"Houston, we have a problem."
You've probably heard that phrase in reference to one of NASA's most famous missions, Apollo 13. Later cemented in history with a Tom Hanks movie, the mission would have executed the 3rd moon landing, but an oxygen tank explosion forced the crew to return home in a minimum power configuration. The ground teams in mission control didn't have a backup plan potted for this specific contingency, but they had practiced the muscle memory of solving complicated problems together for months prior to the mission.
And while diabetes doesn't afford us weeks or months to practice in simulation runs or training events, I do think this culture of backup plans and adapting to new problems parallels the thought process of controlling complicated spacecraft in an unforgiving environment.
As a person with diabetes, I have equipment, snacks, and charging cables stored in several frequented locations. First, there is the big diabetes shelf in my closet full of boxes of supplies, several old glucose monitors, a glucagon kit, backup pen needles, syringes, and test strips. There are probably a few old pieces of pumps or CGMs because occasionally I like dissecting those for engineering purposes! The fridge has a drawer full of insulin vials as well as backup insulin pens with both long and short-acting versions. There are backup site change components in my work backpack, car and desk. Charging cables are everywhere these days -- by my bed, in the bathroom, in the kitchen, at my desk, in my car, and basically everywhere I could possibly be for more than 10 minutes.
Similarly, but perhaps with a bit more scrutiny, we have lots of backup equipment onboard the International Space Station just in case something breaks. We actually have entire flight control disciplines dedicated to tracking all of the equipment and locations onboard. After all, the station is as big volumetrically as a 5 bedroom house and its occupants switch out every 6 months or so. Redundancy is key when it comes to keeping humans alive in space!
Beyond just failed equipment switchouts both diabetes and human spaceflight require their "controllers" to consider an entire set of backup sequences for a particular event. For example, in space one of the most critical phases of flight is rendezvous and docking -- where two spacecraft come close to each other, traveling very fast (like 17,500mph!), and then, gracefully, connect. What happens if a thruster malfunctions or a navigation sensor fails or a computer restarts? Well, we have plans and procedures and automatic software to mitigate any unsafe situation. And then, after we execute those plans or procedures or software pieces we have a safe trajectory and a new plan to dock later or return to Earth. And these plans aren't just one-failure-deep, they often take into account multiple failures and seamlessly replace one carefully choreographed plan with another.
Life with diabetes may have less paperwork, but the backup plans are no less coordinated. A degrading pump or complete pump failure is often seamlessly replaced with a new insulin delivery regimen -- long-acting shot in the morning, short-acting shots throughout the day, and a longer-term plan to regain pump functionality. An unforeseen CGM transmitter detachment is replaced with a series of manual blood glucose readings. A scheme of offloading insulin and eating fast-acting carbs in preparation for a high-intensity workout is replaced with a new scheme of blood sugar corrections and water ingestion when the workout gets canceled (which happened to me just yesterday!).
One of the most (if not, the most) important aspects of human spaceflight is communication with that human. Spacecraft, including the ISS, have redundant antennas, multiple frequency bands, and various mediums to maintain some form of communication. And when all those fail (remember, backup plans multiple-failures-deep?), the crew has a default plan to keep themselves flying safely, with no ground interaction.
And while we have all these new connected diabetes devices that send data and track remaining test strips and sound alarms when we are out of range, the truth is we all have a baseline operating procedure to invoke when the communication goes down.
There is no way to conceive of every possible diabetes malfunction or anomaly beforehand, or address each instance with the exact same recipe for recovery. Instead, we are challenged, just like flight controllers, to adapt our experience, our problem-solving muscle memory to each new scenario diabetes throws our way!