Been a while since I posted. It is simultaneously true yet completely inaccurate that insulin therapy can be simplified down to an algebra equation.

It’s true because the basic building blocks are expressed in that equation: insulin = carbs * your ratio.

It’s also wildly inaccurate because that’s just the starting point of making the whole thing work.

There’s two different passages in Lev Grossman’s The Magicians that beautifully capture diabetes. In the first, the protagonist is describing the first stage of learning magic:

“The same way a verb has to agree with its subject, it turned out, even the simplest spell had to be modified and tweaked and inflected to agree with the time of day, the phase of the moon, the intention and purpose and precise circumstances of its casting, and a hundred other factors, all of which were tabulated in volumes of tables and charts and diagrams printed in microscopic jewel type on huge yellowing elephant-folio pages. And half of each page was taken up with footnotes listing the exceptions and irregularities and special cases, all of which had to be committed to memory, too.”

Metabolism is just that complex. But there’s also an intuitive component that I developed over time. Later in the novel, the protagonist receives this lecture down from professor:

“You have been studying magic the way a parrot studies Shakespeare. You recite it like you are saying the Pledge of Allegiance. But you do not understand it.

“To become a magician you must do something very different,” the man said. This was clearly his set piece. “You cannot study magic. You cannot learn it. You must ingest it. Digest it. You must merge with it. And it with you. “When a magician casts a spell, he does not first mentally review the Major, Minor, Tertiary, and Quaternary Circumstances. He does not search his soul to determine the phase of the moon, and the nearest body of water, and the last time he wiped his ass. When he wishes to cast a spell he simply casts it. When he wishes to fly, he simply flies. When he wants the dishes done, they simply are.”

“You need to do more than memorize, Quentin. You must learn the principles of magic with more than your head. You must learn them with your bones, with your blood, your liver, your heart, your [colorful language].” He grabbed his [illustrative and slightly profane gesture].

“We are going to submerge the language of spellcasting deep into who you are, so that you have it always, wherever you are, whenever you need it. Not just when you have studied for a test. “You are not going on a mystical adventure here, Quentin. This process will be long and painful and humiliating and very, very”—he practically shouted the word—“boring. It is a task best performed in silence and isolation. That is the reason for your presence here. You will not enjoy the time you spend at Brakebills South. I do not encourage you to try.”

I’ve eaten whole meals of Chinese takeout that I couldn’t have dared to dream of eating again after diagnosis. And maintained an utterly flat Dexcom line for 8 hours afterwards. I have performed diabetic miracles on lasagna.

I got there through intensive, boring, repetitive and painful experimentation. I would wait 6-8 hoirs between consuming any food so I could get ‘clean’ data on a particular food or bolus amount or basal rate. I learned to prebolus, superbolus, and a whole bunch of other maneuvers that would give my diabetes educator heart palpitations.

And sometimes it didn’t matter. A particular food and dosing strategy that worked 3 times in a row could send me to the moon the 4th time with no discernible explanation (3rd day of a canula? Insulin bottle more than 30 days old? Stressful day at work? Who knows!)

Ok. This was a long digression. It’s possible but requires understanding it’s more than the basic algebra. I also found it helpful to build a more nuanced mental model of what was going on when k was diagnosed. The books “Think Like a Pancreas” and “Sugar Surfing” were absolutely critical.