- Kathleen Hernder RD, CDE
Why calling blood sugar numbers 'good' and 'bad' isn't helpful
I've been thinking a lot about some topics that are really important to talk about when it comes to diabetes and today I want to talk about blood sugars. No, I don't mean targets and what happens when they are higher or lower than target. I mean the meaning we attach to them and how that can affect you if you have diabetes.
Just like how it's important not to think of foods as 'good' and 'bad,' it's also important not to get wrapped up in 'good' or 'bad' blood sugars. That might sound confusing since there is a target range for blood sugars but bear with me for a minute here!
The thing is, when we think about blood sugars as 'good' if they're in target and 'bad' if they're out of target, we stop using them as information that can help us manage more effectively and start using them as a way to determine self-worth and can lead to a lot of shame and blame. This is especially important since blood sugars aren't a behaviour- they're an outcome that we don't always have as much control of as we think!
Much like how feeling like we are 'good' or 'bad' when it comes to food can lead us down the road of yo-yo dieting, I've been noticing how that same judgement when it comes to blood sugars can lead to a cycle much like yo-yo dieting. Let me walk you through the stages that I've heard a lot of clients describe.
You notice your blood sugars aren't in target
This might be through your own blood sugar checking, or getting a HbA1c result (a measure that helps give us an idea of where your sugars have been, on average, over the last 3 months) from a healthcare practitioner.
You find out that your blood sugars aren't in target and that leads to feelings of shame and guilt. You start wondering what you've done wrong, how you could let it get this far, and what you can do to fix it.
You decide you need to change everything you're doing, right now.
This might mean making drastic changes to your eating or following a meal plan, it might mean testing your blood sugars constantly, or it might mean you start taking up an exercise plan. It might mean you do all of the above.
When this happens, you usually have the same energy of starting a diet. You're determined to change everything, right now so you and your blood sugars can be 'good' and so can you.
Things might improve but a blood sugar number will be out of target (and you might not even know why)
We have this idea that we are in complete control over our blood sugars through our eating and movement but the truth is, there are other factors that affect blood sugars too! They can include stress, illness, medications, and other factors like the time of day, and the progression of your diabetes.
If your blood sugar went high after eating you know spikes your blood sugars, it can also be helpful to remember that restriction naturally leads to eating more (especially of foods that have been restricted) and that's completely normal. If you want more information about this, I've written about that before here.
If you have the view of those blood sugars being 'bad,' then you might think that you're 'bad' instead of approaching your blood sugars from a place of curiosity and non-judgement.
The "Screw it" effect
You've been trying your hardest and maybe your sugars aren't where you think they should be. You might be hungry all the time, focused on food and feeling out-of-control around food, and hyper-focused on your blood sugar numbers. Your fingers might be sore from testing constantly. Maybe you're tired of doing activity that you don't enjoy.
Very similarly to when people feel like something has gone wrong with a diet (or lifestyle change or meal plan or whatever you want to call it), there is often the thought of 'what the heck is the point?'
This is when people often stop what they've been doing- maybe you stop testing your blood sugars all together. Maybe this is when you stop restricting your food and feel like you're out of control around food (this is a completely normal response to restriction by the way). Maybe you stop all your activity too.
You might avoid appointments and phone calls from your healthcare team. You might even stop taking your medications.
Sometimes it isn't that extreme but still isn't helpful
It might not get this extreme- it could also look like avoiding checking your blood sugars because you know they're high, so what's the point? This mindset can prevent people from getting help from medication, stress management, or other factors that could help bring blood sugars closer to target.
Eventually something happens that brings you back to the first stage and the cycle goes on and on.
Does that cycle sound familiar to you? If it does, I assure you that you're not alone. This is such a common thing for people with diabetes to experience that really mimics the reactions we might have to placing a lot of emotional emphasis on weight.
The difference is that while most of the time we don't need to weigh ourselves (although there are exceptions to that like in weight restoration with eating disorders and heart failure), often checking blood sugars gives important information that can provide feedback about whether you might need some additional help with medications to help you bring blood sugars more into target.
No, I'm not advocating for you to stop testing your blood sugars or getting your HbA1c tested
I'm suggesting that how we look at blood sugars might need to change. If this cycle feels familiar to you, in order to break it, a sense of curiosity instead of judgement is really helpful. Having a blood sugar reading out of target doesn't mean you're a bad person or that you're bad at managing your diabetes.
Going around on this cycle, on the other hand is more likely to cause long-term issues, especially if you stop taking medications and avoid doing blood work and attending appointments with your healthcare team.
Having diabetes can be really frickin hard. There are lots of things that you have to think about that people without diabetes don't have to. It's not fair, and it really sucks that you have to deal with it.
If you want to try to break this cycle and approach managing your diabetes in a different way, you can contact me at KatHernderRD@gmail.com. I'm not taking clients just yet but you can get on the wait list!