The Power of Patience

Dynamic Diabetes Management (aka Sugar Surfing™) is a process, not a recipe. Certain virtues or qualities are essential to obtaining the best results. Patience is one of those personal qualities.

In the book Sugar Surfing I discuss the 3 virtues of well controlled persons with diabetes. After working with thousands of patients for nearly four decades, I learned that patience, consistency and resilience are traits which most, if not all, consistently well managed persons with diabetes share. This post emphasizes patience. It might be the most difficult of the three to maintain. It certainly is challenging for me.

In this example, the act of patience is essential to the result you eventually see. Let me walk you through this.

It starts with a slow blood sugar ‘drop’ (orange triangle). This was a controlled drop induced by an earlier insulin micro bolus (not shown). I am using a single basal insulin dose by injection (taken the evening before). My long-acting insulin dose has been balanced and tested to provide the basal steadiness essential to effective Sugar Surfing results (well described in the book). The glucose trend line inflects (blue inflection arrow) into a ‘shelf’ (green rectangle, representing a relatively steady BG trend) after the earlier insulin micro bolus faded away (it was a little over 2 hours in duration).

Still, my BG was too close for comfort hovering in the low 60 mg/dL (3.3 mmol/L) range. I verified the sensor reading of 57 mg/dL (3.2 mmol/L) with a BG meter check (55 mg/dL, 3.1 mmol/L). Next, I chose to drink the equivalent of 12 grams of fast acting carbs, in the form of grape juice. Why 12 grams and why grape juice? Because through prior experimentation I learned that this amount would raise my BG from a steady trend line (shelf) approximately 40-50 mg/dL (2.2-2.8 mmol/L).

The magic is what happens next…or doesn’t happen: I simply waited. In total, about 15-20 minutes elapsed before the BG trendline began to rise (red triangle delta wave). And as previously rehearsed, the expected BG outcome finally materialized (the red inflection arrow).

This outcome stands in stark contrast to my earlier years, before I surfed. In those days I often treated a low BG until I felt better. The funny thing was that it took the same amount of time as this example shows, but since I wasn’t feeling the low improving quickly, I felt the need to ingest more and more carbs. A person can overeat a lot of carbs in 15 minutes. The usual result would be a glycemic overcorrection (spike). My BG would climb well over 250 mg/dl (~14 mmol/L) or higher.

At a recent Sugar Surfing Workshop, the issue of higher A1C values in teens with diabetes versus adults was discussed. Across the age continuum, average A1C levels diminish around age 25 years compared to the years between 13-25.

I pointed out to the audience that current child development experts believe “adolescence” (as a behavioral state) usually ends by the mid-20’s. As more adult style self-care behaviors take over, this is associated with lower average levels of blood glucose across the day and lower A1C values. In essence: different decisions are made. Perhaps more patience and consistency set in too.

The power of omission is clearly illustrated in this image. Through the act of waiting after treatment was completed, an overcorrection of a mild hypoglycemic state was avoided, or at worst minimized compared to treating myself until I “felt better”.

This image walks you through each step in the thought process. Change any one the operating conditions, and a different action or actions would have been required to affect a similar outcome. Sugar Surfing is empowering. It’s the application of the three virtues by a critically thinking individual. But of all the powerful tools at the disposal of a Sugar Surfer, never underestimate the power of patience.