope for the best. Going, low, going high, annoyances and besides I was not checking.

So my friend here is my advice. Don't beat yourself up. If you have never fallen off the wagon you dont even know there is a wagon. My best advice, do the best you can, and yes it is not where you have been that counts, rather, it is where we are going. Oh and best of luck to you.... the train did not leave the station, it is waiting for your return.

You are definitely speaking my language. I try to have that impeccable control. It seems though if I keep it between my goal numbers, it still looks like a heart monitor, rather than my CDE tells me it should look like. I so enjoyed this post and now feel relieved to know that "I am doing okay in managing the best I can." There are definitely good days and bad, and it is refreshing to hear you say that you struggle in the same way. Keep showing us the walk.


Thanks for your blog post. I think it really hits home for many of us and it also makes us feel less alone and guilty about our inability to always achieve the goals in which we aspire. As I look through your reasons for struggling with control I also see that like me, you struggle not with the technical aspects of control, but with the mental. Our lives are busy, filled with stress and we make deliberate decisions that make it harder for us. Whether it be travel, agreeing to certain schedules, events or travel or just putting our careers ahead of certain things. I've always thought of an ideal CDE as also being part coach and part psychologist. It may be reasonable to think you could be your own CDE for technical matters, but it is really, really hard to be your own coach.

Thanks for sharing, you post made me feel better about myself just reading that you also struggle with things.

In past twenty years... I had one A1C spike into the 7's that I attribute entirely to me having to drive in middle of the day for work for a couple months, and keeping my bg "well out of hypo territory" as well as missing out on exercise I would have otherwise gotten.

Thank you Gary for sharing. Someone who is an inspiration and an expert, like yourself, confesses of their own struggles with control inspires all others to do the best that they can do. But more importantly, it reinforces the idea that having diabetes should not stop you from enjoying simple pleasures of life. I question the person with such great control quality of life. Is he so busy with his diabetes management that he has forgotten to stop and smell the roses along the way? I for one, believes that everyone should be able to have cake, and ice cream, with sprinkles, every once in a while!! mmmmmm….not right now though, as I am a little high!

Great blog post, Gary!

I think we all have our "excursion days", I know I do!

I work really hard at not overdoing the 12,000 grams of carb hypo treatment, but there are days when I feel like a rock skipping over the water. You know, 65 ... treat ... get to 85-90-100, then 65 ... treat ... get to 85-90-100, then 65 ... treat ... WITH COOKIES AND MILK!!!

Then there are the days when I do the reverse, 185-200-250 ... correct with 1:60 ... 225-200-185-200-250, correct again with 1:60 ... 225-200-185-200-250 ... ARRGGHH! Let's try 1:30!!!

I was half expecting to see 'April Fools' at the end of the 'confession'!

For me, one factor is the ability to keep my own plans/schedules. But too often 'life' gets in the way. When unplanned events or changes to existing plans are more frequent than usual, my BG management suffers. Traveling is a typical example for that, as well as demanding work/family activities, illness, etc.

But even simple things like the friend that calls to say "we're leaving now for a walk, want to come ?", and I just pre-bolused for a meal. It's frustrating when others don't "get it", that we can participate, but sometimes need advance planning to accommodate !

We just do the best we can.

we do the best we can....some of us do....some don't.
I DO .

Thanks for being honest and real. I’d actually been avoiding your book because I thought it would feel too preachy and all I ever hear is how great you are. Well, you are great but also human. We all are. There is only so much we can do at any time. Thank you.

I love the way you put everything in context. Effective method for getting through my occasionally tendency to glaze over and follow my own thoughts in their own fluid direction.