How can I manage it discreetly in public places?
It is sometimes surprising (and reassuring) to realize that, given the fact that about 1 in every 12 people in our society has diabetes, we encounter people with diabetes virtually every day in our daily lives and are quite unaware of it.
This means that diabetes can indeed be managed discreetly and privately without undue attention and alarm by the vast majority of those who have it.
A renowned diabetes specialist recently wrote that the most important contribution of the diabetes specialist is to help patients build diabetes into their lives rather than to build their lives around diabetes*. Thus, there are many ways in which management of diabetes can be built into our lives without unduly disrupting them.
Circumstances in Which Persons with Diabetes Might Benefit from Seeing a Specialist
1. Difficulty achieving target blood sugar control using routinely available medications with the best efforts of both the physician and the patient
2. Diabetes in which microvascular complications (such as eye, kidney, or nerve) have occurred or are progressing
3. Diabetes in which macrovascular complications (such as heart attack, heart failure, stroke, or other arterial disease) have occurred or are progressing
4. Frequent or unexplained high or low blood sugars
5. Pregnancy or planned pregnancy in a woman with diabetes
6. The use of multiple daily injections of insulin or a pump
7. Treatment of the diabetes complicated by other significant medical problems
8. During or following a hospital admission for decompensated diabetes or a diabetes complication, e.g., foot ulcer
9. When considering the decision to switch from pills to insulin
10. When considering pancreas or kidney transplantation
11. When a course of medium-or long-term oral steroid therapy is planned
Perhaps the two main challenges to discreet diabetes management are performing glucose monitoring and administering injectable medications, such as insulin, during the workday. The main challenge for many occurs in the middle of the day, when most people are at work and privacy is scarce.
Many simply do not check their blood sugar during the middle of the day and settle on a treatment regimen that avoids insulin shots during the day. Fortunately, some insulin treatment plans are designed to prevent this, as they entail use of one or two shots of longer-acting insulin and an injection of short-acting insulin before each main meal.
Moreover, studies have shown that patients on insulin who do not check their blood sugar in the middle of the day achieve poorer control of their diabetes. Modern miniaturized glucose monitors and automated insulin pen devices are at least part of the answer for many people. Continuous glucose monitors (see Question 60) can offer a solution for others.
Some glucose monitors, for example, the Lifescan One Touch Ultra Mini®, are little larger than a conventional tube of lipstick and will provide a reading within 5 seconds. Others, such as the Accuchek Com-pact Plus®, automatically produce a strip when switched on.
While time is required to perform the finger (or arm) stick to obtain the drop of blood, the entire operation can be completed in about a minute, especially if the lancet was previously loaded into the spring-loaded autolancet device. Thus, this can be done at one’s desk or in the restroom quite rapidly.
Similarly, preloaded insulin pens can avoid the need to draw up insulin, or bring bottles and syringes. The dose can be dialed on the pen and given in seconds.
Finally, continuous glucose monitors only require the wearer to check the readings they are displaying, much as we check our beepers and cell phones from time to time.
Remember that regular glucose monitoring during the day can help avoid unexpected low blood sugars, which can be the hardest to manage without attracting attention, especially if they are severe.