Tuesday, June 15, 2010

Bad to the Bone

This post has grown out of a number of things I've seen in the last couple of days, particularly a discussion about diabetes and depression on Twitter, a cool post by Allison Blass,  and also a posting on a forum from a self-described "bad diabetic".  I've posted along these lines before, but it's an important set of ideas.

One of the reasons that depression so often follows diabetes, I believe, is that diabetes constantly invites us to see ourselves as having made a mistake.  PWDs can be caused problems by factors entirely beyond our control or which couldn't have been anticipated.  Highs or lows can also result from simple mistakes, the kinds of mistakes everyone makes. Even if we're secure enough to not judge ourselves for those times, and not all of us always are, the people around us and even our physicians may not be so wise.  And, sometimes, we make choices that might have been wiser.

A few weeks ago, I had lab results that were MUCH better than what I had expected.  I've thought a lot about what could have created such a huge gap between my perception of how I'd been doing and the reality.  Clearly, much of the answer relates to how well my medicines work for me.  But I think I also constantly measure myself against a vision of PERFECT diabetes management, thus only allowing myself to see "mistakes" without taking credit for the better choices.

Consider the following sequence of statements:
  1. A healthy diet has room for an occasional treat.
  2. A healthy diet has room for ONLY an occasional treat.
  3. A healthy diet is better off without any treats at all.
  4. I shouldn't have the candy bar I want, because it's not part of a healthy diet.
  5. I shouldn't have eaten that candy bar: that was a bad choice.
  6. I had a candy bar yesterday, too.  I frequently make bad diet choices.
  7. I take poor care of my health and my diabetes.
  8. I am a bad diebetic.
Any logician would laugh at this list - most of the statements simply don't logically arise from the one before.  Statement #1 is true, but each of the succeeding statements is a little bit farther down a road toward harsh self-judgment.  But my mind takes off down the list so fast that I don't even notice #1 as I fly by.  I live by #7 way too much of the time, and a bad day has me sitting at #8.

Take another look at #5.  In my mind, anyway, that's where a key change occurs.  My choice to eat the candy bar has changed from a choice about nutritional balance to a moral choice. In other words, I'm not a person who made a non-optimal choice, I'm (in my mind) a bad person.

This is obviously not the way for a diabetic to maintain a healthy attitude.  But it's what I do, all too often, and from what I see in the forums and on Twitter, I bet I'm not the only one. 

A healthy lifestyle is about balance, and a healthy lifestyle with diabetes that much more so.  I need to learn to more consistently SEE it as a balance rather than as an unending series of challenges to my adequacy as a person.

Many of us seem to see our encounters with our care team along these lines.  We don't just go to get information and guidance: we go to get approval.  And, all to often, members of our care team encourage this attitude by granting or withholding approval.  No wonder we hate our appointments -- we're not going to the doctor, we're going on trial!  I confess: part of what I was so thrilled about at my appointment was that I felt my doctor's approval.  That's fine, as far as it goes, but what if the approval had not come?  It would be healthier not to grant my doctor that much power over my attitude.

Like everything else, it's a progress.  But I'm gonna work on living higher up on my list.

How about you?  Are you able to separate your sense of worth from the ups and downs of life with diabetes?


  1. Great post Bob. It is SO hard to separate our decisions from our perceived self-worth. I am a master of harsh self-judgment.

    The funny thing is, it often happens in the background, unnoticed. Like you say, a bad day pops you automatically to "bad diabetic".

    It's a tough spiral to pull out of.

  2. It is hard. I try, but it is so hard.

    One thing I noticed from doing a home A1C today - do I only test when I feel like crap and that's why meter averages are higher than what comes back from the lab? And why exactly do I need my endo's approval more than every six months?

    Ugh. Hard questions here. But thank you for posting.

  3. Thanks for a well-written post and observation. I often wonder why the medical profession ponders why the incidence of depression is so high in people with diabetes, even among those whose glycemic control is very good, and they conclude that the answer must be something related to the disease itself, conveniently overlooking the countless, subtle & sometimes not-so-subtle value judgements placed on patients that they would never dream of doing with say a person with say ... cancer. British reporter Shirley Dent once wrote an eloquent piece entitled "Needling Diabetics" http://bit.ly/9ujhQ1 in which she wrote:

    "At the heart of current representations of diabetes is a medical profession that has lost a sense of its duty to cure rather than chastise. When the medical profession turns to prevention instead of cure, the disease becomes fetishised around individual behaviour and experience rather than an understanding of the disease itself. The disease comes to define the person rather than being a physical obstacle to be overcome."

    I couldn't agree more!!


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T Minus Two by Bob Pedersen is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.