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jenny

While sitting in my driveway waiting for a construction truck to move out of my way, the saying “Patience is a virtue” popped into my mind. I can be quick to get irritated when I have an agenda that gets disrupted, but it reminded me how much waiting I do in my life with diabetes.

I’m quite certain that Cato the Elder was not living with type 1 diabetes at the point of noting “Of human virtues, patience is most great”, but he certainly hit on how hard it is to wait in certain circumstances without irritation.  It is an admirable quality in many aspects of life, but it makes me consider how much time we spend waiting for things in our day-to-day with diabetes.

patience

When should we practice patience when living with diabetes?

Required acts of patience include timing insulin around food, pre-bolusing, adjusting for exercise, as well as evaluation of how basal profiles or doses work after making an adjustment. These all require a bit of waiting, watching, and evaluation to get from one point to another with success. This waiting time can provide more stability. Data analysis requires some patience as well. To make adjustments that will work better we may need to allow glucose levels to move out of desired ranges for a time to see where to fix the issue. In the long term, patience pays off here.

Looking at typical food intake or learning how intake of certain macronutrients impact glucose levels can require patience while we watch and wait for something to happen. This allows us to learn how to navigate better next time with preferred results.

Pre-bolusing requires a wait as well. We know that insulin acts slower than carb intake may hit so we must learn to time a dose around food so these two meet at the right time. This leads to a rise/fall in the boundary target we have set which is most pleasing.

What things require patience because there is no other option?

When do we just need to wait? Usually, this happens in the time period where we are waiting for new products. A change from multiple daily injections to an insulin pump can take some time between ordering and assessing coverage and then setting up training. We can understand some delay here, but it is still hard to wait when what is coming will likely assist with improving overall management.

We also must wait each time a new product gets approved. It is very exciting, and we all want the newest and greatest option, but as we all know, rollout of new tech takes time. There is almost nothing we can do except wait. In this time the best thing to do is assess what you know about the latest and greatest, evaluate why you may want to give it a try, and discuss interest with your healthcare team to ensure you know all that is important prior to requesting an order. It is also important in this time to evaluate how your current strategy is working or not working so that you can focus in on this with the new technology.

Starting a new medication may also take some time to see an impact. Discuss new medication t with your doctor so you have a timeline of action and can check-in sooner than later to evaluate how things are working or adjust get the effect you want.

What should we act on with urgency? Why? When?

There are also times where we may need to do something sooner than later, where being patient isn’t the right thing to do. I certainly can think of many times acting sooner than later would be the wise choice. 

If BG is high for no reason, it is time to take steps to evaluate if a dose of insulin was missed, or food was not accurately covered, or even if the insulin pump site isn’t working well, etc. In the example of a bad pump site -leaky, bloody, occlusion or the site was disconnected, action is needed now. Take the steps you have learned to address high BGs by dosing to correct the high and bring BG to target. Even here we need to exercise some patience while the impact of insulin takes time for a change in glucose to be seen. Review timeline of action with your healthcare provider if you aren’t sure how long a correction should take before a change in glucose is seen.

If illness is the reason for the higher glucose levels, then adjusting insulin doses up with temporary basal changes or extra boluses may a be necessary step. The sooner you adjust with more insulin and evaluate if it was enough, the less frustrated you may be and the more likely you are to speed up healing. Make sure to test ketones with any illness, even if blood glucose isn’t terribly high. The more you know the better you can be prepared and the sooner you can act to keep yourself safe.

Stress can also be a factor for higher glucose levels. If you can anticipate some types of stress, like a big exam, you can adjust ahead of time. Don’t let a high BG happen if an experience has taught you what raises your blood glucose.

Low blood glucose is another time to not wait. Depending on the situation that is causing the lower blood glucose, or the drop in blood glucose the sooner you act, the faster you stop a drop or start to bring a low Blood glucose back up. Patience is required to allow the treatment for the low to start to work. I think this is one of the hardest times to wait especially when symptoms of a low blood sugar continue to tell you to eat more.

If you are out of medication or running low, the time to act is as soon as you realize you need more. Don’t wait to call your doctor or the pharmacy, it might take time to get a prescription filled. Plan to have supplies and medication on automatic refill so you don’t have to remember and plan to ask for automatic call or text to tell you when it is sent or ready to pick up.

Yes, life with diabetes requires a lot of patience for many reasons. Learning when to act and when to remember to wait can take time to figure out. If you feel like you need some assistance with figuring out where your management needs some patience give Integrated Diabetes Services a call – we have all had to learn to navigate when to wait and when to act in our lives with diabetes.

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