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Sugar Surfing Lesson #18: It transcends

Sugar Surfing™ is a method for reaching and attaining personal empowerment to live well with diabetes: yours or your loved ones. It transcends carb counting, low carb style nutritional approaches, insulin delivery methods (pumps/pens/inhaled), carbohydrate dosing ratios, correction factors, basal rates, insulin types, loop protocols, and just about everything else. The belief in a singular path to effective diabetes self-control is wrong. Diabetes care has always been a process, not a product. Moreover, choice drives process. This is at the core of dynamic diabetes management.

As in life, the concept of right and wrong is pervasive in diabetes care. So much so that we all too often include the next step in that line of thinking when missteps occur: guilt and perhaps even shame. I personally struggled with this for years as a person with diabetes and as a diabetes health care provider. Sugar Surfing teaches us that there is no morality in blood glucose levels (there never was). We make our choices and we experience (now view with a CGM) the results or consequences. This occurs constantly with or without our awareness. Sugar Surfing aims to remove the “good” and “bad” from the diabetes discussion. By removing moral negativity, we can more clearly make choices and quickly learn from them. To make better plans and choices the next time. This is how self-improvement happens.

Sugar Surfing also acknowledges the individual with diabetes. Choice defines us. Of the short list of actions or behaviors listed in the first paragraph, these and others are chosen/used (or not) in the course of a single day. The hubris of modern diabetes management philosophy is that we can and should be able to control everything. The reality is we cannot. However, we now can see and respond to blood sugar changes as they happen. That allows us to develop the best individual strategies, methods, tools to minimize the impact of blood sugar flux and drift on us and/or our loved ones.

In Sugar Surfing, the proactive (e.g., meal and insulin plans and activity schedules) and reactive (e.g., blood sugar corrections and pre-emptions of impending highs and lows) live in balance (harmony might be too strong a word) with each other. Under ideal circumstances, half of our day is what we ‘plan’ and the rest is how we react or respond. In diabetes care, we cannot regulate or lock down many critical forces that relate to blood sugar control. These include some of the following:

  • Rate of stomach emptying in people (it varies all day in people with/without diabetes)

  • Overall rate of digestion of food (it varies based on many factors)

  • Impact of stressful events or unexpected illness (known or unknown)

  • Molecular integrity of the insulin we infuse or inject

  • Exact amount of physical exercise or activity we engage in from day to day.

We must accept that we lack full control over many of the internal and external forces in our lives. This will always be the case. Feel free to add to this above list, as it is not inclusive.

Sugar Surfing embraces the inability to manage blood sugar levels “perfectly”. This has always been a false idol among many discussed in the book. By acknowledging imperfection, we can more quickly move on to living fuller lives with diabetes. Most of all, guilt about the ‘imperfect’ should not be a primary driver of diabetes self-management as it is a cruel taskmaster.

Extremism is certainly a seductive choice, especially if driven by peer pressure and guilt. Extreme options often offer absolute solutions or results. Ironically, extremism itself acts to limit choices in favor of a singular, invariant set of behaviors or beliefs. However, even in extreme diabetes management models, you will still find some room for dynamic diabetes management principles to exist.

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