2.3: Chapter 3- Managing Diabetes in a Data-Driven World- What Risk Thinkers Need to Know

A Primer for CIS 95C: Risk Assessment and Mitigation – A Practicum

Introduction: When Patients Become Project Managers

In most healthcare settings, patients wait for instructions. But in the world of diabetes, patients become the project managers of their own lives—coordinating data, technology, behavior, and decision-making, day after day.

Every person with diabetes must manage risk in real time—often with incomplete information, under stress, and with consequences that range from mild discomfort to medical emergency. Unlike other chronic diseases, diabetes requires moment-to-moment vigilance and strategic control over variables like food, insulin, activity, and stress.

If you're designing a digital solution for this population—like the SMDC dashboard—you need more than good tech. You need risk awareness, systems thinking, and empathy. This article will help you understand:

• What diabetes is (medically and behaviorally)
• How it affects decision-making and daily life
• Why designing for this population requires structured, early-stage risk planning

The Endocrinology of Diabetes: What’s Actually Happening?

At its core, diabetes is a disorder of the endocrine system, which regulates hormones in the body. Specifically, diabetes involves insulin, a hormone produced by the pancreas that helps cells absorb glucose (sugar) from the bloodstream to use for energy.

In a healthy person

1. You eat food → glucose enters your bloodstream
2. The pancreas releases insulin → glucose moves into your cells
3. Blood sugar stabilizes

In a person with diabetes

• Either the body doesn’t produce insulin (Type 1),
• Or the body can’t use insulin effectively (Type 2),
• Resulting in high blood glucose levels that can damage organs, blood vessels, and nerves over time

The hormonal miscommunication affects every system in the body, from brain clarity to circulation to immune response. Poorly managed diabetes can lead to blindness, kidney failure, heart disease, amputations, and death.

Types of Diabetes: Two Roads, One Struggle

Type 1 Diabetes

• Autoimmune condition: the immune system attacks insulin-producing cells
• Usually diagnosed in children, teens, or young adults
• Requires lifelong insulin therapy via injection or pump
• Involves constant monitoring and adjustment
• Life-threatening if insulin is missed

Think of Type 1 as a full-time job where one mistake can lead to hospitalization.

Type 2 Diabetes

• Metabolic condition: the body becomes resistant to insulin or doesn’t produce enough
• Most common in adults (but rising in teens)
• Can sometimes be managed through diet, exercise, oral medications—or may require insulin
• Progresses over time, often silently

Type 2 is like managing an invisible machine: when it malfunctions, the damage may be hidden—until it’s not.

Despite differences, both types require data, decisions, and discipline.

The Daily Reality: What Patients Actually Do

To manage diabetes well, a patient may need to make 100–200 micro-decisions per day. These decisions involve balancing glucose, insulin, activity, and food—under emotional, environmental, and financial stress.

Here are just some of the tasks:

Diabetes Management Tasks

Task	Purpose
Check blood glucose (3–10x/day)	Know if blood sugar is too high or low
Count carbs in meals	Estimate insulin or anticipate spikes
Adjust insulin dosage	Prevent dangerous highs/lows
Monitor stress, sleep, hormones	These all affect blood sugar
Sync devices and apps	Pull data from CGMs, fitness trackers, meal logs
Respond to alerts or crashes	Avoid fainting, seizures, or ER visits
Communicate with doctors	Share data, ask for prescription changes
Manage supplies	Order strips, syringes, pump parts, backups

And all of this happens on top of work, school, relationships, and daily life.

The Data Problem

Managing diabetes is impossible without data. But in most cases, that data is:

• Fragmented – spread across apps, devices, and handwritten notes
• Delayed – only reviewed during infrequent clinical visits
• Uninterpreted – raw numbers with little guidance
• Emotionally charged – tied to feelings of failure, shame, or anxiety

For example, a person may receive a glucose alert at 3 a.m.—but not know why it happened, what to do, or how to prevent it next time.

Without integrated tools, patients are forced to act as human dashboards, mentally calculating their own risk without system support.

The Social Dimension: Not Just Science—Society

Effective diabetes management is shaped not only by biology and data—but also by context:

• Food and culture – Meals are emotional, spiritual, social
• Technology access – Many cannot afford the best devices or Wi-Fi needed for syncing
• Housing and privacy – Some patients can’t refrigerate insulin or inject safely
• Language barriers – Instructions may be in English only, or full of jargon
• Systemic inequity – Black, Indigenous, and Latino communities experience higher rates of complications due to poverty, stress, and healthcare access gaps

Even the most well-designed app can fail if it ignores these realities.

What Is SMDC Trying to Build?

In this practicum, you’ll be working inside a simulation of SMDC (Self-Managed Diabetic Care Inc.), a startup building:

• A dashboard that integrates health data from multiple devices
• Personalized visualizations and alerts
• A shared platform for patients and clinicians to track and improve care
• A mission-driven company focused on trust, equity, and patient empowerment

SMDC is visionary—but it’s a startup. That means:

• Limited budget
• Tight timelines
• Regulatory uncertainty
• Cross-functional miscommunication risks
• High stakes for user safety

You are now joining the team as a risk analyst.

Why Risk Management Starts Now

You can’t build a product for people with complex needs without understanding the risks involved. Some are obvious (data breach). Others are subtle (user confusion, delayed device data, unclear visuals, clinician distrust).

In this course, your job is to structure those risks clearly—before the team charges ahead.

You will begin with Milestone 1, where you’ll create a Risk Breakdown Structure (RBS) for the SMDC project. It’s a visual map that organizes different types of risks—technical, clinical, operational, financial—so the team knows what’s coming, where to focus, and what to do next.

Key Takeaways Before You Begin Milestone 1

• Diabetes is complex, and no two patients manage it the same way
• Data is essential—but fragmented, emotional, and overwhelming
• Risk shows up in both obvious and hidden places: delayed alerts, API errors, equity blind spots
• SMDC needs your help to structure, organize, and plan for risks before they’re overwhelmed by them
• Your job in Milestone 1 is to step into the role of risk leader: ask better questions, structure complexity, and help the team see clearly

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“Risk isn’t a surprise. It’s a structure. The sooner you see it, the more power you have to do something about it.”

Now, it’s your turn.

Turn the page. Your first Scenario Briefing is waiting.