How treatments are labeled, and how we PWD *really* use them

Coming out of a software background, what always strikes me about doctors is their inability to debug. They can follow a flowchart, which is how their practice guidelines are arranged, and they have memorized a lot of factoids, but they don't really understand the way you approach diagnosing something that isn't already in a clearly marked box on a flowchart. And as you all know, they never ask you how anything they prescribed worked for you. They just prescribe it and forget about it unless you call up and tell them you are covered with spots or vomiting.

However, getting back to engineering as it relates to people with diabetes, I think people either are born thinking analytically, and having a knack for using math to solve problems or they aren't. And the people who don't have that knack, in my experience, though they can be exceptionally bright and creative, can not be taught to think the way you have to think to use numbers to help you understand things. It isn't just that they had bad math teachers in high school or math phobias. It's some kind of missing part of the brain. Things that are completely obvious to someone who thinks analytically never make sense to someone who doesn't have those skills. If you live with someone who has been using a PC for 20 years and still is afraid to copy files from one directory to another, or who reboots their computer every time they get an error message from their browser, you know what I mean.

So I have accepted that diabetes is a condition that really penalizes people who aren't good at thinking analytically and mathematically. Those of us who can think that way are very lucky. But after many attempts to teach the way I think to people who are visual and don't have that mathematical brain structure, I've accepted that it goes beyond people not trying. These people are probably trying much harder than I am. They just don't have the brain structures to do it.

More importantly, it isn't a matter of "personal responsibility." People who don't know they don't know this stuff also are unaware when they are doing things that a person who understands math wouldn't do.

I have a different kind of deficit--I can't remember faces. At all. So I know what it is like to not know that I don't know something, because I will walk right past someone I have had many conversations with with no idea that I know them if I meet them out of context. So I suspect people must have some kind of similar math deficit where the places where my mind starts working things out, they just don't see anything to be worked out.

But I think before people can begin to use tools in a way that they are not necessarily "designed" to be used, they need to learn to use the tools in the way that they were designed. You're right, a lot of people (especially Type 2s) aren't given much information on even the basics like how to count carbohydrates accurately or how to adjust their basal and bolus doses. But, at the same time, there are a plethera of books and websites out there covering this that peopel can find freely at libraries and online if they go looking (that's how most of us ended up here, I'm guessing). So I think the first step for many is helping them come to the realization that they themselves (not their doctor) are responsible for thier disease and adjusting medication and finding diet/exercise that helps their blood sugar. Once they do that, then they can move on to the more advanced stuff...

I am a little more optimistic. Folks (patients or docs) who don't understand control loop theory, can still learn various rules of thumb to help control their bg's. Correction factors, insulin sensitivity factors, Rule of 1800, etc. These are all closely related to control loop theory but don't require a lot of deep understanding of control loops. Many of these can be simply programmed into a pump now.

Many of these rules of thumb are not purely reactive PID loops, but are "feed forward controls". e.g. doing the math to convert carbs to a required bolus. I think our thoughts about such feedforward rules predate the home bg testing era, but really they can be integrated well into a control loop.

You make some very good points, Jenny, about how ability varies all over the map.

Still, the penetration of the kind of knowledge and practices we're discussing in this thread is minuscule among those diabetics that are capable, willing, and interested in taking a (far) more thorough approach in managing their disease. This is primarily T2s -- T1s gotta learn this stuff, or die.

So, we have a long way to go. If you can't handle the math and the concepts, fine. You should be using a protocol that you can handle. However, we should not be dumbing everything down to that standard, and denying the more capable and willing diabetics these tools.