Wednesday, June 25, 2014

"How Are You Managing Your Diabetes"?

Are you asking what devices I use? A glucose meter, an insulin pump, and a continuous glucose monitor (CGM), mostly. Sometimes my phone joins the party. I know that the tools I use are not indicative of how "bad" my diabetes is, but I recognize that you may not know this.

Are you asking about medications? My insulin pump uses short-acting insulin (Humalog), if that's what you're wondering. I know that insulin is a scary medication to have to use, and I've had to reach a place of acceptance. I don't expect you to realize that on your own.

Or maybe you want to know my A1C, to give some indication of how "controlled" I am. That's what the measurement exists for, right? To be able to judge? I clocked in at 7.0 last week. Does that tell you everything that you want to know? I know that it won't, but I acknowledge that this is the easiest way for you to find an answer to what you think your question is.

It could be that you're wondering how many severe glycemic excursions I experience; how many times my postprandial readings fall outside of a specified range. Maybe you wonder what my fasting numbers look like. They may tell you something, but with the absence of context I know you won't be allowed to see the full picture.

Do I count every carbohydrate accurately? Do I bolus with precision and punctuality? Do I make smart food choices? Not all the time, no. But I strive to be kind to myself and realize that there is no "perfect" when it comes to diabetes.

Perhaps your curiosity lies in my abilities - do I feel up to the task? Do I wake up each morning motivated to do all of the things I must do to care for myself? Do I actually live when I live with chronic illness? Those are valid questions.

It is said that living with diabetes is a test of patience. This is true for more than one reason; while the disease itself tests me daily, the conversations and questions it inspires in my daily life allow me the privilege of practice: to not bristle at a sharp comment; to swallow the instinct to be defensive; to remind myself that someone's questions about my diabetes are always, always shaped by the experiences that person has had in their life and any misdirected hate has actually nothing to do with me; to practice kindness with both myself and with others. Each question is a chance to remind myself of our shared humanity and curiosity and to respect and (when warranted) educate those around me.

Part of what is so challenging about advocacy is the vulnerability required of those sharing their stories. Part of the reward, though, is that the process allows us to practice and become better human beings.

Too deep? I don't think so. We're getting better, and we're doing it together.


  1. What a loaded question that is - and your discussion is spot-on.

  2. I really, really like those last two things you said. And all the others too. But especially those last two. To borrow a 60's phrase, that's really where it's at. Thanks

  3. The "privilege of practice" : so true. With other people and with all the other (counting carbs, dosing insulin, treating lows, managing bgs during exercise...). This is a great post.

  4. You are so spot on.

    I wish I had read this before yesterday's appointment with a substitute pediatrician whose criteria for ascertaining how well we manage diabetes is whether we are or are not "dipping his urine for glucose."

  5. Wonderful post. So full of truth.

  6. I get that question from some of my doctors who are well-meaning, but don't quite under what it means. My eye doctor wants a quick number so he can quickly escape the room until some day when he sees a problem in my eyes. My internist is convinced that a bedtime snack will solve all of my problems. My dermatologist realizes that I am different from her Type 2 patients, but is not quite on the same page yet. I am happy that I am still capable of being the one in charge, but it's scary to think of the day that I will need help.

    Wonderful post, Kim.

  7. Insightful, honest, and real. Every day is an opportunity to allow this disease to help us grow into who we're suppose to be. Thank you for the post.

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