JUSTIFYING THE MEANS... There is an oft maligned phrase “the end justifies the means”. Simply stated, it’s only the results that matter; just win baby. This philosophy often conflicts with our ethical or religious upbringing since applying it might endorse excessive, unconventional or manipulative behaviors to achieve a desired goal. But diabetes knows no morality and should never be given those considerations. Do what you can so long as it doesnt harm you or others. What I share here with you are two 24-hr CGM sensor plots. One is from a person without diabetes and the other is me. Guess which one is the non-diabetic person. Most of you will (or should) get it right since you begin with a 50-50 chance of success by simply guessing. My point is that all our diabetes self-management training aims to help us achieve daily blood sugar tracings as close to non-diabetic as possible. And since management is intended to be individualized, we can employ many methods to get this desired place. This is one way l characterize Sugar Surfing™. When is good enough, good enough? I created Sugar Surfing as a metaphor for dynamic diabetes management, using real-time information coming from a CGM device as a focal point for in the moment decision making. We are all taught a static approach to diabetes self-care at diagnosis. Most of us are never exposed to a dynamic approach, and for many different reasons I will not go into here. So the “gold standard” of diabetes control is displayed here (a non-d sensor tracing). But are there other ways which can arrive us to this same state of glycemic bliss? Two come quickly to mind: pancreas (or beta cell) transplant; or use an artificial pancreas. Both work but have major challenges or drawbacks. First, transplants are reserved for those where the burden of diabetes is great, or has taken a huge toll on the person physically (kidney failure, severe hypoglycemia unawareness). Transplants are invasive, not always successful and most require a lifetime of powerful medications to inhibit the immune system from rejecting the transplanted tissue. And the cost? Very high. Other forms of cellular transplantation and beta cell encapsulation are being explored, but these are still in the realm of research only. Exciting? Yes. Ready for everyone to partake in? Not yet. The second method to attain this level of control is the artificial pancreas. It’s a reality and may someday be available to anyone wishing to wear it. The AP also relies on current CGM technology, which is directed through sophisticated computing programs to direct specialized pumps worn by the person to deliver sugar-lowering insulin or sugar-raising glucagon to attempt to maintain blood sugar patterns within designated ranges. Successful? Yes. Cheap? Not yet. High maintenance? Afraid so. But there remain limits to what a machine only can do. The AP tends to remove the user from the decision-making loop. That is both good and bad in some ways. Bad in the sense it limits certain abilities of the device at this time. Still, very reasonable levels of control are attained and the research is exciting. Right now, of the options to achieve near-non-diabetic blood sugar control you have transplants, an artificial pancreas, or a CGM (used by an enable, trained Sugar Surfer). The first two options are severely restricted right now. The third is relatively easier to obtain. All three approaches have costs associated with them. Each requires careful recipient selection, a self-commitment to succeed, and patience. Of the three methods available now, Sugar Surfing is already helping users around the world. It will always be less costly (in terms of money) compared to the other two. But surfing provides another return on investment the others lack: developing the ability to feel in control over one’s diabetes which quickly evolves into personal confidence and improved outlook on life. Near-normal blood sugar control is achievable today. It’s no longer an issue of “can it be done?’ but rather “how long can I maintain it?” I’ve been surfing for several years now and keep my A1C in the low to mid 5% range (5.3% yesterday). That’s another way to endorse Sugar Surfing. But my sense of self-confidence and the feeling of control over this disease which used to control me is my true return on investment for what I put into making that happen. And while a machine helped make that possible, it is my choices and actions which really define who I am as a person with diabetes. So…do the ends justify the means? In this case my answer is a resounding YES. Please share your thoughts and share this post freely.
Posted on: Sat, 27 Sep 2014 16:00:01 +0000
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