What “Controlling” Your Diabetes Actually Looks Like, According to a Behavior Scientist

What “Controlling” Your Diabetes Actually Looks Like, According to a Behavior Scientist

Think back to the last time you had a conversation with your doctor about living with diabetes. Maybe they talked about “controlling” different trends in your blood sugar, or perhaps you went over some strategies to “control” your weight and help improve your diabetes. Either way, the word “control” can be difficult to escape when you’re living with diabetes.

And yet, anyone who lives with the condition knows that you can’t actually “control” every factor that influences it. From financial support to healthcare access, there are plenty of constraints in life that are simply beyond your influence—and, in fact, research suggests that being told you have “poor” or “unacceptable” control of your diabetes can actually hinder your ability to manage your health, thanks to the stress that comes with these types of judgmental statements.

For a more empowering perspective, Dr. Harpreet Nagra, PhD, licensed psychologist and VP of behavior science at One Drop, walks us through what the word “control” can really look like in successful diabetes management.

Allie Strickler: First, how is the word “control” typically used in the context of diabetes diagnosis, treatment, and management? What do doctors expect you to control?

Dr. Nagra: Diabetes is a numbers-focused condition, and with numbers, you usually have “right” or “wrong” answers; either you’re doing well with your numbers, or you’re not doing well. Healthcare professionals in the diabetes world typically talk about having your blood sugar levels within a certain range. The idea of “control” is to ensure you’re managing your blood sugar enough to maintain that range. However, there are a variety of factors that can affect your blood sugar, from the temperature outside (something you can’t influence) to whether or not you drank enough water that day (something you can influence).

So, when you fall outside of the blood sugar range that your doctor has prescribed to you, then you might start to think, “I’m losing control.” And your doctor might even reinforce those worries by warning you that, if you continue to lose “control,” you could be in danger of certain diabetes complications, such as losing a limb. In a way, the word “control” is often used in this context to essentially scare you into taking actions that maintain that sense of “control.”

Allie Strickler: So, in other words, there’s an illusion of control in diabetes management, right?

Dr. Nagra: Correct. The purpose of that illusion of control is related to anxiety management. If we have a narrative that we can tell ourselves about what’s going well and what’s not going well, that gives us a sense of perceived control over the situation and eases any anxieties about it. We need those stories to help us psychologically cope with our stressors.

When living with diabetes, particularly if you’re using medication such as insulin to manage the condition, doctors often assume that you can control all the food you eat, the amount of physical activity you get, the number of carbs you have in a day—the list goes on and on—just as well as you control that specific, measured dose of medicine. But, as anyone living with diabetes will tell you, it’s just not that simple the majority of the time.

So, because the list of what to control in your health is so long, and so much of it is actually outside of your control, that tends to heighten the sense that you’re failing if you’re not able to handle every single item on said list.

Allie Strickler: What are the potential consequences of this illusion of control?

Dr. Nagra: Some research has shown that adults living with diabetes may be at risk of developing disordered eating habits. In some cases, those disordered eating behaviors can manifest as what’s known as diabulimia, which entails limiting how much insulin you use to avoid the bloating or weight gain that comes with taking the medication. It’s also not uncommon for people living with diabetes to control what they eat so much that they end up having the exact same foods every single day, or dosing the same amount of insulin each time they take it, even when the dose or the number of carbs you eat should change depending on your current blood sugar levels, meal timing, etc.

Regardless of how it manifests, the consequences lie in the fact that you’re coming up with a system around eating and medication administration that you think will help you maintain control, even though it won’t. The reality is that there are a lot of other factors at play, not all of which can be controlled, nor can they all be controlled in just one way. Coming to terms with that truth can leave you feeling frustrated and powerless—that no matter what you do, you’re not going to be able to change your situation. When you’re doing what feels like your best, but you’re still not seeing the results you want, it can be quite disheartening.

Allie Strickler: So what can we control when it comes to managing and living with diabetes?

Dr. Nagra: Self-talk is a major variable here. We definitely have control over how we talk to ourselves. If we’re not talking to ourselves with compassion, more likely than not, our thoughts are going to start deviating toward the negative and reinforce a negative self-image.

At the very least, we need to be aware of our self-talk. But we also need to intentionally work on shifting our self-talk when it’s negative. We have to try to practice as much gratitude and compassion as we possibly can, even on a daily basis. Especially when you’re in the thick of a rough patch with diabetes management, it can be really hard to step back, see the bigger picture, and apply more positive, empowering strategies to your self-care. But it’s a necessary step if you want to change your mindset around what it means to “control” diabetes, and it requires you to have the confidence that you can change your skills, knowledge, and treatment opportunities over time with practice and education. That’s what we call a growth mindset. It’s about being open to learning, but still allowing yourself to make mistakes and, perhaps more importantly, to continue moving forward after those mistakes.

You also have control over who you’re exposed to. For instance, if you’re working with a medical team that doesn’t seem to be validating you or supporting you in both your strengths and your challenges, then that might be an opportunity to seek out a second opinion, a third opinion, or even a different medical team altogether.

To that end, oftentimes people have different seasons, so to speak, that they go through in terms of what type of medical provider or medical team will be best for them. Maybe at one point, you’ll need somebody who’s going to be more constructive with their feedback about your health or nudge you more about the changes you need to make; other times, you might want someone who’s a little softer in their approach. It’s all about paying attention to what your emotional needs are at any given point, as well as your medical needs, so you can decide what works for you and what does not. All of that is within your control.

This article has been clinically reviewed by Jamillah Hoy-Rosas, MPH, RDN, CDCES, and VP of clinical operations at One Drop, and Dr. Harpreet Nagra, PhD, licensed psychologist and VP of behavioral science at One Drop.

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Allie Strickler
Oct 11, 2021

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