Friday, May 11, 2012

The Age of Science Fiction

Often, as I sit on the train watching the city flash by on my daily commute, I think about how we are beginning to live in an age of science fiction.

I've always loved science fiction. I grew up watching Star Wars and Babylon 5 and reading books like Ender's Game and the Foundation series. These books sparked my imagination and made me excited about what the future might bring. And while space opera was my favourite sub-genre, it's not the only topic covered by science fiction. I clearly remember reading stories as a teenager that involved e-readers, social media, and smartphones long before these devices became reality. In fact, if you look at some of the science fiction stories and films from 50 or even 30 years ago, in some ways their imagined worlds looks at lot like ours does today ...

Take snippets of my daily life as an example. Every morning when I wake up a machine automatically turns on and makes me a cup of coffee. I log onto a global network of computers and check electronic mail and social media sites as I eat breakfast (yeah, I'm guilty of eating at the computer). I ride a bus that uses GPS technology to display and announce them in a slightly robotic, female voice. I board a fully automated train (no driver) that whisks me underneath the city for a few stops before rising onto elevated tracks, where it weaves between buildings and over streets packed with morning commuters. As I stare out the window and listen to music, checking for new text or e-mail messages periodically, most people around me do the same. Portable music players, mobile phones, and e-readers are now more prevalent on buses and trains than paperbacks and newspapers.

Diabetes management has also seen a huge shift in the past 20 to 30 years. Just 30 years ago there were no blood glucose meters and insulin pumps were still experimental. Only 20 years ago there were no insulin analogues, no "smart" features like bolus calculators on insulin pumps, no five-second countdown times or tagging readings on meters, and logbooks were still exclusively paper. When I was diagnosed in 1991 there was no mention of an insulin pump being in my future. It wasn't until I was in high school in the latter half of the 1990s and a kid a few grades below me had a pump that I realized it might be something I could use in the future.

Now for some snippets of my diabetes life ... Before I get to work I grab a coffee. I prick my finger and squeeze until a tiny bead of blood appears. I touch my finger to a strip that, sensing the liquid, sucks my blood into a tiny computer that then estimates the amount of glucose molecules in the drop. I use my iPhone to look up the carbohydrate count of the coffee, then use my meter again to program in an insulin dose, which it beams wirelessly to my insulin pump, which delivers insulin with its tiny, precise mechanics. I log the entire thing in my electronic logbook on my iPhone, which I can later sync to my computer. My calendar, which holds all doctors appointments, and to-do lists which hold errends like picking up prescriptions, are also synced across all my devices.

I watched a TED talk a few months ago about how the past few decades have been the information age, and how the next few decades will be the age of bionics and technology's impact on health and medicine. Today there are already devices like cochlear implants, bionic limbs, and artificial hearts. Retinal chips, mind-controlled wheelchairs, and more advanced artificial organs like kidneys seem to be on the horizon. And, as much as some people dislike the artificial pancreas, I suspect it will be the next big breakthrough in diabetes management (note I don't say cure). All of this is hugely exciting, if for no other reason than it's amazing that it's even possible to emulate something like a retina or a pancreas with technology.

It boggles my mind that much of what I take for granted today was considered the realm of science fiction when I was born. Who knows what will come next, or how it might benefit those of us with diabetes.

Sunday, May 6, 2012

Putting In the Time

Type 1 diabetes takes up a LOT of time.

Testing your blood sugar may only take a few seconds, but weighing and measuring food, looking up nutritional information, programming boluses, adjusting basal rates and other pump settings for activities, changing infusion sets and refilling pump cartridges, and logging all of this (whether on paper or digitally) all adds up. And that doesn't even include the time taken to review diabetes logs, refill and pick up prescriptions, treat extreme highs and lows, and going to doctor's appointments.

And this isn't even including all the waiting and watching the clock. Wait 15 minutes to re-test after a low. Bolus 20 minutes before eating. Test after two hours after a meal or correcting a high. Adjust basal rates an hour before exercise. Change sites every two days. Refill prescriptions every few weeks. Get blood drawn every three months. It's a wonder we have time for anything else!

In the past, I've sometimes found it a struggle to maintain a balance between diabetes an the rest of life. I've heard Type 1 diabetes compared to another job sometimes, and I don't think that comparison is too far off. (In Canada, you can even receive the Disability Tax Credit if you use insulin and can document that you spend 14 hours a week on diabetes-related tasks.) I've frequently found that either I get busy and my diabetes gets out of control, or else I put so much effort into diabetes that the rest of my life gets out of control.

It's a difficult balance to maintain sometimes. My diabetes control seems to get nudged out of whack every time there's the slightest change in schedule, food, stress, or any other variable. For the past few months I've been putting a lot of effort into consistently doing things like eating healthy and logging, trying to integrate it into my life so that it's just routine rather than an extra effort.

So I was pleased when I looked back at my logbook for the past week and found that I had actually managed to keep a decent handle on diabetes—and keep decent records of it all. Oh, I had highs and lows. I had an encounter with high blood sugar accompanied by large ketones, even. But overall my blood sugars weren't bad, for me; especially when you throw in the fact that I've been transitioning from one job to another and my schedule has been crazy.

I sometimes get frustrated and disappointed that, for whatever reason, I struggle so much with achieving tight control. I look at all these people running around online with their A1c in the 5% and low 6% range and wonder why I can't seem to do that, even after more than 20 years' experience.

More recently, I've realized that I put in a lot of time and effort into diabetes. In fact, I put in more time and effort into my diabetes than most other Type 1s I have met in person. And I've realized that there is only so much I can do. If I am putting in the time and effort to eat healthy (and limiting carbohydrates), accurately count carbohydrates (weigh/measure food or use labels), test eight or ten times a day, bolus for everything (including frequent corrections), exercise daily, record everything, and go to the doctor regularly ... what more can I do? Not much, at least not without making my life revolve around diabetes. That's a lot of work. And if that amount of work only gets me to an A1c of 7.6% (which was my result last week), then is that so bad? Sure, maybe it won't guarantee that I never get complications, but at least if I do get complications I can't say it's due to lack of effort.

Maybe if I keep up the efforts long enough it will pay off in a lower A1c at some point. But, even if it doesn't, I need to stop and give kudos to myself for the effort rather than beating myself up over a number. It's like grades: a person gains more pride out of taking a really hard course, working their butt off and putting in hours of studying and passing with a C+ than they do taking an easy course, hardly studying and skipping half the readings, and pulling off an A. As much as A1c counts, maybe this is one instance where putting in the time and effort should count just as much as the result.