Not Good Enough

I joined the people-with-diabetes club in '86 when it seemed that an A1c under 10 was great. The tools for management just weren't there, and the DCCT had not yet proven Dr. Joslin was right by quantifying the value of tight control.

Over the past 19 years, so much has happened in the world of diabetes. I've gone from a big old 60 second Accuchek meter that required a hanging drop of blood on a strip that I wiped with a cotton ball to a smart little meter that doesn't even need to be coded with strips that wisk a tiny drop of blood off my finger. Chunky needles and 2 shots of NPH and Regular each day have given way to Continuous Subcutaneous Insulin Infusion. Gone is the system of exchanges that dictated meals. Now, a carb is a carb is a carb... as long as you count it.

You newbies with diabetes have no idea how good you've got it (just as I my diabetes adventures really don't hold a candle to those before me, with their stories of bathroom chemistry sets and needles that needed to be boiled and sharpened).

Technology marches us forward, and there is great reason for big hope, if not for a cure then at least for health and longevity despite this disease. We can - and many do - achieve normal or near-normal blood sugars most of the time.

And I have to say, it's kind of freaking me out.

The discovery of insulin made diabetes the first fatal disease you could live with. And even before insulin became available, living with diabetes was up to the patient. There's a boatload of guilt there, and I think that recent advances have only added to that pressure. Diabetes is unpredictable and irrational. The routine that works like a charm one day is easily thrown off any one of a million variables. But when the A1c comes back high, well, we think, "What am I doing wrong?"

I spend a lot of time on discussion boards that include women with diabetes who want to become pregnant. It breaks my heart to hear some of their struggles to acheive an acceptable A1c before conceiving. The bar has been set so high (or, rather, the A1c goal has been set so low) and there are stories of 'permission to TTC' being withheld by doctors who insist on A1c's below 6 before conception. To make their point, they rattle off the horrors that can result from conceiving before acheiving diabetes perfection. Information which is largely based upon conjecture, as most of the (now somewhat old) research says that an A1c under 8.5 puts you in the same statistical boat as non-d women. To me, who was given the pre-conception goal of under-8 in 1997, it seems overwhelming.

Hanging out on line with the d-elite (motivated, informed, well-cared for people with resources to manage the disease) is a double-edged sword. On the one hand, I am inspired by the stories of control achieved. On the other, I sometimes wonder what the heck I'm doing wrong - and what kind of life I'd have to live - to achieve 'normal'. I don't know whether to laugh or cry when I hear people complain about their horrible A1c's... and they are a full point below my best.

Anyone else feel that they are just not good enough at this diabetes stuff?