The Insight: Gaming With Diabetes

In the summer of 2012, Kyle Moody was diagnosed with Type 1 Diabetes Mellitus. This is the story of how gaming helped him to cope with his new condition.

By Kyle Moody

Every two hours I prick my finger, scrape the blood off with a test strip, and then record a number in a book. I compare the number to what’s come before and see how I’m working on the disease inside me. Once I’ve adjusted the number, I take a pen filled with fluid out of my refrigerator, place a needle on its tap, and inject myself. I write down how many units of fluid I put inside my body, and set my alarm to repeat this process again in two hours.

I’m not a character in a video game monitoring my health. This isn’t Far Cry 2 or Metal Gear Solid 3. All of these games involve injecting yourself to continue playing, at least as a way to stave off the in-game poisons that attack you without any choice. Gaming usually allows its characters to ingest a “power up,” at which point they return to blowing up LibertyCity or restoring the MushroomKingdom from the tyranny of a fire-breathing lizard.

There are no mushrooms in sight for me. Instead, this is my daily routine. I’m not Leon Kennedy, Bayonetta, or Naked Snake. I’m a diabetic.

I found out about my diabetes when I lost 20 pounds in the span of two months. Much as I wish it was diet and exercise that was taking away the weight, a problem called diabetic ketoacidosis did the job for me. When my pancreas stopped producing insulin to process sugar (glucose) as a source of energy, my fat became the fuel that powered me through my day. In fact, as my blood sugar kept climbing and my body consumed my fat reserves, I became unable to keep food in my system. Finally, I had to go to the hospital a week before my wedding, where the doctor told me that my blood sugar measured 621 mg/dl. A healthy person is supposed to have a blood sugar level of 70 to 130 mg/dl. I’ll never forget the urgent look in his eyes as he rushed an IV of insulin over and jabbed the needle into my arm.

When the doctors told me that I had diabetes, I sat in the hospital bed. Not blinking, not moving, barely breathing. I was a mute character in a world that I didn’t understand. Events occurred to me that changed me irrevocably, yet life went on. Even when they ran to inject my body with insulin and made me call my now-wife to tell her that I wouldn’t be able to come home until I no longer displayed symptoms of hypoglycemia, I didn’t know what was truly going on.

What I didn’t recognize at the time was that I was being presented with a new set of limits on myself. The worst thing about being a diabetic is learning to accept those limitations. It’s even worse if you’re a twenty-something who has been remarkably healthy your whole life.

Being diabetic taught me one thing: I’m not invincible. I never will be. No matter how many miles I travel while training for my first marathon, or ride across the state of Iowa on my bicycle during RAGBRAI (look it up!), I will never outrun this disease. Instead, I can only live with it and make changes where it counts.

According to the American Diabetes Association, in 2011 there were eighteen million Americans who were diagnosed as diabetic. Of that remarkable number, over 95% could be categorized as Type 2 diabetics. The rest fall into a category of Type 1 diabetes mellitus.

The difference between the two is relatively thin, but Type 2 diabetics are persons whose insulin production slows over time, and their bodies become resistant to insulin since they do not use insulin properly. Type 1 diabetics are different in that an autoimmune disorder causes their pancreas to break down, meaning that their bodies can no longer produce the insulin needed to use and store blood glucose. But whatever the difference between the two groups is, there is no such thing as beating diabetes. Instead, there is only the fact that one must accept that they have a chronic disease for the rest of their lives.

Serious complications that can arise from diabetes include heart disease, kidney failure, eye problems and blindness, and the possibility of a stroke. Even greater damage can be caused to the nerves, meaning that pain sensation in hands and feet could degrade over time. While it might seem like that’s exactly how a video game’s “invincibility” works, by taking away pain receptors a person is unable to feel the sensations equated with easily treatable causes. If a person doesn’t check their feet regularly and they lose sensation to their lower parts…well, statistically it’s shown that people with diabetes account for 60 percent of nontraumatic lower-limb amputations in the United States.

Since I am an avid gamer, I decided to see if I could find a game that would help me in dealing with Type 1 diabetes. The results were…interesting, to say the least.

The Nobel Prize website had a game titled Diabetic Dog that allowed users to take care of a playful puppy with Type 1 diabetes. I named my affected digital pup after my own Boston Terrier (“Orson Welles” is his name, for the record) and away we went! Using a simple “point-and-click” control, I was able to feed my dog and provide his necessary insulin shots at the touch of a button. The purpose of the game was to help users monitor blood sugar within dogs while also learning what foods affected their blood sugar levels. While cute, it didn’t exactly teach me what I didn’t already know, but it did come the closest to replicating my experience with diabetes. Even with a segment where my virtual Orson went behind a bush and marked his territory. Good virtual puppy!

Another game in the United Kingdom – called My Life, although it was less “so-called” than expected – gave me the opportunity to recreate my experience by way of Nadeem. This spritely Englishman jumped around and was encouraged to eat all of the healthy foods in a two-dimensional Mario platforming game, at which point a description of those foods came up. Surprisingly, ice cream and fries affected his health, along with falls from great heights.

Many other games followed the similar patterns of My Life. Eating healthy, exercising regularly, and avoiding sugary foods was prominent in many of these games. Yet I couldn’t help but feel that the resource management portion of the game was missing out. Instead, the closest I got to the sensation of putting a needle into my body to assist my decaying pancreas was when I dragged a syringe into my poor virtual puppy. Even at their most engaging, games about diabetes and diabetics have a ways to go when it comes to addressing more intermediate concerns of their subjects.

Don’t think that this my pity party. If diabetics make the necessary changes to their lifestyle, they can live a long and healthy life. Not to be egotistic, but this means I’m going to be okay because I’m pretty damn healthy. I already train for marathons with my wife and live by the food pyramid in my diet. In fact, the biggest surprise for me was being diagnosed as a diabetic while I was in the best shape of my life.

However, this does require a shift, and it means that now I must accept my condition by making changes to my habits. The gaming connection comes here, in that I must disconnect. If games are about immersion and losing oneself inside a simulated world, then I can no longer play games like I once did because I must take control of my disease. Maintaining control of this condition requires those habits of testing blood sugars and taking regular injections. This stops full immersion into any gaming experience because it can be dangerous to ignore diabetic side effects.

When I was diagnosed, I was playing through Half-Life again on my PlayStation 2. Half-Life seems quaint now compared to the visual wonders of Halo and the Call of Duty titles, but when it was originally released on PC in 1998 it changed how players experienced first-person shooters. Instead of playing through singular levels that have no connection to each other, the idiosyncratic developers at Valve gave players a large, interconnected world of a military research facility invaded by aliens. Moreover, it provided a new narrative delivery mechanism by embedding its story in the player actions. As protagonist Gordon Freeman, the user causes the alien invasion by making a science experiment go awry, then watching as the story unfolds while they’re controlling the action.

The best part of playing Half-Life is seeing how it requires the player to pay attention to the gameplay as the story delivery device. There are no cut scenes that take place outside of play, but rather scripted events that occur when Gordon runs into a room or pushes a button. If the player’s don’t immerse themselves in the world, then they will miss the story and a level of meaning for their actions.

Yet this immersion was much harder to reconcile now. Every two hours the alarm would go off, and I’m out of Black Mesa to prick, test, record and inject myself.

But there are similarities to gaming amidst the habits of Type 1 diabetics. Diabetics begin to look for ideal target ranges of blood sugar levels. Monitoring blood sugars, testing blood sugars at a regular basis, and counting carbohydrates to calculate blood sugars is honestly no different than a game of Starcraft. The goal is the same in both cases: Equilibrium, balance, and the sense of winning. IT’S ALL ABOUT STRATEGY AND PLANNING.

Only you can’t win with diabetes. You can only control it, or try to control it. Like my virtual denizens of “Moodyville” in SimCity 2000, all I can do is hope that my commands will equate to a stronger control. But sometimes I feel like no matter what I do, there’s always going to be an alien thing that shows up (such an alien ship arrived and destroyed Moodyville during a bathroom break in November 1997. It’s a day that we’ll never forget!). Habits change, the disease changes, and the game changes. Understanding how each one operates helps, but there is no true victory. Most games aim for the short-term stimulus with their goals. Push this button, get this key, make this trade, kill this dude, run down that corridor, and pwn that n00b. All easily compiled and put together.

Controlling diabetes is different, but it’s also haunting when you consider the similarities that exist. I monitor my blood sugar at the beginning of the day, decide what type of food and how much I’m going to eat based on the number of servings I get, the amount of carbohydrates in each serving, and how this relates to a ratio of carbohydrates per unit of insulin I’m allowed at different times per day. Remind anyone of resource management in Civilization, or assigning points in role-playing games like Fallout?

It’s no different, except I don’t win. I never do. I test, record, inject, sleep, reboot, and do it again every day.

Kyle Moody is the groundbreaking educator who teaches the University of Iowa’s very first course in videogame journalism. 

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