What Choice Do We Have?

By The Grumpy Pumper

The Grumpy Pumper is from the UK and blogs about diabetes from https://grumpypumper.wordpress.com/. He is also an active commentator on Twitter (@grumpy_pumper) and Facebook.

He was diagnosed with Type 1 Diabetes on 26th August 1994 and has been an insulin pump user since 2009. He says that he will NOT be beaten by diabetes (and is GRUMPY!).

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 The Grumpy Pumper an honorarium for his services as a guest reporter.

We all want to choose how we live our lives.

Choose what’s best for us.

Choose where we live.

Choose what job we do.

Choose who our friends our

The list goes on……

Choice is an everyday task for us all.

Of course, none of us living with diabetes chose to have this condition, regardless of the type of diabetes we have, and at diagnosis I doubt any of us got to choose the treatment that we received or the tools that we were initially given right at the start.

And if I had been given a choice, I would not have been able to make an informed decision anyway. Everything was so new to me and to be honest, I felt so unwell before I went into hospital that all I cared about was feeling ok again.

What choice means to those of us living with diabetes and what influences our choice can depend on a lot of different things. The type of diabetes that we have, the healthcare system in the place that we live and often the specific area of the country that we live in. Due to the cost of technology and medication, some PWDs may be in a position where they have to prioritize feeding their family over buying their own medication. In some countries there is no choice at all, and the more modern medications or devices needed to manage diabetes are simply not available.

Then we have the choices that we make in the way that we manage our diabetes. The choices that help us to fit our diabetes around our lives and not out lives around our diabetes. How and where we wear our medical devices. Do we inject in public or are we not comfortable with doing that? Do we declare our diabetes on a job application? Not all countries are protected by laws that prevent discrimination. Do we tell family and friends about our diagnosis? Not everyone is comfortable doing this for fear of being judged or stigmatised.

There are so many choices that we as PWDs make. Some on a daily basis and others less often. None of these choices are easy without access to technology and medication, and the education required to make those choices informed ones.


I guess the first choice I did get was what I ate from the “Diabetic Menu” at the hospital (it was 1994 and I do hope that the language has moved on now). I now know that it was a menu that was carb counted (carb exchanged in those stone age days) and was not a menu of special foods. I do remember being surprised how varied the foods were and that it didn’t seem too restrictive. The other choice I had to make was where I did my injection. Which site to use to ensure rotation. Simple choices but that was the start of having to make choices around my diabetes management.

Through my 25 years living with diabetes (and counting of course) the choices I have had to make in my diabetes management have increased.

When I changed to MDI (multiple daily injection) I had more choices and decisions. I had to calculate my own insulin doses and carb count. I moved to a pump so needed to choose which one.

Later choices meant I decided to start using CGM (Continuous Glucose Monitoring) and more recently a DIY loop system.

But that’s just me. A very privileged person with Type 1 diabetes in a hugely privileged country (the UK) with a tax funded healthcare system and no out of pocket costs (except for CGM in my case).

So what about the rest of the world? What about people living with type 2 diabetes? What choices do they have and how do they compare?

Well this is a topic we want to examine in a series of posts coming soon. We want to explore some of these differences in choice as part of diabetes and the challenges that they pose for people living with diabetes around the world.

We will cover these subjects:

  • Respecting people’s choices
  • Choice - the policy perspective
  • Different aspects of choice in diabetes
  • Personal experiences of people from different geographies

We hope that you will find this series interesting, so please look out for the first post coming soon.