Diabetes is a marathon, not a sprint
I don’t think perfection is possible with diabetes.
I know that many of you will likely agree with me. But there are so many voices in the T1D community that are advocating for really extreme interventions — especially extreme for our youngest kids — all in the name of getting tight, tight control. And even if we don’t agree, we’re all victims of this in some way. Of course we’d like to chase down those highs and be in range as much as possible. But at the same time, it’s not a good life, a rich life if all we do is think about diabetes and fret over each bit of food, every out-of-range number.
I’m just not that person. Sure, in range numbers are nice, important even. Allow me to get a little defensive here: My kids’ A1Cs are respectable and healthy. It’s not like I’m advocating that we unclip the metaphorical seatbelt and not pay attention to diabetes at all. But my kids certainly aren’t in range all the time — nor do I expect them to be. Instead of encouraging them to have a perfect A1c, here’s what I’ve learned about diabetes management over time:
*Diabetes is a marathon, not a sprint. Sure, you can have a day, or a week, or maybe even a month, where you eat a clean, clean diet with nothing that spikes a blood sugar and where you exercise away any little spikes. But it’s not sustainable over time. What’s more, when your T1D kids (and your non-T1D kids) hit their teen years, they are going to be even more likely to reach for the foods that are “bad” for blood sugars— and have no idea how to manage them. I don’t want to shame them about that: I’ve seen teens with T1D feel so bad that they are eating these forbidden foods that they don’t dose so there’s no record that they’ve eaten these guilty pleasures. I don’t want to chose that for my kids.
*A1c is a lifestyle choice. I got this from a dear friend in the T1D community — and it couldn’t be more true. You certainly can choose to have (or aim for) a perfect A1c — the kind that some folks brag about on the internet, making the rest of us feel like we aren’t performing well enough. But, in truth, if you do that, it will be all you do or think about, all you arrange your life around. One 20-something I talked to about this once said to me, “I decided to go back onto shots because it feels easier for me right now. So I’m getting a B+ on my diabetes — and I’m okay with that.” In the meantime, she was traveling the world and heading for college, laying the groundwork for a rich life. I would say that that’s a much better choice than getting that A+ in diabetes. (An important caveat here: If you’re new to diabetes or your child is really young, I know that it doesn’t even seem possible to get a “perfect” A1c. And that’s true. There’s a lot of learning and a lot of growing. It’s still important to try to recognize that the ups and downs are part of the disease — and not let them tug you around too much. See the next bullet point…)
*Numbers are just information. This is something I learned when I first started attending camp, when I was new to diabetes — and I still couldn’t agree more. There really are no “bad” numbers. If your child is high, you correct; if they are low, add juice (or the carb du jour). Believe me, I know that it doesn’t always feel that simple. But if you approach it that way, not only is your stress lower, but you’re modeling something important for your kids — so they will be more likely to approach management that way as well. If you’re overly anxious about numbers, you’re more likely to create conflict with your kid as they get older. Which could mean that they will be less likely to share their diabetes reality with you. I worked with one young woman once who was so worried about highs that she never checked her blood sugar. All she could hear in her mind was that those numbers meant that she was bad. We don’t want our kids to feel like that. Sure, you can think with them about what caused the high (or the low), but keep it neutral and scientific. Help them think — not feel bad about themselves.
*Diabetes isn’t a flat line. Nope. Basically not possible. Okay, sure, you might be able to pull off something gorgeous and in range for a day (or a week), but it’s really not sustainable. (Okay: Maybe if you only eat the same food on repeat, exercise on a regimen, etc. I just don’t know any kids — or humans, for that matter — who can really pull that off.) I’ll never forget a talk I attended when CGM technology first started to become mainstream. The endocrinologist presenting showed CGM data for adults who were considered to have “good” control The whole room gasped. Instead of the gorgeous flat line we expected to see, there were lots of hills and valleys. It’s just the way diabetes is — and it’s that way even more when diabetes is in a younger, smaller body that’s growing.
We have to hold diabetes — and help our children hold diabetes — as only one part of their multifaceted lives. We have to show our children how they can have it all — a rich life, even with diabetes. And a rich life includes some cake, some high numbers, an occasional low. A rich life means there’s nothing to worry about when numbers are out of range — you just make a course correction and move on as best you can. Of course, you’re going to have days (and nights) when diabetes takes over, when the pump or CGM fails, when you so overcorrect for the low that you’re chasing a high, or when the numbers keep bouncing down below 80. But most of the time, I advocate for the rich life, one where diabetes is only a slender part of the proverbial pie.