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Re: [IP] Re: Diabetes Burnout

On 14 Jul 00, at 4:35, Clifford Tener wrote:

> I can't believe you people "Diabetes Burnout".  Does
> this mean you don't want to try to live with diabetes?

No, it just means that sometimes we get tired of all the stuff we have to do 
to live with diabetes.  Things like always remembering to have your 
emergency kit with you - the spare insulin, infusion set, food, meter and 
everything else.  We can legitimately get tired of not being able to do 
anything "on the spur of the moment" but always having to be planning 
ahead and alert for the next monkey wrench in the works that this condition 
is going to throw us.  How about someone coming to your door and asking you 
to come with them for a quick trip to visit someone who's in the hospital in a 
town 50 miles away - and having to carry the briefcase/backpack full of all 
the stuff you might need.  You cannot leave it in the car because it doesn't 
need to cook in the heat and what if your car got smashed by a truck (don't 
laugh until it happens to you!) or towed off or otherwise blocked to your 
access.  You need the stuff because in the time it takes to make the trip you 
could be in trouble (unsafe or unable to drive, or at least feeling very, very 
bad!) if you had to run back home to change a set, check your bg or handle 
one of those unpredictable challenges that we are constantly encountering.  
I run into this all the time given my areas of work.

>  I take everyday as a challenge, to make my numbers. 
> Some days I fail but I try never the less.

One of the facts of diabetes is that some people have a more difficult time 
controlling it than others.  I know of a few people who manage to have an 
A1c of around 6.0 with just the old R/NPH two shot a day routine while 
other people who are using a pump and intense therapy protocol still have 
problems keeping their bg stable for a few hours, much less worry about 
their A1c.  For many of us it seems that things go well for a while then get 
difficult for a while - and when they are difficult it's not just a one or two 
day thing but it lasts for months...  Ever had one of those days when you've 
changed your infusion set five or six times because their either extremely 
painful or you took a 15 unit bolus two hours ago and your bg is still 
ramping up and is now going over 350?  Those are the kinds of days when a 
combination of physiological, emotional and physical states combine to 
produce what we've called "Diabetes burnout".  This effect is due to many 
factors, one of which is usually that the person has been doing everything 
right but nothing is working - and after you've tried eveything in the book 
and several variations on each one you're left with nothing else to try and 
you're still stuck in a situation where all your experience and training tells 
you you need to do something...

One of the contributing factors is "helpful" people around us - one of my 
worst episodes of burnout included attending a dinner where the hostess 
told everyone about her wonderful new dessert and even had the nutritional 
information ready for me - but she forgot to tell me that she had made a 
few changes, like substituting Equal for the sugar.  Then about an hour later 
I was crashing because I had bolused for what I was supposed to be eating 
instead of what we actually had... or the converse happens - when you eat 
out and discover that the cook has improved the recipe by adding a couple 
of cups of brown sugar to the chili and doesn't tell you because it's a 
secret ingredient.  Or the person who grabs something you're eating out of 
your hand because their cousin's inlaw's great aunt Maxilea had diabetes 
and she never could eat bread, pizza, drink a soft drink (even diet) or 
whatever food item they remember... and then they hand you something 
sweetened with honey because "it's natural and won't hurt a diabetic"...  
Some of us fight these battles day in, day out, day in, day out, day in, day 
out,...   and there comes a point where you just want to stay at home, hide 
out and do the bare minimum you can to stay alive for a few days.  That's 
what diabetes burnout is...

> only 7 months but I think that burnout is something
> that you give yourself.  Diabetes Burnout, I think
> not, be glad you are alive.  Put that (Diabetes
> Burnout) in your attitude and get over it. 

Consider yourself fortunate that everything seems to work well for you all 
the time.  Not everyone is able to get by as easily and some of us put a 
great deal of effort into keeping our numbers on track while trying to live 
a somewhat normal lifestyle at the same time.  Remember to think kind 
thoughts about us when we seem to be struggling in ways that may be 
difficult to comprehend.  We don't understand it either, we just know that 
we're having a tough time at the moment.  Over the past 18 years I figure 
that I have spent about 10,000 hours trying to manage this condition.  
That's roughly equivalent to five working years (full time) - and I've been 
told by doctors and CDE's that I seem to get by with much less effort than 
some of their patients (I don't weigh most of my food and since I use a 
computer to handle the statistical analysis I have an advantage over people 
who are doing it all manually).  

Try to understand that Diabetes burnout is exactly the same kind of 
burnout as other more fashionable kinds - like caregivers burnout, sales 
burnout, sports burnout or whatever kind of condition is caused by 
constantly being on call, in the spotlight and in demand  when you're at the 
point of not having anything left to give...  we don't choose it, we don't like 
it, it's not any fun at all.  We just try to marshall our resources and get 
through it... For many of us the pump is much easier than the tight control 
protocol (intensive injection therapy) with it's four to six shots a day ride 
the rollercoaster to failure scenario programmed into it...

Rev. Randall Winchester
WD4HVA (email @ redacted)
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