Diabetes Management: What Constitutes Good Enough?

Kelsey Bonilla Health Guide
  • Are you the type of person who recognizes a need, say for new casual shoes, and then spend hours upon hours shopping for just the right pair? Do you obsess over finding the best shoes at a great price that fit perfectly and look stylish?  Then, after making a choice do you worry that you could have gotten a better pair or a cheaper price and thus don't ever truly enjoy the shoes.  Or, do you run into the store and find the first pair that fit your criteria and happily leave with your purchase? 


    I've been reading a book, The Paradox of Choice that outlines the difference between maximizers and satisficers.  Maximizers are illustrated by the first scenario.  These individuals have a difficult time in modern society because they insist on only choosing the "best" option from the many hundreds they face each day.  Satisficers, on the other hand, recognize that "good enough" is good enough and quickly make choices regarding basic issues.  Regardless of a person's objective reality, maximizers will have a more negative view of their subjective situations and therefore are less happy and satisfied than those individuals who can happily make a choice and move on.

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    These personality types can also be applied to people with diabetes, I think.  When your blood sugar is out of range, how much to you obsess over the number?  Do you agonize over how best to treat a low blood sugar?  If you've chosen an insulin pump, do you question whether you've chosen the right one?  How much do you worry about whether you've chosen the best medications and technology to manage your diabetes? 


    According to Barry Schwartz, the author of The Paradox of Choice, there is an important distinction between maximizer behavior and perfectionism.  The difference lies in the individual's emotions.  Perfectionists typically know that their high standards are unrealistic and do not expect to meet them.  Thus, they do not feel negatively about their efforts toward perfection.  Maximizers do expect to choose the "best" option and therefore are always disappointed because it's simply impossible for them to investigate all the options and know for certain that they've chosen correctly. 


    In thinking back to my diabetic pregnancy, I see that I predominately operated like a perfectionist.  I actually felt a lot of joy while managing my blood sugars into tight control.  There were times when my quest for the "best" became a bit obsessive, but for the most part I knew that perfection was not a realistic expectation. 


    In thinking about these concepts, I wondered, what constitutes "good enough" in diabetes management?  How can we be happy satisficers, rather than unfulfilled maximizers when it comes to our diabetes life?  I imagine that the specific numeric values that would be considered "good enough" would differ for each person.  However, generally, we all can reach a happy place where the quality of our diabetes management balances with our efforts maintaining it. This place would encompass a healthy A1c, but would allow for the fact that some levels require too much mental strain to consistently reach. While postprandial blood sugars under 140 mg/dl are the goal, we shouldn't feel inadequate when the occasional spike occurs after a yummy meal. 


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    Schwartz also argues that the sheer number of options available to modern Americans can exacerbate the maximizer tendency.  I felt this when my endocrinologist and I discussed continuous glucose monitoring.  Even though my control is good (and was excellent during pregnancy... I've got a healthy daughter to prove it!) I started to doubt the quality of my diabetes management because I'm not taking advantage of all the new technology.  However, the satisficer side of me kicked in as I realized that the information provided by CGMS does not justify the presence of yet another invasive medical equipment on my body (at least until they become more reliable and less expensive).


    How do you judge whether your diabetes control is "good enough?"

Published On: June 26, 2008