Air travel safety is a great American success story. This wonderful track record is driven not only by high tech avionics, but by a clear, focused and ongoing attention to maintaining the skills of the human element: the pilot. Ironically, our avionics can become a crutch of sorts. We’re now seeing calls by the FAA for pilots to get more involved with actually flying their planes since so much of the process has become so automated after take-off. There is apparently too much reliance on autopilot technology. And when something does goes awry, as it did over the Hudson River in 2011, everyone wants a Captain "Sully" Sullenberger at the controls.
There is no question that “easy does it”. But can “easy” be taken to an extreme? I think so with diabetes. I’ve managed this condition for decades (professionally and personally), seen the rise and fall of several self-care technologies, but have not yet found anything that removed my need to be an active and involved participant in my own diabetes care.
We all yearn for the “easy button”, a one-step solution. But can we take this too far? I think we have with many of our diabetes devices. Today, it's not uncommon for children to be mostly in charge of the critical elements of their own blood sugar control. We've made dosing insulin and checking blood sugars extremely easy to perform tasks compared to twenty years ago. We take much of the thinking out of diabetes with algorithms, formulas and sliding scales to direct most if not all actions.
With a push of a button, I can deliver an insulin dose through a pump or instantly check a blood sugar trend line on my CGM device. But what ensures that I know how to properly interpret these data or administer the proper dose in the right fashion? Or when to follow up on my actions or inactions?
And remember this…many of these diabetes tech users are pre-teens with all the emotional immaturity that comes with this age group.
Diabetes progress is often defined more by the “latest and greatest”. In other words what new things are coming into existence: new medicines, new devices or new procedures? Less exciting is the opening of a new diabetes teaching program or arrival of a new certified diabetes educator (CDE) in the community. Medicine and society in general have effectively turned diabetes care and education into a purchasable commodity. And how can a commodity be that exciting or motivating compared to a novel shiny device or exotic therapy? It can't.
Hammering a nail, sawing a board or using a power drill are defined actions, just like checking a blood sugar, injecting insulin or reading a food label. But do those former actions, by themselves, make me a skilled carpenter...or in the latter case: a well-controlled person with diabetes? Absolutely not!
Diabetes self-care is a lot like a vocation. But unlike electricians, plumbers and glazers there is far too little time spent as an apprentice. In some cases, none at all. “See one, do one, teach one” is a lot more like it.
Now I'm aware of the fact that there are far too many patients with diabetes than there are specialist health care providers to see them. It's why 80% of persons with diabetes never see a diabetes specialist. But insulin requiring patients are much more likely to be seen by endocrinologists. But even that luxury is no guarantee of success. Fewer specialist physicians’ offices employ a CDE, largely due to the expense and the fact that diabetes education is so poorly reimbursed by the health care system. It's one reason so many CDE's teach in classroom settings. Education in bulk.
The promise of technology often falls short of expectations. Insulin pumps and glucose sensors rarely normalize blood sugar levels unless in the hands of a motivated, educated and supported user. More tech is not what we most need. Rather, it’s a better understanding and comprehension of diabetes, translated into prudent choices and actions, which drives the engine of diabetes control.
If you or a loved one struggles with their diabetes control, don’t assume it’s just for lack of tools or technology. Rarely is that the case. In the majority of cases it’s the lack of experience and understanding that undermines control.
Homer Simpson once said “do you want it done right, or do you want it done fast?” Easy might be a fast solution, but it might not always be the right solution. There is no substitute for understanding.