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From Isle of Man, the United Kingdom:

I am a 21 year old girl who has had type 1 diabetes for ten months. I have made every effort to educate myself about my condition, and I would say there isn't much that I don't know about diabetes. Which is why I have become suicidal about my failure to control it. I follow the perfect diabetic diet (everything in moderation, nothing too sweet, nothing too fatty, always combining a high glycaemic food with a low one). I exercise for half an hour every day at the same time at the same intensity. I eat my meals and take my insulin at the same time every day. I eat the same amount of carbohydrates at every meal. I test my sugar when I get up, just before meals, two hours after every meal, and when I go to bed every day. I get up in the morning at the same time, and I go to bed every night at the same time. I take NPH at night and three lispro injections a day. I would like to try glargine, but it is not available in the UK. I have seen every diabetes expert there is and tried every diet. I have had every food allergy test under the sun. I don't smoke and I don't drink alcohol, but I make sure I drink plenty of fluids though.

Despite all of this, my insulin needs fluctuate from week to week. I can be stable for a week, but then every dose I take is suddenly totally wrong (either way too much or way too little). For example, sometimes 2 units of lispro is the right amount before breakfast, and then suddenly I will need 12 for five days or maybe a week for no reason even though my blood sugar is the same in each case(no matter if its 12 mmol/L [216 mg/dl] or 5 mmol/L [90 mg/dl]). It is not connected to my period. I am on the verge of giving up because I cannot control it, and the more it goes wrong the more I withdraw from life. I average about three hypos a day when I am in a transition period during which my insulin needs change. It makes me very emotional, and I just have to be alone. The manic hunger I experience during these periods of constantly plummeting blood sugar is also extremely difficult for me since I used to be a compulsive overeater and the urge to binge is almost too much sometimes, but I assure you I haven't binged for a long time so that has nothing to do with it. Please help.


You sound burned-out by diabetes, and there are so many good reasons to feel burned out by such a demanding disease. As you have so clearly pointed out, managing diabetes is not black and white. There is no right answer that allows you to have perfect blood sugar control. However, your struggles are more intense than many others, and diabetes does not need to be as much of a burden as you are currently experiencing.

You may find the book Diabetes Burnout: What To Do When You Can't Take it Anymore by Dr. William Polonsky, published by the American Diabetes Association, to be very helpful. However, the most important thing you can do right now is to ask your diabetes team for a referral to a mental health professional with expertise in working with young adults with diabetes. If they do not know of anyone in your community, perhaps they can help you find someone with expertise in working with individuals who live with a chronic illness. Your primary care physician may also be a good source of referrals. Please get some help and support so that you can feel less overwhelmed by the diabetes.


[Editor's comment: I agree will Jill in that it sounds like you are in need of some professional counselling right now. In addition, I would you like you to consider a few additional thoughts:

  1. Given your duration of diabetes, it is quite possible that your honeymoon period is ending. In this case, your pancreas produces varying amounts of insulin in response to an identical glucose load (food). This means that the amount of insulin you need to inject can vary greatly depending on how much insulin your body is producing, regardless of any changes in food, exercise, etc.
  2. It appears to me that your diabetes is controlling you rather than your controlling it. You seem to be obsessed with having perfect blood sugars, which is an unrealistic goal, even with the most sophisticated of treatment plans. The bottom line right now for diabetes control is the HbA1c. If your values are 1% or less above the upper limit, you are doing a great job, despite the day to day fluctuations in glucose levels.
  3. You have allowed diabetes to run your life, controlling your daily routines and eating habits. This sounds like it may be in conflict with what you really would like to do, and is a major source of your frustration.
  4. It is extremely important that you set up an appointment with your diabetes team to discuss all of these frustrations and concerns so that together you can devise a treatment that will help with improved control and, more importantly, be more conducive to the way in which you want to live your life. Your situation might well be clarified by using the The Continuous Glucose Monitoring System for several days to try to sort out what's happening in more detail, and perhaps switching to an insulin pump can help you fine tune blood glucose levels.

Original posting 14 Jan 2001
Posted to Behavior


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Last Updated: Tuesday April 06, 2010 15:09:18
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