One of my core beliefs about diabetes is that quality self-care is derived from an ongoing series of choices we’re constantly making (whether we realize it or not). Action and omission (NOT acting) are both choices. The ups and downs of our blood sugar levels are beholden to many (if not most) of our actions (or lack thereof).
The corollary to this is that a health care provider can’t really manage anyone’s diabetes unless they’re at the patient’s side 24-7. From my perspective, the primary task of the health care provider is to serve as a coach, teacher, mentor or even a role model at times. Sadly, in some cases the provider assumes the role of judge, jury, and critic.
Take home message: hands-on diabetes training, face to face (and written) education, plus personal experience construct a unique framework for how we each approach our diabetes choices and actions. That framework is hopefully always growing and reshaping (hopefully improving) itself as we gain new knowledge, experience and wisdom. “Chance favors the prepared mind” as the famous scientist Louis Pasteur once said.
A 2007 study examined the number of food choices made each day by healthy adults (WITHOUT DIABETES). They discovered that a typical adult makes an average of 221 decisions each day regarding food alone. And I'm not referring to a typical person with diabetes. [Mindless Eating: The 200 Daily Food Decisions We Overlook, Environment and Behavior, January 2007 39: 106-123].
So how would that estimate of daily food choices be affected by also having diabetes? I'm not sure it's been studied, but it certainly stands to reason that having diabetes would add even more options to consider, not less.
And this brings me to my point. How many decisions do you or your child with diabetes make each day (knowingly or not) that somehow affects the control of blood sugar? How many of those choices are made with a clear understanding of what will happen next, and how many are simply mindless actions or habits?
Mindful diabetes care is rarely child’s play. This is where we all need to be "given a break" to some degree or another, especially kids and teens. Parents often step in and make many choices for their youngsters with diabetes, as they would for other children without diabetes. There’s nothing unusual about that. It’s necessary.
And realistically, how many of those choices (no matter who is making them) reflect the best possible actions, and in the correct sequence? The answer is: no one ever knows for sure. But one thing is undeniable: we make far more choices each day than we realize. The more we can open our eyes to these opportunities the more points of control we might be able to exert on our diabetes control.
Sometimes, the enormity of our choices and how we try to arrange them reminds me of a line from the original “Back to the Future” movie. Doc Brown explains to Marty McFly the seemingly improbable sequence of events that must unfold in order for the DeLorean to return to 1985:
“Don't worry. As long as you hit that wire with the connecting hook at precisely 88 miles an hour, the instant the lightning strikes the tower... everything will be fine!”
Thank goodness tight diabetes control isn’t like time travel, huh? Although it might seem that way at times. But the movie plot is the ultimate embodiment of taking advantage of a chance event (lightning bolt), is it not?
The greatest shortcoming in our American health care system as it relates to diabetes is a lack of greater emphasis and access to ongoing diabetes education. Education, experience and training best prepare you for the unexpected.
If you don’t believe that, just ask Captain Sully Sullenberger or the members of Seal Team 6 what they think about good preparation.
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