There’s a number that has been floating around the Diabetes Online Community (DOC) for a while now, mostly on Instagram. It says that people with type 1 diabetes make 180 extra decisions a day related to their diabetes. Wow, that seems like a lot! No wonder I’m so tired all the time.
The first time I saw this claim I was kind of surprised by the number (it seemed really big), but didn’t think too deeply about it. Every few months, this number would come around for another cycle of sharing and commiserating. And every time it would bother me more and more.
This last time, I decided to finally look into where this claim came from and, as it turns out, this claim doesn’t seem to have a basis in any research. Best I can tell, it originated in a 2014 blog post/press release from Stanford for a study that was about maintaining steady blood glucose levels overnight. The blog post, which was written by a staff science writer, makes this claim at the beginning without any citation or reference. People see the study cited and assume that this is where the number came from, but it’s not. When you actually look up the study, the word “decisions” isn’t even in the article. The number 180 comes up once, but only regarding the maximum number of minutes that the automated insulin pump delivery system should be suspended per night.
So why do people trust this claim? And why does it seem to be everywhere? If you Google “diabetes 180 decisions a day” almost 8 million results come up, many from very mainstream diabetes institutions. First of all, it’s a number, which conveys scientific certainty and research. People are likely to trust numbers because they believe that they are objective and represent some kind of fact or reality. Second, this claim’s source is Stanford Medicine, which is a reputable organization that people are familiar with. Most people (or literally anyone else, it seems) are not going to check the source to see if it’s accurate or not. We trust the article from Stanford Medicine because we don’t really have a good reason not to. And this is behavior of not just “regular” people on Instagram, but also other researchers, who should actually know better.
Moreover, and more importantly I think, the number doesn’t make any sense. Let’s say that you sleep 8 hours a night and are awake for 16 hours a day, which is 960 minutes. If you were making 180 diabetes decisions a day, you would need to be making a health-related decision every 5 minutes you were awake, all day every day. If you have a CGM, getting a blood sugar reading every 5 minutes, this would mean that you looked at every single one of those readings as they came in and made some kind of decision. No one is doing that. Humans are not great at estimating the frequency of events like this, so 180 seems right, even if it isn’t. Now, if you’re on an automated insulin pump system (like with Tandem t:slim x2 or Omnipod 5), that pump is making a decision every 5 minutes – but you are not.
And if we assume that you are not sleeping through the night, since diabetes occasionally makes that difficult, you’d still be making a diabetes decision every 8 minutes, all day and all night, if you were trying to get to 180.
There’s no way this claim can be true – and if you think you are actually making that many diabetes-related decisions in one day, please talk to a certified diabetes educator so that they can help relieve some of that burden because that is not normal or ok.
So why do people keep sharing it? I think the main reason is that it is really hard to explain to non-diabetics the mental burden of this disease. We do have to make a lot of extra decisions every day to keep ourselves alive and healthy. It is at times overwhelming. It is challenging and hard to predict. It is constantly in the back of your mind. I feel lucky when I can forget about it entirely for a couple hours. And we want other people to understand the weight of this burden. So when we find what we think is a reputable, research-based claim about how objectively difficult this is, and we share it. Because it feels true. Even when it actually isn’t.
Cynthia D'Angelo 