Do You Dread the Diabetes Report Card?
Diabetes sets the stage for perfectionism and feelings of failure.
No wonder many people with diabetes struggle, when you think about it. All efforts in diabetes management are an attempt to regulate blood sugar, which is a quantifiable measure. And these efforts are personal behaviors including taking medication for diabetes, food choices, and activity level.
It’s hard not to feel like your blood sugar is either “good” or “bad” and that you are personally responsible for that number on your meter.
The diabetes report card
Plus, an A1c can feel a lot like a report card, as if you are being graded. The feelings I hear from so many folks associated with getting their A1c results are strikingly similar to this idea of getting a report card. And, A1c results not in the “ideal” or “recommended” range feel like getting C’s, D’s, and F’s on your report card.
I often hear individuals describe the dread of getting these results from their doctor, hearing the doctor’s instruction to “do better,” and the feeling as if they have let their doctor down by the A1c result.
This can be so deflating, especially if you have made real efforts to improve lifestyle behaviors. And, much like wanting to hide a report card from your parents, most people want to hide a less than optimal A1c from their loved ones. Still, others may lie about the results to avoid concern or judgment-fueled conversations.
How to cope with the diabetes report card
To help combat this report card feeling, let’s set the record straight about your blood sugar and A1c:
Your blood sugar is not going to always be in target range or stay there
Highs and lows are going to happen, period. Don’t beat yourself up when they do. Your blood sugar is affected by literally dozens of factors, many of which are outside of your control.1
Blood sugar is not an accurate reflection of your efforts
Yes, behaviors have a big influence. But sometimes you can do everything right and still not get the results you were hoping for. Do your best and forget the rest. But remember, doing your best is the important thing here. And don’t forget to reach out for some support when needed to put forth your best efforts.
An opportunity to learn
Try viewing A1c results outside of the recommended ranges as opportunities to learn about options to improve your health. That may mean talking to your doctor about alternate means of treatment or ways you can switch up your approach to daily management practices.
It's okay if you're not a "straight A" diabetic
A1c recommendations are guidelines of what is best for you to minimize your risk and, the generally accepted target is under 7%.2 But, it doesn’t necessarily reflect what is normal for people like you with diabetes, as in how many people with diabetes achieve this. In one presentation, Dr. William Polonsky describes this recommendation and how “so few achieve metabolic success” (2011).3 To use the grading analogy, that would be like saying that an A1c under 7.0% is an “A” and that everyone with diabetes is going to be a straight-A student.
Just to clarify, I’m not advocating for not striving for measures that will give you the best chances of avoiding or delaying diabetes complications. And, if your A1c is consistently in a range that puts you at risk, it's best to reach out for help to address this. However, if you are not a “straight A” diabetic, that’s okay. Try your best but don’t beat yourself up.
Consider timing in life
The actual standards of care for diabetes have somewhat flexible recommendations based on ages and certain situations, where the target may be more or less stringent for different individuals.2 And, different times in life are going to come with different challenges and influences on your behaviors for eating and activity, as well as stress, which has a direct impact on blood sugar.
You will need to discuss your targets with your doctor and come up with a plan that is right for you and where you are right now. That may include adjusting your expectations and practicing flexibility depending on what else you are going through in your life. If you are going through a particularly difficult and stressful time, beating yourself up for your blood sugar is only going to add more stress and make things worse.
How stressed out do you feel today?