So Much For Standardized Care

Some health conditions are a snap to treat. Have an upper respiratory infection? Antibiotics hit the spot. Thyroid gland under-producing? Pop a thyroid supplement. Difficulty seeing at a distance? These lenses will get you back in focus.

Diabetes is anything but simple. While there are standards in place for treating diabetes, pretty much everything about it needs to be customized to the individual. For example, at the ATTD (Advanced Treatments and Technologies in Diabetes) conference that just took place in Barcelona, Spain, my colleague and T1 buddy Mike Riddell presented findings from research he conducted on exercise in type-1 diabetes. His research team sought to gain a better understanding of the impact of different forms of exercise on glucose levels. The study included nearly 500 people using either multiple injection therapy, basic insulin pumps or hybrid closed loop systems. Over 15,000 exercise sessions were recorded and analyzed. What they found is that aerobic (cardio) exercise tends to cause the greatest decline in glucose levels and anaerobic (strength training) causes the least decline. Hybrid exercise (high-intensity interval training) placed somewhere in the middle. No big surprises there.

But here’s where it gets interesting. The results varied across all types of diabetes treatments and exercise types. They varied between individuals and within the same individual. According to Dr. Riddell, factors that appear to be linked to the glucose response to exercise include: resting heart rate, glucose level and rate of change before exercise, insulin on board, time of day, gender, time above/below/within range for the past 24 hours, and even the participant’s A1c. Had the stage of the moon been evaluated, I suspect it would have had an impact as well.

What does all this mean? It means we can’t manage diabetes by looking things up in a textbook. This is a highly personal condition that requires a personalized approach. A considerable amount of trial-and-adjustment is necessary to put yourself in the best position to succeed. It also means that your healthcare providers can provide basic guidance, but they have to be flexible and willing to give you the opportunity to experiment. This certainly applies to exercise, but it also has implications when refining one’s diet, medications and lifestyle choices.

Our clinical team takes a great deal of pride in accepting what we DON’T know – namely how each person’s diabetes is going to respond to a particular strategy. Not that we don’t have our suspicions; that comes from a collective 200+ years of personal and professional experience. But ultimately, we recognize that every individual deserves to be treated as… well… an individual. No one-size-fits-all approaches here!

If you’re tired of being treated like a number, give us a call. It would be our privilege to get to know you and help you develop your own personal diabetes management playbook. Working together, there is no challenge we can’t overcome.

Enjoy this month’s edition of Diabetes Bites. Your feedback and suggestions are always appreciated!

Sincerely,

– Gary