Striving for Perfection in Diabetes Management
Many blogs have been written about poor diabetes self-care skills, the attention to detail necessary in diabetes management, and the commitment to the long term in the hope of an eventual cure or innovative treatment. Less has been written about the type of person who tries to be "perfect" in all aspects of his/her life, including diabetes management. These characteristics certainly include the diabetes caregiver (even more especially for the very young and very old) as well as in certain patients. In the pediatric and adolescent age group, certain developmental characteristics may enhance this "perfectionist" attitude, especially in school-age children (who very much want to please authority figures) as well as in teenagers.
Some teens, especially those with very high standards who may lean toward perfection, may find difficulty in managing diabetes to their satisfaction. Recently, one of my teen patients labeled herself as "a diabetes diva," and expressed frustration in trying to have ideal blood sugars. In this situation, it is often the healthcare provider saying that it is okay to not always be perfect and that life happens. Perfectionism also may be a symptom of obsessive-compulsive disorder, which may come to the surface with a diagnosis of diabetes. Ironically, healthcare providers require that our patients and caregivers become more attentive to diabetes related details, which often provokes those with latent obsessive-compulsive tendencies to become more apparent.
I am always very gratified when my teens assume much of their self-care skills (with the support of the caregiver); however, I become concerned when a hardworking adolescent becomes frustrated with the lack of objective results. Examples:
- Why are my blood sugars so erratic even when I do the same thing everyday?
- Why am I high despite giving the exact calculated amount of insulin for carbohydrates and correction?
- Why is my hb A1c greater than 8 percent when my blood sugar average is 160 mg/dl?
- Why do my blood sugars go up instead of down after competitive events and exercise?
- Why am I so frustrated and even sad about not being able to control my own blood sugars despite enormous efforts?
Parents and caregivers also are very concerned and upset for their child when they know that he/she is trying so very hard. Sometimes, there is no direct objective answer to these questions. The goal is to first try to make any insulin/diet adjustments and then if there is no improvement, work to determine if there is anything going on in terms of emotional stress, puberty, or sports-related counter-regulatory hormone response. It is important to first rule out behaviors/techniques we can change and then work to the best of our abilities on those we can only mitigate or prevent. Often, the only answer is that once we solve this particular conundrum, we need to tackle the next obstacle! The whys are never ending.
The fact is that my families and teens who want to do all the right things in the correct way often do not succeed at every visit in reaching the perfect hb A1c or blood sugar range. In truth, I always tell my patients that the goal is NOT Machiavelli's- The end always justifies the means, but rather, the means will justify the ends! I believe that statement truly exemplifies my philosophy in caring for people with diabetes. I reassure my perfectionist patients and families that if they continue to perform diabetes self-care skills to the best of their abilities (without sacrificing a reasonable quality of life) to include blood glucose monitoring at least 4-6 times/day, giving insulin in the manner suggested by their diabetes team, eating well (perfection NOT always required), they will achieve very respectable control of diabetes. It is important to hone the diabetes self-care skills that will ultimately launch our children and teens into adulthood.
Likewise, one bad day does not mean that diabetes care has hit rock bottom. It is one bad day--that is all. Start again at the next opportunity and begin anew. Diabetes care is not a sprint, but rather a marathon. As I note to my patients, an unexpected hb A1c is only one in a "sea of thousands." It is the means by which we apply our self-care skills daily, not expecting to make the correct decisions at every opportunity. Our team asks that our patients and families do the best they can and not become upset for being less than perfect.
After all, who is always perfect?