So we've talked already about how we just can't say that we want normal blood sugar, because it's often a lot more complicated than that, and actually what we need to do is choose a level of risk that is in balance with both our approach and our ultimate preferences.
I've brought this matter up several times, elsewhere on the internet, and it seems that some people just don't get it, but these tend to be the people that just look at diabetes as normal blood sugar or bust, live as long as possible or bust, but they don't realize that these are merely preferences and not everyone may share their set of preferences here.
When I use the term values, I use it in the broadest sense, where values are the underlying preferences by which we judge our actions as being in accordance with them or not, in other words, rational or not. So what we're talking about here is value fulfillment, which really means what pleases you the most, what makes you happiest, etc.
You might actually choose to be unhappy, and it seems that a great number of people have this preference actually, but we're using happiness in the broadest sense here, so being unhappy is what makes you happy, and happy here means fulfilling a goal, a value.
So what does all this have to do with diabetes though? Well we all have our own values here, meaning what our ultimate objectives are. To take an example, there are people who value a long life, preferring quantity over anything else, and that's perfectly fine since it's what they value.
We can argue with this if their actions don't match their values, for instance if someone ignored their diabetes and they were shortening their life dramatically, yet they ultimately valued living a long life over anything else, we'd say they were acting irrationally and may look to help them get straight, where either the behavior or the value must be reexamined, since they aren't compatible.
On the other hand, if someone held the value of wanting to live their life the way they wanted to and that was more important to them than living a long life, quality over quantity we could call this, then we can't say to them, well you need to value living as long as you can, and you need to change.
Although this whole thing is not quite as simple as just looking at quantity of life versus quality of life, this is actually a good way of looking at the decisions we make in terms of how we approach our diabetes. We have people on both extremes, and we all fall somewhere between these two extremes.
The quantity lovers though seem to have a lot of trouble accepting that there's another value here that is even valid, and the quality lovers probably see these people as being way too paranoid and missing the whole point of life, which is to enjoy it to the fullest.
However, each has their own values here, and that's fine, again this is their values, everyone is entitled to them, it's not that one is right and the other wrong, and we need to make sure we don't narrow our minds to the point of just assuming ours are right.
So I'm telling you this because we really do need to take this all into account when we speak of how we should best approach life as a diabetic, and there are people, for instance, that might say, I'll eat dirt all my life if that helps my blood sugar, and others who may not be interested in living a life where they cannot eat what they want. Neither are wrong, they just are what the people want.
I've met some diabetics where I want to just shake my head at how they are managing it, and I'm pretty open minded about this actually, and I have to stop myself and think, well this seems to be what they want. So we want to educate these people but we need to stick to the facts, consequences, but if they have this knowledge and are still OK with it all then there's nothing more to do.
So with that out of the way, once we get clear on our preferences, we do have to put this in perspective by looking at the risks involved. So the first thing is to look at risks of various blood sugar levels. I see people who approach this with more than a healthy dose or paranoia, Richard Bernstein is the champion of this actually, you need to be under 90 all the time, A1C in the mid 4's, or monsters be on the other side of these lines, so if you cross them well it's insulin time.
On the other hand there are people who just don't think double digit A1C's are much of an issue, which is clearly false. So the risk with blood sugar that is very high is very significant, versus the meaningless amount of risk when you're looking at normal versus slightly elevated above normal blood sugar.
So we need to get clear on what the risks are here and a lot of people just make some wild guesses here, but this is not something we want to be guessing at, on either side of this actually, as I see people do themselves harm with stress over blood sugar levels that they should not be stressed about at all, as well as people not worrying at all about disturbingly high blood sugar.
Beyond that, there is of course the risk profiles of treatment, but that's actually another matter, and we first want to get our own particular preferences straight, and the risks of following them straight, before we can even know much about what is going on.