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"Fine tuning my diabetes"

This is an overused phrase. It's overheard when people discuss theirs or their child’s diabetes. It’s classically said in reference to a static insulin dose, insulin basal rate setting, or insulin/carb dosing algorithm.

‘Fine tuning’ is a metaphor referring to the act of adjusting an analog radio channel to the best possible frequency to receive the clearest audio signal from a particular station. I used to be an amateur radio operator and recall many hours adjusting the tuning on my receiver to catch a radio signal from the other side of the world. In my opinion, fine tuning is an incomplete metaphor for managing diabetes in a dynamic world. Why? Radio stations transmit their signals on fairly narrow frequencies. Often, non-Sugar Surfers equate static insulin to carb dosing formulas, pump settings or correction algorithms as cornerstones of good glycemic control. By this thinking, all that’s needed are a measured blood sugar value and/or an accurate carbohydrate count of the food or snack to be eaten. This overly simplistic approach is how the majority of persons with diabetes are first taught about self dosing insulin. Many persons never move away from this. Sugar Surfers respect and understand that their ability to effectively steer a glycemic trend-line requires more than a few fixed formulas driven by a couple of data inputs or estimates (BG level and carbs). Diabetes self care is always multi-dimensional. It’s constantly in motion. General rules are helpful, but static formulas lack the depth to anticipate every source of unpredictability that persons with diabetes routinely encounter in daily life. Fine tuning infers that making a few changes to static dosing inputs somehow results in stability. However, dynamic systems are by their nature prone to change. They are designed that way. I propose the concept of ‘fine tuning’ be viewed as modifying one’s critical thinking and decision making skills to match the situation. It’s this type of flexibility which underlies a sustainable pattern of optimal glycemic self control. A surfer can’t fine tune how she rides every 30 foot wave. Waves are a unique happenstance. Similar, yes, but no two waves will ever be exactly alike. Her surfboard may be well balanced, but her stance and balance must constantly shift as she moves forward towards her destination. Ocean Surfers acquire tactics and methods to achieve their ultimate goal. Sugar Surfers do the same.

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