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<blockquote data-quote="Scott-C" data-source="post: 1708437" data-attributes="member: 374531"><p>Newly dx'd seem to take strikingly different approaches to it. Some will tackle it head on. Some will become obsessed about complications. Some will do both at various times.</p><p></p><p>It seemed much simpler when I was dx'd. The consultant said to me, "look, Scott, try to keep between 4 and 7, have some sweets if you go below 4, try to get it back down if you're above 8 or 9 but don't sweat it too much if you are, because these things happen and it's not a big deal provided it doesn't happen too often. See Sister Carmichael on the way out - she'll tell you about digestive biscuits."</p><p></p><p>It was a simple plan and it has worked well for me.</p><p></p><p>Compare that to today. Information and the internet is a good thing, but I sometimes feel that newbies might feel deluged by all that's available. </p><p></p><p>Instead of being left to make their own mistakes to figure out their own parameters, they can very often be subject to very divergent views on what's right. </p><p></p><p>When they read about good a1cs, see flat cgm traces, read about complications, I imagine it might seem that unless they are in range all the time, complications are inevitable. </p><p></p><p>Sure, staying in range is important - I put in a fair bit of thought to try to do that - but for newbies, it can lead to an unhealthy preoccupation and an unwillingness to take even slight risks, which does not serve their interests on the long run. How will they know where the boundaries are unless they experiment a bit, make mistakes and then reflect on whether that excursion was due to pre-bolus mistiming, incorrect ratio etc?</p><p></p><p>I think it is important to reassure newbies that their target range can be a bit looser to start with than the ideal 4 to 6, with a medium term aim of tightening it up through trial and error as time goes by, and that this can be safely done without impacting to any real extent on longer term complications.</p><p></p><p>If that process doesn't happen, there's too big a risk of newbies becoming terrified of any sort of excursion out of range, and it's only a smal step from there to a whole host of eating disorders developing, along with a constant negativity, limited food options and a gloomy view of the future.</p><p></p><p>I like this quote from an endo:</p><p></p><p><a href="https://diatribe.org/issues/58/quotable-quotes" target="_blank">https://diatribe.org/issues/58/quotable-quotes</a></p><p></p><p>"In all the work with diabetes technology I’ve done, I’ve worn CGM for long periods of time. I don’t have diabetes, but I’ll eat a dessert and go up to 200 mg/dl. I’ll also drop down to 50 or 60 mg/dl. People with diabetes are comparing themselves to a false standard. The pancreas, for all of the advantages it has, still allows big excursions. It’s crazy to think it’s ideal.”</p><p></p><p></p><p>-Dr. Steven Russell (Massachusetts General Hospital, Boston, MA) urging people with diabetes not to be too hard on themselves</p></blockquote><p></p>
[QUOTE="Scott-C, post: 1708437, member: 374531"] Newly dx'd seem to take strikingly different approaches to it. Some will tackle it head on. Some will become obsessed about complications. Some will do both at various times. It seemed much simpler when I was dx'd. The consultant said to me, "look, Scott, try to keep between 4 and 7, have some sweets if you go below 4, try to get it back down if you're above 8 or 9 but don't sweat it too much if you are, because these things happen and it's not a big deal provided it doesn't happen too often. See Sister Carmichael on the way out - she'll tell you about digestive biscuits." It was a simple plan and it has worked well for me. Compare that to today. Information and the internet is a good thing, but I sometimes feel that newbies might feel deluged by all that's available. Instead of being left to make their own mistakes to figure out their own parameters, they can very often be subject to very divergent views on what's right. When they read about good a1cs, see flat cgm traces, read about complications, I imagine it might seem that unless they are in range all the time, complications are inevitable. Sure, staying in range is important - I put in a fair bit of thought to try to do that - but for newbies, it can lead to an unhealthy preoccupation and an unwillingness to take even slight risks, which does not serve their interests on the long run. How will they know where the boundaries are unless they experiment a bit, make mistakes and then reflect on whether that excursion was due to pre-bolus mistiming, incorrect ratio etc? I think it is important to reassure newbies that their target range can be a bit looser to start with than the ideal 4 to 6, with a medium term aim of tightening it up through trial and error as time goes by, and that this can be safely done without impacting to any real extent on longer term complications. If that process doesn't happen, there's too big a risk of newbies becoming terrified of any sort of excursion out of range, and it's only a smal step from there to a whole host of eating disorders developing, along with a constant negativity, limited food options and a gloomy view of the future. I like this quote from an endo: [URL]https://diatribe.org/issues/58/quotable-quotes[/URL] "In all the work with diabetes technology I’ve done, I’ve worn CGM for long periods of time. I don’t have diabetes, but I’ll eat a dessert and go up to 200 mg/dl. I’ll also drop down to 50 or 60 mg/dl. People with diabetes are comparing themselves to a false standard. The pancreas, for all of the advantages it has, still allows big excursions. It’s crazy to think it’s ideal.” -Dr. Steven Russell (Massachusetts General Hospital, Boston, MA) urging people with diabetes not to be too hard on themselves [/QUOTE]
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