The Tyranny of Numbers

We live in a quantified world.  Almost everything can be reduced to numbers.  But should it?

This morning I heard a show on NPR in which a sleep expert was talking about how a number of her patients were people who used “sleep quality” devices (a lot of smartwatches and similar things) to “score” their sleep.

These people became so obsessed with their sleep scores that they couldn’t sleep.  Literally.

I’ve seen the same thing recently in diabetes forums.  We get so obsessed with keeping our blood glucose value near 100 mg/dl that we forget why we do it.  Or we obsess over our A1c values.

These numbers obsess us because they’re more and more easily available.  Right now I’m wearing a device on my wrist that tells me what my blood glucose is.  It’s wonderful.  But it can also be terrible.

It’s terrible when the number becomes the goal, rather than having a healthy and enjoyable life.

Some background on reasons that I might think this way:

In 1971, hen I was 13, my parents noticed that I was always thirsty.  They noticed this especially when we were on a fishing trip and I drank all the water we had on the boat and then started drinking lake water.

We got back and they took me to our HMO, where a glucose tolerance test showed that I was, in fact, diabetic.  Within a few hours of the results, I had been given start-up instructions and shown how to draw up insulin in a syringe and inject it.  And I was sent back to school.

I was given a test kit that looked like this:

I was to take this into the bathroom a few times each day, drop (if I recall correctly) three drops of urine and three drops of water into a glass test tube, drop in a reagent tablet, and wait 60 seconds (if I was lucky) or 120 (?) if I wasn’t.  If the highly exothermic (hot!) reaction turned the liquid in the tube blue, I had no sugar in my urine.  The more sugar I spilled, the closer to yellow/brown would the result be.  If it turned green, I had to wait to 2 minutes for the result.

The goal–I was told–was to show a dark green, which you can see next to the blue above.  This represented “trace” sugar in the urine.  Seeing pure blue was bad, because it could mean that your blood glucose was below normal, which can cause immediate problems (like passing out).  Anything above trace was bad, because sugar in the urine can cause, inter alia, kidney problems, and was indicative of bigger problems that could lead to blindness, stroke, etc.

The test kit was eventually replaced by new technology, like Lilly’s Testape, which you could carry in a plastic dispenser in your pocket.  It wasn’t terribly accurate (less so than the test kit) but it was convenient.  Just tear off a bit, wet it, and compare it to the chart on the dispenser.

This was followed by various kinds of plastic strips that you could dip in your urine (I recall Diastix and Ketodiastix).  I used them, but didn’t especially care for them.

By the time I started high school in 1974 (high school began in 10th grade in those days), I had pretty much stopped testing.  I took my dose of insulin, and if I felt shaky, which indicated low blood glucose, I took some sugar (I used to keep packets of sugar cubes wrapped in foil in my pocket.

I didn’t start testing anything again until the early 1990s, after I had become a father.  What I did in between, in no particular order:

Acted in plays

Learned to swear

Dated

Rode my bike for transportation

Got a job (several, in fact)

Graduated high school

Went to college

At lots of chocolate

Went to graduate school

Read that the average post-diagnosis lifespan of a diabetic was 25 years

Rambled around Europe by car and England by train and foot

Learned to enjoy beer and wine

Discovered butter

Went camping

Protested the reintroduction of the military draft

Discovered sex

Smoked marijuana

Went to lots of weddings, including (in 1986) mine

Went to concerts (including a fantastic Grateful Dead show)

Moved to Chicago, and then to upstate New York

Got married

Learned to play guitar and formed a band

Dissolved a band

 

Lots more, too, but those are the highlights.  My point is that between 1975+/- and 1991+/-, I had no idea of what was happening in my urine or blood as regards sugar.  And I didn’t especially care, so long as it didn’t get in my way.

After we had our first kid, T insisted that I ought to test, and she was probably right.  I went through a series of meters that required drawing a droplet of blood.  The first few were pretty analog:  drop the blood on the test strip, wipe off, wait, and read the number.

But the digital revolution was upon us, and increasingly the results came as numbers.  100+/- was ideal.  70 was too low (or 80, or 90, depending on your endocrinologist).  200 was too high, unless it was within one hour (or two, or three) after a meal.  A clinical A1c below 7 was ideal, unless it was below 6, which indicated problems.

It was confusing.

Now, continuous glucose monitors (CGMs) make getting the numbers easy.  I can glance at my wrist and know what’s happening in my blood (getting the data to my wrist is a little bit more complicated, but still).  But is my life any better?

Well, so long as I understand that my numbers are my numbers, yeah.  The problem with numbers is that they tempt us to comparisons with other people, to standards.  Whether it’s sleep or diabetes, numbers tyrannize us if we let them.  We turn those numbers into our goal, rather than understanding that our health is associated with the numbers.  They’re just a measure.

I love being able to tell where my blood glucose is with a flip of my wrist.  But that’s my BG, not yours.  Numbers, like computers, make wonderful servants but terrible masters.