There are people who know what they’re supposed to do, and they do it. Then there are people who know but don’t do “the right thing.”
I am in—I must confess—the latter group of people when it comes to diabetes. It’s not a new thing. I’ve mentioned this issue in passing a couple of times here and talked about it with very close friends (with and without diabetes) before. I even tried to tell my endo about it one time when she asked why some of my readings were unexpectedly higher later in the day, but I think I might have been too vague on the issue, and she didn’t quite get it. I always assumed it would get better. “One day I will have insulin pump settings and carb counting skills that I believe in,” I told myself. “Then I’ll live in a new golden age of diabetes, A1c- and confidence-wise.”
It’s not that easy . . . not for me at least.
I’ve done the testing, and I’ve seen that the settings work. I mean, just look at the CGM trace during a basal test a couple of months ago:
But insulin still scares the hell out of me! Seeing a big number in my pump’s bolus wizard is daunting and triggers a thought process like this: “12 units of insulin is enough to lower my blood glucose 600 mg/dL without food, and my BGs are really good right now, so there’s not a lot of wiggle room. . . . .” So I often dose too little for the carbs I
know suspect are in food, and then I have to chase the high blood glucose later. Frequently, when all is said and done, I end up correcting over several hours with the insulin that I should have given initially.
Couple this with defensive eating. What’s that? Consider a graph like this one, which shows my BG heading downhill precipitously.
Is my blood glucose going to stabilize, leveling off as it approaches the target like it’s supposed to? Or is it going to keep speeding downward until I’m hypoglycemic? In this instance—as in most that I’ve seen recently when I’ve forced myself to just let it go and see what happens—it’s the former case; my meal bolus, correction, or exercise brings me right where it’s supposed to. Nevertheless, I have to work really hard to hold off the temptation to preemptively treat a low (which might never arrive).
“Why do I do this?” you might ask.
Because having hypoglycemia sucks in a way that’s hard to imagine. Because I don’t want to be in a situation where it might embarrass me—or worse. Because I don’t like the feeling of losing control of myself that it brings. Because I don’t want other people to worry about me if I go low too often. Because I don’t like relying on other people or inconveniencing them. Because I’ve been hypo a lot in my post-diagnosis life, and I’m not very confident that I can do things the right way.
Basically, because being brave is hard. It takes mental strength and faith, and it is very draining to be constantly pushing oneself out of a comfortable zone, even when it’s not a good place to begin with.
But I’ve been here before in other diabetes contexts, and I find it very comforting to know that I’ve succeeded when I put my mind and courage into it. Here’s what I wrote about it a year and a half ago:
For the longest time I’ve only been making haphazard changes to my diabetes management for exercise. Now is the time, though, to treat diabetes like swimming. I have to jump into the deep end. Or rather, I have to jump into the open water where I can’t see the bottom and where I’m far away from land and where all that I have around me is the water and my insecurities and the hopeful knowledge that I can do this because I’ve done this before. I have to gather up my courage and take a risk, make the observations about insulin and food and exercise, bolus for things I eat before exercise, and eventually (hopefully) arrive at a place that’s more manageable (if not always comfortable).
To quote Mark Twain, who would totally have been a BA-D-Mofo: “Courage is resistance to fear, mastery of fear—not absence of fear.”
So to that end, I’m doing a bit of cognitive behavioral therapy
every time frequently when it’s time to make a “difficult” (but utterly routine) diabetes decision. If I find myself hesitating about bolusing, I ask myself why I don’t want to give the full amount. If I catch myself thinking I should eat to prevent a low, I ask myself why I’m prepared to do that. Usually the answer to the question is based in fear and not fact. I then remind myself that 90% of the time bolusing or not eating has worked in the past, and then I do the right thing (usually). It’s getting easier, and hopefully these decisions will be part of a successful, unconscious habit soon.