How Easy It Could Be to Slide

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This week I want to spend a bit of time talking about my diabetes. I know! Finally, right? After weeks of thyroid cancer this and papillary thyroid carcinoma that.

But… Before I get into diabetes, let me say — for anyone who’s followed my blog for the past month or so — that most of my concerns surrounding the cancer, which were mostly about the unknowns (who the surgeon would be, not hearing from schedulers about clinic visits, not getting any callbacks regarding a surgery date), well, these have all been taken care of. I have my preoperative visit this afternoon, and on January 7 I will have my thyroid — along with some lymph nodes near the thyroid — taken out of my body.

I will keep you posted on how that goes. But back to diabetes…

Or, OK. Yes. Diabetes. The thyroid cancer diagnosis still has a number-one position in my health-concern worries, but it’s because of that that I want to talk about my blood glucose control. For the past, oh, nearly three years now, I’ve managed to have good control of my blood glucose numbers. My usual HbA1c numbers that I get at my quarterly endocrinologist visits average somewhere in the 6% range, which is pretty tight. I’m happy with this. I don’t aspire to below-six numbers, because I really don’t want to spend that much of my time concerning myself with the potential for going hypoglycemic (which increases greatly with attempts to decrease HbA1c below numbers in the 6% range). Also, when my endocrinologist told me that there’s been no conclusive evidence that lowering my HbA1c into the 5% range would decrease the likelihood of complications, I realized that the risk-reward scenario just wasn’t worth it.

On the other side of that 6% range, however, is where I feel I may be headed during this cancerous hiccup in my life. I’m predicting that the next time my HbA1c is tested, it could be popping up into the 7’s. See, prior to the cancer diagnosis, I was an efficient and pretty obedient monitor of my blood glucose numbers. I always corrected for the higher numbers, and I was vigilant in avoiding lows. I kept tabs and compensated for each and every carbohydrate I put into my system.

I’ve discovered, since my diagnosis of thyroid cancer, that I can only handle so much medical self-management. Some of this may be due to cancer coupled with the ever-difficult self-management season in which I find myself, but I’ve elected to give myself a holiday break this year that’s even more lax than in the past. I’ve seen my average blood glucose readings creeping higher the past few weeks by 20, 30, sometimes even 40 mg/dl. And sure, that’s not really healthy. I find myself ignoring my insulin pump glucometer’s call for a check two hours after a meal. And that’s not really responsible. And yes, I’ll grab that holiday-party cookie off the tray, decide not to bolus to cover it, and as I walk away nibbling on the chocolate-chip deliciousness, I have a moment of internal dialogue. And what wins out, mostly? The internal voice that tells me “cussword it”; “indulge a bit,” it says; “you have cancer,” it says; “you’ll do this only so long before you’ll get back to how you were, so just enjoy — or at least don’t worry about — a few transgressions.”

As a whole, my self-management scheme right now isn’t the healthiest. At least, not compared to how it was. But I’m preaching to myself my own jeremiad. But hear me now before you begin chastising me: I’m aware of what I’m doing. How could I write this blog if I weren’t? Overall, I’ve been good diabetic citizen for a long time now, obeying all laws and speed limits. So if I throw some litter and miss the wastebasket, I’m not picking it up. If I drive a few miles per hour over the speed limit, try and arrest me. I’m not bringing my entire self-management system down around me with my errant behavior. Not at all. It’s a simple month-long slide only a rung or two down the ladder. All will return to the way it was before.

I think — or rather, I know — that I need some comfort right now, that I need to loosen the hold that my medical life has on me, and there are areas where I can do that. My blood glucose control will be where that happens. But only for a little while. And only just a little bit.

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