180 Decisions

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I'm sure you've seen this post on social media that says people with type one diabetes make an additional 180 decisions every day, just related to managing their diabetes. You know the ones, it's usually on one of those blackboards with the white letters, like a bougie coffee shop. Well, I remember when I first saw it, it seemed like a pretty big number. But when you think about what you could consider a diabetes decision, it can really start to add up.

Is looking at your blood sugar and deciding not to do something, a decision? Is deciding whether to eat half a bag of fruit snacks or the whole bag of fruit snacks, a decision? Is thinking about when you should pre bolus for your meal, a decision? So you can see how all these little micro decisions could really add up during the day. But 180 is still a lot. And I've never felt like I've done 180 decisions in one day, but I've never really counted.

My friend Cynthia was actually curious about this number and decided to look into it. And I'm going to leave a link in the show notes to her blog post about this.

So when you see this number posted, it's usually citing this 2014 blog post from Stanford. And Stanford seems like a pretty legit source, right? But the blog post isn't even about decision-making. It's about maintaining blood sugar levels overnight. The author makes this claim about 180 decisions a day without any citation or reference as to where they got this number from. That's right, it's totally made up, right there in the article. A blog post about overnight blood sugars with a made up number about the number of decisions a diabetic makes in a day. So we're all out here, sharing this made up number because no one bothered to fact check it. And everyone from influencers on Instagram to the nonprofit Diabetes UK to the magazine Good Housekeeping, keeps sharing this fake number, reinforcing this fake fact as truth, so it spreads even more.

Even if you've never looked up that Stanford blog post, we can think critically about this number. As Cynthia breaks this down, let's say you sleep eight hours a night, which to be fair, many of us with diabetes don't always get a full eight hours of sleep. But let's say we do this one night. During those 16 other hours where we're awake, that would mean we'd be making a health-related decision every five minutes. All day. Every day.

And yes. If you wear a CGM, you're probably getting a new blood sugar reading every five minutes. But if you're anything like me, you're not looking at your blood sugar every five minutes when that updates and then making a health related decision about it. If my blood sugar's in range and my phone doesn't beep or I'm not going to eat or work out, I really don't have much of a reason to look at it. So 180 decisions a day seems pretty unrealistic. And when I do look at my blood sugar, like before I eat, I'm usually not making 20 different decisions right then and there. It's probably just how much insulin am I going to take and when should I take it.

So even though this number is fake and, when you think about it, pretty unrealistic, why is it still so prolific? Well, Cynthia has an idea about this and I agree. We all know how hard it is to live with diabetes, but it's not an easy thing to convey to people who don't have diabetes. How do we make someone understand the sheer amount of work that goes into staying alive? The daily management of counting carbs, bolusing, pre bolusing, post bolusing. Deciding what you should do if you're going to go for a walk or work out. Knowing how much you should bolus ahead of time for pizza, so you don't go low while you're eating it. And that doesn't even include all the work it takes to be able to manage it, like scheduling doctor's appointments, picking up prescriptions, fighting with insurance to cover the prescription your doctor just wrote for you, trying to find coupons or navigate patient assistance programs to pay for those prescriptions. And all of those things add up and make diabetes really hard. And the only way to really convey that in a way that's understandable to someone else is a number. The problem is that the number we've been telling people just isn't true.

So I'm torn, because I want people to understand the burden of diabetes, but I don't want to go around sharing a fake number to do that. And you probably shouldn't either, since it's wrong and all. But I do think this is a good wake up call for all the kinds of fake things that get posted all the time on social media and Stanford blogposts, apparently. We're all aware of how much fake information is shared online now, and it makes sense that that would spill over into the diabetes world too. Whenever you see a diabetes fact, whether that's what to eat. What device to wear, or even where to give your money, take a moment and think about it. We're so critical when we see someone say that cinnamon is the cure. But why aren't we as critical when it comes to other facts too? Just because someone has diabetes and some followers, it doesn't mean they're trustworthy or have checked the information that they're sharing. Take a moment to think about what you're seeing, and figure out if it's true or not, before you share it. Thanks.