Too tight control?

[digihat]

Afternoon Everyone

Had my catch up with my consultant yesterday good 15-20 minute chat about a few bits. Happy with my current ratios/Basal didn't see a need to tweak anything for reference:

Basal Tresiba: 32 Units once a evening

Bolus Nova Rapid: 1:10 ratio try to pre bolus around 25 minutes if I can seems to be my sweet spot

TIR about 90% at the moment

One thing the consultant and my DSN keep mentioning to me about is making sure that my control is not too tight they are happy with how I'm doing things generally

Last Hba1c was 45

Is it a bad thing that I keep my control so tight?

I dont go low too much as much libre likes to tell me.. For me libre reads about 1mmol below a finger prick for me which I'm very happy with. My motto these days is "think 1 above"

 

[helli]

Is it a bad thing that I keep my control so tight?

The concern is how much diabetes is “costing” you to maintain this level of control.
If you are spending too much time and effort and brain power on diabetes, it is controlling you and you are at risk of burn out,
It is important to look after all of yourself, not just the diabetes part.

 

[Thebearcametoo]

If you’re finding it easy to stay in that level of control then congrats and you can enjoy knowing that you’re doing great. If it’s causing you effort or stress then you can afford to relax a bit and you’ll still be fine. The concern over ‘too tight’ control is burnout as helli says. I think with sensors it’s easier to stay in better control (there is data to suggest that sensors give the best bang for their buck in terms of results) and some of the attitudes around tight control haven’t updated since everyone was on fingerpricks.

 

[Merluza]

My Hb1ac is usually 40. It has been around that for years. I take care to keep it so but it doesn't control me and the idea of burnout strikes me as very strange. Obviously peoples physical and emotional responses are all different but I think it sounds as if digihat can be happy and confident about the way their management is going. Consultants sometimes are just working from the general guidance and assume they know more about it than the person actually living with the illness and the consequences. Congratulations digihat, keep up the good work.

 

[trophywench]

My Hb1ac is usually 40. It has been around that for years. I take care to keep it so but it doesn't control me and the idea of burnout strikes me as very strange.

As it always did me too - just things we do every day - just normal stuff......

Oh hang on - it's by NO means normal - and I damnwell need a day off after 50+ years.

 

[Inka]

….the idea of burnout strikes me as very strange

Burnout, which I’ve had and which was horrible, is more than just the Type 1. There’s a trigger, something extra, something that goes wrong - and that’s the straw that breaks the camel’s back @Merluza I lived for many years doing all the tedious diabetes chores day after day, week after week, year after year with no problem. However, then it all went wrong and burnout hit extremely fiercely.

Anyone can get burnout no matter how long they’ve had Type 1, how good their HbA1C is (mine was excellent) or how well they’ve coped with things previously.

 

[CliffH]

….the idea of burnout strikes me as very strange

Burnout, which I’ve had and which was horrible, is more than just the Type 1. There’s a trigger, something extra, something that goes wrong - and that’s the straw that breaks the camel’s back @Merluza I lived for many years doing all the tedious diabetes chores day after day, week after week, year after year with no problem. However, then it all went wrong and burnout hit extremely fiercely.

Anyone can get burnout no matter how long they’ve had Type 1, how good their HbA1C is (mine was excellent) or how well they’ve coped with things previously.

I wonder if people tend to underestimate the long-term stress of diabetes, because it's often invisible to other people and because it doesn't have the same emotional resonance with the public as some other long-term health conditions?

 

[trophywench]

I wonder if people tend to underestimate the long-term stress of diabetes, because it's often invisible to other people and because it doesn't have the same emotional resonance with the public as some other long-term health conditions?

Possibly
Maybe
Perhaps

er, How would that help anyone if we did know? So - does it actually matter that we don't?

 

[CliffH]

Possibly
Maybe
Perhaps

er, How would that help anyone if we did know? So - does it actually matter that we don't?

Perhaps if the long-term stress of diabetes were acknowledged more widely, it would be easier for people to spot (and act upon) early warning signs.

 

[Inka]

I think I read Diabetes U.K. is doing research into burnout. It’s misunderstood and off people’s radar until they’re unfortunate enough to get it.

 

[nonethewiser]

….the idea of burnout strikes me as very strange

Burnout, which I’ve had and which was horrible, is more than just the Type 1. There’s a trigger, something extra, something that goes wrong - and that’s the straw that breaks the camel’s back @Merluza I lived for many years doing all the tedious diabetes chores day after day, week after week, year after year with no problem. However, then it all went wrong and burnout hit extremely fiercely.

Anyone can get burnout no matter how long they’ve had Type 1, how good their HbA1C is (mine was excellent) or how well they’ve coped with things previously.

Well said @Inka

 

[CliffH]

I think I read Diabetes U.K. is doing research into burnout. It’s misunderstood and off people’s radar until they’re unfortunate enough to get it.

I wonder if the word 'burnout' is unhelpful? I think it implies something sudden, inevitable and final, whereas 'the stress of managing a long-term health condition' is more accurate.

 

[Inka]

I wonder if the word 'burnout' is unhelpful? I think it implies something sudden, inevitable and final, whereas 'the stress of managing a long-term health condition' is more accurate.

I don’t think ‘burnout’ is the best word, but it’s not an awful description either. Maybe a more medical and accurate description would help and would also mean it’s taken more seriously.

 

[nonethewiser]

Word burnout is fine to describe condition IMHO

 

[everydayupsanddowns]

I wonder if the word 'burnout' is unhelpful? I think it implies something sudden, inevitable and final, whereas 'the stress of managing a long-term health condition' is more accurate.

I think there are two phrases which are used to express those things - diabetes distress, and diabetes burnout.

For some people there’s an external trigger or trauma, for other people it’s simply an outcome of the relentless grind of living with it.

What is diabetes distress and burnout?

Diabetes distress is what some people feel when they’re overwhelmed by the relentlessness of diabetes. This can lead to diabetes burnout. The way you react to things and the emotions you feel can vary for different people. You might feel frustrated, guilty, sad or worried. Sometimes you might...

www.diabetes.org.uk

Well done on your great HbA1c, and cracking TIR @digihat

If you aren’t having lots of hypos, and are finding your diabetes management relatively do-able, you could perhaps just carry on as you are?

 

[helli]

I wonder if people tend to underestimate the long-term stress of diabetes, because it's often invisible to other people and because it doesn't have the same emotional resonance with the public as some other long-term health conditions?

I don’t think it has to be long term.
People can get burn out at any time.

 

[Kol]

people tend to underestimate the long-term stress of diabetes

Hi @CliffH

This is exactly what it is.

CGM can also be considered be a double edged sword, it’s great when it’s green, but if D taken seriously then the pressure imposed mostly by ourselves to maintain, can be immense, and am aware of the leeway accepted into the orange, even the red.

But sometimes the hourly, daily, monthly, yearly, the thinking, decisions, hypos, hypers, injections, food, activity, actions, planning and so on etc, etc, can just be overwhelming and all consuming.

We know what we need to do and how to do it, but if it’s not working right resentment sets in and round and round you go.

 

[Kol]

My Hb1ac is usually 40. It has been around that for years.

Hi @Merluza,

That is outstanding, honestly impressed and jealous! 🙂 would you mind me asking how long T1? MDI or Pump?

Thanks.

 

[Kol]

Is it a bad thing that I keep my control so tight?

It’s the best thing, if you can make it work.

 

[helli]

It’s the best thing, if you can make it work.

As long as the cost to the rest of your life is not too great.
I compare dedicating your life to perfect BG with dedicating your life to a well paid job and having no time to spend the money,