The Diabetes Gamble: Playing The Odds To Keep What We Value

Making wise choices is possible only after accepting the reality of our situation.

After receiving a diagnosis of diabetes, reaching a point of acceptance can be a bumpy road fraught with detours. Traversing it takes time. No one wants to admit how susceptible we are to diabetes complications, what the severity of those complications can be, and what is required to keep them at bay.

Our Best Bet

Even after a level of acceptance is reached, making and keeping good diabetes decisions remains difficult because we know our wise choices do not create certainty—they are a gamble. Some people who conscientiously control their blood sugar develop complications, while others who live carelessly never do.

This uncertainty breeds fear and denial, so without certitude we cannot rely on positive emotions to motivate good self care. Our best bet lies in making informed choices based on probabilities and values; this works well for people with type 1 and type 2 diabetes.

Probabilities

In each area of life we simultaneously make choices and take chances. With diabetes, choice involves things such as exercise, diet, glucose monitoring, and insulin. Chance comes into play with the unknown factors that leave some at higher risk for complications than others, or make blood sugar control harder for some to achieve.

The dance of choice and chance means that after 25 or more years of disciplined diabetes management with continued good health a person knows two things. One, they have played the game of life with diabetes skillfully and persistently. Two, they may be benefitting from the luck of the draw. Others can play just as skillfully and still develop complications.

Despite the inherent uncertainty of choice and chance, the probability of a healthier future is significantly greater with good glucose control than with poor. Research and common sense tell us so. However, going with the odds does not reveal exactly how each person should play their hand. That requires value judgments, or knowing what is worth our effort.

What We Value

By focusing on what is important to us glucose control is no longer a matter of “Is this food forbidden?” or, “Is eating this cookie cheating?” It becomes a matter of whether our actions reflect our values. Do we value feeling better, living longer, being in control, or enjoying our pleasures and preferences despite the consequences?

Determining what we want from our various relationships, from work and leisure time, and acknowledging how much freedom and responsibility we desire increases motivation to persist in our lifestyle choices—because we know “what’s in it for us.”

The big umbrella question is, “What do I have to live for and are these things worth the effort of unwanted but necessary lifestyle changes?”

Playing the Odds

Though most of us can name things worth staying healthy-as-possible for, no one is suggesting that working with probabilities and values make diabetes management easy.

Humans have never been aces at denying themselves immediate pleasure for a long term, uncertain benefit. Nor do we generally feel susceptible to health complications when today’s symptoms are mild, and we feel good.

Still, we can be wise gamblers, playing the odds to maintain what we value by choosing our actions wisely, one day at a time.

Source: Brodsky, Archie, and Edelwich, Jerry; Diabetes: Caring For Your Emotions As Well As Your Health; Perseus Books, 1998.
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