Why "diabetes control" is oxymoronic

Stephen W. Ponder MD, FAAP, CDCES

"Diabetes control" is a poorly composed and overused phrase in the diabetes world. Patient referrals for “poorly controlled” or “out of control diabetics” are commonplace in my practice. Nevertheless, I cringe inside whenever I hear the word control and diabetes in the same sentence. Why? Because these two words are fundamentally incompatible with each other. Allow me to explain.

As a physician, I understand the intent of how the word "control" is used in this case. But are we doing our patients and ourselves a disservice? I think so. In fact, I believe its use only sets us all up to fail.

To me, actions which consistently result in a consistently predictable outcome or reaction defines what I might consider using the word “control” to describe. For example, I flip a switch and the light comes on. I turn my steering wheel right and the car turns to the right. I step on the brakes and the car slows down or stops. My action results in a dependable and predictable response. Get my point?

But there are far more things in the world of which I have little to no “control” over. The weather is not under my control. The thoughts or feelings of others are not under my direct control. The ocean does what it does. The list of uncontrollable things and forces is gargantuan. Diabetes is a prominent member of that list.

At first this sounds very wrong. But with a little reflection it sounds perfectly reasonable. When we first enter the world of diabetes, we are taught actions and behaviors which are expected to allow us to “control” our diabetes. If we are consistently unsuccessful implementing these skills, it’s all our fault or a direct result of our incompetence or inexperience. In addition, it could be due to poor training, or an ineffective health care provider. Of course, diabetes self-management education is essential in my opinion, but it is just a first step of many which we must take to best manage our condition.

I teach my patients early on that there is no bucket of something called “control” that I can dispense to them at each office visit. There is not something they can live off until the next refill. We may chuckle about this, but many persons with diabetes make periodic pilgrimages to the diabetes team or provider with an emotional expectation of being somehow anointed with a tangible resource that will keep them “in control” until the next encounter.

I remind them that it’s their choices that determine the quality of their management at any moment in time. And we make thousands of choices each day which could affect our blood sugar levels.

Diabetes is best likened to an ocean. Sometimes calm seas prevail. But riptides and under currents can steer our diabetes in any direction. At times we might experience violent glycemic tsunamis with little to no warning. Sugar Surfing™ is a method for best navigating the capricious ocean of diabetes through all its moods. From the utterly serene to the most destructively violent.

Sugar Surfing is about managing situations. To be specific, managing the glycemic MOMENT. You can appreciate the fundamental difference between ‘controlling’ a situation and ‘managing’ one. We never really control the day. We manage what we do as it happens or unfolds. As I said above, I don’t control the weather or the ocean, but I can manage how I interact within each, with the ultimate objective of meeting my personal goals “in the moment”.

So next time you want to discuss your “diabetes control” with anyone, think twice. This phrase is an oxymoron: it’s inherently a contradiction. It’s really all about how you ‘manage the moment’.