Official ‘Look! We’re at a conference!’ photo.

One of the best things about going to diabetes conferences is finding time to speak to, and bounce ideas off, fellow people with diabetes. It’s always so great to hear others’ ideas and opinions – sometimes I find myself nodding in furious agreement, and other times their views are completely opposite to how I see things. 

A couple of weeks ago at the America Diabetes Association Annual Scientific Meeting, The Grumpy Pumper and I spoke about a post I was writing (and subsequently published last week) about using the latest diabetes technologies at diagnosis. I knew that he would have some strong thoughts on this topic. 

Grumps said he had some concerns with my ‘give us all the tech right now at diagnosis’ approach, and today, he’s written his thoughts. (Seriously – my pestering him to write is paying dividends these days! Note to self: keep on it!)

Here’s what he has to say…

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I’m not really sure if this is a What Would Grumpy Do (#WWGD) post or not. Or if it’s just rambling of the kind of crap that occupies my tiny brain on a daily basis.

Anyway…

Last week, the Nigella of the DOC posted about the use of diabetes tech and how early someone should be offered it post diagnosis. (Renza note: Grumps: We’ll be talking about that nickname next time we catch up…)

This subject always interests me, and, to a point, concerns me.

Don’t get me wrong: I love the idea of everyone having the choice of whatever kit they want and need to manage their diabetes, as early as possible in their journey with diabetes, to be able to relieve their own personal burden of diabetes. This also goes for parents and carers too – (those that manage diabetes in a different way, for or with the person with diabetes, dependent on their age etc.).

Of course, the utopian world is for a fully functioning ‘Artificial Pancreas’ (AP) to be commercially available and affordable; a world where at diagnosis, everyone has access to this and the information to make an informed choice if it’s right for them; a world where for most, if not all, that burden of diabetes is not even realised…

My interest and concern?

Well, my job, (as uninteresting as it sounds to most), is business continuity. Or planning for what happens when (as an organisation) things go wrong: when technology that you rely on is unavailable; when your supply chain lets you down; when there is a skills shortage to carry out the things you need to do.

As a result, my brain (tiny as it is) constantly sees the possible risk of what could go wrong, and the mitigations and plans. (The saddest part? I actually enjoy it…)

You can maybe see where I’m trying to go with this now?

The more we rely on diabetes technology, and the earlier we do so, then we (in my opinion) need to have better contingency plans in case things go wrong.

Our ultimate safety net is hospital. However, none of us want to have that as our contingency, do we?

Continuity planning isn’t complicated: it can be detailed; it’s often dull. Ideally it never has to be implemented, but inevitably it does.

The official definition of business continuity is:

‘…the ability of an organisation to maintain essential functions during, as well as after, a disaster has occurred.’

Basically: the ability to carry out the essential things you need to do when shit goes wrong!

I’ll try and keep this brief since I can see you are already dropping off to sleep.

For me, with my diabetes management, it breaks down to this:

Essential functions (the minimum things I need to achieve):

  • Avoid DKA
  • Stay in a safe glucose range (so wider range than usual target, and sod any talk of flat lines!)
  • Be able to detect and treat hypos
  • Be able to fulfil driving regulations

Tasks I need to do to achieve the above:

  • Get a measured amount of insulin into my body
  • Be able to check my glucose levels
  • Treat a hypo when detected (meter or hypo awareness)

Critical tools needed to achieve the above:

  • Insulin
  • Insulin delivery method
  • Blood glucose monitoring system
  • Hypo treatments

The level of continuity that you wish to plan for is total up to the individual. Ideally, we usually try to plan for minimum disruption.

My current diabetes kit is:

  • Insulin
  • Insulin Pump
  • CGM
  • Blood glucose meter
  • Hypo treatments (various)

Whilst I am lucky enough to have spares for most of this kit, I, in my opinion, benefit from being old school. My journey to diabetes technology has been progressive and having started on injections (via syringe) I am confident that I have the skills to keep myself safe if all my technology failed.

As a result, my base-level back-up is:

  • Insulin
  • Syringe
  • Blood glucose meter (and of course strips)
  • Hypo treatments (or cash to purchase as a back-up to my back-up)

So, there you have my interest…

My concerns?

Skills shortage.

In that utopian world where all go onto AP at diagnosis, how do we ensure that we have the skills to stay safe if technology fails? Or if a suppler fails to be able to get a component to us? Let’s face it, a hurricane in the wrong place can cause production issues that lead to shortage of supply; transport strikes; fuel shortages. All of these, and more, have possible impacts.

So if we don’t have the skills to implement our back-up plan, then what use is it?

Some would argue that PWD would need to be educated on MDI etc., which is very true. However, it is another thing for most adults to know how to inject and actually doing it for the first time.

Then there are children with diabetes. Diagnosed as a baby and on a pump soon after, the child may never know how to inject. Until they need to. That could be a huge psychological thing for any child.

There is no one easy answer. As always, and as I said above, our ultimate safety net is hospital so we should always be safe.

But my advice to myself is:

  • Have a plan
  • Know how to use it
  • Wear sunscreen

Live Long and Bolus!

Grumps

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