At The End Of The Spreadsheet

There's never going to be enough money in any healthcare system to fund everything for everyone. But when the bean counters forget there's a human being at the end of a spreadsheet, we're all in big trouble.

Mike Hoskins at DiabetesMine, posted a very powerful, personal story earlier -
Letter to My Insurance Company: I'd Rather Not Die Today

http://www.healthline.com/diabetesmine/letter-my-insurance-company-id-rather-not-die-today

Janki stayed awake in bed until I got home (late) from work tonight. I've been late every night this week. Big trouble. We said goodnight. We hugged and gave a goodnight kiss. Then she had a hypo. The CGM had seen it coming, not soon enough to avoid it completely, but soon enough to help. We rounded it off with Ribena and a biscuit. Her numbers came back. After her hypo, instead of going to sleep, she got a little emotional (not unusual after a low):

" I wish I didn't have diabetes"
"Why do I have diabetes - no one else in Mrs W's class has diabetes. None of the children in Miss H's class. Only me"
"Why is it me?"

We hugged. I told her I loved her, that we loved her. What else could I say? She settled and snuggled up to her Mummy. She slept. It's gone midnight and, thanks to Nightscout, I know 4 minutes ago she's 7.5mmol/L (her target). All is well for the next five minutes.

In my (humble opinion) book, go ahead and make regular diabetes education programmes mandatory*, put the onus on us to demonstrate we are trying to optimally use all those test strip BG data and sensor glucose values. Test my ability to carb count (ok, test my wife's...), challenge and discuss our treatment decisions, assess the psychological impact on having access to the extra BG tests, CGM or a pump that dual-wave boluses. If it doesn't work out, redirect the resource / technology. Your doctor wouldn't plough on with a drug that isn't working for you (but you'd hope you'd have a conversation first and the chance to consider other treatment options...)

*Why aren't these more readily available and part of more clinical trials into CGM efficacy?

But, please don't let us tot up the number of times anyone with diabetes is (potentially avoidably) in the back of an ambulance or set a threshold HbA1C (above which you clearly need 'help') to win the prize of the opportunity to live with less fear, less guilt and more empowerment.

At four years old, fortunately, our little one doesn't have the full-on fear of what can happen with T1D - I don't think she does anyway. But the guilt? The emotional impact on her and her quality of life? They are already there.

How does that score on the spreadsheet?