If you have been reading these blogs you know that I have had Type 1 Diabetes for over 31 years now.  I was diagnosed at age 14 and am about to turn 46.  I have only been on the insulin pump for 2 years.  Prior to going on the pump I struggled to attain A1C results below 8.  Now my A1C’s are between 6.1 and 6.4.   And I don’t have very many low blood sugars.  I was surprised to find out recently that not all people with the pump are getting A1C’s below 7.    I was also surprised to learn that 90% of Type 1’s are not on the pump.  I really should not be surprised.  I mean it took me 29 years to get there.  Nobody wants to be hooked to a pump.  Especially if it is not going to make a significant difference in one’s life.  I am here to tell you that from extensive experience with the disease and a really hard look at some of the significant issues that lead to balancing blood sugars that no other insulin delivery system comes close to the pump.  I want to outline these issues with the goal of persuading you to consider the insulin pump for your insulin delivery system.  The closest alternative to the pump is injecting one dose of Lantus combined with several injections of a short acting insulin (humalog or novolog) to cover meals and make insulin corrections.  Lantus is used as the basal and the short acting insulin is considered the boluses.  There are other insulins like Humulin N but these are dark age therapies.  The Lantus approach is called the “Poor Man’s” pump because it seeks to simulate the pump through multiple injections.  But it is so inferior to the pump that there is almost no comparison.  The thing is that the pump itself is not the answer.  Insulin dosage and delivery is but one aspect of controlling blood sugars.  I am sure that there are plenty of people on “The Poor Man’s” pump that are doing better than people on the pump because they have a better handle of the other aspects.  These other things are food intake, exercise, general health (especially one’s weight) and most important perhaps, one’s attitude toward the disease.  The last two years I have experienced a transformation that I have been seeking since diagnosis.  I struggled with understanding how to control my blood sugars.  I became depressed and reached times of wanting to give up believing that I had a limited impact on my success.  This created feelings of hopelessness and helplessness.  Looking back I see that I really never did give up and through the blessings of good fortune and support from others I have made it to today.  And today I am thriving.  I am in the best health of my life and I feel better than ever.  The insulin pump was the tool I needed to get over the hump.

I would like to put forward one perspective of many I have been contemplating.  All of my working career I have been involved in systems and procedure assessment and development along with the corresponding Training protocols to support the system utilized.  I am using my work experience and applying it to Diabetes management.  As a trainer I have learned a few things.  First, you can train 3 things;  you can impart knowledge, you can develop skills and you can enhance attitude or the optimal thought context approach to be applied to the task(s) at hand.  Second, it is critical to have a clear understanding of the primary objective of the system.  And third, we learn most effectively via metaphor or analogy.  The knowledge and skills that must be internalized and mastered to have success in the management of the disease are not overbearing but seem to be illusive without the proper thought context.  And the optimal thought context is only achievable with courage, discipline and a desire to excel.  Difficult characteristics to foster when one is knocked hard across the head with a diagnosis as serious as Type 1 Diabetes.  It took me 29 years to get there so I know.

The primary objective with Type 1 diabetes is a desired range of blood sugar readings.  My range is 80 to 120.  Of course, I am not there all the time but that is where I want to be.  If I am not in that range I take action to get back in there.  There are several metaphors and analogies I am working on.  To conclude this posting I would like to share one of them with you and show you why the insulin pump is superior.Think of yourself as an Automobile.  There are several types of Automobiles.  There are big ones and small ones.  There are fast ones and not so fast ones.  There are fuel efficient ones and there are gas guzzlers.  There are new ones and there are old ones.  Your body is the Automobile.  If you have Type 1 Diabetes there has been a malfunction.  Sorry, but that is the truth.  Specifically, the malfunction has occurred  with the accelerator.  The cells in the body responsible for the production of insulin have been destroyed.  The immune system has decided that they are foreign invaders and has attacked and killed them.  This malfunction is a fatal flaw.  Without insulin the body will die.  Without the accelerator the automobile is immobile.  It can’t get the fuel to the engine.  Insulin is the accelerator.  The food we eat is the fuel.  Your general health will determine whether or not you are a sports car or a beat up old Chevy truck.

So how do we use this analogy to understand and better handle our diabetes?  First and foremost, get yourself in the best shape you can.  Get to a weight that is ideal for you.  Exercise vigorously.  Drink water.  Take vitamins and supplements.  Get your lab tests every three months.  Second, use premium fuel.  Eat well.  If you drive a sports car you have to put premium gas into it.  It won’t run properly without it.  Third, fix the accelerator as best you can and learn how to use it.  This is where the pump comes in.  Remember, Insulin delivery is the accelerator.  The pump allows you to create an accelerator that is dynamic and state of the art.  You can adjust it any second of the day as opposed to “The Poor Man’s Pump” where you can press on it once with the Lantus injection and perhaps up to 8 more times with short acting insulin.  Last thought in this posting………….When you are driving you are constantly looking at the speedometer to check and make sure you are pressing the accelerator properly.  Check your blood sugar at least 8-10 times per day.  Your blood sugar readings are your speedometer.  You want to stay in a specific, predetermined range.  You are driving blind if you don’t check.

I went to an Adult Diabetes Support Group Meeting the other day.  It was the first time I have been to a support group meeting for diabetes.  There were about 12 people there including three young children that were brought by one of the participants.  THe meeting lasted for 3 hours.  Most of us were on the pump.  There was a group facilitator and she was not a diabetic.  I have been developing ideas on how to help others with diabetes and the meeting confirmed to me that there is a need out there.  Everyone of us was at a different place.  And everyone us is at a different place with respect to the handling of diabetes in our life.  Diabetes is not a disease that can be dealt with separate or apart from dealing with oneself. The facilitator of the group used a visual in the group that I had been writing about.  “Put your mask on first before assisting others.”  Instructions we hear before taking off in a plane.  It is especially true with diabetes.  Forget about it!  If you don’t handle your shit first you are screwed in this game.  In the meantime I saw some that were coasting….Ok, don;t blame them but let’s go …………As for me….I am perfect of course….just perfect.  Hope someone reads this..

I have introduced in prior writings a five step process that I have used in assessing and developing systems and procedures and the associated training protocols. I would like to expand on that here and also offer a few different perspectives from which to understand it. My primary objective is to communicate the reality of the challenge that faces those of us who have Type 1 Diabetes and to put forward a perspective and a process to achieve positive results.

The 5 steps are:

Step 1:  Objective

Identify and state primary objective. What is it you want to accomplish or manifest? What does the outcome look like? It should be, in the end, a written statement that is specific, time bounded and measurable.

Step 2:  Functions/Ingredients

The second step is to identify and prioritize the ingredients or functions involved in accomplishing the objective. This step is a brainstorming exercise followed by a ranking from most important to least important. What are the components involved? Which ones are more important?

Step 3:  Systems and Procedures

In this step it is time to create a system that most effectively accomplishes the functions we identified in step 2. This is the creative step. How do I want to go about this? How do I integrate the tasks so that I am doing it in an effective way? What procedures do I want to put in place?

Step 4:  Implementation

Step 4 is the implementation step. We work the system that we created. Training is involved here as well as action steps. What do I need to do? How do I do it? What should be my practice?

Step 5:  Managing Outcomes

As a result of employing steps 1 through 4 we will have achieved outcomes. Step 5 is about managing these outcomes. How do we measure them? Am I getting the results I want? How do I enjoy the results I get? What are these results telling me?

The 5 steps are a step-by-step process but it is by no means linear. Instead it is more cyclical. Once we have reached step 5 and assessed our outcomes then it is time to go back and re-commit to the primary goals, explore for unseen or now more important functions or ingredients that we may have missed, alter systems and procedures, and evaluate our implementation strategies.

This 5 step process was born from what I have learned over the years as a systems developer and trainer. One of the most profound things I came in contact with is something called the Growth Cycle. The 5 step process mirrors the growth cycle. What is interesting, at least to me, is that many of my studies in metaphysics, religion and spirituality have similar tenets running through all of them. They all in one way or another refer to the cycle of growth from the seed level to the manifestation level. Christianity and Judaism reference the Tree of Life and the Tree of Knowledge. The Buddha sat under a tree and contemplated the roots of suffering. Continue reading Confront, Understand, Internalize, Master and Triumph; A Step by step perspective in dealing with Type 1 Diabetes →