New to this forum; got diagnosed early this year, handling it well I guess, got questions though

[athx9891]

Yeah, I understand. I think that I can control T1 to a large degree, but a significant portion is beyond control. The endocrine system is hideously complex. Not even the beta cells themselves actually “control” anything, they only react.

This is something I’m working at, splitting diabetes management into a “proactive” and a “reactive” part. Steven Ponder would probably call these “static” and “dynamic”.

Proactive management is calculating the necessary bolus amount based on meal carbs; pre-bolusing; adjusting the speed of eating to slow down carb absorption; mixing the meal so that carbs are accompanied by fats fiber and protein. Reactive management is: given the current situation (BG level, BG trend, IOB, COB), perform a course correction if necessary.

I have been learning that hard way that reactive management is sometimes just necessary. The meal may have some more carbs than you thought. Your insulin sensitivity may be off today. Lack of sleep may be triggering stress hormones which raise insulin resistance temporarily. You might be having an infection you don’t even know about yet etc. I try to make sure my proactive management is right on the money as often as possible, but sometimes I just miss the mark. That’s why I want to give me some tolerance range.

As for the complications, while I do agree with you, I’ll keep my tight BG control. My endo told me that one trap many T1Ds fall into is that they are told that T1D is “not that bad”, that they don’t have to pre-bolus, that they can eat everything and just inject as needed, that having a high BG after meals is not that bad etc. The problem is that, while it is true that a high BG after meals may not be that bad, this is only true if it doesn’t happen regularly. However, many T1Ds think it’s just no big deal that they spike into the 200s or even 300s after meals, “because it goes down again”. She told me that she has seen 28-year-old T1Ds with severe complications because of this, and specifically criticizes the insulin manufacturers for selling that lie about not having to pre-bolus. But, she also said that while the treatment options in the past were much worse than now, T1Ds back then on average had more discipline, simply because they had to.

So I am trying to find a middle ground. Not obsessing over T1D management and over the numbers, but also taking it seriously and trying my best to keep tight BG control. My hope is that my honeymoon will continue for several months, or even a year or two. As a LADA, there’s a real chance of that happening. I hope so because by then closed loops will be more widely available, and more mature, and these can significantly ease the burden of T1D management. Until then, I just do my best.

I am also trying to adjust my diet to have significantly reduced carbs while still providing me with enough calories. Carb reduction is what works for many T1Ds well, and also makes my T1D management easier.

As said, my main problem right now is anxiety. Sometimes I just feel despair when things don’t go as planned. You are right that there’s no point in feeling like that, but such feelings aren’t easy to get rid of. Hopefully it will vanish over time…

But if you feel down, burned out, what do you do to save your day?

[mohe0001]

I hear ya’, athx9891. I’m naturally a lower anxiety human. Born that way. Can’t change it. But, I have talked about diabetes stuff with a psychologist who did a lot of work with diabetics. I don’t know if it helped. I mostly went to discuss anxiety dealing with other peoples chronic illnesses, which I find more difficult and frustrating because other people aren’t always as proactive as I would like them to be. You aren’t that type. You seem like the opposite type of animal. I admire your proactive nature.

After watching other people struggle a lot with a variety of chronic illnesses, I made a deal with myself. Me and diabetes are friends as long as I am making my best effort. As long as I am making a good, honest effort that is reflective of my abilities, I don’t feel guilty or “less than.”

Sometimes I do feel ‘backed into a corner,’ where I can’t think of any solutions to fix a certain problem. Sometimes I stumble upon new solutions for my toolbox. But, sometimes the waiting game resolves things on its own. Like, I’ll work on a problem for so long, unable to fix it, that the system just shifts and problems resolve themselves. That is sometimes just a random event. Given enough time, the system just changes. Its fluid. Think of it like your doing control engineering for a complex system.

Sometimes I am afraid for my physical well being. Sometimes I doubt my ability to survive. But, I take comfort in that people tend to over-estimate risk, in general. That’s common. Given a long history with chronic illness, I have proven surprisingly difficult to kill. Fear fades after a while of waking up alive day after day.

Diabetes may sharpen your instincts regarding risk. Honestly, I think you’ll get sick of watching the numbers so closely once you feel acquainted with system behavior. Your numbers are likely going to get more erratic. Thats OK. Your gonna be fine. You are managing a complex system. It will not always stay within control limits. Thats just the nature of the beast.

I would encourage you to ask yourself, “Do I need to call 9-1-1?” After decades of dealing with other peoples chronic illness, I think thats a good line in the sand. If you dont need the medics or the police, then its over-reacting to feel anxious - You have everything under control. Keep telling yourself that. I’m certain its true. If you need a confidence boost, then listen to some gangsta rap that tells you your ‘the man.’ You could go train as an EMT, if you feel like you need better skills in an emergency or need more perspective about what situations qualify as ‘bad.’ Sometimes helping others helps oneself.

But, I feel confident in your abilities and motivation to handle all this diagnosis entails. When you really want to challenge yourself as a diabetic, find something physically challenging to do. It will do a number on your blood sugar values, but its good for you in other ways. Are you a disco dancer? Do you like to do construction (you could volunteer for Habitat for Humanity)? Experiment with something you can do where you are not all alone so someone can help if there’s a big failure, LOL. Maybe ‘up in your head,’ isn’t the best place for you to be sometimes. I know its not the best place for me all the time.