Today, I want to share some musings on a side of diabetes I think a lot of people don’t see, and that’s the need to constantly be analyzing a million possible outcomes and making decisions off of them. If I do X, then my blood sugar might go up. But if Z happens unexpectedly, then I need to be prepared for X number of low snacks, and so on. 

Analyzing possible outcomes is something everyone naturally does to differing degrees, and it can be a very beneficial skill. Doing so allows you to be prepared and make smart choices in life. However, with a disease like type 1 diabetes, I’ve found that the line between doing it well enough to keep your blood sugars optimally managed is very close to where it controls your whole life, and it’s easy to tip over into a world of overthinking everything. The overthinking then becomes part of everyday life and not just something you do at times to manage diabetes, and that’s where the problem lies. 

Enter: Analysis Paralysis

I really started noticing this issue when I got my first continuous glucose monitor, which updates with blood sugar readings every 5 minutes, a few years ago and could literally watch the outcomes of my decisions in real time. It was such interesting data, and I quickly became hooked on it. I would do something and then sit and watch my CGM reflect the data back to me. It became almost like a game—if I tweaked my overnight basal insulin by 0.05 units/hour, could I stay in the 5.5-6.0mmol range all night? What about if I adjusted it by 0.08? These were things that I previously would never have known about, and certainly never would have spent time thinking about and adjusting, but suddenly they consumed a lot of my thoughts. Going above or below the desired range of 3.5 to 10.0 felt like a failure, whereas I never really considered it that way before having a CGM. 

These small decisions became a slippery slope, and I found myself considering aspects of my diabetes that I never had before. The decision fatigue became real, very fast. Variables like exercise, food intake, background basal, and unexpected changes in routine became all things I needed to constantly consider (often at once) to keep “winning” my diabetes and keep my Time in Range (TIR) above 85%. Then, when that became my regular state, I was instructed to tighten my range to be 3.8 to 7.8 instead of 3.0 to 10.0, and strive for the same 85% TIR. This was certainly good for my overall diabetes management—my A1c was around 5.5% as a result—but I realized after a few years that it wasn’t good for my mental health. The problem was that I had started applying the same hyper-analytical thinking to all areas of my life. Suddenly, I didn’t know how to stop overthinking and preparing for a million possible outcomes, and it made life unnecessarily difficult. 

Experiencing Diabetes Burnout and Decision Fatigue

I noticed that I struggled with making both basic and complex decisions, waffling back and forth and weighing different possibilities, when previously I would have made most decisions without second guessing. It suddenly felt overwhelming deciding what food to order, what movie to watch, which vacation spot we should visit this year... If we chose Spain, we could see a football game and meet up with some family, but what about visiting Scotland or finally doing that African Safari I’ve always wanted? I would spend hours reading blogs and doing research before eventually giving up and not making a decision because I was too overwhelmed. 

While these things didn’t seem related to living with diabetes, it took me quite a while to realize that this was actually part of diabetes burnout. I used to think of diabetes burnout as something that only happened when you were overwhelmed with diabetes tasks and therefore stopped taking care of yourself as much as you should. I’ve definitely experienced that version of burnout, however, this was different. My diabetes was doing great on paper, and yet I was still burnt out. In fact, probably worse than I ever had been. I know there is some research coming out about information overload and the feelings of being overwhelmed that can come with using some of the newer diabetes technology, and my experience definitely supports that. The same patterns that helped me to become really good at managing my diabetes have inadvertently made me struggle with general life management, because it’s impossible to research and plan for every scenario. 

Taking it one day at a time

While I don’t have any great solutions to offer since I’m still in the thick of this one myself, I do think recognizing the pattern is the first step. It’s important to take a step back and think about if you’re becoming obsessive towards your diabetes management goals and routines. Ask yourself if your diabetes tech is adding to your life or taking away from it (which can look like constant notifications that stress you out, making impulsive decisions like bolusing multiple times in a row when you don’t see a change in blood sugars quickly enough, etc.) and then try to make adjustments as needed. To help with some of the burnout, I’ve turned off any unnecessary alarms and opted not to buy an Apple Watch to get Dexcom updates for now, although it would be convenient. I also try hard not to watch my Dexcom graph all the time, and I remind myself that a non-diabetic’s blood sugars wouldn’t even be a perfectly straight line throughout the day, so I shouldn’t be setting that goal for myself. 

If you find yourself feeling this way as well, you’re not alone. Diabetes technology has come such a long way and can help so much, but I think it’s also raised the bar for the expectations we set for ourselves. This is a reminder to all of us, myself included, that perfection shouldn’t be the standard, and it’s impossible to boil the ocean before making decisions. Sometimes we just have to go with the flow.