In my previous blog, Managing Blood Sugar and a Relationship: 5 Rules to Live By, I addressed how to cope in a relationship when you have high and low blood sugar episodes. In that entry, I brought up a few questions that need answering. First off, what is emotional self-care? Secondly, when your blood sugar numbers are out of range, what constitutes good internal thought management?
Growing Up Bad
When I was growing up, I discovered that if my blood sugar was too high or too low, I was at fault or bad. I remember hiding my blood sugar results from my parents. Back then, there were no blood glucose (BG) monitors—just urine testing kits. I would go to the bathroom and pee on a strip and wait 30 seconds until the strip changed colors. If I recall correctly, blue was in range, and brown was very high. I can’t tell you how many times the strip turned brown. It was a lot. I can, however, tell you how many times I told my mother or father. I can count them on one hand; in fact, the correct answer was once.
I didn’t care to hear that I was bad. It was hard enough knowing that I had messed up and was a bad boy. While growing up, I went around blaming myself for every high and every low. This excessive self-blame was poor emotional management. In fact, that negative thinking sent me on an emotional roller coaster.
The Impact of Thinking and Feeling With Diabetes
How we think affects how we feel. How we feel impacts the stability of our blood sugars. Depression, for example, releases cortisol—a hormone that causes the release of glucose into the blood stream. We can only control a few of the factors that impact BG levels, the rest we are unable to control.
Later in life, I started to realize that no matter how hard I tried, I could not get my blood sugar management under control. I was in a cycle of “poor me” thinking. I blamed myself over and over again. I spent many countless hours trying to keep my blood sugar in range; after all, I didn’t want to be called bad.
Moving in the Right Direction
After enough psychotherapy and life experience, I realized my negative self-blaming was keeping me depressed, my blood sugar high, and was a waste of my time.
Shortly after college, I came to a conclusion that I still believe in and, as a professional diabetes-focused psychotherapist, recommend to my clients. The conclusion is that there is no such thing as good and bad blood sugar, only undesirable or desirable.
I know some of you are going, “Wait! Hold on for a darn minute here! Isn’t a blood sugar reading of 250 mg/dL bad?” Well, I am glad you asked. No, it’s not—and let me explain.
The goal is to keep blood sugar in range. I think most of you will agree on that point, but there are several other truths about BG that need consideration.
Several Truths About Blood Glucose
From time to time a person with a healthy pancreas may work out for too long and hard, causing their blood sugar to drop below 70 mg/dL. And on the other end of the spectrum, a person may eat or drink lots of fast-acting carbs in a short span, causing blood sugars to rise above 180 mg/dL for a short period. However, there are many advantages a non-diabetic has that keeps their blood sugar under tight control, which is not present in people with type 1 or may only be partly working in type 2 diabetes.
Natural insulin has two peaks were genetically created insulin only has one peak. The first of the two peaks reduces the initial impact of the carbohydrates and peaks in 1-2 minutes. The fastest genetically created insulin peak is equivalent to the second peak and happens 1-2 hours after injection.
That makes good management an uphill battle. Type 1 diabetics are ill-equipped to handle carbohydrate intake without that initial burst of insulin produced by non-diabetics.
Genetically created insulin works differently than natural insulin is one of many things working against ideal BG control. How genetically created insulin works is out of the control of the person with diabetes. With all the potential things that can cause fluctuating blood sugars, how could an individual with diabetes take full responsibility for high or low blood sugar?
It’s hard to accept that there are things beyond our control. Unfortunately, in life, there are many things outside our control like lines at the post office or a tsunami.
Things not in your control will always cause blood sugars to fluctuate out of your target range occasionally, and that’s OK. As long as you take the appropriate steps to get them back within normal range, you are doing a great job.
Diabetes is unforgiving if you are unable to see the gray. Black and white views like bad and good only cause undue stress and emotional turmoil. BG readings are just numbers to guide you on your next step in managing your diabetes.
It may be better to look at high and low numbers as “undesirable” instead of “bad.” “Bad” is a punitive word and implies that the owner of the bad number is bad for letting BG numbers go out of range. There is no gray in the word “bad,” whereas “undesirable” is more emotionally neutral.
Emotional self-care is reducing or removing negative internal thinking. Changing the word “bad” to “undesirable” is a good start. By changing negative words like “bad” to “undesirable” when your blood sugar numbers are out of range, constitutes good internal thought management.
There are many other factors aside from the release of cortisol or insulin peaks that cause BG numbers to become undesirable. I will talk more about those in future blogs, but for now give yourself a break from negative thinking and refer to out-of-range blood sugars as “undesirable,” rather than “bad.”
Eliot LeBow, LCSW, CDE, is a diabetes-focused psychotherapist. His private practice, located in New York City and is also available via Skype. LeBow, who has been living with type 1 diabetes since 1977, treats the many diverse cognitive, behavioral, and emotional needs of people living with type 1 and type 2 diabetes.
All the advice included in this blog is therapeutic in nature and should not be considered medical advice. Before making any changes to your diabetes maintenance program, please consult with your primary physician or endocrinologist.