I like ice cream.
With some foods, I never quite know what will happen with my blood sugar (i.e. pizza or a bagel), but I SWAG (Scientific Wild Ass Guess) for ice cream with a confidence that I rarely have with other desserts. Most days, I bolus my insulin like a boss for my small cup of peanut butter fudge ice cream with peanut butter sauce. The graph of my continuous glucose monitor rarely spikes or plummets for this treat; it’s a boring flat line that I adore.
On one particular day, my family and I ventured out for a meandering walk around the neighborhood. It had been a few hours since I’d eaten ice cream, and dinner was on the horizon. My CGM showed a magic number of 173 mg/dl and two arrows pointing down. We didn’t intend to be gone long.
Fifteen minutes later, the magic number wasn’t so magical anymore. Meandering became speed walking and chewing glucose tablets while the CGM alarm accused me of being low. The meter agreed: 62 mg/dl. Those glucose tabs got a chaser of juice.
My first “foolish” response was not to suspend my pump, followed quickly by not following the standard hypoglycemia protocol of checking 15 minutes after treating a low blood sugar. I ignored blaring alarms from the technology I wear to keep me safe. And then when I did finally treat the prolonged hypo, I… overtreated. The rest of the evening was spent ignoring my family and focusing on bringing myself back into an acceptable range.
This disease is not my fault. I know this. My choices, foolish or not, are my own, and when they’re incorrect and cause issues with my disease, it’s my fault. I blame myself and the guilt flows freely within me.
I’m not alone.
Michelle Sorensen, a clinical psychological associate and person with diabetes, who counsels people living with diabetes in Ottawa, shared her thoughts with me about diabetes related guilt:
“Personally, I do experience guilt about my diabetes, but have learned to better manage my thoughts and therefore control my mood. I do not think guilt can be prevented, but I think it can be reduced to a manageable level where it is productive rather than destructive.
When working with people with anxiety, I often point out our goal is not to eradicate anxiety, it is to reduce it to a manageable level. If we had no anxiety, would we check our blood sugar before driving, or before going to sleep at night? It’s the same with guilt. A little can help us attend to the tasks that need to be done. However, when it is too much, it gets in the way of coping with diabetes.”
The sheer existence of diabetes in our lives can lead us to make poor decisions, due to decision fatigue. A 2011 article in the New York Times explains that the more decisions forced upon an individual through the course of a day, the less likely the choices are to be rational or beneficial. For every choice made about dosing decisions and food choices and how much exercise, the mental reserve one has is slowly eroded. We are less likely to make good decisions under stress and the unintended consequence is guilt upon reviewing the day. Turning the guilt into a positive tool is crucial for all people with diabetes.
Learning to accept the constructive role that guilt can play in diabetes management isn’t easy. For years, the guilt I harbored about my less than perfect A1c’s held me back. I believed that no one else was having day-to-day difficulties managing their blood glucose levels and didn’t seek out support from professionals and other people with diabetes. Looking back, the shame I felt inside for simply having the disease was not productive.
Sorensen concurred: “I think guilt is detrimental to health. The longer I provide therapy to people, the more I believe in a strong mind-body connection. Guilt is from thinking about things you did wrong, or should have done better. It’s about behavior. Shame is especially destructive over the long term because it is the belief there is ‘something wrong with me’.
There is not necessarily anything wrong with anyone with diabetes, save our malfunctioning pancreases. The guilt I feel these days is fleeting. When I review the days that don’t turn out the way I want them to be because of the choices I made, I remind myself that tomorrow is an opportunity to make different choices. And perhaps, one of those choices would be a change in my basal rate for a walk after ice cream.