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If You Want To September 6, 2013

Posted by laosita in diabetes.
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“…if you want to,” said my endo. He added on this last phrase, as an afterthought.

My endo plays significant roles in many top Type 1 diabetes studies, including a recent study for the closed loop solution with automatic suspension. Essentially the closed loop system means an insulin pump and a continuous glucose monitor (CGM) talk to one another and can make a treatment decision without user intervention. A key part of this particular study is when the CGM alerts to a low during the night, the pump automatically shuts off for two hours*.

I am not cool with this.

If I turned off my pump for two hours in the middle of the night I’d be sky high by morning. Sure, you can override the turned off pump, but that kind of defeats the purpose of an automatic action. (YDMV – I can see the value of this for kiddos, worried parents and hypo-unaware folks).

I don’t trust my Dexcom CGM 24/7, the best sensor on the market today, enough that I’d be okay with it talking to my pump and making a decision without my input.

This closed loop system uses a different CGM and pump than what I currently use. I picked my system for a reason. Because it works for me and my life right now.

Those are three significant downfalls, for something that I am not convinced will improve my care. And “…if I want to.” is the LAST phrase from my endo after his spiel?

I’ve lived with diabetes for a long time. Since I was old enough to make decisions, I made the decisions about how I handle my care. Yeah, I could be in better ‘control’, but the things that often throw me out of control have nothing to do with my choice of treatment tools.

So Dr. Endo, you are absolutely right – if I want to. It is my decision, not yours. I value your bias yet educated opinion, but only if I want to, will I take action. The tools I use every second of my life – those are tools that I use because I want to. Because I see their value to my health and because I want to find a way to incorporate those tools into my health care.

Don’t you dare make me feel guilty if right now, I don’t want to.

*Note: I am not a doctor. I have not read the study details. Talk to your doctor or do your own research for the scientific facts. The study is titled Threshold-Based Insulin-Pump Interruption for Reduction of Hypoglycemia .



1. Scott E - September 7, 2013

Wow, this caught me off-guard! I would interpret “if you want to” as a positive thing, like the endo is taking the role of an adviser to your self-care and not dictating exactly HOW you should care for yourself. Maybe the tone, or your expectations, or the context are different than I understood it.

Anyway, I can certainly understand your hestitation about yielding control to a machine; there’s a lot of it, though I haven’t seen much in the D-blogosphere (moreso on TuDiabetes). But is it always a full 2-hours that it suspends? I thought that was an “up-to” amount.

laosita - September 9, 2013

Thanks for the comment Scott. I feel like the context was slightly different. However, you make a good point. It’s cool my endo is in touch with some of the newest technologies, and extends those opportunities to me. I’d definitely need to do more research – I don’t know enough about the basic functionalities such as the question you asked.

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