Decision Fatigue And Low Blood Sugar
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The episode, word for word
Today's episode is a little different.
For the next 5 to 7 minutes, I'm going to try to sneak as many Princess Bride references as possible into one episode about type 1 decision fatigue. Your job is to listen, count them, and then tag me on Instagram or TikTok with your best guess.
If you get the number right, you might win something slightly less stressful than a battle of wits with a Sicilian... which, if you live with type 1 diabetes, you've basically been doing with your pancreas for years anyway.
Underneath the game, this episode is about one thing: why you're so tired, and why that tiredness is not you "failing," it's your brain doing its best under impossible conditions.
I'm Neil Greathouse, and this is Your Best T1D Year.
Welcome to Week 7 of the Low Blood Sugar Challenge, where the theme is Decision Fatigue & Automation.
If the last six weeks have felt like "life is pain, highness" and anyone who says differently is selling you essential oils... that tracks. You didn't just change how you treat lows, you messed with a survival instinct.
Now that you've built a new low-response pattern, this week is about something bigger: taking seriously how many decisions you make in a day and building systems so you don't have to be the Dread Pirate Roberts of willpower every morning.
Most people without chronic illness make around 35,000 decisions per day: what to wear, what to eat, what to click, what to ignore.
With type 1 on board, you've basically added a full-time job's worth of choices:
Do I bolus now or wait, because my CGM arrow looks like it's plotting against me?
Do I correct this 190 or let the pump handle it?
Do I eat before I drive? Before I work out? Before I shower?
Do I treat this "maybe low" or see if it's just anxiety in a mask?
As one October episode put it, diabetes isn't just insulin and carbs, it's decision fatigue layered onto everything else you're trying to be.
Every one of those micro-choices uses up mental energy. Eventually, your brain is like Fezzik after climbing the Cliffs of Insanity: still hanging on, but absolutely gassed.
So when you wake up and think, "I didn't fight a R.O.U.S. today, why am I this exhausted?" the answer is: 35,000 decisions plus diabetes.
In behavioral research, decision fatigue shows up the same way over and over:
As mental energy drops, people make more impulsive choices and default to the easiest option, not the best one.
They start avoiding decisions entirely, procrastinating or skipping tasks.
Adherence to complex routines drops, even when people care deeply about the outcome.
Sound familiar?
Morning you: "If I'm low, I'll treat with 12 grams of glucose, set a timer, and wait."
Night-time you, after a long day of "to the pain": "Whatever, I'll just eat until I feel better and fix the high later."
Studies looking at binge-style eating and diabetes show that higher emotional load and stress are tied to more overeating, higher A1C, and more diabetes distress. Not because people stopped caring, but because a tired brain goes for "get me out of this now" instead of "follow the plan we made when I had a brain."
So when you see yourself overtreat a low, forget a bolus, or say "as you wish" to the cereal box instead of your guideline, that's not proof you're weak. It's proof your brain has been mostly dead all day, and that's hard to come back from.
Here's the entire point of this week:
You don't need to become more "disciplined." You need to ask fewer questions.
Every time you build a default, you're telling your future exhausted self, "Good news. I already did the thinking. When this happens, we do this. No more debating Vizzini-style."
You've already built one:
Low = Glucose Tabs, glucose gel, or Glow Glucose Gummies, measured, timer on, wait.
No kitchen heist, no "what do I feel like," no six-fingered snack attacks.
That was your first automation.
This week, we're expanding the idea to the rest of your diabetes life:
One standard breakfast you can almost bolus for in your sleep.
One default correction rule you trust for mild highs.
One backup snack plan so "what should I eat?" isn't a fresh crisis every afternoon.
Not because you're "incompetent" without them, but because you're human. Research on routines and self-management keeps finding that when people use simple, repeatable patterns instead of constant improvising, adherence improves, numbers stabilize, and the mental weight comes down.
In other words, you are not obligated to fight diabetes hand-to-hand on the Cliffs of Insanity every day. You're allowed to build stairs.
Think about The Princess Bride like a diabetes training montage.
At the beginning, Westley is just reacting: sword fights, Fire Swamp, shrieking eels, chaos. Later, he walks into the castle with a plan: a wheelbarrow, a holocaust cloak, and one extremely convincing "miracle" move.
Most people with type 1 stay stuck in chaos mode for years: reacting to every number, every alarm, every low, every high like it's a new crisis. You've spent seven weeks building one solid plan for lows. Now we're adding a few more tools to the wheelbarrow so it's not just you vs. diabetes, one-on-one, every time.
And yes, if your brain is saying, "I do not envy the headache you will have when you awake," that's kind of the point.
Here's your question for today:
"What's one diabetes decision I am sick of making over and over again?"
Is it "What do I eat when I'm a little low but not crashing?"
Is it "How do I correct a 180 at night without overdoing it?"
Is it "What do I do with that stubborn 140 before a workout?"
Pick one. Wednesday's episode is going to turn that into your next shortcut.
Also: Don't forget the game. How many Princess Bride references did you catch? Count them, tag @thebetes in your Story on Instagram or TikTok with your guess, and I'll pick a few of you for a small prize that does not involve storming a castle.
If this is your first time listening, you just jumped into Week 7 of the Low Blood Sugar Challenge.
So far we've:
Treated lows with glucose, not food.
Separated cravings from medical needs.
Started shrinking the blood sugar roller coaster a little at a time.
Now we're adding mental load to the mix:
Go to yourbestt1dyear.com.
Sign up, you'll get one short weekly email, no spam, just one tool and one nudge.
This week's mission: build one diabetes shortcut on purpose instead of trying to hero your way through every decision.
You'll get a digital badge at the end of the challenge because adults deserve stickers for doing quietly brutal work like this.
If you're listening to this thinking, "I am not just mostly dead, I am fully exhausted," that's exactly why Blue Circle Health exists.
Blue Circle Health is a free virtual care program for adults with type 1. You get real endocrinologists, diabetes educators, social workers, and tech support who help with CGMs, insulin adjustments, mental health load, and insurance mess. They've already helped hundreds of people improve time-in-range and reduce diabetes distress.
They're now in 23 states plus Washington DC, including newer additions like Minnesota, Wisconsin, and Illinois. It's actually free. There is no catch. Go to bluecirclehealth.org, see if your state is on the list, and sign up for free.
Type 1 diabetes is relentless, but managing it doesn't have to be. New episodes drop every Monday, Wednesday, and Friday.
You're not tired because you're doing a bad job. You're tired because you've been carrying a job most people don't even know exists. This week is about putting some of that work onto systems, so you don't have to fight every battle by yourself, every time.
You've survived a lot of Fire Swamps to get here. You're building something stronger and smarter than you realize. Keep going.
// Year 34 Day 4 #YourBestT1DYear
Feb 18 - 159
This is the script as read on the mic, lightly tidied for reading. Education, not medical advice. Talk to your care team before you change anything about your insulin.