When I sat down to write this post, I found myself full of ideas and, unfortunately, full of frustration. With so many diabetes-related topics that I was passionate about, what was I going to choose for my very first blog post ever? At first, I was certain that the importance of exercise in keeping our blood sugar levels under control was the way to go; then, about two hours and 14 ideas later, I was leaning toward tactics for keeping a positive mental attitude through all of the challenges diabetes throws in our path. I was in creative confusion overload. Then, through the haze of ideas misting down upon me, I found a brief moment of clarity.
It occurred to me that one doesn’t necessarily need a great attitude toward diabetes to successfully manage our condition. It would certainly be tough, but it could be accomplished. By the same token, one could, I suppose, achieve relatively good control without exercise. Again, it wouldn’t be easy, but it is possible. There are many things we can do in our diabetes self-management that are extremely beneficial, but not necessarily required. But in my momentary epiphany, I realized there is one thing that sits far above all others and is an indispensable prerequisite for our success—that is, self-knowledge.
Now I was getting somewhere.
Inscribed in the forecourt of the Temple of Apollo at Delphi in ancient Greece was the aphorism gnothi seauton or “Know Thyself.” The Greeks were very fond of this concept and used it frequently in the philosophy and literature of the time. In Plato’s dialogues, the character of Sophocles often condemns, and in some cases mocks, those who pursue lofty knowledge without first coming to a knowledge of themselves. For Sophocles, self-knowledge was so important because it yielded an enlightenment of sorts. A knowledge of self reveals much about human nature which, in turn, helps us understand the others that fill the greater world around us.
But do we need to know ourselves and understand the deepest motivating forces of our psyche to successfully manage our diabetes? Well, it certainly can’t hurt if the information we’re operating with is accurate information. But often we don’t see ourselves through the most objective of lenses. Our fears and insecurities distort our self-perception and, in many cases, keep us from looking inward at all. So coming to a true knowledge of the self can be really tough, and well-intentioned introspection doesn’t always lead to the enlightenment we’re searching for.
Regardless, I believe the ideal of “know thyself” can have tremendous value if we just slightly alter the direction we’re looking. Why? Because there’s another form of self-knowledge that isn’t so subjective and difficult to obtain, and it can enlighten us in ways that can truly change our lives. The self-knowledge I’m talking about is the knowledge of our diabetes.
I’ve had a lot of interesting conversations with diabetics over the years. Usually after I’ve found out what type of diabetes they have, I ask, “So how is your diabetes?” This is a somewhat open-ended question, but I’m going somewhere with it.
Very often I get the response, “Well, it’s not going as well as I would like. I’m following all of my doctor’s advice, but I’m still not in good control.”
Then I follow up with, “Tell me more about your diabetes.” At that point the diabetic usually issues a troubled glance as if I had been dozing during his or her previous description.
“Well, it’s like I said, it isn’t very good.”
Moving further to the point, I probe deeper asking, “How many types of type 1 diabetics are there?” Here, I usually get another puzzled look that is rarely followed by an answer. This is, of course, somewhat of a trick question. When a few moments of silence have passed, I go on to mention that type 1 diabetes describes a cluster of symptoms that are similar to a particular group. But, and this is an important “but,” how those symptoms manifest themselves varies in degree from diabetic to diabetic. Thus, your type 1 diabetes is not the same as my type 1 diabetes.
This is when the look of bewilderment begins to turn to a look of, “Ah, yes, I got it . . . I think.”
Just using type 1 diabetics as an example, there are so many variables that differentiate one from the next: The amount of insulin still being produced by the pancreas, the degree of insulin resistance, activity level, age, stress levels, hormone levels, and the presence of complications are all factors that can affect a type 1’s diabetes self-management. With so much variation, it isn’t realistic, or possible, for our doctors to figure it all out for us. They are our guides and our support staff, but to master diabetes self-management, we have to do what no one else can—we must learn our diabetes. It may be some work, but I promise you that the rewards for doing so are immeasurable.
So, how do we gain this all-important self-knowledge? Essentially, we have to take a scientific approach of observe and record. We must carefully watch what’s happening with our blood sugar levels and make specific notations when things don’t go as planned. We’re collecting data, and what we’re looking for are cause and effect relationships. For example, if my blood sugar goes low during several workouts, I might discover that my insulin was peaking during those workouts and that was the cause. I test that theory by either reducing my pre-workout insulin or eating more carbohydrate right before hitting the gym.
Here’s another example: Say my blood sugar suddenly begins running significantly higher when I wake up each morning. Looking at what I been doing and eating in the prior evenings might show that those new low-carb snacks I’m enjoying are actually high in fat and causing some middle-of-the night blood sugar spikes that my nighttime insulin doesn’t cover. So, I either eliminate the snacks (not likely since I really like them) or I make a small adjustment to my bedtime insulin. I’m always looking for patterns that give me the information I need to make accurate estimates in my insulin dosages. I may not have been extraordinarily good at science in school, but I have become quite the scientist in the observations and calculations made in my diabetes self-management. If someone with my weak scientific acumen can figure it out, you can too!
Think about this: If you knew the exact amount of insulin to take at the correct time for anything you ate, diabetes might not be so bad. Right? Well, we may not be able to get it perfect, but that scenario is not too far from reality. If we devote ourselves to gaining self-knowledge of our diabetes, we can get very very close. Again, it requires work, but the payoff is huge! If you study yourself long enough, and really pay attention to the interrelationships between the medication you’re taking and the food you’re eating, you will reach a point one day where extraordinary burden becomes manageable routine. That, my friends, is a life-changing moment.
But hold on a minute! There’s one prerequisite to gaining that life-altering self-knowledge. All diabetes self-management must sit on a solid foundation of knowledge of diabetes in general. We have to understand the general nature of diabetes to fully understand what is happening in our bodies with our own self-management. As opposed to the Greek philosophical ideal of self-knowledge that moves from the individual to larger society, our personal self-knowledge of our diabetes moves from the general to the specific. So this means that we must take the time to learn what diabetes is and does so we can better grasp and understand its effect on our bodies. We don’t have to go to medical school to become masters of self-management, but we do have to go to diabetes school.
Many years ago, I came to the disheartening realization that the average diabetic knows very little about diabetes. Doctors’ orders are often followed, but little effort is put into understanding why the numbers on our glucose monitors show what they do. When blood glucose levels run high, we just take some insulin according to our prescribed sliding scale and move on. We don’t take the time to learn what caused the effect we experienced.
Here’s a short 3-question quiz:
- Do you know what effect stress hormones, such as cortisol, have on blood sugar levels?
- Have you heard of the Somogyi Phenomenon?
- Do you know why blood sugar levels can make a downward trend the day following intense prolonged exercise?
If you’re a type 1 diabetic, I hope you knew all three of these answers and were a little irked with me for even asking. If you didn’t know all three, then you have some work to do. The reason I picked these three questions is because they are three very common reasons for blood sugar variations. This is also why I said that we must know the general to understand the specific. Without a solid understanding of these variables, we can easily draw incorrect conclusions and misunderstand the cause and effect relationships taking place within our bodies. If you do know and understand how they impact your diabetes, then fluctuations in your blood glucose levels begin to make sense and you move one step closer to living a normal, in-control life. That’s what I want for you. As the saying goes, “Knowledge is power.”
Here’s a little history lesson: Not only were the Greeks some of the first to fully explain the need for self-knowledge, they were also responsible for the first use of the term “diabetes” in 250 BC by Apollonius of Memphis. Later, in the first century CE, ancient Greek physician Aretaeus of Cappadocia provided the first in-depth clinical description of diabetes.
So, know thyself. Learn about diabetes so you can better understand your diabetes. If someone asks you, “What is diabetes?” the last thing I want to hear you say is “It’s all Greek to me.”
–Tad