My Diabetes Confession

by Gary Scheiner MS, CDE

twitter summary: AADE educator of the year Gary Scheiner on how even he sometimes struggles to maintain excellent diabetes control

short summary: Even AADE educator of the year Gary Scheiner has a hard time sometimes controlling his diabetes. A lot of factors can affect blood sugar levels, including travel, stress, exercise, and burnout. After all, we are all human, and providers should all understand the challenges and obstacles we need to overcome for good diabetes management.

There’s a saying: the barber with the worst looking hair gives the best haircuts. After all, since he can’t cut his own hair, he’s the only person in town who can’t benefit from his own services. I have no idea where that saying came from, and given that I haven’t been to a barber in years (one look at my photo and you’ll understand why), I have no way to verify it. But it does make sense.

Maybe the same can be said for blood sugar control. I think my practice does a pretty good job helping people to meet their diabetes management goals. But quite frankly, my control stinks sometimes. My A1c has crept up to nearly 8%, and despite using a pump and CGM religiously, I still experience more than my fair share of lows. There are plenty of possible reasons:

Travel – For years I’ve been called upon to lecture and present all over the US and overseas, but this year has been busier than ever. Since receiving the 2014 AADE Diabetes Educator of the Year Award, I’ve been on the road an average of two or three times a month. In fact, I’m writing this on a flight from Philadelphia to Spokane, WA (via Chicago and Seattle) to do a talk on insulin pump management. Traveling makes blood sugar control difficult for a number of reasons: time zone changes, mystery meals, long stretches of sitting in one position, and changes to one’s workout routine, just to name a few.

Stress – Emotional stress can wreak havoc on blood sugar levels. Even “good” stress – like trying to manage a growing practice – can have its effects. This year, my wife and I have kids in four different schools (college, high school, middle school and elementary), and each participates in multiple activities. Figuring out the schedule is mind-numbing! We’ve also suffered through the rigors of a particularly rough winter (including two separate power outages totaling 8 days). The blood sugar implications have been significant to say the least.

Exercise – If I’ve had one mainstay in my diabetes management program, it’s exercise. No matter where I am or how busy things get, I find a way to work out just about every day. But that doesn’t mean its effects on my blood sugar are consistent. The time of day and nature of the activities vary quite a bit: Morning or evening basketball, afternoon yard work, post-dinner runs or cycling, midday weight lifting, and so on. What it all amounts to is a lot of variability in terms of insulin sensitivity and blood sugar patterns throughout the day and night.

Dietary Discipline – Like many people with type 1 diabetes, I have an appetite that just won’t quit. Perhaps it’s genetic, or maybe the lack of the hormone amylin really does make a difference. Regardless, I’ve always struggled to avoid munching between my usual meals and snacks, and I tend to overeat – especially when faced with hypoglycemia. I’ve taken to using Victoza (liraglutide) on a daily basis to help curb the hunger, but I still often find a way to eat myself into trouble. [Editor’s Note: Victoza is currently not labeled for use in people with type 1 diabetes, although some patients with type 1 diabetes use it “off-label.” For more information, please read Editor-in-Chief Kelly Close’s experiences in her test drive. Novo Nordisk is currently studying Victoza in type 1 diabetes in a large clinical trial.]

Burnout? – This is something most people with diabetes can relate to. But here’s where my situation is unique. My job involves teaching, motivating and coaching people with diabetes for eight to ten hours a day, day in and day out. The last thing I want to do when I’m not helping a client is think about my own diabetes. This makes me a bit lazy when it comes to counting my carbs, taking insulin at the right times, and making adjustments for lifestyle activities. I’m like a chef who prefers to order takeout, a cleaner who leaves his or her own house a mess, or a writer who would rather talk on the phone than send letters or e-mails.

I’m not sure why I’m telling you all this. Maybe it will help you, maybe it will help me.

A few years back, I was presenting at a CWD (Children With Diabetes) conference in Cincinnati. Anyone who has a child with diabetes should get to know this organization. A physician with type 1 diabetes showed me how he managed to keep his glucose levels remarkably steady. We’re not talking decent control. We’re talking impeccable control. He rarely had a reading above 150 mg/dl (8 mmol/l) or below 70 mg/dl (4 mmol/l). While I stood there feeling horribly guilty about my own numbers, I saw most of the parents in the room shaking their heads in disgust, and heard many commenting to each other: “Is this guy kidding? What planet does he come from?”. I could tell that they tuned him out completely, which is a shame because he had some really useful and practical things to say.

When I presented later that day, I made a point of sharing the ups and downs of my blood sugars during that particular trip. The audience smiled, nodded their heads, and warmed up to me almost instantly.

Apparently there is something good about “keeping it real”. None of us is perfect when it comes to diabetes management. We all have our challenges and obstacles to overcome, and I’m certainly no exception. And while I’ve learned how very important it is to accept ourselves for who we are, it is even more important to not stop trying. I, for one, am committing to cover my irregular eating with matched doses of insulin, and to be more aggressive at bolusing for highs as early as possible. I’m also going to make a serious effort to treat my lows with less than the usual 12,000 grams of carbohydrate. Interestingly, none of this changes the way I teach and manage my clients. But it certainly gives me a stronger appreciation for what many are going through.

So welcome to my little barbershop of diabetes management. My haircut may not be the best, but I promise to give you the best-looking “do” in town.

This article was originally published on Integrated Diabetes Services at http://integrateddiabetes.com/my-diabetes-confession.

Gary Scheiner is Owner and Clinical Director of Integrated Diabetes Services, a private consulting practice for people with diabetes who utilize intensive insulin therapy. Gary is the 2014 AADE Diabetes Educator of the Year. He has written several books on diabetes self-management, including “Think Like A Pancreas” and “Until There’s A Cure”. Gary and his team offer consultations worldwide via phone and internet for those looking to gain better control of their diabetes and enhance their self-management skills. Gary has had type 1 diabetes for 28 years and has worn and trained on every make and model of continuous glucose monitor and insulin pump. He can be reached at gary@integrateddiabetes.com, or (610) 642-6055.

Interested in learning more? Read more of Gary's columns on a pathway to an artificial pancreas system, tips on how to pick a pump, and best ways to treat hypoglycemia.

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