As people with diabetes, we are tasked by our medical teams with conducting our lives in a manner such as to minimize or mitigate the destructive effects of our medical condition. A lot of press is given to the concepts of "patient compliance" and "patient adherence" -- enough to raise the blood pressures of many of us past the levels covered by our antihypertensive, renal-protective pharmaceuticals. The idea of being "a diabetic in control" (or "out of control") has also been known to raise the hackles of a number of the T1s among us, whose blood glucose levels vary with the tempo and dynamic (but none of the grace) of a Mahler symphony.

Like the four movements of a symphony, or the members of a string quartet, the cornerstones of diabetes self-care are:

Management which consists of a number of care protocols. These include blood glucose testing, following a prescribed diet plan, taking one's medications (and/or insulin) as prescribed, and exercising regularly and sufficiently.

• Some people with diabetes have trouble understanding the care protocols, especially when they are complex, or when they change based on the current state of medical knowledge regarding diabetes, or the current state of our own health.

Compliance. Following the care protocols prescribed by one's medical team. In their eyes, we may have no unplanned food excursions -- no binges, no skipped meals, no occasional treats, no foods that are not on our diet plans; we may not skip our exercise sessions or add additional ones; we must not stress ourselves beyond that for which we are medicated.

• Work and life, money issues, and cultural issues may make it difficult for us to be 100% compliant at all times -- but most of us try, most of the time, to follow doctors' orders and correct for unintended highs and lows.

Control. Textbooks suggest that if we are 100% compliant with the care protocols needed to manage our diabetes, all of our numbers will fall into line, and we will not suffer complications.

• Some people with diabetes reject the concept of "control" because diabetes does not always respond to care protocols in textbook manner. In theory, if we are "in control" of our diabetes, our carb:insulin ratios will never change, we will never suffer unexplained spikes or drops, and our blood glucose levels will always respond in a predictable manner, to a predictable scale, in response to food (glucose), insulin, and stresses.

Frustration. Some things in life, we can't control. others, we can. If life events throw us a loop and the stress shoots our blood glucose levels up or down, unexpectedly, we may be annoyed, but we understand. Life Happens. But when everything is going along its usual course with no unexpected bumps, you're perfectly compliant, and still you can't get that meter to stop greeting you ("HI!" in big, not-so-encouraging letters) or your blood glucose levels to stop playing Limbo, your A1c stays stubbornly in the double-digits, and your doctor thinks you don't give a used test strip... is there a better word to describe this?

As much as we try to orchestrate "good outcomes" by complying with management protocols, it's hard to maintain the harmonics of control when diabetes frustrates you like a discordant, petulant child.