Thursday, August 1, 2013

How Type 1 Diabetes is like Mission Control

Last week I showed you some views behind the scenes at NASA, I hope you enjoyed those because it may be awhile until you have more interesting photos to feast on. We are now moving into our “Boot Camp” phase where we learn all of the common content between subsystems on board the International Space Station. It’s a little more intense than tours that take all afternoon!

As I was intently listening to the lectures this week, a few key phrases, thoughts and ideals were repeated over and over and over. Of course, we are learning how these relate to our jobs in mission control, but outside of work I realized a lot of these nuggets of knowledge rang true for those of us whose lives have been affected by Type 1 Diabetes. I’m sure you must think I’m a bit off my rocker for trying to draw comparisons between Mission Control and a life with Type 1 Diabetes, but it’s not as different as it seems.

For instance, the International Space Station is arguably the most complex machine ever built by man, coming in with a cost around $150 billion. But Type 1 Diabetes is one of the most complex diseases to understand, with no concrete reasons for diagnosis and no ultimate “cure” (yet). The disease is estimated to cost approximately $245 billion per year to diagnose, treat and maintain. And both systems require combinations of micro and macro corrections, check-ins, and software updates to maintain successfully.

Situation Awareness

Today I had a three hour lesson on the levels and categories of situational awareness. It was actually helpful to break up this usually vague topic into more specific levels and to understand how critical SA was on each of those levels. The first level is “perception”  - this is where we take in the information we are seeing (monitoring, cue detection, current states, etc.). As a Type 1 Diabetic I practice this form of SA almost constantly. I am constantly checking my CGM, taking a blood reading, reading nutritional facts for the foods I am about to consume, responding to low blood sugar feelings, etc. This type of SA is second nature for most of us, most of the time.

The second level of SA is “Comprehension”. This level raises the bar and requires the person to synthesize disjointed information using pattern recognition, interpretation, evaluation, training, and experience. I think this is a skill that takes practice. If you have only been diagnosed 2 weeks, you will most likely struggle to put together all of the events that lead to a low blood sugar (exercise from 2 hours ago, combined with a large lunch requiring SWAG and overbolusing, not watching trending CGM data, etc). But, after a while, maybe even a few years, this becomes easier (although never perfect, something I will talk about later). However, the mental model must be updated each time a new piece of equipment or capability becomes available.

The third level of SA is definitely the most difficult, it is the “Projection” level. This is the ability to extrapolate the information available now to predict what will happen in the future. For instance, if I had a low carb dinner and see a two hour flat-line trend at 100 before bed, I can combine that with my knowledge of tightly controlled basal rates overnight to predict that I will maintain an even blood sugar throughout the night and wake up with a blood sugar within my specified range. This is a fairly straight forward example, but there are many more complex equations that we use to predict where our blood sugar will be far in advance. Sometimes we are right and sometimes we are wrong, but hopefully that experience increases our situational awareness in a future situation.

Plan / Next Worse Failure

Another key concept of mission control is to plan for the “Next Worse Failure.” If this happens, what might be next? In the Diabetes world as in the mission control world this concept often has to do with redundancy. If I lose this power channel, what will be the consequence of losing the next power channel? And in Diabetes words, If my pump transitions into an unrecoverable failure, what is my alternate means of delivering insulin? Or what is my low blood sugar contingency plan? Or how will I check my blood sugar if I’m out of test strips? Etc? As a general rule, I always carry backup insulin via insulin pen, try to keep extra test strips in my purse and my car, and I always have a low blood sugar plan (glucose tabs or other goodies).

Conflict Management

What do we do when our equipment doesn’t agree? Or when we don’t agree with our endo’s recommendations? Or when your pump reported delivering 5.0 units, but your blood sugar is rising up to the 300s? We troubleshoot conflict in the Diabetes world every day. We constantly correct the world’s perceptions about Type 1 and Type 2 and others. Along with the physical conflict manifestations, we also deal with the intellectual and emotional conflicts nested within the Diabetes diagnosis. It’s a constant battle for the mission control team, and for the team controlling this disease.

“To always be aware that suddenly and unexpectedly we may find ourselves in a role where our performance has ultimate consequences.”

That line is a quote from the “Foundations of Mission Operations”. As flight controllers in training our job requires the skills described in the document, and if we are good, they will always be on our minds.  

As Diabetics we could draw up our own mantra, describing the skills required to live day-to-day with this disease. And, as much as we don’t like to think about it or dwell on it, the mission control quote applies to us too. Diabetes can place us (or those who take care of us) suddenly and unexpectedly in a role where our (or their) performance has ultimate consequences. I think this is ultimately what keeps us ticking each day. This notion provides the motivation to shove needles under our skin or draw blood or prick fingers 6 or 7 times a day (or more).

As mission controllers we know space is an unforgiving place, and as Diabetics we know Diabetes doesn’t take any days off.

Did you copy that?