I must start by explaining the way I see things around treatment with an insulin pump & a continuous glucose monitor. A couple of days ago, someone posted a picture with a quote on Twitter which made me laugh:
Managing type 1 diabetes is easy! It’s like riding a bike. Except the bike is on fire and you’re on fire and everything is on fire and you’re in hell.
Sometimes, it can really be like that. Type 1 Diabetes is a very dynamic disease where most of the times, the only three things you get to control are: Carbohydrates ( how much you eat and when you do it ), Insulin ( how much you pump and when you do it ) and Exercise ( includes everything from walking around the office to doing real exercise routines ).
So, let’s imagine you are a very organized person and you have everything planned in order to have exactly the right amount of food at exactly the right time and so you know the effect of the carbs you are taking so that you can exactly calculate the amount of insulin needed to return to the same blood glucose level you started with before eating or exercising ( hopefully around 90 ).
Great! you can just eat, input amounts of insulin, sit back and relax and enjoy the day!
Well, ITS ALMOST NEVER LIKE THAT! Remember I mentioned the “dynamic” part of the disease? Let me explain, how “dynamic” works ( dynamic is real good friends with Murphy, that guy from the famous laws who is a real jerk ).
I’ll walk you through a day in a T1D’s life:
— Wake up in the morning, lets hope you had a good night. Lets hope you slept well cause changes in metabolism change the way your body processes sugars. If metabolism moves, your blood glucose moves and you need to adjust ( measure, evaluate and make a decision about how much insulin to add or subtract ). Let’s assume you woke at 8:00am and had to do some minor corrections to your insulin input.
— You take a bath, and decide to get something for breakfast. You count your breakfast carbs and input some insulin before starting to eat ( remember you changed insulin about 30 minutes ago, and that decision is just starting to kick in, but there is still no change in blood glucose ).
— You head for work. Lets imagine this particular day was a busy day and you had to walk more than you would regularly walk to get to work. Guess what you just did, you changed your metabolism and now your body will treat insulin and carbs you already got for breakfast a bit differently 🙂 ( That’s a sarcastic happy face )
— Let’s suppose that the walk made your blood glucose go a bit low. You will not know that will happen until you start seeing your blood glucose change and then you’ll have to correct again.
— So… it was a Monday, a busy day. You had your meal planned, but at the last minute, you got called into a meeting. One of those really important 2hr ones with really important people. As your blood sugar started changing, you were unable to detect the changes and were unable to do something about it ( I do interrupt my meetings to check my blood glucose, but hey, you can exchange a meeting event for: making a line to board a plane in the airport, taking care of your kids, talking with a friend, being at the movies, driving, or any other activity that requires most of your uninterrupted attention…
It’s funny, I’ve been noticing most activities do require your uninterrupted attention.
— You finished that activity and after reviewing your blood glucose data, you had to do some more corrections. Since it is now late, you now have to go and look for something quick to eat. You go around the corner to that new place people were saying had some really good food. You get to the place and now you have to eat something you have no idea how much carbs it contains. You make a guess.
— One hour later, you realize you guessed wrong and now you have to correct again!
We’ve just gone through half of the day. We’re still missing all of the afternoon activities!!! If you did not make a mistake, your blood glucose graph should be within “safe” limits. If not, you will be struggling ( or just hoping ) to get things back to normal in the least amount of time taking into account all of the stacked events that accumulate during the day.
In a regular day, a T1D makes more than 200 treatment decisions ( or 300? )
Some days I look at my pump & cgm data more times that what a normal person would look at their smart phone ( Just wished it was smarter! Just kidding pump & cgm companies! You’ve done great work and can’t thank you enough )
Ok, so you get the idea…
In order to have good control of your blood glucose, you must be super conscious of everything you are doing.
I really can’t all the time, and I am pretty sure its the same for many. Now imagine being a kid… or having one with T1D…
That is the main reason I want an artificial pancreas. I want to be able to enjoy life being sure I am getting the right treatment for this complex and dynamic disease.
I just really want to clone myself, use Wayne Szalinski’s shrinking machine ( Honey, I Shrunk the Kids ) and attach that little nice clone afterwards to my pump. He’ll be 100% of his time checking and reacting to whatever the hell is happening to my blood glucose. I’ll be drinking a beer.
My next post focuses on fuzzy logic concepts applied in the creation of simPancreas:
simPancreas Fuzzy Logic Based Controller