From Dump trucks to race cars

How diabetes technology is aimed at saving lives, not necessarily making them easier.

Diabetes technology has been changing at a pace that is easy to ignore for the newly diagnosed, but for those of us who’ve been kicking the tires on this thing for more than a decade it is down-right breathtaking! For decades we had little movement at all in technology, and what there was ranged from useful but not accessible to many (like insulin pumps), to useless and to be avoided at all costs (like any CGM prior to the Dexcom G4). But now that we have new technologies churning out every 6-12 months I am forced to answer one question to myself, my clients, and my peers: Does it make it any easier?

Does all the tech make it easier to live, day in and day out with type 1 diabetes? Does it reduce the burden of the number of times I think about my management? Does it make it less physically painful or restrictive? Clinically speaking does it improve my outcomes? And surprisingly the answer to this typically ranges from “a bit” to “nope”.

Insulin pumps reduced the math burden, and track IOB and a big perk for me was not forgetting my insulin at home. But they do some with their own work as well, so there is a definite individual cost benefit analysis to do there. Reliable CGM use is probably the first resounding YES in the diabetes technology realm. CGM reduced finger sticks, hypo-anxiety and lets us be bold with our insulin use since we can see what is happening in “real time”. Hybrid closed loops are the newest technology to come along claiming to make diabetes management easier and more effective. But does it? I put it like this:

In the past we have pad insulin pumps, these were made for practicality and utility but not performance. They are like dump trucks. But life with diabetes is like a formula 1 race! It is high speed with a lot of tight turns requiring skill, timing and precision control. Running a formula 1 race with a dump truck means we are learning to drive the tires off this dump truck just to avoid a crash! Finishing the race is amazing and placing in the top 3 is virtually a pipe dream. Now along they come and say “hey we have a more maneuverable car with more features, cruise control, anti-lock brakes and airbags!” So, we make the switch thinking anything is better at this race than a dump truck. But what we’ve got now is a midsize sedan. Is it safer than the dump truck? Yes. Is it more maneuverable than the dump truck? Yes. Is it a race car? NO! Just switching form a dump truck to a sedan means that we are going to crash less, and that when we do it won’t be so spectacularly dangerous, it means we can take turns a little tighter and a little faster, and it is going to help with some visibility, but it is still not a race car. We are still going to have to learn how to drive these things to get through the race and we are still going to have to drive the tires off them to try to place in this race. Even the most customizable system (Loop) really is just a highly customized mid-sized sedan! It’s still not a racing machine. The frame we have is too big, too heavy, too rigid and just not built for speed. Our insulin is vastly slower than the human body and even slower than the speed of our modern lives. Meanwhile we are making the best of what we have and improving our driving skills.

So WHY are these systems not making LIVING with diabetes easier?

Because they are designed to make Dying of diabetes harder! Just putting on a hybrid closed loop system is not going to make the life of someone with good control, strong skills and a lot of knowledge easier just by turning it on. It is not designed to! These systems are designed to help the 70% of people with diabetes who never achieve their clinical management goals (An A1C below 7 without severe hypoglycemia). These people are going to have major impacts on their diabetes management and way of living. These drivers are going to greatly benefit from rear view cameras, assistive braking, proximity alerts, and auto-parking features! They’re going to stay on the track and survive the race! That is HUGE! There are so many people who are going to live longer with fewer complications because they started using a hybrid closed loop system. A Mid-sized sedan is not going to make a race car driver a better driver, but it will let them look up from the track more often and appreciate a more comfortable ride along the way. It might even let the drivers with white knuckle grips on the wheel relax a little and enjoy the scenery for a change. So for those of us with good control, we can learn how this sedan works, we can learn to work with its strengths and work around its limitations to really drive it to its best.

That’s what we do here at IDS, we educate novice drivers on safety, we educate struggling drivers on technologies and driving strategies to help them stay on track, and we educate professional drivers on the best ways to really drive the wheels off this thing!

And when it comes down to it, my car has traction control. It’s a safety feature, but it drives me NUTS! When I use it I actually feel less safe! It feels like my car is doing something without me that I don’t like and compensate for well with my learned driving skills, so I turn it off! And there are times I turn my HCL system off too and go it old school with the skills I know and trust.

So does an HCL improve my life with diabetes?

Sometimes. Sometimes it improves a lot and lets me really enjoy the scenery and the ride. Sometimes my HCl gets in the way and needs to be turned off. And from time to time I am frustrated that it’s not working properly or making things a bit more complicated than they used to be, and in those times I am thankful on behalf of the people who are going to be helped by it and that I have the opportunity to have a development with which to be frustrated.

IDS specializes in helping our clients make the most of their Hybrid closed loop system. Whether it is keeping things on track with cruise control to free up some energy for the rest of life, or learning to really drive the tires off the thing! Give us a call to learn the ins and outs of your system and how to best fit it to your needs and goals.