The theme for Wednesday’s blog post for the 3rd Annual Diabetes Blog Week is “One Thing to Improve.”
THAT list is a mile long. How do I choose just one?
And yet, one issue pops up immediately in my mind. It’s actually something inspired by an intervention we are trying for Madeline’s sensory difficulties. During her occupational therapy sessions, she’s learning about how to identify her “engine speed.” She’s figuring out to interpret the signals from her body and mind to determine if her “engine” is too slow, too fast, or just right. From there, she will learn strategies to help her regulate her “engine” to get it as close to the just-right mode as possible.
In this intervention, there is no “right” or “wrong” engine speed. Her engine speed just is what it is. That assessment simply provides information that then guides Madeline, and us, about what steps to take in an effort to get things running just-right again.
In diabetes management, most effort is geared toward getting blood glucose levels within a specified target range. Madeline’s mind and body function at their best when her BG stays within this range. But wow, that range is elusive. She has had exactly one 24 hour period in the past 14 months during which every single BG check yielded a within-range reading. We come so close, so often. And then, it slips away.
It’s hard not to consider BG readings as “good” or “bad.” To be honest, there truly are “good” and “bad” health implications associated with these numbers. 112 is “good.” 54 or 351 are decidedly “bad”—one indicates that her cells are starving for fuel, the other reports that her bloodstream clogged with unprocessed glucose. I do want Madeline to understand that there is a problem with 54 or 199 or 351.
And yet, when we apply “good” and “bad” labels to Madeline’s BG readings, we are also assigning a judgment on our efforts to manage T1. A 98 means we did something right, we followed the rules, we guessed well, we know what we are doing. Two hours later, a big ‘ole 276 shows up, and bam, we relegate ourselves to detention to think about what we did wrong and figure how not to mess up again. Over time, these judgments transform from being about BG levels to being about our inherent value as people trying to manage a wily disease.
It’s ridiculous, these judgments. I don’t want Madeline to derive her sense of worth as a person with T1, from the numbers that pop up on the glucose meter. Instead, I want her to understand these readings as pieces of useful information—nothing more. It’s important information, yes; she needs it to make informed decisions about how to help herself feel better and how to protect her health and well-being. Still, they are just numbers.
So that’s what I need to improve. BG readings are no longer “good” or “bad.” They just are what they are.