Our lives and the decisions we make are influenced by the constraints placed on us, whether it be by our environment, our beliefs, or our bodies. To understand what this means in the context of type 2 diabetes, I faced the challenge of taking my already busy life and layering on the constraints faced by a 75 year old man with type 2 diabetes and multiple comorbidities.
To be honest, I failed my simulation less than ten minutes after waking up on the first day to start it. My patient profile detailed that my persona rarely leaves his house (let alone exercises) and I woke up that morning to run six miles. As someone who needs to run or workout every day, I refused upfront to stop exercising for the simulation. As a lifelong runner, I can confidently say that little else makes me crankier than going for longer than two days without exercise. I told the other fellows that it was in their best interest to allow me this exemption and deluded myself into thinking that this was going to make my simulation manageable.
Having received no instructions in advance of the simulation other than that I should limit my carb intake to 75 grams per meal, I was forced to determine for myself what my dietary restrictions were. Following the comorbidity-based dietary restrictions outlined in a previous post, I ended up cutting a thousand calories out of my diet and unsurprisingly was not a happy camper. I made it through three long days before pulling the plug and significantly revising my simulation.
To attach numbers to my emotions, across those three days, my running pace on a six mile loop rose from 7:13 min/mile to 7:42 in the first two days, before jumping to 8:57 on day three. This third day started off poorly and only got worse as I sat through meeting after meeting, failing to process what was being said and increasingly distracted by my struggles. Revising my approach on day four helped to improve some of these pains, though unfortunately the shock to my system put me at an increased risk for getting sick—which is exactly what happened as myself and two other fellows came down with a cold immediately after the simulation ended.
Taking a look at my life going into the simulation and the patient profile that I was given, my struggles makes sense – I went into this being among the least able to change my lifestyle and was given the persona that required the most dramatic changes. This is the same predicament that is endemic in type 2 diabetes: those who are the least able to change are often the ones asked to change the most.
Another reality that our simulation unintentionally mimicked was the lack of support that the type 2 diabetes community provides itself as compared to the type one community. At the start of the simulation, each of us had only worked together for two weeks, so we didn’t know each other that well. Each of us also had a very different patient profile, so our individual challenges were vastly different. For these two reasons, we shared little to no information with one another about what was working for us during our simulation, aside from mutual complaints about our hunger. By pure accident, we wandered into a space in which each of us was made to feel alone during our diabetes simulation, in spite of doing it all together.
Coming out of this simulation, we’ve uncovered two puzzling design questions: 1) how do you develop a product or service that provides a simple incentive for users to change their lifestyle for the long term? and 2) how do you design for a community that is heterogeneous and hesitant to self-identify or organize? I’m afraid we don’t yet have the answer to either of these, but welcome input as we ourselves debate these topics.