Choice in Diabetes Series (Article 4): Different Aspects of Choice in Diabetes

By Renza Scibilia

Renza Scibilia is from Melbourne, Australia and authors the blog Diabetogenic about real life with type 1 diabetes. Renza has lived with type 1 since 1998 and for the last fourteen years has used an insulin pump. She works for Diabetes Australia and is a proud member of the Diabetes Online Community (DOC). She is a diabetes consumer representative and a vocal advocate for ensuring the voice of the ‘patient’ is heard loud and clear.

The opinions presented in this blog post are those of the author and may not represent the opinions of Ascensia Diabetes Care. Ascensia have paid Renza an honorarium for her services as a contributor to this blog.

The Ascensia Blogger Editorial Board has been looking at how choice shapes diabetes management.

I’m picking up on that and looking at different aspects of choice and how they impact on our decision making. I fully understand that choice means different things to different people. While some of us are grappling over the choice of which pump we want next, or which CGM to strap to our arm, others are in a very different situation, wondering whether or not they are able to afford more than one blood glucose check a day.

My experience when it comes to being able to choose how I manage my diabetes is one of extreme privilege and I never, ever forget that. I am fortunate to live in Australia where we have a health system designed to support everyone, regardless of private insurance status. For those of us living with diabetes, we have the National Diabetes Services Scheme which safeguards affordable access to diabetes consumables such as blood glucose test strips, syringes and needles, and pump consumables. For certain cohorts this scheme also funds CGM. And prescription drugs, such as insulin, are a set price, meaning no surprises at the pharmacy checkout when it’s time to refill a prescription.

But regardless of where you are in the world, and how much choice is available to people living with diabetes to shape their condition, we all need to make decisions about our diabetes management.

For years, I have quoted that people with diabetes make an average of 121 diabetes-related decisions each day. Turns out that I was 59 decisions short! A study out of Stanford suggests that it is more like 180 a day. That’s a lot – and remember, that’s on top of the non-diabetes decisions that we make. (Which striped top will I wear today? Do I want a second latte before 8am? Which pair of boots go best with this outfit? Which music will I play as I drive into work today?)

But those diabetes decisions? They are constant and there are many. Once I started to try to tally them up, but lost count once I hit about forty. And that was before I’d even left the house.

Of those decisions we make, some are small and some are not-so-small. And it is very clear that the choices that we have available to us help govern the decisions we make and the decision-making process.

It is all very easy to suggest that someone should make the decision to leave a healthcare professional they don’t feel is aligned with their diabetes management philosophy, but that only works if there are other HCPs to move to.

Deciding we want to use pump brand XYZ is only possible if that is endorsed by our healthcare team, or, if we’re from a place where insurance seems to govern management choices, that pump is one of the brands supported by the insurance provider we are with.

Choosing to find a peer support network is somewhat easier in modern society, as we are no longer reliant on only local groups for face-to-face support. I’ve chosen to engage in peer support as a critical part of my diabetes management – in my opinion, it is just as important as the shiny tech and brilliant experts I see, but I’ve decided to do it in a way that means that I am surrounded (albeit virtually!) by a few good friends rather than massive communities.

Making diabetes decisions is exhausting. We don’t get a break from it. Sometimes, those decisions just happen – almost as if on autopilot – because we all have habits that we fall into. But other times, it takes a huge effort to make those decisions because there is a lot we need to weigh up before doing so. Just as there is no right or wrong choice, (as eloquently highlighted in Kelly’s earlier piece on this issue), there is no right or wrong way to make decisions. As is ever the case with diabetes, the equation we need to consider to get to the answer is convoluted, variable and constantly changing. And just as we should never be shamed or questioned about our diabetes choices, we equally shouldn’t be judged for the decisions that we are unrelentingly required to make just to get through the day.