[UomoNeroNero]

Friend, you’re diabetic.

Your survival is ultimately your own responsibility. Prepare yourself for a few hard truths.

No one — including nurses and doctors who are not specifically trained in diabetes management — truly knows your situation.

I had a TIA. I was barely functioning, hospitalized, semi-conscious. Not a single person in the ER, nor during the entire week I was admitted, stopped to think that maybe I wasn’t mentally fit to manage my own CGM.

Always be prepared.

I once found myself in what my company had sold to me as a “hotel” in Germany. It was really more of a shack. I was having a severe hypo, glucose at 70 and dropping fast. There was no lobby, everything was closed, emergency services didn’t speak English, and I couldn’t even find a taxi willing to come out there.

I ended up licking sugar crumbs and biscuit dust that had accumulated over the years in the pocket of my suitcase.

Your CGM can fail. In fact, it will almost certainly fail while you’re on vacation on some Greek island with no signal.

You must know how to manage your blood sugar with insulin pens. Even with different insulin types. You need conversion charts. You need the phone number of your diabetes center so you can get proper instructions. You must be able to change an infusion set in the dark, slightly drunk, like Rambo — except this isn’t a movie.

You need to remember your insulin-to-carb ratio and be able to estimate the carbohydrates in a dish you’ve never seen before.

I’m lucky enough to be able to “feel” my blood sugar. More importantly, I can sense when I’m heading toward a hypo, and I do everything I can to preserve that personal superpower.

As we say in Italy, being diabetic is serious business.

My colleagues and friends see only the outside. They see a well-managed condition, an HbA1c of 6. They laugh when I tell some of the more extreme stories.

But they have no idea — absolutely no idea — how difficult our lives are.

Ours, and our families’.

[mettamage]

> while you’re on vacation on some Greek island with no signal.

Not diabetic but my car was stuck on a mountain on a Greek island with no signal. In hindsight it was fun, but when it happened I initially feared for my health. We were at the highest road stuck in the snow with a car that had no business being in snow. Luckily my wife is a born and raised Michigander and she showed my Dutch ass how to handle real snow. She started digging in the mountain side to grab as much small rocks as possible since every Michigander has cat litter so that wheels can get traction.

Without it, we would still be stuck.

[Neywiny]

You didn't bring glucose tabs or glucagon with you or get more when you ran out? Was it an overconfidence in your ability to feel low?

[ninjin]

As a type-1 diabetic, in my experience it is perfectly possible to end up in a situation like this even if you are responsible. Remember, type-1 diabetes is a condition that requires your attention tens if not a hundred times per day. This is not just on good days, but also on your very worst days when you are juggling everything else that life throws at you and you may not have slept properly for days. So, maybe you had noticed that your emergency glucose was low, but in this instance out of a hundred you forgot to replace it when you came home because you were exhausted and then overslept and had to rush out in the morning. What makes type-1 diabetes challenging is not that you can not technically manage every single one of the decisions and actions that it demands out of you, it is that you must carry them out under all conditions and largely without fail for every day in your life or you will suffer both short-term and long-term consequences. Everyone I know has had a nightmare episode.

Just a final recent anecdote to illustrate some of the complexity. It may look like maths on the surface, but even something like "carbohydrate ratio" is a fluid concept. Yesterday for example I was out and about in the sun and had the very same bottle of sweet tea that I have had for months. Given that I knew I was physically active and it was hot, I reduced the usual dosage for this specific drink by 80% to be on the safe side. To my surprise, on this particular day for whatever reason this was still far too much and I pushed myself into hypoglycemia in little over an hour. We humans are highly dynamic and complex systems and this is me failing with the very best technology we have available: Insulin pump and continuous glucose monitor.

[Neywiny]

Yes but there has to be a reason why the nightmare scenario existed. For example in the article it was because the author had hubris over 20+ years of the pump never failing. It's a good admission of cause. I certainly can't blame them for it. They also admit they didn't have a backup plan packed. It's a humble article if you see through all the anger. Your scenario was caused by trying to do the right thing and it was still wrong. Again, great reason. Was the other commenter exhausted and overslept before the trip? We don't know. Did somebody steal their supplies? Did they fall in a vat of toxic waste? All we know is that they were on a trip with no packed way to increase blood sugar and I think we all agree that's not the expected plan. But they also say they're usually very good at feeling their blood sugar and were bait-and-switched by the trip organizer, so it's not unreasonable to assume they assumed they could catch anything early and just go buy something. Which isn't really a plan, again as we learned from the article.

[UomoNeroNero]

As the saying goes, "The graves are full of hindsight."

In twenty years of living with diabetes, I've made an unbelievable number of mistakes — enough to fill a warehouse.

Every one of them became a lesson, provided it didn't kill me first.

One of the biggest lessons, in fact, was learning to be extremely organized and always prepared.

Yes, in that particular case I had already used up my supplies (and during a three-day trip I hadn't thought about bringing a refill), and, rather stupidly, I wasn't carrying glucagon with me.

I've never claimed to be smart — just a survivor of my own stupidity.

[Neywiny]

A perfectly cromulent answer, thanks

[chopete3]

Exactly my question. Something is missing in this story. We carry a bag of sugar, juice mix, biscuits and candy

[Rapzid]

Until you don't. Then you'll have a story with something missing.

[kotaKat]

DR doesn't just stand for 'disaster recovery', it's 'didn't realize'. It'll always be the one day you didn't realize you forgot the kit...

[UomoNeroNero]

Yes. Really

[UomoNeroNero]

Oh, and one more thing.

I always keep a blood glucose meter in my backpack. You know, that medieval-age stuff with the finger-pricker and test strips. (You can buy one for about €10 in pretty much any pharmacy in Europe, but it’s better to already have one with you.)

And pen needles, too.

[s1artibartfast]

Re access:

You can also walk into any pharmacy or walmart in the US and by rapid acting insulin for about $20. no doctor, no insurance, and no Rx necessary (unlike France). Also, they had a massive supply of insulin. If they bothered, they could have bought some needles and looked up the conversion.

[Projectiboga]

Regular Human Insulin isn't "rapid acting" it isn't delayed released like NPH, which lasts almost 30 hours, but it isn't "rapid". Yes getting R & NPH can keep you alive but it creates a caloric and glycemic burden as those types of insulin stoke the stove without enough glucose to run it. Some remote place in Greece might only have the pharmacy open M-F business hours like 8-4, we living in built up urban or suburban USA might not realize that other countries may not have pharmacies open late or over the weekend like here.

As to $20, their website says

"ReliOn™ NovoLog® insulin Rapid-acting mealtime insulin, starting at $73." on a block without any link to go further. This is rapid-acting but it is buried on the site to access any clear information about is that the stuff that can be accessed without a script.

[UomoNeroNero]

P.S.

As a European, I genuinely struggle to understand how you cope with your healthcare situation.

In France, in a small mountain village, I walked into a pharmacy and, through a combination of gestures and sketches, managed to buy a box of rapid-acting insulin at full price (around €30–40).

The insulin was clearly available. The issue was purely bureaucratic — technically I needed a prescription from a French doctor. But the urgency of the situation, and the fact that I was obviously diabetic, were equally obvious.

We certainly have our own problems over here, don't get me wrong.

But I don't envy yours.

[adev_]

> through a combination of gestures and sketches, managed to buy a box of rapid-acting insulin at full price (around €30–40).

Quick tip for people that might encounter such situations:

- Phone to the emergency number. In Europe, it's 112. In France 15 is also working. Explain your situation (they generally do have English support).

- In many European countries, it is a Doctor you will have on the line. They can forward a medical prescription by email to the pharmacy close by.

- Even if you are not insured, the only thing it will cost you is the price of the medicine. For insulin, it variates from 20 to 40€ depending of the country.

- If you are over weekend or in middle of the night, in many EU countries have emergency pharmacy system. Some dudes somewhere on duty will open a pharmacy for you and you have to come on site.

If you are in France and if you wake them up at 03h00am, you can probably expect the legendary 'frendliness' (irony) of French customer service but at least you will stay alive.

[georgemcbay]

> As a European, I genuinely struggle to understand how you cope with your healthcare situation.

As an American, most Americans don't realize how bad it is because everything seems fine when you are insured and only need basic care. The huge problems aren't immediately apparent until you suddenly get diagnosed with something serious and become a cost center for your private insurer instead of pure profit for them. At that point they realize how fucked they are and how much the insurance company will fight tooth and nail to deny care.

Everyone else tries to ignore how fucked those people are out of superstitious belief that maybe they too will fall into the Unfortunate Situation group if they think about it too much.

[cm2012]

In the US every CVS had rapid acting insulin for $35 for one month supply. This is not special to europe.

[gusgus01]

Are you talking about the Lilly Insulin Value Program? If you're uninsured, you do need to get the savings card but it's mostly a matter of filling out the form. And that's only since they started the program in 2020.

[cm2012]

Yes, the manufacturers coupon. Savings card takes 2 min to fill out, I have done it on my phone at a CVS

[1234letshaveatw]

As an American, I am astounded at the the smug ignorance I see from Europeans online. I don't envy that cultural lack of self awareness

[gmac]

Are you trying to claim that American private healthcare is anything other than a giant shitshow of inefficiency, profiteering and death?

[jeffwask]

The thing that struck me most was that for 25 of 27 years, they have relied entirely on machines and computers to manage the condition which means every hard-earned lesson you have experienced they did not and the author likely has very little person knowledge and experience on how to do anything off the pump.

It's the AI argument in a nutshell. We are handing things off to machines and losing the knowledge to do it ourselves.

Imagine if this were a systemic catastrophic failure, that lasted months... how many people would perish just because they weren't taught or never learned how to manage without the machine.

[DennisL123]

> Friend, you’re diabetic. Your survival is ultimately your own responsibility. Prepare yourself for a few hard truths.

This.