Our home was built in 1913. It’s a beautiful Edwardian house with a ridiculously high peeked roof and gorgeous ornate features.

I love that although the house still has all its beautiful old world character, it has modern touches that make living in it in the 21st century much easier and far more comfortable than when the house was first built.

I have no interest in living the way the original inhabitants of our home lived. I like knowing that when I walk into the house after work today the hydronic heating will have been programmed to have switched on half an hour earlier to take the chill out of the air. I love that the Aga stove is still nestled into a corner of the kitchen, but the fan forced oven on the other side of the room takes no time to heat up for when I want to bake a batch of brownies. (Or these blondies which I made a couple of weeks ago, and are my new favourite 10 minute bake up!) I love that hanging from the pressed metal ceilings are electric lights that switch on and off as needed.

I am more than happy to give a nod to the old, and admire its loveliness. But I don’t want or need to live that way.

Period features galore.

It’s how I feel about diabetes. I can only imagine what diabetes was like many years before I was diagnosed. But I have no desire to sharpen needles, boil syringes or pee on sticks and analyse the colour that appears after ten minutes to give me a not-especially-accurate idea of how much glucose is floating around in there.

And yet, in most cases, people with diabetes are asked to step back in time with older management options before we earn the right to use newer management techniques. We are told this is done so that we understand the basics. Or have a back-up plan if things go wrong. But surely there is a way we can tick those boxes while still being able to utilise the technologies we choose to use – even the newer ones.

If I were newly diagnosed today, I would want to go straight onto an insulin pump and CGM. Obviously, I would need to learn to do blood glucose checks because CGMs in Australia need calibrating. That should simply be part of the training. And yes, I’d need a back-up plan in case my pump stopped working, but again, providing basic information about how to do an injection and insulin doses could also be part of that training – and repeated at follow up visits.

Why should we have to learn how to use old methods of treatment when there are newer methods that might suit us better?

The other day, my daughter asked me how she would manage diabetes if she was diagnosed. (Her question was the prompt for this post.) After I remembered to breathe again, I suggested that it would be up to her and that I’d support whatever she chose. ‘I’d want to Loop,’ she said. ‘I see how you are and I think that’s what I’d want, too.’

I thought about it and realised that most – all? – people who are newly diagnosed are put on MDI and BG monitoring, and I thought that there is no way that I would want that to be the only option offered to my kid if she were diagnosed. It seems archaic to me.

I would want all the options presented to us, including the ones we’re told we have to earn our stripes for before we are allowed to use them.

Now obviously, I’m coming from this with the perspective of someone who is not new to diabetes. Twenty years of living with diabetes under my belt, a job at a diabetes organisation and a career in diabetes activism and advocacy means that I would be far more in the picture than someone who is completely new to diabetes. I totally get that. But I also know that I think everyone diagnosed with diabetes should have access to the latest and greatest if that’s what would be right for them.

But why can’t that initial training be inclusive of back up plans?

Also, I do wonder if we are setting ourselves up and falsely believing that by having our back-up plans we are all sorted in case of emergency. I have not had a pump break in over seventeen years. I guess I’d be fine doing an injection, but apart from probably half a dozen times where I have injected to bring down a stubborn high, I’ve not had to use a syringe or pen. My back-up plan of long-acting insulin frequently is out of date. How confident would I be if my pump died this afternoon and I needed to go back on MDI for a few days? Not especially confident, I have to say, even though I know how to do an injection. (For the record, I have a spare pump. So MDI is actually the back-up plan for my back-up plan.)

This is just another one of those ‘it’s about choice’ situations. At ADA last week, I attended a CGM update. (Two things to note about this session. Firstly, it is held at 5.30am and I was there at kick off. Secondly, the coffee was shit and I was seriously feeling grumpy. But despite that, I managed to pay attention and hear what the speakers had to say.) Viral Shah MD in his presentation encouraged the use of CGM from diagnosis of type 1 diabetes (with a strong caveat of it must be up to the PWD to make that decision).

And one final point: CGM is not new technology. Neither is pump therapy. These are established, well-researched and safe technologies that have been around for a number of years. So why are they not offered as first line treatments?

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