For tomorrow.

I had breakfast with customers on Friday morning and found myself (shockingly!) talking about living with diabetes. The doctors I was visiting that morning ran a busy primary care clinic, and were lamenting to me about their challenges of keeping their patients with diabetes well controlled.

“What’s your A1c right now?” one doctor asked me, testing the waters for what she was about to say.

“6.7” I answered, unflinching.

“Ok, so maybe you can answer this for me then – why do so many of my Type 1s come in here with these horrible A1cs and they just, they don’t seem to care! They think they’re just fine with these high numbers all the time and nothing I say makes them change. They don’t test, they eat whatever they want – they just don’t care.”

Her frustration was palpable, but my answer wasn’t going to help. Because the answer was that I don’t know. I don’t know what makes one person care about taking care of their diabetes and another person completely lose their give a shit. Some people find the motivation day in and day out to take care of this burdensome disease, others decide to live fast and complicate young. Shoot – I was almost one of the latter folks – a single bout with DKA at age 18 turned my trajectory around, but thousands of people with diabetes go in for DKA as much as monthly and never want to change. Other people never get access to the right information and education. I’d once met a man who was told by a doc as a teenager that he wouldn’t live past 30 with Type 1. So the guy partied like there was no tomorrow and then hit 30 and was still alive – but with massive complications caused by years of ignoring his disease thanks to that one doctor. You never know a person’s reasons for not taking care of their diabetes – sometimes they don’t even know why.

“You know doctor, diabetes is so hard from a motivational standpoint. We live in a society of instant gratification. People get annoyed when their iPhone won’t load an email in a half a second, so it’s understandable that most people can’t understand that being healthy now will prevent complications years down the road. They don’t want to deal with it now and they’d rather not think about it. And your patients with those high A1cs – they might be used to living with chronic high blood sugars and don’t even realize how crappy they feel because they’ve forgotten how to feel good. I don’t know why some people care and others don’t.  I don’t think anyone, diabetes or not does everything right for their health. It’s always easier said than done. But all we can do is try. Your patients are lucky you care so much.”

She nodded and said she hoped she made a difference, but that some patients made her want to give up on them. If the patient doesn’t care, why should she? It was hard to argue with that.

The challenge of diabetes is ourselves. We have to manage this thing every second of every day. Insulin is a merely a treatment that keeps us alive, and it’s administered in an artificial manner that is at best a crude interpretation of the body’s mastery. It’s no wonder management is an imperfect and unpredictable science. And guess what? Human beings don’t like imperfect and unpredictable – we tend to abandon things that don’t produce consistent results. But with diabetes, you can’t abandon the project. It’s ongoing, and the only choice we have is to manage this disease the best we can. I lose my motivation as much as the next person, but I try to keep the power of tomorrow in my mind at all timse. If I take care of myself today, tomorrow can be guaranteed. And even if I screw up today, I can try again tomorrow. I want to be able to always say that, so I have to keep trying.  So that I can have a tomorrow.

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Unfortunately, caring about your blood sugar control and actually achieving good blood sugars are not directly linked. I have always cared…a lot. Even when I had poor control I cared, but caring wasn’t enough to make it work.

Emily, you make an excellent point – even people with good control who care a lot about this disease end up with complications – that’s the cruelest part of this disease, it’s completely unfair with who it hurts and even when you play by the rules, you’re not guarenteed that everything will work out. I’m dealing with that exact issue right now – I have good control of my diabetes and strive every day to care, but I’m still suffering from some nerve issues in both of my hands. It just isn’t fair. I’m so glad you made that comment and it’s something I should have included in the post – that hope and caring are sometimes not enough. But I do think that even when things don’t work out with well with diabetes, we have to dig deep and find some motivation to keep trying. We don’t know much about this unpredictable disease, but we do know that good control – although not a guarrentee – is the best way to prevent, delay, and slow complications. Thanks for your comment, its important that we keep this issue in mind – its another issue that makes finding the motivation to manage this disease so hard.

What makes this disease even tougher is caring can never stop. Burn out happens so easily. I get it and I have only had type-1 for 5 years. For folks like you Lex that had to “care” through high school and college years when life is supposed to be as care free as any time. I have great respect for all the young type-1’s that battle through those years. I fortunately developed it when I was at my most disciplined time i my life but still get burned out. Thank God for the dexcom and omni pod. They certainly make caring easier to gain and act on our physiological shortfalls.


Agreed! Thanks for the post!

Why should diabetics have more willpower than anyone else? What is the national obesity rate these days, 70% or so? How many double-chins and pot-bellies do you see at the mall? Most of these people don’t worry about their A1C at all, but because we are diabetic, we are supposed to have an iron will to resist all temptations.

Its totally frustrating that we’re expected to be perfect all the time – really the advice for good diabetes management is the same for people without diabetes. I think the difference is that if someone is just overweight, they may or may not have problems later. We know though, that the best predictor of preventing complications (although not a guarentee as Emily pointed out) is good control. So although it’s not fair that we’re expected to have an iron will, our consequences could be viewed as greater than your average person which pushes outsiders to think the way they do.

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