YDMV, diabetes truth or dodge?

I’ve participated in diabetes online forums for many years. One idea almost universally accepted and cited is YDMV or “your diabetes may vary.” I prefer a pump and continuous glucose monitor to manage my blood glucose while you like multiple daily injections and a fingerstick meter. I like to limit my carbohydrates to 75 grams per day and you target 150 grams per day while we both enjoy similarly good control.

We acknowledge that human physiology, psychology, personal circumstances exist along a spectrum and the mutual recognition of YDMV allows us all to see that there are many facets of the truth of living with diabetes. Does the YDMV mantra, however, relieve of us responsibility when we choose not to step up our diabetes game, knowing deep down that we could and should?

In my case, many years ago I followed the contentious low-carb debate on this site and others. Remnants of that debate still arise from time to time more recently but a great deal of the intensity has diminished. I think the YDMV aesthetic provided a way to unify people on both sides of that debate.

I lurked on the TuD site for about a year before I signed up for an account and posted my first comment. While a lot of emotional energy was expended on both sides, I eagerly read each thread because I found a strong attraction to the idea. But I didn’t want to give up my way of eating that included bagels, bananas, and bakery goods. I had bought into the “carb-up, shoot-up” way of thinking popular in the diabetes medical advice of the '80’s and '90’s.

I was active physically, often riding my bicycle hundreds of miles each week. But my glucose variability was huge. Almost every day I went above 200 mg/dL and below 60 mg/dL. I didn’t use a CGM back then and I was lucky to avoid many close calls. With a strong independent streak, most of my bicycle riding was solo. I also lived alone.

During this time as I read websites like TuD, I took refuge in the YDMV argument and continued my carb-happy way of eating. When I received a diabetes complication diagnosis six years ago, I decided it was time to expend some willpower and give the lower-carb way of eating a trial.

My lower-carb eating efforts, like the efforts of many before me, were met with unbelievably good glucose performance. My variability came way down along with my glucose average. I also experienced fewer lows that were not as deep and didn’t last as long as before.

Thinking about the YDMV truth, I stumbled on a cognitive dissonance that took me some time to resolve. YDMV is as true as the differences between human beings. Yet it has another face that I found equally true and a little unsettling. Someone resisting change, especially change to something as fundamental to our existence as eating, could simply rationalize that while low-carbing might be the best thing for some people with diabetes, it could not work for them because their diabetes was different from others. YDMV!

I fully recognize the diversity in our experience. Children, awash in intermittent growth hormones, experience diabetes differently than a mature adult. Women face unique glucose challenges due to their monthly hormonal cycle, much different than men. People with diseases in addition to diabetes must deal with special circumstances not shared with those free of a comorbidity. In the end, however, we share some basic experiences since we’re all human beings with diabetes.

While I respect the truth that YDMV rests upon, I now conclude there is another facet to this truth. YDMV may be employed to avoid taking steps that could help with a diabetes treatment plan. I know this because that is what I lived for many years. I come to this forum to find other individuals who are like me and get my struggles. I know that we are separate human beings with our own unique differences, but in the end, we are all human beings sharing the same disease. I come here mostly due to what we share, not what we don’t.

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That’s a thoughtful post. I think some people, for any of a number of reasons, do have a much harder time maintaining good control, all other things being equal. To me, that’s the essence of YDMV. I think it is also human nature that if you seek an excuse for something, you can always find one.

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Over a much shorter period of time, I followed much of your path, @Terry4. I, too, managed terrific results on a higher-carb diet - though still somewhat limited, I suppose - and felt that MY diabetes was, clearly different. Unfortunately, in my case, I saw significant unwanted weight gain as a result of that approach, good BG numbers notwithstanding. I’ve since gone with a much lower-carb approach, but struggle with the “leftovers” from the previous patterns.

That said, I do think that there are aspects of YDMV that are clearly true. After all, there are many, many, MANY factors that can play into diabetes management and success/challenges. Difficult to change lifestyle components, for example - like type of job, location (which will mean weather differences that will affect outside “play” for instance), and family responsibilities. These things, though not “unique” dramatically alter a person’s ability to exercise, control meals, manage schedules - all of which affect diabetes. In addition, the “baggage” one brings to the diagnosis varies greatly: Some are overweight and sedentary, some have other illnesses or injuries, some already have complications that directly impact diabetes management, etc. Finally, there are genetic factors: Some people are more prone to complications, while others more resistant; some have sensitivities to certain foods or medications; some are naturally more sensitive to carbs or insulin.

Bottom line - -there are certainly many commonalities and there are certainly mental and emotional barriers to success with any given treatment plan; however, there are also many issues that are, simply stated, good examples of YDMV.

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I agree that YDMV but there are a few things that will universally improve control and those are either testing BG’s very frequently or getting a CGM, being very truthful with yourself about how much you are eating and exercising, and educate yourself, the more you know about your body and this disease the better off you will be.

For me personally it took an extreme diabetic regimen change to finally get some control, although it certainly isn’t perfect what is working for me is Afrezza, Tresiba, a CGM, and strict low carb. I wasn’t ever able to get Humalog to work well for me, every time I took a dose of it I felt like I was playing Russian roulette so I often ended up with higher BG’s than were safe because I was so wary of over doing it. My impetus for changing my regimen was I was sick and tired of being sick and tired. I didn’t have any complications and I still don’t (luckily) but living with high BG’s was a huge burden on my general well being and I simply had to do something about it.
I don’t think I ever dodged the fact that my diabetes wasn’t very well controlled I just didn’t think that there was anything else I could do to improve my control without (a) endangering my life with hypos or (b) using a pump which was financially out of the question and I really did look into it. However I am so glad that I made the push to change the way I take care of my diabetes, the quality of life I was experiencing was terrible and now I am so much happier.

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I’m a rookie when it comes to diabetes (~6 years) and even more so for the forums, so I’m probably one of lesser qualified to weigh in here, but I do think it’s a great question!

I’m a computer programmer by day, so my analytical, black-and-white mind really had a hard time wrapping itself around the imprecision involved with diabetes. I thought when I started it would be easy-- 1 unit >> 10 carbs >> 30 mg/dL. Simple. (insert slightly crazy laugh here) Not as easy as I thought… maybe I underestimated the carbs, maybe I didn’t include enough insulin to cover the protein, maybe there was too much fat and it slowed conversion to glucose down, maybe I exercised too much after eating while I had a nice dose of insulin on board, maybe I’m sick, maybe I’m stressed, maybe the site’s bad and only 50% of the insulin made it to my blood, maybe the insulin is on day 28 and it’s not as effective, maybe it’s morning and I have some sort of insulin resistance going on… Too many variables. And this is just on my mix of medicine-- other people are using different insulin, different equipment, MDI, etc etc. This is a big chunk of YDMV to me.

In addition to the variability, we’re all going to have different definitions of what is acceptable for ourselves individually. My “acceptable” might be keeping blood sugars between 70 and 120 mg/dL and I’m willing to give up stuff to hit that, whereas someone else is totally fine floating between 70 and 200 mg/dL in order to do what they want to do.

You also can’t ignore the primal nature that eating plays for (I’m guessing) most of us. When I’m stressed, had a terrible day, or just feeling in the dumps, guess which of these I’m going to pick?

… or … icrecream

That said, there is obviously some degree of willpower required here (which is the interesting angle of the YDMV question)-- if I drink sour milk I’m going to throw up; if I put my hand on a hot stove it’s going to get burnt; but if I eat that dish of ice cream there’s usually not going to be any immediate negative feedback.

Of course, YDMV… :slight_smile:

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It would be great to fit a version of this into a cartoon bubble of two people considering what to order at a nice restaurant, one with diabetes, one gluco-normal. Most people have no idea about the complexity of this extra layer of life we must live.

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Great topic @Terry4. Good reality check. I understand YDMV. And fortunately for me, I refuse to use it as an excuse to not do the right control actions. When tempted to use the YDMV excuse, just think complication risks. Dialysis, neuropathy, retinopathy, heart attack, stroke. Really? Is it worth taking the risks?
.
Diabetes is a serious painful deadly disease.
Give it the respect it deserves.
I know some diabetics through family. Some will not even check their blood sugar in the morning. Go figure.

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Love the topic and it again gets to that mental side of this disease. We can talk numbers and treatment plans and drugs and diet but it really comes down to what each of us is willing to put into it.
Back when I was diagnosed, having brittle diabetes was a common term because most of us suffered from it. I mean how could is not be brittle when you were testing urine and taking one shot a day. How any of us survived and how my parents survived amazes me.
And like many of us long timers, I have gone through the bad times with very poor control and than the light goes on and diabetes starts getting the focus it needs. We don’t all get there quickly and some are still fighting to find it. Mine was a battle everyday. That was how I viewed it.
But I still have to use YDMV in many cases. Yes, I would say 95% of the time when I get a high or low number out of my target range, I can pin point what happened. I’ve been doing it long enough to know when I missed one of those hundreds of steps we have to take for each decision we make.
That being said, there are definitely times that it just doesn’t make sense. I have the privilege of working with a number of endocrinologists due to the clinical trials I have and am in. And even with multiple doctors looking over my reports, there are spans of time that just don’t make sense and are hard to explain. Does that mean I’m not trying hard enough? Does that mean I am making bad decisions on my life style? I think it means I have diabetes and it doesn’t always play fair and MDMV. I think there are maybe some people out there who are not as dedicated and focused as many of us but many people have a hard time with life style changes no matter the reason why. I agree that there maybe some who can’t or won’t be honest with themselves and make those changes but I think if they are told to do just one thing, it could get them on the path that might make them happier and their health better. But YDMV is pretty true because we don’t all want or need the same things.
I have learned that pre bolus is the biggest tool in my toolbox to help with those post meal spikes. Yes, I could do low carb but I like food. I like the family memories and connections and big family dinners. So I make it work for me. I don’t down play a low carb diet. And I know it is probably a great way for me to control my blood sugars better but my 75% in target is good enough for me and if I miss once in awhile, I have the tools to fix it and move on. Yes, I could exercise more and do other types of exercise but my walking 10+ miles a day, is ok for me and it works. And the drugs I have added to my treatment plan, work for me and I have had good results with them. But YDMV is big here because we all know how each body reacts differently to drugs.
I love this group and have learned so much here and I hope I have helped share some learnings I have had over the years but I have left sites that get into that tone where if you aren’t on the same page than you are on the wrong page. Many of those coming here, can’t get the help some of us have. They don’t know the many things we know. Like low carb diets will make your blood sugars easier to manage even if many medical professionals don’t talk about it. Or maybe introducing a type 2drug into a type 1 treatment plan might help. But their medical team doesn’t know about it.
So I think YDMV is not a bad thing to say because for many it does. It could be, they don’t know any better, or they are new to the disease, or they got some misinformation or maybe they are suffering from depression and really feel there is no answer to the madness that is diabetes.
I know, i’m On my high horse here and I’m sorry but I must say I have sat through many, many workshops, classes, group therapy sessions and I have heard it all. And I know we all care here and we want to give the best support we can. It is a slippery slope this could head down. There is really enough blame and shame to this disease.
My diabetes may vary from yours and my diabetes may (and does) vary from my own. And just when you think you have all the answers, something happens that sends it spinning out of whack. So YDMV, yes it does and sometimes daily!
Love you all terribly and completely because the care and concern you all have is great. Just don’t forget what it was like when you were new to this or you didn’t know any better or you thought it was hopeless.

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I so agree with you, Sally.
When we start on our diabetic journey we are given instructions that we tend to view as absolutes. But everyone is different, some people are very sensitive to carbs and some not so much. The real problem is that we are not told about restricting carbs until you find your balance. The other problem is that it needs a deal of bravery to buck the high carb/low fat mantra that we have been following for years. When I told my doctor my good numbers were due to low carb he was horrified. I don’t discuss diet with my doctor any more.
There is very little I can do as a T2 to adjust my blood glucose, I prefer to keep things going as well as possible with diet and exercise plus medication, just tablets for me.

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For me that concept didn’t arrive until about 2003 when I finally got on basal-bolus MDI after 20 yrs handcuffed to R/N. So it has always seemed kind of alien to me. I think you’re right that low-carb (or LCHF) diet is the quintessential YDMV issue, and partly for historical reasons. It’s only the advent of newer insulins and pumps that open up these choices and make this a question in the community at all.

I remember when I first heard “you can eat what you want, you just have to dose for it,” it was with a mixture of release and apprehension, kind of like the cliche about how people being released from decades in prison feel. I’ve definitely enjoyed indulging once in a while, but I’ve always gravitated back to keeping carbs to a minimum, partly because of that long indoctrination but also because it’s just, well, simpler.

And I think that’s the fundamental thing. For me it isn’t a matter of principle, or ketosis-inducing diets; it’s just that it’s almost impossible to get doses exactly right–I always seem to under- or over-shoot, or not pre-bolus far enough ahead, or too far ahead–and the more carbs I eat the more time I end up spending dealing with the results, and my personal preference is to keep that kind of noise to a minimum. I’ve explained it that way to endos who were pushing me toward eating more carbs, as well as to non-D friends/acquaintances when the topic of “You can’t have that can you?” comes up. I can, and sometimes I do, but on the whole it’s just a lot easier if I don’t.

Because it’s simply a reality that artificially administered, subcutaneous insulin, as it stands today in spite of all the advancements, is still a crude substitute for a fully functional endocrine system. If the baseline is “not injecting any insulin,” i.e., having a healthy, normal pancreas, it’s almost a truism that the closer you can get to that, the less trouble you’re going to have with it. YDMV certainly applies to the question of where you make that trade off, but it is universally the case that we all have to make it.

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Very true. The path of straight and narrow is not a popular path. Human nature. But success is at the end of this path. Let’s go!

This is important. It was on my mind as I considered writing on the topic. The last thing I wanted to do is to marginalize people and make them feel estranged from this community. It’s a delicate task.

In my experience, I could see that my reluctance to adopt better treatments cost me a few years of benefits that I could have accrued. How much did that physically cost me? I don’t know but once you reach the threshold of complications, I think every day matters.

I guess this is what many parents face in the choices they make. How do you balance providing a loving, warm, and supportive environment for your child while also providing critical discipline that may not be understood by the child in the way it was intended by the parent?

We are not children and parents, however. We are peers and we must honor each other’s autonomy. This is a difficult balance to strike.

Perhaps the best social model we could try to emulate is the one of good friends. Sometimes friends must communicate things that can hurt. But if taken the right way, it can stimulate growth and provide a mutually satisfying path forward.

I definitely do not want to be part of a community known for harsh judgments and a clique mentality.

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You distill our common challenge well!

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At first I read that as "put up with," which is also true :wink:

I mentioned above being on R/N for faaaaar too long. But even today it has its fans. That’s one of the places “YDMV” comes in handy for me, because I really want to challenge people and tell them how liberating it would be for them to at least try a Lantus-Novlog MDI regimen. But there are a few, fairly regular participants here who say they’re fine with it and don’t want to change, so YDMV, even if the thought of taking that stuff makes me shudder.

OTOH, we do run into some actual misconceptions that need to be cleared up just so people know what it is they’re actually doing. There was a person who was struggling with what seemed like erroneous advice from her physician a while back, and people were advising her that she needed to do some basal testing, a concept that she was resisting because she didn’t seem to understand what the term actually means. Which I mention not to embarrass anyone but simply as an example of something where YDMV doesn’t apply; you actually DO need to get certain factual things straight. If you think the world is flat, it’s not a matter of “opinions differ.” I’ve been corrected that way myself here (as a relative newcomer to pumping I had a completely wrong idea about what programming a “dual bolus” does) and I’ve really benefited from being set straight.

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@DrBB
Agreed.

My issue often lies with separating facts from opinions. Too often they are blurred and confused either intentionally or from honest misunderstanding.

(And somebody claiming something is a FACT is often the first sign it is not. Not always.)

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Any common trope can be misused as an easy out or excuse. The fact that there will always be some people who abuse it that way doesn’t render it any less true.

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To start - nice summation, Terry4; when I saw the title, I was expecting something more aggressive. I was dx’d in May 1966… and raised on N and R and STRICT dietary controls… I didn’t start using modern insulins (lantus and novolog at first) until the late 80’s, and never participated in an online forum until about a decade ago. I never took the “YDMV” trope to mean anything other than the primary tactics (carb control, balanced diet, exercise, and meds) may have differing degrees of effectiveness for different people. Of course - I majored in biochemistry and am familiar with the fact that everyone is a unique biochemical being, so there’s no reason to expect that the combination of x carbs with y units of insulin (or any of the T2 meds) and z minutes of exercise will have the same BG level result in everyone. EACH of us DOES have a different response to the insulin we use (if we use insulin at all - obviously, most T2s don’t) and the exercise we get (which also varies in terms of intensity and duration - my 45 minute hike along a mountain ridge in a local state park may not be as intense as your 20 minute bike ride). So I’ve never seen YDMV as an excuse for not following the basic facts… exercise will help lower BG, and improve insulin sensitivity; carbs raise BG; insulin will lower BG. For me… from there, YDMV - how MUCH your exercise improves your insulin sensitivity will be different from everyone else; how MUCH your BG rises from consuming, say, 15g of carbs will vary from someone else; and so on. I guess I’m too late to the discussion to be aware that YDMV was an excuse for “eat all you want, just dose for it”. But as David_dns commented… any trope can be misused… or as my dad put it… any tool can be used as a weapon. That doesn’t make the tool off-limits for its proper use. Just an observation - thanx for the balanced perspective.

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Not referring to anybody specific nor posts on this thread but this is a concept which some people truly do not understand. Whereas for yourself @T1Wayne you would see this as blatantly obvious and the truth, for some - they just are not going to believe it. That being said, I certainly hope the majority of people have an inherent understanding of this.

In terms of that, it is also important to realize that some people will be very new to a diagnosis or may have received horribly incorrect education during diagnosis. These “basic facts” as you mention are worth repeating. Being able to provide very simple and concise points to start with have a huge value. Obviously everybody is not at the same point in terms of their education. There is always a starting point.

lol - Jump in.
I am a firm believer in eating what you want and dosing for it. Disclaimer - I come from the perspective of a Parent of a Child/Teenager with T1D. I believe this is an entirely different perspective in many regards.

We had an outstanding education from one of the top institutions in the country during initial diagnosis.
The approach we were taught was that it is not nutritionally sound to feed your child cake and ice cream with a soda chaser everyday. Nothing to do with D - simply not nutritionally sound. But on the other hand, this typically is done periodically with most children (ie - parties) and there is no reason the child with D should be different. Yes - we can dose for this. Telling your child they can never go to a party OR that when at the party they can not join in with the other children has the potential for longer term damage of another kind. I look at life as a balance. We can not go “hard core” on one aspect without impacting a different aspect.

The education we received and which we follow is to eat a healthy diet. Which does not mean never eat what is often referred to as “junk food”. For a child (and now teenager), the reality is that “junk food” simply “IS”. At this point, rather than deny the reality, we have the tools and the education to handle this. That being said, purchasing “junk food” at the grocery store to bring into the house is not a part of our typical routine.

YDMV - I entirely agree with the concept. I believe it allows discussions such as this entire forum to function.

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@Tim35 - thanx for the thoughtful response. And for demonstrating the “at” function here. Just to expand on one of your points… I WAS the child/teen (and drove my parents nuts at times - as is a teenager’s job), but in those “olden days”, rigid dietary restrictions were still the standard of care - as a result, many T1 children from those days grew up “under-statured”. We didn’t grow as tall as we should have because our dietary needs were not met; as a result, I find myself advising newly dx’d parents of T1 kids to be sure to talk to their docs about making sure they’re kids are getting the nutrition the need for GROWTH, not just survival; most folks have no understanding of this, and all too often, T2 tactics (which limit food intake) are utilised to minimize insulin need - just when a kid’s body is trying to grow (which requires calories, carbs AND insulin). I was 5’2" at dx’s at age 11; I’m now 5’4". My dad was the “runt” of the family at 6’; his bro and dad were 6’4", and on my mom’s side, her dad and bro were 6’6". I simply stopped growing - because in those days, there was no accommodation for growth - just glucose control (using urinalysis tests, which are of course, nearly worthless). Good luck to you and your Teenager… and be sure (s)he gets all the balanced nutrition needed!! :wink:

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Salley you are wonderfull with the way you have handled it up to now. I have been through this a number of times but kept going now for 68 years and still looking ahead ???
Why should a nice person like you stand down, I want to see you in another 10 years, Cheers