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Does diabetes technology absolve us from personal responsibility?

As a person with type 1 diabetes for over half a century, I've lived through many technological breakthroughs in how my condition has been cared for and managed.

Many examples come to mind. Disposable insulin syringes certainly made the process of preparing an insulin injection much easier than boiling (to sterilize) a glass syringe and reusable needle each morning. Blood glucose meters gave me more specific information about my diabetes control compared to testing my urine in a glass test tube chemistry set or with a plastic dipstick. Insulin pumps changed the way my body received insulin compared to erratic, long acting forms of insulin like NPH and Lente. Like most persons with diabetes, once I adopted a new technology the waiting only began for the next advance or breakthrough in the way I cared for my diabetes to take its place. Secretly I yearned for a technological leap forward which would totally remove the daily burden of self-managing this disease altogether. That has yet to happen, in spite of a constant stream of indisputable scientific and technological advancements and conveniences. Technology makes certain self-care tasks less time consuming, more accurate and simply easier and less painful to perform. But diabetes technology has not yet absolved me of my most important duty: taking responsibility for my diabetes. By this I don't mean that I'm responsible for having or getting diabetes. I'm talking about the hundreds of daily choices (proactive and reactive) I make, what I learn from those actions (or omissions), and (hopefully) how I improve my skill set as my experience grows with time (Sugar Surfing). Diabetes technology has not replaced this duty in any way. In many ways I'm faced with even more choices and decisions to make each day based on having more diabetes tech. In any battle or conflict, the party who possesses the greatest situational awareness over an opponent ("intelligence" in the military/spy world parlance), usually has the upper hand. That intel is more likely to help one side prevail in a dilemma or confrontation. Louis Pasteur famously said "Chance favors the prepared mind". So even if the unexpected happens, the person with diabetes who is best prepared and aware will be ready to minimize the negative effects that might otherwise befall them when chaos rears it's head. Face it. Diabetes technology sells. It drives a lucrative and thriving medical economic system we are all a part of. Diabetes technology would not exist without a market. That market consists of patients, health care providers, insurance companies and countries. In other words: us. But the true value of any technology is in how it's understood and applied by educated and empowered people in their everyday lives. The current shortcoming of diabetes technology has been in treating most technologies as if patient empowerment is somehow optional to their success. That is what must change.

Automotive companies have large budgets to advertise luxury cars with attractive or humorous spokespersons. However it is not the responsibility of the car makers to teach people how to drive. There is nothing suave or sexy about learning traffic laws, road courtesy, car maintenance schedules or becoming a smarter driver. Our diabetes technology marketplace is a lot like car sales but with different spokespersons. Sugar Surfing is agnostic to which technology a person uses. Surfing is about leveraging to the fullest the information you get from whatever technology you choose to use. It's about making decisions in the moment with the best glycemic 'intelligence" you can muster. By this perspective, Sugar Surfing will never go away. Technology can enhance the ability to Surf, but at its core the person must wish to do it and make the commitment to this method of management. The book "Sugar Surfing" is a great primer and will get you started to a new world of diabetes self-management. Diabetes technologies and devices have been life changing for all of us with diabetes. But they have not yet absolved us from the burden of personal responsibility and investment in our daily condition. Let's not lose sight of this as we face the never ending gauntlet of seductive products and pharmaceuticals promising a better life.

Control of our diabetes is no further away than the next few choices we make. We either sieze the day or let the day seize us. It's our choice to make.

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