Control vs. Manage

As a parent of a child with Type 1 diabetes, I have been asked by people if my daughter’s diabetes is “under control.”  Until recently, I answered this question with information about her A1C and the A1C targets for her age.  Luckily, I haven’t run into people who question us about her diabetes based on individual blood sugar numbers.  But, after reading several different blog posts from adults with Type 1 or other parents of children with Type 1, I think I understand the problem with the “control” question.

First, look at the definition of the word control.  Here’s the definition most applicable to the “control” question.

  • to exercise restraining or directing influence over

This does not at all describe diabetes for a person with Type 1.  There are too many factors affecting blood sugar for anyone with Type 1 to actually “exercise direct influence” over their blood sugar levels.  Sometimes, you do everything “right,” and you end up with blood sugars in the 50s or 300s.

Instead, it’s more appropriate to say that people with Type 1 diabetes “manage” their condition.  Here’s the definition of manage:

  • to work upon or try to alter for a purpose

This is a much better description of diabetes for a person with Type 1.  People with Type 1 work 24/7/365 to keep blood sugars in the normal range for as much of the day as possible.  With current treatment methods, it’s not possible for people with Type 1 to “control” their blood sugars; to always have them in the normal range.

So, why are people with Type 1 diabetes asked if they have their diabetes “under control?”  I think this is another example of people confusing Type 1 with Type 2 diabetes.  In thinking about the differences between my diabetes and my daughter’s, I can actually “control” my blood sugars.  No, I can’t make a particular number come up every time I test my blood sugar.  However, by my actions, I can keep my blood sugars in the normal range.  I don’t have low blood sugars, and as long as I eat within my carb limits, I don’t have high blood sugars either.  Not all people with Type 2 diabetes can control their blood sugars through their actions, but public perception is that diabetes can be controlled as long as people eat right (whatever that is), exercise, and take their medications.

So, how should people with Type 1 or parents of children with Type 1 answer the “control” question? Should we try to educate people or should we just answer yes?