Noncompliance

At some point, I will finish up my Diabetes Blog Week posts.  I've missed the Sunday prompt, where we "Share the Love" and share three links from posts this last week that we really loved.  Unfortunately, life hasn't been cooperating and I haven't been able to read very many posts.  I can't wait to have a bit of free time to do that and then share some of my favorites.

But right now I have something else on my mind.  I just read Wil Dubois's post on DiabetesMine on the new AACE algorithm.  He ended the article with a couple of quotations from AACE President Alan Garber:

 “There is no excuse for high blood glucose in the United States, given the vast array of agents to choose from,” said Garber, who then followed up with, “What undermines our efforts is noncompliance on the part of patients.”

This reminds me of a poster I've seen in the office of my Italian diabetes doctor.  It's a big chart about patient care, but one thing jumped out to me: the word NONCOMPLIANCE.  This wasn't translated into Italian, it's a word that is borrowed directly from English.

It also makes me think of an excerpt of Walsh and Roberts' Pumping Insulin* that stated that once on an insulin pump, there was no reason for glucose levels to fluctuate more than 40 points or so.

My overnight highs I keep getting?  Not from noncompliance OR lack of trying.  My post-lunch high?  Still trying to kick it.  The sine wave that follows most meals I eat?  Well, I wish it were a pretty, straight line.  But it isn't.

Absolutely, I could be doing things differently that might improve these highs.  Absolutely, I could be doing every single thing my doctor said.  Absolutely, I could choose to eat fewer carbohydrates.

And yet, I don't consider myself noncompliant.  Sure, I could have done the basal testing I've been meaning and wanting to do, but when you have visitors in Rome who want to go to restaurants and eat gelato, it's hard to explain and justify the fasting.  Or when I'm not getting enough sleep as it is because of said visitors and a stressful day-to-day life, I don't really want to add to the problem by waking up every two hours to test my blood sugar.

If these things make me noncompliant, then I guess I am.  What I am really perplexed about is Garber's characterization that we who are noncompliant are UNDERMINING the AACE's efforts.

Last time I checked, my choices affect me and my diabetes.  They are not done with malice to ruin the work of large organizations.  And we who happen to have hyperglicemia at times aren't always to blame.  If I were to listen to what the doctors here in Rome have been telling me to do with my insulin pump and its settings, my A1c and blood glucose levels would appear even more noncompliant than where I currently stand.

Diabetes is not a one-size-fits-all disease, nor should an algorithm attempt to make it so.  And telling a writer for a site dedicated to informing diabetes patients of the goings-on in the diabetes world that we shouldn't be having high blood sugar seems foolish to me and a gross mischaracterization of millions of individuals.

But I don't anticipate this word going way.  And I don't anticipate changing many aspects of my self-care because people keep tossing it around.  As wonderful as my health team is, this is my disease and I'm the one who deals with it on the front lines.  I will do my best, and I hope that one day that might be interpreted as compliance of a kind.

*Note: it's possible that I'm quoting the wrong book.  I bought two books just before going on the pump and read them both, but I am pretty sure it came from Pumping Insulin.  Unfortunately those books are in a storage unit some 3000 miles away from my present location.