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Lessening the Cognitive Load

At the JRDF Government Relations Day(s), there was a lot of discussion about the Artificial Pancreas Project (APP) and it’s benefits.  I am a firm supporter of the APP as I believe it will help patients obtain control much sooner than they could using current techniques/technologies.

One of the points that was made several times was the amount of cognitive load a type 1 diabetic has to deal with on a day-in-day-out basis.  We are constantly counting this, calculating for that, the list goes on and on.  This is one area where the APP could really help alleviate some of the burn-out we have all experienced, of which our daily mental processing is certainly a major factor.

But, as with every good thing, there can, unfortunately, be a down side as well.  However, I believe that it is one that can be overcome.  Let me give you a couple of real life examples of things that have actually happened to me involving the various components of an artificial pancreas (insulin, pump, cgms, etc).

Last week I blogged about how my insulin had “gone bad” somehow (FYI, it contains just a bit of profanity, you’ve been warned!) ironically enough at the JDRF event itself.  So there is one point of potential failure.

Next, let me described something that happened to me just over a year ago.  In January 2010 I received a Dexcom CGMS, I love the device but our relationship had a rocky start.  Rocky as in having to have 8 out of my first 12 sensors replaced.  Since then, things are much better except for one thing that I believe is a major safety issue.

I am talking about the ??? status that appears every once in a while.  This happens when the receiver doesn’t quite understand what the sensor is saying.  From a technical point of view, this is normal and the device is working as it should.  However, from a patient point of view, the device is not functioning in a manner where we can use it.  The safety issue arises because the Dexcom will not alarm to let us know it is no longer monitoring our glucose; no matter how “normal” the ??? are, from my perspective the device simply is not working at that point.

I have hypoglycemic unawareness and the Dexcom has saved my rear-end plenty of times, and living alone most of the time I am very grateful that I have one.  But there is one time where it didn’t.

I regained consciousness in the middle of one cold winter night.  I knew that I wasn’t just waking up for a couple of reasons; one, I was drenched in sweat and two, I was paralyzed.  As in totally unable to move.  I knew I was was in serious trouble, drifting in and out for lord knows how long until I was able to get a hold on my pump.  I couldn’t operate it, but somehow had the sense to pull the cartridge out so the insulin delivery was stopped.  This may have been as close to being killed by diabetes as I had ever been.

When I was finally able to reach the glucotabs on the nightstand, I looked at the Dexcom.  It showed ???.  I have no idea whether it alarmed and I just didn’t hear it or just plain stopped working and didn’t warn me of that little fact.  This is another potential point of failure.

The APP will contain multiple components that all must work flawlessly for it to truly be effective.  An undetected failure in any one of those components could lead to tragic consequences.

While the device maybe able to do a lot on its own, we will still need to be able to do everything we do now.  As in count carbs, test our levels, correct highs and so on so that we will be able to monitor this device to make sure it is working properly.  This will be a machine and, no matter how rarely failures occur, they will happen.

And this is where “lessening the cognitive load” comes in to play.  Yes, it has the potential to make life a lot easier than it is now and that is incredible.  But we must make sure that we still know how to do things on our own, without the aid of that device to ensure that tragedies do not occur.

As I’ve said, I’m a proponent of the APP, but as with everything, there is a trade off.  The trade off here is making sure that we are trained and have regular “refreshers” to make sure we know how to handle that “cognitive load” when we have to;  so we don’t become a tragic victim ourselves.


Today’s recap of this long-winded post: Whatever tools are available, don’t become lazy about being able to do it all yourself!

** Disclaimer:  The JDRF covered my travel, hotel and meal expenses for this trip to Washington, DC.  They did not ask me to blog or not to blog about my experiences and these were my own thoughts and opinions **

© 2011 Scott Strange, Strangely Diabetic and

  • so scary for you to have to go through that…excellent post and so true…kind of like begging our kids to show their math and do it the long way so they understand it instead of using the calculator =)

  • Well said Scott
    Personally I don’t really hold out hoping for tech. advances like the APP. Granted they would be great but most of that is “beyond” me. I don’t really think that’s apathy so much as reality and understanding my place in the scheme of things.
    That being said, I would agree with all that you have said in regard to cognitive load. That is what has brought me online and across great people like yourself in the DOC. For me, at least, I am content with that “solution”. It doesn’t fix my pancreas or remove the load it just helps me feel normal, connected and valued.
    Thanks for another great post. Your insight and personal experience is always valued this side of the Pond.

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