Wil Dubois

Who doesn't sometimes need a little help navigating life with diabetes? That's why we offer Ask D'Mine, our weekly advice column, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil tackles that tough, timeless topic of teenagers with diabetes. (Actually, he offers some advice that any D-Parent might want to know.)

Oh, and speaking of time... read on.

{Got your own questions? Email us at AskDMine@diabetesmine.comom}


Debbie, type 3 from Texas, writes: I have a 19-year-old Type 1 daughter who was diagnosed at age 3.  She wore an Animas pump for many years, but during her senior year in high school wanted to go on Lantus because of all the dances, Prom, etc., where she didn't want her pump to show in her fancy dresses. I agreed because she's the one who has to live with this frustrating disease. However, she is now in her first year of college and has a boyfriend and she has no interest in going back on the pump! She says she loves the freedom of wearing what she wants and not being constantly hooked up to a box on her hip. My fear is she will never return to the pump, which she had better control on. Do you have any advice on this subject?

Wil@Ask D'Mine answers: Sacrilege and spoiler alert: I'm about to reveal a truth no one wants to hear. And that truth is that pumps don't matter as much as their supporters would have you believe. From both personal and clinical experience, I promise you it's possible to have excellent control using a handful of disposable syringes and a couple of glass vials; while it's equally possible to have completely crappy control wearing the latest, best, and brightest pump.

Pumps, pens, and syringes are only tools. A sharp mind with a dull tool can accomplish wonders; a dull mind with a sharp tool usually results in injury.

Yes, yes, yes. I know. Pumps can make life easier. They can deliver more precise dosages yadda, yadda. And while it's true that pumps have the potential to turn the struggle of diabetes control into an elegant ballet, they can only do so if the operator of the pump is engaged.

Let's see. First year of college. Hmmmm.... Away from the nest for the first time. New friends. New challenges. New adventures. New foods. New experiences, freedoms, and responsibilities. Oh, and a new boyfriend. Yeah, no distractions there. No reason to not be fully engaged.college-students-2

I suspect that even if your daughter were still on the pump, her control would be less than stellar her first year of college.

Of course, she could wear a Patch Pump to avoid some of the wardrobe issues, but I doubt she'll be interested. She's surrounded by non-D peers, and it sounds like she doesn't want to stand out. Of course we older and "wiser" people know that it's unlikely her peers would even notice the damn pump, and even if they did, they would probably find it pretty cool—but for teens, perception is reality. What she believes is Gospel truth for her. There's no advice, tip, or trick I can give you that will get her on the pump again. And what's more, I don't think she should be on the pump if she's not too engaged in her diabetes management—because people who aren't engaged in their self-care do worse control-wise on pumps.

Why? Well, it's easy to fool yourself into thinking the pump is more magical than it really is. If you're disconnected from your self-management while still being connected to a pump, it is all too easy to put the pump on autopilot, put your brain on autopilot, and just let everything slide. In all likelihood you won't die anytime soon, but neither will you thrive, as you'll be setting yourself up for complications down the road. On the other hand, using either pens or syringes forces you to think at least a little bit, or get sick very quickly. I think that's why the non-engaged do better on pens than pumps. Older tools force you to think, at least a little bit.

So my advice is to love her and try to relax. I know you've been the diabetes air traffic controller for 16 years, but now it's her turn to run her diabetes. So long as her A1C stays below 9.0, I think you should let her find her own way. On the practical side, you could buy her a copy of RapidCalc and Calorie King apps for her phone, to help optimize her non-pump plan, but the bottom line is: Let go of your fear that she may never go back on the pump. The pump really doesn't matter. She can control her diabetes with it or without it, and over the years, like most of the rest of us, she'll probably choose to use a pump sometimes, and to use older tools at other times. What's really important is that she chooses the right tool for the right moment in time.

And I think that for right now, she's done just that.



{See also: an insightful guest post titled, "Teens with Diabetes: Freedom is Their Secret Drug"}



A Wish from Wil: Speaking of time, it's probably important to point out that my calendar tells me "Daylight Saving Time" begins tonight. I can never remember which is the "real" time and which is the daylight savings time. Do you save daylight in the summer or the winter? I guess I don't care enough to look it up, but I do remember how to remember how to know which way to turn the hands of my clocks to get them in line with the rest of the country (except Arizona): You fall back and you spring forward. Tonight is the night for springing.Daylight savings 2014

In the old days, this whole screw-with-the-time thing never bothered me. I reset my watch the first time I was either an hour early or an hour late to something, and I was done with it.

Life is more complicated now.

First come the clocks. In my house there are two in the library—one on the wall, and one on my desk. Then there are two in the living room. Plus two in the kitchen. Two in the master bedroom, one in my son's room, one in the master bath, and one in my mother-in-law's suite. Then there are the watches, the cellphones, the TV, and the video recorder. And my wife's roving alarm clock. Sometimes the computers take care of themselves. Sometimes they don't. But they have to be checked, along with the iPad Mini and iPod. I also have to go over to my mother's house and repeat the entire routine.

Oh, and I always forget the damn cars.

I don't think we're an overly time-obsessed household, because despite all these timepieces, I can't remember the last time we were on time for anything anywhere.

But that's just the beginning. There are still the D-devices. I'm not wearing a pump right now, but if I were, changing the time on it would be critical. If the pump clock is off, so are your basal rates, your insulin-to-carb ratios, correction factors, and all the rest. Of course, my CGM has a clock, as do the several meters I use.Insulin Pump Time Change

A couple of days from now, I'll need to fix the desk and wall clocks at my office at the clinic, too. And then the D-devices of 300 other people, as they straggle in an hour late over the next few weeks.

It's easy to change the time on some meters. For instance, updating the Verio is a piece of cake. Other meters are an inside joke, not so bad once you are "in the know," but impossible to divine by logic; the Presto would be a good example of this species. Then there are some meters that are just plain impossible, even with an illustrated manual, like the frickin' FreeStyle Lite.

I'll bet if George Vernon Hudson had been one of us PWDs instead of a shift-working bug collector, this whole daylight savings time thing would never have happened. (I bet that made you check the link, didn't it?)

Like many things in life, daylight saving time is a hassle, a hassle that's supersized by diabetes.

I wish we could just spring forward a half an hour and forget about it. Forever. But in the meantime, Gentle Readers, don't forget to spring on your diabetes, diabetes gear, and other timekeeping and tracking devices.

The daylight you save might just be your own.



This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.


Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.