Control Freaks

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I was just scanning through my daily google alerts and noticed a ton of articles from the Los Angeles Times about diabetes, from a basic primer on diabetes to a multimedia illustration of how diabetes affects blood sugar to pieces about lifestyle changes and  incretin therapy (both relating primarily to type 2). It seems that they’ve chosen October 26th as an unofficial “diabetes day.”

But they also ran an interesting piece last week about the chasm diabetes can cause between patients and doctors thanks to our never-ending quest to achieve “control.” Earlier this weekend I wrote a post about my own issues with control — about how I am constantly fending off an auto-immune attack of self-hatred every time my glucose goes too high. I think the LA Times piece makes a nice complement.  Here’s an excerpt:

The concept of control is rampant in healthcare. With puffed chests and reassuring certainty, the medical establishment regularly touts, “She’s got her cancer under control,” or “He’s learned how to control his Tourette’s syndrome.”

But what most people don’t realize is how the concept of control is unusually emphasized in the diabetes community. The medical establishment has gone so far as to create a new definition for the word. When doctors ask someone with diabetes, “Are you in control?,” they mean, “Are your blood sugars balanced?” and “Are you following the doctor’s orders?”

Most people are also unaware of the treatment that people with diabetes receive when their blood sugar levels are “out of control.” It’s the dirty little secret that nobody wants to talk about. It’s the thing that medical professionals don’t want to admit. People with diabetes of all ages, from all walks of life, are regularly reprimanded, shamed and degraded by healthcare professionals when they don’t meet medical standards for normal blood glucose levels. . . .

What’s driving all of this? How did we get to the point where doctors have come to view diabetics as errant children in need of a good spanking while patients are scrambling to hide their report cards so that they don’t get the belt? . . .

What’s ironic is that healthcare professionals readily acknowledge that there are a multitude of factors that impact a blood sugar levels — emotions, stress, illness, hormones, insulin absorption, metabolism, etc. Yet, there’s almost always an assumption that if one’s blood sugars are not “in control,” it’s because the person is ignorant, incompetent or “noncompliant.”

I find the idea of diabetic control endlessly fascinating — and frustrating. As diabetics, we need to be “in control,” to see our doctors regularly, eat healthily, exercise, and do as much as we can to keep our blood sugars in check. But when it comes down to it, we’re not the ones in control — just as we weren’t in control of whatever screwed up our pancreases to begin with. There are times when, despite our best efforts, there’s just nothing we can do.

I think both these pieces invite a much bigger discussion about the idea of control. What do you guys think?  How do you define “control”? How does it affect your behavior and the way you think about yourself? And how do you balance your quest for control with living the rest of your life?

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Jeff Nobles

Catherine, I always enjoy your posts and am glad you are blogging here. I’ve had type 1 since 1973 and my definition of control has certainly changed since those days of one daily NPH injection and urine testing.  I wear a pump (since 2001) and am about to begin wearing a continuous glucose monitor. Even so, there are a number of variables that take me outside my target range regularly — insulin resistance, willpower, food choices, pump and infusion site problems, mental mistakes, physical activity, and the occasional bG that has no easy explanation.  If I thought about the causes… Read more »

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