Theory versus Practice

09/25/08 Disease Basics

Everyone with diabetes understands that if following four guidelines reduces the risk of complications: 1) Testing blood glucose levels four or more times a day; 2) Injecting insulin at least three times daily or using an insulin pump; 3) Adjusting insulin doses according to food intake and exercise; 4) Following a diet and exercise plan. It is the implementation that becomes difficult, because there is far more to it than simply following directions.

I give directions every day to my students. I instruct them how to perform tasks correctly. I demonstrate how to succeed. I assign homework for them to practice what they've learned. I could logically assume then that if they follow the guidelines I've given them, they should all succeed. Of course they all don't. The same analogy is true for diabetes. People with diabetes know and do the listed guidelines and still fail. Why?

The reasons are personal, yet universal. I test close to 10 times daily, yet my last HbA1C was 6.3 percent. I have used an insulin pump for the past 10 years and adjust both basal and bolus profiles as needed. I follow a strict diet and exercise regimen. Despite all this, I never have a perfect day of blood glucose readings; there is always a high or a low I must treat.

We all strive for the best health we can achieve. However, life gets complicated and gets in the way of that goal. The black and white dictums do not help—they mostly reinforce unnecessary guilt. The guidelines may intend to prescribe some universal truth of management, but none can exist. Life does not respond to absolutes. "The only constant is change." That is all that we can put into practice.

Eric Devine, 30, has lived with type 1 diabetes since he was 12. He lives in upstate New York with his wife and two daughters where he works as a high school English teacher. Devine is an avid writer and is currently seeking publication of two Young Adult novel manuscripts.