Bubbles and Shells
One of my roles as an endocrinologist and certified diabetes educator (CDE) is to educate and support my patients' diabetes care skills in ways that help them understand how to best problem-solve and troubleshoot daily diabetes dilemmas. It's all about fulfilling my mission of empowering persons with diabetes.
We all have a set of values and beliefs we use to interact with our world. There is a phrase (not necessarily a complementary one) called "living in a bubble". It means you see or interpret the world more narrowly than others. Sometimes very narrowly.
I'll be first to admit that I have lived in many different "bubbles" over the years. Perhaps my opinions or attitudes on social issues diverge from those of my friends. We all live in a multitude of unique bubbles of our own creation.
With diabetes self-care there are a number of common 'bubbles' I discover in my patients. I aim to expand the size of their bubbles by sharing new skills and knowledge. Sometimes I even burst bubbles. My experience as a person with diabetes comes in handy since it makes me equally familiar with diabetes success and failure.
Here's a good 'bubble' example of my own. Following my diagnosis in 1966, I received a single daily insulin injection for 14 years. When I first saw an Endo in 1980, he discussed changing me to multiple daily injections. But...in my bubble, I saw NO need to change. I felt fine (I thought) and vociferously proceeded to bargain my way to keep my daily shots to a minimum. Why? It was all I ever knew.
After some time, I compromised and agreed to take two shots daily. My first A1C was over 10%, but I had no idea what that meant. Over time my control did improve. Slowly I started to feel more energetic and clear headed. This experience began to expand my bubble.
As I spent more time with the diabetes educator, I was able to work through my personal resistance to change. I stretched my bubble further until it finally popped. Ultimately, I suggested taking 3 injections daily and used that approach until I chose to try insulin pump therapy in 1981. Bursting my bubble made a huge difference for me: literally changing (and extending) my life. It took time and patience on the part of my diabetes team. It’s also the reason I chose to become a diabetes educator: the ability to change the direction of someone's life with diabetes.
I don't know if I truly 'pop' someone's bubbles. That's tough. I do believe we (as persons with diabetes or those caring for loved ones) must pop our own bubbles from the inside as I did. I just aim to be a bubble expander and who knows, maybe it gets so large it pops by itself. Who knows?
But some of us have lived in bubbles for so long that they’ve hardened into thick shells. Nothing I or anyone can say or do will dissuade some persons to let go of a certain care belief or certain "fact" that explains their universe of diabetes. I suppose if that bubble provides the skills needed to live well with diabetes and attain a full and productive life, who am I or anyone else to challenge that. But that’s not usually the case.
One common hard shelled bubble I encounter involves carbohydrate counting and teens. I see many families and teens who dismiss any suggestions to visit with the diabetes dietitian. "We are good with carb counting" is a common retort. I try to crack their shell by discussing with them a 2009 study conducted at the prestigious Barbara Davis Diabetes Center in Denver.
In this study, teens were asked to assess the amount of carbohydrate in 32 foods commonly consumed by their age group. Foods were presented either as food models or as actual food, with some items presented as standard serving sizes and some self-served by study participants. They underwent a thorough training process to learn to carb count. Very cool.
After one month away at home, the participants returned and were retested. Amazingly, only 23% of teens estimated daily carbohydrate within 10 grams of the true amount despite selections of common meals. For dinner meals, individuals with accurate estimation of carbohydrate grams had the lowest A1C values.
Take home message is that carb counting is to