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The definition of "controlling diabetes"


As described in the book “Sugar Surfing”, control of one’s diabetes always exists “in the moment”. This means that “control” is truly a DYNAMIC process. There is no ‘reservoir’ of diabetes control dispensed by a doctor. What we define as ‘control’ is the ongoing result of numerous choices made by the individual over time.

At one point in my professional life as an endocrinologist I believed that a doctor could really ‘control’ another person’s diabetes. This was an incorrect assumption. There is no way a doctor can truly “control” anyone else’s diabetes. Why? Because a doctor can’t never make another person’s choices.

If we define diabetes control based on the trending of one’s blood glucose levels, then the range in which our sugars exist ultimately defines our “control”. Therefore, aiming to keep one’s blood sugar trend line (using a CGM device) in a near-normal range is a daily objective.

It’s an inescapable truth that diabetes control truly exists in the moment. This forms the conceptual basis of Sugar Surfing™. Many of you reading this post have embraced this idea, or were already subscribed to this concept beforehand.

One’s state of blood sugar control is always the result of recent actions and omissions. These include actions such as the last basal insulin injection or the basal rate delivery of an insulin pump, food consumed, stress experienced or physical activity. The effect of snacks, meals or stress which might raise blood sugar levels is constantly offset by the effect of rapid-acting insulin doses (boluses)and physical activity. The actual insulin dose amount, or even its timing, also plays a role. And don’t forget the ever-present companion we call ‘stress’. It can influence blood sugar levels in either direction.

Type 1 diabetes self-control exists in a ‘time window’ which extends slightly backwards and forwards from the present. A person’s blood sugar control extends slightly backwards to the point in time when the last basal insulin dose was injected (or 2-3 hours of a basal insulin infusion through an insulin pump) plus the sum of the all self-care choices which ensued afterwards.

When looking forward in time, diabetes control extends from the most recent decisions and choices made based on an ongoing self-review and analysis of BG trends or values (collected by a meter or CGM device). Control is influenced by any actions or omissions in self-care which ensue. However, this effect only extends a few hours ahead.

Why is this important? Depending on how you define diabetes control, it’s actions and omissions made “in the moment” which shape and propel one’s blood sugar levels. The empowered Sugar Surfer understands and embraces this truth.

This is an immutable concept in my opinion. Choose how (and if) you wish to embrace it.

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