Seventy to one-eighty -- don't patronize me

Mental and Emotional Wellness
41

I get your point, @mohe0001. A single small increment toward a better blood glucose would not likely reap much benefit in the long run. Yet I have made many small steps over a period of many years that have ended up accumulating and materially improving my glucose management and certainly giving me a physiological benefit.

On top of that, better glucose management gives me an emotional boost knowing that I am indeed doing the best I can do.

While you might write off tactic “A” since it won’t improve your blood sugar much, you then cut off the the whole stream of follow-on tactics that only become apparent to you once you employ tactic “A”.

Thanks for your comment. Blood sugar management set-backs can irritate me from time to time but I never let them persist for very long. I play the long game even though the length of my game gets shorter every year!

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42

If you could see how I have been behaving lately, Terry, you would feel really, really good about your own self. LOL. I’m getting things back on board this weekend…with any luck. I’m running tech support on my devices. Gotta do it, or I wont survive this coming weekend. Hugs from Minneapolis! The weather has turned. Party on! Prince - 1999 (Official Music Video) - YouTube

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43

I gotta tell you this quick diabetic story…

All my devices have gone down and I’m on MI. Of course the Rx is expired. So, I go to Walgreens and they tell me such.

I look at the lady and blurt out, “I’m a drug addict. You have to sell me syringes.” Things have been bad and I am desperate for solutions.

She looks back without batting an eyelash and says, “The only people who say things like that are DIABETICS. When drug addicts try and buy syringes without an RX, THEY say that they are diabetics.”

Dead silence. I have no response. She’s got me pegged as a common diabetic. What do I do next?

Then, she smiles sweetly, and sells me syringes anyway. She’s pretty funny…for a pharmacy tech.

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44

This time of year in the upper latitudes when warmer weather first makes an appearance raises a joy unknown in perpetually warm climates. My bones still remember the frigid cold of the last winter I spent in the Twin Cities.

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45

Were the Ds in the study using CGM? If not the study, IMO, is outdated and no longer applicable.

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46

Love this perspective Marilyn6. And I’m with you. After 40+ years of being Type 1, with the last two decades never having an A1c above 5.7 (That was my highest, though I’m generally lower), I still am just now experiencing the early stages of kidney damage. (The same is true of my RA; feeling good with little pain and no symptoms, yet the joints are still deforming at a slow but steady pace.)

My childhood control was pretty awful, and not for lack of trying. My parents and I were diligent about it, but tech was not great, and the insulin wasn’t spectacular either. We just have better tools now. I was diagnosed at 4, so when you say “depends somewhat with how long you will live with diabetes” I think is so very relevant to this conversation.

I view things more like Terry4. 40 years and counting and I may have another 4 decades to live with this. In my view, I have to be as anal retentive about it as I can possibly afford to be.

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47

So sorry to read about your complications, @Sarah_K1. It can be depressing to see complications crop up even in the face of very good current glucose control. Diabetes doesn’t play fair.

Many of us have periods of poorer control in our past but there’s nothing we can do about that. All we have is today and that’s what we should focus on. I do think good current control matters even if we’ve exerted worse control in the past. We have no absolute evidence of this but I still think it counts in the end.

May Lady Luck be on your side, Sarah.

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48

Sarah, I believe that all I can do is take care of my diabetes as well as I can. Doing that keeps me sane. Diabetes can be a very cruel disease, and I want to know that I did the very best I could with the knowledge that I had at the time. Sometimes the information is wrong, hence my heart stents, but then I began again with new information.

Diabetes is certainly challenging and a lot of success with this disease depends on luck. I wish you lots of luck with your beginning kidney damage and RA. It sounds like you are doing your very best to stay healthy.

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49

Thanks to both of you! I didn’t intend for my note to sound like a pity-party, haha. I just wanted to reinforce the point that you can be a model patient (and my endo certainly considers me one) and still have it come back to haunt you.

I know far too many folks who will take this as an excuse to be lax, reasoning, what is the point in the end? I take it as a reason to buckle down and be as diligent as humanly possible! I can tell you both see it that way as well. :slight_smile:

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50

Well it’s a 24/7 high wire balancing act, and not just in terms of BG levels but also in terms of psychology. The great thing about CGM systems, f’rinstance, is that they are, well, continuous: they give you a whole movie, rather than just still-shots of points along the time-line. Trend info, yay. Many of us old-timers remember when finger-stick BG meters were The Next New Thing—just think of how much better my control would have been through the 80s, 90s and Oughts if I’d had access to that timeline info instead of the occasional result scrawled in a notebook I mostly only remembered to keep up the week or so before my next appointment.

All good… but… little acknowledged CGM side-effect… you can get, well, a little obsessed with it, can’t you. And even that obsession kind of teeter-totters between good and bad. I think I notice this even more now that I have it on my wrist as well as my smartphone. Everyone knows how rude it is to look like you’re checking the time in a social situation, and I’ve felt myself violating that etiquette frequently. I’m not looking at my watch, I mean I am but I’m not checking the TIME. I’ve actually gotten to the point of explaining that nine times out of ten if I’m looking at my wrist it’s to see my BG.

Spouse: “What time is it, hon?”
Me: “Oh, sorry, dunno, I was looking at my blood sugar.”

Because I gotta eat in half an hour and do I need to pre-bolus now and how much, or I’m planning a bike ride in an hour and do I need to do a temp basal, or a million other reasons. But no one else around me lives in that mindset, and I hate inflicting it on them but…

The thing is, to have really tight control, you pretty much HAVE to be obsessive about it, and that’s a two-edged sword. I liken it to the discipline of playing an instrument at a professional or advanced-amateur level. It is necessary to the art, but art is well known for demanding more at the expense of other things of value in your life. It feels unqualifiedly virtuous even as it is distracting you or interfering with other important activities, making you seem self-absorbed or actively rude. Same with participating here. I want to share successes, techniques that have worked for me, whatever—if I can’t obsess about it here, where can I obsess about it! But how that communicates to newcomers, especially the newly dx’d, is a real consideration. I remember how utterly overwhelming it felt at the beginning, invading every aspect of my life, and here’s this whole crowd of people obsessing about stuff I never wanted and didn’t sign up for and my numbers suck!

TL;DR: Good point, @MBW

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51

I have been thinking about your post for awhile and was actually thinking about posting with a different line but I am hoping I can slide it in here.
First, I love your view points and they make me think, sometimes, like this one for awhile. I don’t always agree with your points but I must say, I have learned a lot from you and enjoy the back and forth.
One to your point about the ADA standard of 70-180 is hurting more than helping as it keeps everyone locked in. This is probably true for many physicians, they get locked into a set goal and demand all their patients adhere to it. This I think falls on the doctor patient relationship. When I first started using my Dexcom, my upper level was 250. I mean we talked about where I was and how much I was bouncing around and we didn’t want the alarms to push me out of using it. Over time, that upper number has come down as we have fine tuned things and gotten better equipment. But this is with a doctor that works with me to get goals I can live safely and happily with it.
So I am one of the many that use the 70-180 goals with a SD of 40. Yes, these are moving targets but this works for me.
This also brings me to the “good enough” thought line. I have gone through most of my diabetes timeline, it in the best range from a blood sugar mode. Those early years were not good. And I continued to beat myself up because I couldn’t mean the hard to meet goals all medical professionals wanted from me. I was never good enough. Finally connected with the team at Behavioral Diabetes Institute where I learned there is a good enough. I don’t need to be perfect and I don’t need to worry about everyone else and what they are doing. So, I agree whole heartedly with @Laddie about the good enough line. We all need to discover our own good enough. I have also learned that super low numbers doesn’t lead to better outcomes. They lead to about the same outcomes. So my thinking (my thinking), I don’t need to work so much harder to get better numbers when I am doing fine keeping my numbers in my goal range.
I don’t feel you line of thought here is wrong. Your frustration with the medical professionals is sound but that is probably something you deal with every time you see a doctor because you probably know then they do. But also think about all those professionals and how many patients they deal with who don’t have any idea how to do what you do everyday. And everyday they have to get people to buy into testing blood sugars will help, or walking around the block will help, or weighing their food will help. Very hard because diabetes is so darn hard and so unfair. And most of us are juggling family, work, exercise, diet, other conditions. It’s hard and maybe that 70-180 is a fair standard for most.
My other thought, I will try that later. Love you @Terry4 and really have learned so much from your posts, so please keep them coming!

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52

It’s not so much that they have less hypoglycemic awareness but the consequences of a low (a fall, or seizure, auto accident) can be much more consequential than in a younger person.

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Sally, thank-you for your kind words. I certainly appreciate the value of accepting a “healthy good-enough” when attempting to meet a diabetes goal. That’s certainly wise beyond its simple three-word expression! And I remember you and I having this conversation in person at one of the TCOYD conferences we shared.

I wish, however, that those who have followed this thread this far could just let sink in that I’m not proposing to delete their preferred 70-180 range. I’m seeking that the normal range be acknowledged, valued, and made part of the discussion. Ok – that’s my last attempt to restate that sentiment!

I am thrilled that this post has made you think more about this issue!

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54

I think the older diabetic person needs to be looked at individually. If I lived alone,I would definitely be more worried about hypoglycemia unless I had an alert dog. I never drive without first testing, have never been hospitalized for diabetes since being diagnosed in 1959 and have never had a seizure. I try to keep my glucose levels as steady as possible. I exercise at least an hour daily. I have only very rarely needed help with a low in my 63 yrs living with type 1.

Maybe at 75, I will rethink this, but at 71 I think I am happy with my 4.8-5.2 A1c’s with a low percentage of very lows.

I guess I have no proof that having low A1c’s is better than an A1c of 7, but I would have a difficult time changing at this point without proof that I am hurting myself. I hope that I am not being foolish. I would like to stick around well into my 80’s. Hopefully while feeling as well as possible.

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55

Diabetics are today more than 10% of the population. It is a crime that there isn’t more of a built framework for its treatment and understanding from the scientists to the doctors and obviously us the diabetics. There is a huge amount of information which is unknown to all of the above 3 sectors that hamper even a reasonable understanding of how we are dealing with our chronic disease. I am only in my 13th year of diabetes at 60 years of age. And even with the massive amount of stuff I’ve learnt over the past 13 years, I know it is not nearly enough to be able to treat myself so that I will live the rest of my life with a reasonable amount of quality.

56

I have to agree it is so easy to be obsessive about your CGM. And some downsides definitely come with that.

When I realized I was upset by the warm up time or not having one, I realized maybe I was a little too obsessed? I purposely give myself downtime now from wearing one. Usually that’s when I change my sensor about once a month. For about 1-3 days. That gives me a break from the 24/7 and makes me feel like I am taking a vacay from it. I probably test more in that time frame now than I ever did before, but if I go a little higher or lower in between tests, oh well. I was nervous the first few nights and that was weird as I was fine before I ever got one. I proved to myself I don’t have to have one? That eased up the obsessiveness for me. It doesn’t mean I still don’t check it all day long though lol.

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Why do you think this ?
I have had T1D 55+ years, and my Mom is 90, diagnosed T2 in her late-50s. I would say we both have above average QOL.

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58

I would like to suggest to Sally the same thing my Endo said to me. It is not necessarily the case that all kidney disease in a diabetic is due to the diabetes. I am T1 and have been at stage 3 for over 6 years. No progression–knock on wood. My A1c guesstimate average has been 6.5ish all this time. Of course, I am older than you by decades and my endo says age is as likely a factor as diabetes. But still, non-db get kidney disease.
I agree with the ‘do the best for you’ approach. I’m getting the Tandem-Dex combo because I have been scared witless by driving at least 8 to 10 miles on a 4 lane thru my city without knowing I was in this world. A bunch of cops finally got me to stop and I don’t know why I stopped without crashing into anyone or the cop in front of me. I was not ticketed. They were all so nice I still can’t believe it. A friend had to come drive me home though and they drove my car to the sheriff’s office for me to pick up next day. I asked why they didn’t shoot me! I was still out of it when I asked that. They said they could tell something medical was wrong but then I was white, old, and gray haired. So yes, I do not want even a 1% low. PS. One of them went to a store and got me a snickers bar. I had a purse full of sugar packs and a tube of glucose tabs but could not find them.

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59

Just trying to be realistic. I know that I’ve treated myself better in the past 13 years because of my diabetes but still there are deteriorations over the years - some directly connected to diabetes and some not

60

I prefer to be more optimistic!! :smiley:
(I am also a cancer survivor).

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