Nirvana is a state of being at peace or complete happiness. If you look at the real concept of nirvana, it is possible for any person to achieve but in most Buddhist sects only monks attempt to achieve it. The lay Buddhists practice to achieve a higher level of existence. This makes me think of life with diabetes. I see the pancreas as the ultimate monk in terms of a state of Diabetes Nirvana – the pancreas knows what to do, when to do it and how to do it and is in a state of complete connection with the body’s needs.We the people with diabetes are more like the lay-pancreas here – we try hard to function like our body would, but we have to think and interpret a lot daily to get to a place of management that is healthy.
As I work with so many with diabetes, I often see the struggle to define what is “perfect” management. What is that state of true Diabetes Nirvana?
There is no 100% perfection – Living with diabetes can be tough. There are a variety of distressing things that many people with diabetes experience. The variables to management add up – over 100 from my last count of comments from those I have had the opportunity to help. As we manage a condition that is 24/7, it is important to remember another piece of your management. How are you managing all your thoughts about diabetes?
Mental health is often forgotten in many clinical visits. There is always a review of records and data from pumps or glucose records, lab results are reviewed and even your feet get checked (I hope – if not, ask your Endo to look at your feet each time you go in!). But how often has someone asked about how you are managing all of the variables? How often have you thought about how you mentally manage?
Do you think the many variables are impacting your day-to-day life to the degree that you are “all diabetes, all day”? Are you at peace with how you manage or are you constantly navigating and falling short of where you think you should be?
Think about the past week or month – do you feel discouraged when you see high numbers you can’t explain? Is it to the degree that you feel overwhelmed in your aim for perfection? Or do you feel like what you try to do isn’t enough at all? At some point we all have seen the “perfect” day, but sometimes it seems like if we can just get it right all the time then it would mean we have reached that state of peace in our management strategy. Like all the ducks are finally in a row and you are no longer herding cats!
I’ve found that I must take the emotion out of my management. To do so I avoid looking at what others are aiming for, which is hard in this world where technology connects us to everything our neighbors are doing.Am I perfect at this all the time – NO. But most of the time I know the strategies I put into action are from a place of perspective that doesn’t judge. It doesn’t help to criticize yourself while you are trying to set goals.
Take a breath – step back and define WHY you are aiming for perfection. Take emotion out, and just define what it is you think will happen when you get 100% of it right.Is it that you are worried about what your doctor will say the next time you have an appointment? Is it that you are concerned about your ever lingering thoughts of Complications? Have you defined what your goal is or are you aiming for a goal that is based on someone else’s plan? Are you aiming for perfect without a strategy of evaluation?
A lot of times due to lack of individualized goals in education, people with diabetes are lost in what their goal should be short term and long term. They are trying to reach a goal defined by a health practitioner, but not that is specific to THEIR needs. This brings about a lot of mental frustration.
Setting goals for where you want to be starts with short and long terms goals and then defining an action plan to evaluate if things are working.
If you are struggling with some mental fatigue in management a first step might be to talk to a mental health specialist who knows about diabetes. If the frustration is from aiming for nirvana but have no path to get to where you want, then I suggest looking at where you are right now.
Make a list of what is working. Start out with the positive to help you narrow down the list of things to evaluate and adjust.
Start simple – Define a target.
Evaluate how much time you spend in that target range. Are you at 70/80/90% of the time in target and does this meet your target already?
How much time low or high?
Does the time out of target happen at the same time of day?
Evaluate the tools you use. Are they a source of frustration?
Do you know how to use your insulin doses via injection or pump?
Can you evaluate your BG or CGM records to spot areas that need attention?
Do you know how your insulin acts in your body?
Do you have a good software program to evaluate your information? (Dexcom Clarity, Libre, Tidepool, InPen, Carelink, glooko, mySugr are all good options for data analysis)
Define what to work on first.
Identify your trouble spots – too many highs? Too many lows? Issues around particular meals or activities?
Look at the target you have set – How much time in range are you aiming for overall?
Understand that some of the aim for perfection and frustration is that there is variance in our data and the tools we use too. Again, we do the best to be a pancreas, but it isn’t perfect. You must be willing to give yourself some wiggle room for variables you can’t 100% control.
From a mental health standpoint when you consider the basics of where you are and where you want to be, or think you need to be it helps to consider if this plan to work harder moves you there with a positive attitude or a negative one. While you may not love the idea of evaluating your information, if the outcome of more time in range makes you excited then that is a good goal. If it is more struggle and brings in more frustration the goal may be too big OR it might be helpful to get some assistance with navigating changes.
There is also a lot to be said about how you talk to yourself about managing your diabetes. Take the emotion out of it and don’t criticize your actions. Instead of saying “I stink at the management”, try to acknowledge the day-to-day work you do and how hard it is and then define a goal to improve. “Diabetes is hard, but today I’m going to do _______ to aim for navigating better”.
Management is not all or nothing – every day requires decisions and if you define where you want to be in terms of your management it can help to avoid the common problems caused by aiming for what your pancreas would do without asking you.
A Diabetes Nirvana attitude can lead to a lot of frustration. Aim for peace in your day-to-day management using strategies you define for YOUR need.
If you feel you need a bit of assistance navigating to this place of peace it can help to talk to someone who gets it!
Integrated Diabetes Services now has a wonderful mental health specialist –Kristi Paguio LMSW, CDCES, CSOWMwith type 1 diabetes herself who would be a great first step if you feel the need for diabetes nirvana without burning yourself out.
Integrated Diabetes Services, Director of Lifestyle and Nutrition.
Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems.