Internalizing Our Numbers

Instagram: @diabetictruths

There's a lot of bad habits we accumulate as type 1s. Not changing our lancets, scattering our used test strips all across the globe, over-treating our lows...the list goes on. But a particularly bad habit we have is internalizing our numbers.

When I say "internalize," I mean we take our numbers too close to heart. We see them as a direct indicator of how good or bad we are doing at life. 

When I say numbers, I am referring to many things - our sugars, our A1Cs, our percentage of time in range. 

Over-identifying is something I talked about in my last post about guilt. We tend to see our numbers as a direct reflection of who we are as people. And we put a lot of stock in the numbers we are inundated with on a daily basis. We're all familiar with the dreaded trip to the lab to get our A1C checked, and the tense waiting period until we get our report card delivered to us by our doctor.

A word to healthcare providers

To be clear, numbers are an integral part of diabetes. Aside from our gut feelings, they are the only somewhat clear indicators we get in this ambiguous, ever-changing disease. Also, doctors love numbers. Numbers are data. This is definitely a factor in the development of this habit. We have the message "lower A1C" drilled into our heads by our diabetes team. We see the looks of disapproval when our numbers are higher than preferred. And for sure, we all try our best to keep our numbers in a reasonable range. There is no doubt that numbers in range keep us in better health. But numbers are also rigid. They are a spot, a speckle on the vast map of our life with diabetes. And taking numbers at face value can lead to unnecessary stress. It shouldn't be that a high A1C result delivered by a stern endo causes a slow spread of shame across our psyche.

For example, consider A1C. Anyone on a medical team who hears an A1C of 10% will not be able to stop themselves from spiraling off into a lecture of how awful you are doing. But maybe your last A1C was 14%. Or maybe your health insurance termed last month and you've been rationing your insulin. There are so many factors that are hiding behind the numbers. This is an important thing to remember if you are a healthcare provider, or if you know someone with diabetes. Don't jump the gun. Gently explore what is going on with your patient from a non-judgmental, not-knowing place. It's so easy to delegate people into the dichotomy of "bad/good" A1C," which then often translates into "bad/good" diabetic, or "bad/good" person.

Being kind to ourselves

On our end, we must work to be kinder to ourselves. In the world of social media, it's especially easy to fall into the trap of comparing our numbers to others'. It's easy to see another person's flat line on their Libre and assume they're having a great day. But, as we all know, there's usually a deeper story. Work goes into those numbers. Stress. Blood, sweat, and tears. And sometimes they're not the numbers desired.

So, the first step is, stop comparing. Focus on you, and your care. Your body is different from any other body, whether it's a fellow body with diabetes or not.

Next step, take your numbers in context. Remember they are only a piece of your diabetes. Use them to inform how you care for yourself, but don't make a mountain of them.

And finally, advocate for yourself. Don't let others make you feel badly about your numbers. They are yours to feel how you want about. If your doctor or your partner or an annoying stranger is solely focused on the numbers, speak up. No one deserves to feel ashamed of their care. We're all doing the best we can.

Drinking With Diabetes: Answers to the Questions No One Wants to Ask

Ah, alcohol.  One of the most hotly debated illicit substances in American history.  Growing up in a society where the drinking age is regulated legally but not enforced socially puts individuals, namely adolescents/teens, in a tough spot.  Many young people feel uncomfortable or guilty discussing underage drinking openly with their parents.  This is dependent of course on the parent-child relationship, and how the person was raised.  Maybe your parent/parents are accepting of drinking as long as you do it responsibly.  Maybe they hammered it into your head that it was not to be touched until age 21. Whether you fall into either of these two categories, or even if you are overseas where underage drinking (and drinking in general) is less taboo, one thing is for certain: if you are living with type 1 diabetes, you must tread carefully when it comes to alcohol.

While it's not impossible, drinking with diabetes is infinitely complicated.  It requires careful experimentation and constant monitoring.  Every body is different, therefore there is no cookie-cutter method for safe drinking.  However, some truths are applicable to most drinks and all PWD.

Bottoming out is very common.

Whether it's the next morning or an hour after your first drink, bottoming out typically happens after a night of drinking.  For me, a night of wine leads to all-night high blood sugars, then a drop after breakfast the next morning.  A night of vodka-cranberry leads to an evening of very high blood sugars, then a drop just before bed or in the middle of the night.  This can obviously be a risky situation, especially if you do not feel your lows at night.  Generally I try to air on the side of caution; keeping my levels higher and giving half-corrections.  Cautious experimentation should be had to figure out how certain drinks affect you.  In moderation, I've found beer to be the most steady course.  Typically if I give little bits of insulin for each beer, my blood sugars stay in the 200s and don't bottom out--unless I over-bolus, whether for the beer itself or for food consumed during drinking.

Snack often.

No one should drink on an empty stomach, but the risk of bottoming out runs extra high with type 1 diabetes.  When I was an infant, the diabetes educator who came to my house told my parents (because yes, they did ask about drinking even back then, as I've found many parents do) that he would snack on peanuts while drinking.  Of course, you don't want to make yourself sick by overeating.  Shy away from extra sweet sweets--not only will they make your hangover worse, they'll spike your blood sugar and make the regulatory process even more complicated.  But snacking on a bag of chips or even grabbing a late night slice of pizza can be good for soaking up some of that alcohol and keeping your sugar steady overnight.

Test often.

There's no piece of advice that I could give that is more simple or more important.  Test often.  Test every hour. At the very, very least, test before you go to bed.  The bottom line is, your judgement is impaired.  You cannot feel your highs or lows as well.  So test.  It's better to know where you're at than to be floating in BG-alcohol outer space; a complete mystery to yourself and others.  Especially test if you're vomiting.  Medical professionals typically suggest that if you're vomiting from drinking and have type 1 diabetes, you should immediately go to the ER.  This is a loaded judgement call.  But it's always better to be safe than sorry.  So again, at the very least, TEST.

Keep your eyes open.

This is another piece of advice I would give to all who are drinking, especially when you are in a new place or with unfamiliar people.  It's a good idea to have at least one buddy with you who knows that you are diabetic, and what diabetic means, if you plan on getting hammered.  However, no matter what excellent support system you surround yourself with, no one knows your body as well as you.  Therefore it's in your (and your diabetes') best in interest to keep your eyes open.  We all know how scary it is to not be in control of our bodies.  Blacking out or passing out from drinking wipes out your ability to consciously respond to your blood sugar.  Being outside of the locus of control both physically and cognitively is a dangerous place to be.

Above all, the general rules for drinking with diabetes are very similar to the rules for drinking without it:  be smart, be safe, and experiment cautiously.  If you're a parent, foster communication between yourself and your child.  Let them know it is okay to ask questions about drinking.  Zero communication means they may be more defiant, or go in completely blind.