The Conundrum of Control

I found a very nicely written article - written by, of all people, a non-diabetic - summing up a lot in just a page. I found it valuable because it gave me some insight on how friendly, but nonknowledgable, people think about diabetics. But it also is probably applicable the other way around - it can help a friendly but nonknowledgeable person gain some insight. Here’s an excerpt:

Diabetic or not, no one is an expert about your life except you. No one can control you and, by proxy, no one can control your diabetes. The beauty of diabetes, as my young patients taught me, is that control is what you make it.

Complete article linked at A Sweet Life.

I think that “control is what you make it” is a bit of an oversimplification? I think that’s a decent suggestion for perhaps a newerbie but how would that work for say a person struggling with various control issues? Maybe that particular “program” works well but what about people like our many friends here who, for whatever reason, aren’t getting the advice they need from their doctors?

Plus, donuts are for breakfast, not for dinner!

The article (to me) was not so much about the medical details control, but more about the overall attitude towards control.

You and me, when everything is working right, might be trying to shave 5 points off our average bg and get from 105 to 100. But control to someone who is struggling to bring A1C from 11.0 to 10.0, has to fit into the perspective as well. And I think that essay can fit either, and perhaps best of all, can explain to a non-diabetic, how control is such a slippery subject. i.e. someone might think that if my average bg is 105 that my numbers all fall between 100 and 110. But that’s far from the truth!

Excellent article!

I agree that the article is a good sense of the value of goals however I am always saddened by TuMembers reporting that they are sort of shooting at the same # every day, don’t seem to have a “plan” that counts carbs and things of that nature. I am sympathetic to them, since they are kind of rolling along like they have been but, at the same time, I have a 12 year old who is probably more than capable of at least the counting/weighing/ math part of it and, were I to push her, could probably do a pretty decent job keeping track of all of the wacky stuff I do w/ the insulin too but, at the same time, the medical people involved, either at the request of the parents or because that’s how they roll, aren’t pushing the patients to the logical step of using widely avaialable tools and pushing themselves to improve their numbers? I don’t feel like I do a lot that’s beyond “normal” practice in terms of managing stuff, I count, weigh adjust, etc. constantly but I see posts from people in every cohort, young/old/T1/T2/active/not active/ etc. saying “I can’t [reach goal, get numbers to behave or whatever]” which often, after we discuss it a bit, turns out to be that the doctor says “you should do this. I don’t believe in [counting carbs, giving you a pump if you don’t meet my A1C goal, giving you a CGM unless you have hypos all over the place or whatever…]” which gets in the way of patients doing stuff they might be able to do to take care of themselves and, most importantly, improve their attitude by showing diabetes who the boss is.

It’s easy for a “social worker” to say “you have to control this” and, if she’s in a good, proactive health network that takes care of their people, those people will benefit from what amounts to a superstructural process of having an admirable goal to achieve control. Unfortunately, the people who don’t get the coaching/ support/ assistance or simply prescriptions that would benefit a patient are left out because the “National/ World* Standard of Care for Patients with All Kinds of Diabetes” sucks and there is no broad intiative to improve it.

*= I can think of a few people from other countries also reporting problems w/ care.

I think the article was right on! We have to choose, every day, to manage our diabetes - as well as the many other issues we each face. The point is we have to accept ownership of our health.

I agree with AR that “control is what you make it” is over-simplified. I do think you need to put the effort or you won’t get too far. But I also think we are like moving targets and there are still a lot of things that we can’t control – hormones was one thing listed in the article. I have seen T2s ask to be put on insulin and turned down. I have seen T2s say their doctors cut back on their meds when they finally reached a good A1c number. I have seen people having trouble with Lantus and their doctor refuses to give them a script for Levemir. We are still at the mercy of doctors writing the script for the stuff that we need to get in good control. Not everyone lives in an area that they have 100 different doctors to choose from and can keep changing until they find someone that will help them.

Then you throw in people with other health problems. People with asthma or other conditions have to take steroids – they get to choose between being able to breath or have good control. I have gastroparesis and found absolutely no help from doctors. It wasn’t that I did not want help – I asked several doctors for help and got nothing. I was working 12 hours a day and did not have time to sit on the internet looking for information. I know someone that went to the Mayo Clinic and was told she could never get her A1c below 7 with gastroparesis. If that is what the Mayo Clinic is spitting out, where is the hope for the rest of us?

Yes, you can try to make the best of it but sometimes your hands are tied and there is nothing you can do about it.