June 29, 2015

Do We Control or Manage Diabetes?

Another blogger and I are having a discussion – more a disagreement in terminology between control and management of diabetes. I doubt that we will change the opinion of the other, but there are differences of opinion about diabetes everywhere and mainly about the lack of physician care for people with diabetes. And let's not forget some of the “experts” at the professional diabetes organizations that want to limit our testing for self-monitoring of blood glucose (SMBG).

If you want to read the discussion to-date go to this link. I am referred to as 'Mark', but this doesn't bother me. I left a comment and Phil felt that he needed to ask my permission, which he does not need to when the comment is posted to his other blog.

I refer to diabetes management because there are too many variables to diabetes that cannot be controlled. My blogs explain some of the variables. I will list the variables from the two blogs. You may read the blogs for further explanations.
From the first blog:
#1. Food consumption can be a large component of blood glucose reading variability.
#2. Meter accuracy can be a factor.
#3. Exercise and physical activity is another variable.
#4. Insulin is also a variable.
#5. Liver output of glucose is a variable.
#6. Emotions and stress are variables.
#7. Illness and injury is a variable.
#8. Hormones are variables.
#9. Food consumed at other meals and snacks are variables.

From the second blog:
Physical or emotional stress
The puberty variable
The menstruation and menopause variable

For those with type 2 diabetes on oral medications, another variable is the amount of insulin the pancreas may still be producing. The last variable I can think of at present is the amount of sleep a person gets on a daily basis.

With all these variables, diabetes is almost impossible to control. If a person with diabetes could control each variable then it might be possible to say that controlling diabetes might be a goal.

In his blog, Phil says that to manage diabetes, “It gives us permission to ‘fall off the wagon’ because the reality is that we will not stay on the straight and narrow everyday. I think I understand most of that line of thought. It’s a very human, forgiving approach, isn’t it?”

I don't feel that the word 'manage' gives us permission to 'fall off the wagon', but it does remind us that when a variable causes us to miss a goal, then we need to analyze what caused us to miss the goal and correct it. Sometimes a daily goal is missed because we did not have enough sleep and the stress of the job becomes greater because we are over tired.

Yes, we are human and do make mistakes, but when we do, we are not controlling our diabetes. The word 'control' means that we would not and cannot make a mistake or get too little sleep. I could not imagine having to live with the daily stress of controlling my diabetes with all the possible variables. Managing my diabetes may be a softer way and forgiving approach, but we still strive to manage diabetes to the best of our abilities.

We can still manage diabetes to avoid most of the diabetes complication. Then as we age, our pancreas may become less able to produce any insulin and we then need to consider insulin to keep our management at the preferred level.

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