When I was in high school, the phrase du jour was, “That’s so random.” For example:
“OMG, did you see the dress she was wearing?”
“Yeah, that was so random!”
“Hmm, I want ice cream.”
“That’s so random.”
And so on. As you may notice, the use of the word “random” here has little to do with actual randomness, by which I mean having no underlying design and selected from an arbitrary statistical distribution. Really what all the teenagers around me meant was something akin to, “That’s so strange.” (As an aside, the current version of this phrase seems to be, “That’s so awkward.”)
This abuse of the concept of randomness bothered me in high school, and I bring it up now because I find that I still hear “random” misused often, although not by teenagers anymore.
We as diabetics misuse “random” frequently, and I think it is to our detriment. For example:
“Ugh, I ate the same breakfast for the last two days in a row. Yesterday, I went low. Today, I went high. It’s so random!”
“This insulin is like water– I keep bolusing, and nothing is changing. It’s so random sometimes.”
Raise your hand if you’ve said something like that. Yeah, that’s what I thought.
Diabetes is hard. It is unpredictable, and it often seems uncontrollable. But we do ourselves a disservice by calling this unpredictability and variability randomness. Random implies that there is no rhyme or reason, no governing principle behind the changes in blood sugar that we observe. In reality, we often don’t understand or can’t see the physiological inputs, but they _are_ there. Perhaps you have different levels of hormones circulating this morning. Perhaps the tissue around your infusion set is more resistant today. Perhaps the extra mile you walked home yesterday afternoon is having a lasting effect on your metabolism. Perhaps your body is fighting some minor infection you haven’t even noticed. And on and on.
It’s not random; the source of variation is just outside of the parameters we are able to measure. My body in many ways is a black box to me: I put insulin and food and exercise in, and blood glucose values go out. But that black box is not a random-number generator. There is rhyme and reason and cause and effect– it’s all just hidden from me.
So when we say, “That’s so random,” really what we mean is, “I don’t understand what happened to result in that particular blood glucose value.”
What’s wrong with saying diabetes is random, even if it’s technically not? It changes how we think about ourselves and our own control, and perhaps more importantly, it changes how other people think about us and our own control. If diabetes is truly random, an artificial pancreas will never work; a computer is always just going to be reactive if there is no method to this diabetes madness. If diabetes is truly random, why waste my time and effort managing it in a methodical manner? Better to just guess and roll my eyes when I’m wrong.
But diabetes is not truly random. It is unpredictable, and we can’t see all the variables, but overtime we will gain insight into more and more of the variables. We gained insight and control over variables with home blood glucose meters, with CGMs, with faster insulins, with insulin pumps. Technology will continue to progress, and we will get further and further in our quest to understand the system that generates blood glucose values.
Until then, let’s not fool ourselves or others into thinking diabetes is random. Random is scary and uncontrollable. Random is not FDA-approvable. Let’s call it what it is– not, “It’s random,” but, “It’s unpredictable.” “I didn’t see it coming.” “I don’t know what changed inside of me, so I don’t know why it was different today than yesterday.” “It’s variable.”
But it’s not random.