Anyone who has lived “long enough” with T1D knows about criticism. Criticism can come from ourselves, our diabetes healthcare team, friends, family, coworkers, the media, and even strangers.
Often we are the hardest on ourselves. It is easy to have an internal dialogue running that may sound something like, “I am so mad at myself! I should have known better! Why can´t I get this diabetes stuff RIGHT?!?!” Or “I really messed that one up!”
Where does this internal critic come from?
And more importantly, how can you get it to take a hike and leave you feeling peaceful instead of feeling drained from ongoing self-criticism?
Sometimes the inner critic gets ideas from things our healthcare providers have said. Perhaps you´ve heard, “That A1c is wayyyyyyyyy too high ?” (including the frowny face drawn on the A1C results paper on the desk at your appointment). Or “Why do you keep taking your insulin dose after you eat instead of before?” Or, while reviewing your glucose data in a report, “WOW!! That glucose was REALLY high!!”
People around you may feel the need to make comments like, “Gee, what did you eat to make that glucose spike like that?” One of my personal favorites is, “You shouldn´t be eating that!” Another of my personal favorites is, said in an annoyed tone, or worse, a condescending tone with a hint of Tsk! Tsk! in it: “Your glucose thingy is beeping AGAIN!”
Unfortunately, it is easy to think of a multitude of negative things I have heard people say about my body, my T1D, their perception of my ability to take care of my health needs, and decision-making skills related to managing my glucose levels. Usually, the comments came from well-meaning individuals who actually wanted me to be healthy and happy. The comments often come from people without the right education about what living with T1D is ACTUALLY like. They are looking into my life from the perspective of their own life, without the many lived years of experience of living through all that T1D can choose to throw your way whenever it feels like it.
In the case of unhelpful comments from healthcare professionals, only once did I see an Endo who seemed to have a goal to scare me into submission to keep my A1c in target. Many times, small comments made by healthcare professionals are not intended to induce guilt, fear, or judgment. However, I have found it is easy to perceive their comments or questions from a defensive standpoint. It is easy for me to assume that an Endocrinologist or a Certified Diabetes Care and Education Specialist (CDCES) is looking at my CGM and insulin pump data with a critical mindset.
What I learned many years ago has helped me work through my innate fear of criticism about my diabetes-know-how.
I met with great CDCESs over the years. They taught me that I am too hard on myself. The issue is not my know-how or my ability. The issue is that I have a pancreas that does not produce much or any insulin. I am trying to imitate the work of an organ, but I am doing it manually from the outside of my body using only about 3 pieces of information:
- What I will eat and how it will digest?
- What physical activity did I recently do or plan to do?
- How much insulin do I have on board?
The body, for someone without diabetes, uses multiple organs, and multiple hormones, peptides and enzymes to manage glucose levels. What makes me so singularly egotistical that I think I SHOULD be able to manage glucose levels the same way as someone without diabetes?
The CDCESs taught me that I can EXPECT my glucose levels to be erratic sometimes. Even if I try to prevent variable glucose levels. Even if I follow all of the tips and guidelines. They taught me that they are NOT looking for “perfect” glucose levels, a non-diabetes level A1C, or any other high-pressure related idea I may have invented for myself along the way.
They told me, “YOU are NOT YOUR NUMBERS. Above and below target glucose levels are just numbers. They are tiny pieces of data. They are inputs that you can use to make decisions with. They are not reflective of your intelligence or your desire for good health.”
This was a HUGE stress relief in my life. When I was a teenager and young adult, I would absolutely dread going to see my Endo and my CDCESs because I imagined that they looked at me, my log sheets, my glucose levels and thought I was “a terrible diabetic.” My invented internal dialogue was so very far off from reality for many years.
I worked with a therapist and asked for help with re-writing my natural tendency to self-criticize, to project my internal insecurities and doubts to other people by imagining what they were thinking. Thankfully, I learned several techniques and strategies to help re-write much of that unhelpful narrative.
Once, a good friend learned a concept and asked to share it with me. She said, “Why do you think you are SO important that others are constantly thinking about you and judging you? Are you the president of the world? Are you a terrible criminal? No! You are just you. You are not that important that others are thinking of you that often. Just like you are not constantly thinking of them and judging them.” It was such a simple concept, but it helped me to reframe some of my anxiety about what other people MAY be thinking about me.
One more bit that helped get that inner critic to shush was when someone taught me that there are no perfect human beings living on earth. We can try to be perfect as hard as we want, but it would be the same as me trying to become 5´5” (I am 5´3” on a good day). It is futile to try to be something that I am not. It is better to try to be the best version of me, imperfect and all. Some days I will do better than others with the time and energy I have. I do not need to waste another minute trying to achieve perfection in my diabetes management.
With a clearer mindset, the newfound skills and information helped me to face my diabetes with a new perspective. I hope that by sharing what I have learned, you can benefit from the same wisdom that was thankfully shared with me.
As for criticism and annoying comments from friends, family, and strangers: That will be discussed in an upcoming article. Stay tuned!
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