Diabetes by design

As Diabetes awareness month comes to an end we wanted to share an amazing story of how one designer found a way to channel the ups and downs of her illness into a project that could change lives.

Alex Durussel-Baker found out she had been diagnosed with type 1 diabetes at a hospital in New York city. Nine hours before, while taxiing to the runway, her doctor called to say her blood glucose levels were through the roof and that she should get to a hospital immediately. After a nerve wracking long-haul flight, Alex finally reached a hospital where a nurse informed her that she was one step away from a diabetic coma and lucky to have been diagnosed in time.

This is not unusual for type 1 diabetes diagnoses — in fact one in four unknown sufferers will be in a critical state by the time they seek help. And for some that diagnosis comes too late. This is just one of many messages, myths and misconceptions that Alex is now trying to raise awareness of with her latest project — a series of beautifully designed posters, made with Sketch, that were shared online and displayed at a local exhibition.

What was the motivation behind the Diabetes by Design project?

With Diabetes by Design, I set myself the challenge of making a poster a day that encapsulated the obscure, funny and sometimes ridiculous sides of living with type 1 diabetes. I wanted to visualise living with a chronic illness in a way that was a little less clinical.

Initially my motivations were around building awareness of the symptoms of type 1 as well as dispelling it’s many misconceptions (yep, you can get it at any age, yes, I can eat that donut, no, I can’t live without insulin) but as the project grew I realised the bigger conversation was around the mental health aspect of living with a chronic illness.

As with any chronic condition, it’s often not the outward signs of the disease that affect our mental health, it’s the relentless management the condition requires. Indeed, the hardest thing about type 1 diabetes for me isn’t the needles or running to the pharmacy when I am out of supplies — it’s the invisible, relentless, daily grind of coaxing my diabetes to behave.

Did you know much about the condition before your diagnosis?

I didn’t know anything about type 1 diabetes at the time, I thought diabetes was something you got for eating too much sugar or when you were really old. I had no idea there were multiple forms of diabetes and that I had the auto-immune version that would mean I would need to inject insulin to stay alive from now on. I had lost over 12 kilos in three months and I’d been feeling a bit low on energy so went for a blood test thinking I had an iron deficiency or something.

For those that don’t know type 1 diabetes is a chronic autoimmune condition that occurs when the body’s own immune system attacks and destroys the insulin-producing beta cells in the pancreas. After the attack, the person is left with little or no ability to produce insulin, the hormone responsible for regulating blood glucose. High blood sugar over time can affect major organs in your body, including heart, blood vessels, nerves, eyes and kidneys.

People with type 1 must inject or pump insulin every day and carefully regulate their blood sugar or otherwise risk life-threatening complications.

Why did you decide to design the posters in Sketch?

I’ve been using it almost every day for five years now and it’s the tool I am the fastest in as a result. When I started off, I was producing a poster a day and couldn’t commit more than 30–40 minutes on each so speed was everything. I love the modularity of the Artboards and the use of Symbols. While I knew that when it came to printing the posters, Sketch might not be the first port of call, the ability to view all 80 posters on one Canvas at once as well as easily export in multiple screen sizes was very handy indeed.

I use Sketch for everything! From using artboards to map entire user journeys with multiple streams, to polished interfaces for digital prototypes in my client work, to designing physical exhibition spaces and graphic design posters in my own projects.

Tell us a bit about your work — what you do, the kinds of clients you have and how you use Sketch for those projects

I’ve been working in design for close to ten years now and call myself a product strategist, as my work today centres around helping companies find market fit when developing new products or services. My clients range from established companies with R&D units to startups looking to grow their reach. When I’m not prototyping new business models I am the host and producer of CreativeMornings/Edinburgh.

I use Sketch for everything! From using Artboards to map entire user journeys with multiple streams, to polished interfaces for digital prototypes in my client work. I even designed the physical exhibition space for the Diabetes by Design project in Sketch!

How was using Sketch for the Diabetes by Design project different to your normal experience of the app?

It really stretched my knowledge of the platform! Within the 80 posters there are a few collections, for those I used symbols a lot to get a consistent feel across. I loved going wild with gradients — something I don’t usually get to do in an accessibility focused UI design. Because everything is vector based in Sketch, it also allowed me to work freely without worrying about resolution issues.

Areas that were perhaps less simple in Sketch were when I was going for a textured grungy look. I’d paste in a layer made up of thousands of tiny shapes, any edits after that could cause some issues. But when it came to printing the posters for the exhibition and applying different sizes of bleed that’s when things got a little tricky.

Thanks to Sketch’s amazing community I found Peter Nowell’s article “Sketch for Print Design!” and instead of adapting pixels to the physical world, I flipped it and figured out that 1mm is approx 3.3 pixels — I went from there and hit my print deadline just in time!

Can you share some of your favourite posters from the project that highlight some of your experiences of living with type 1 diabetes?

A dram a day

This is not actual medical advice but if there is one thing diabetics need once in a while, it’s is a drink. As alcohol is technically a poison, your liver has to stop everything else it‘s doing to manage the booze it detects in your system. While it’s dealing with your poison of choice, it can’t simultaneously produce glucagon (the glucose produced by your liver) which in turn causes your Blood Glucose to drop — leading me to believe that, ”a G&T a day to keep the diabetes at bay,” could actually be warranted.

Symptoms: Mood change

This is a lesser known symptom and one that only made sense to me in retrospect. About three months before diagnosis I started to get really anxious about the smallest things, I would obsess over past conversations and I remember having really vivid dreams of people taking things from me, my job, my flat, my stuff etc.

It might have just been in my head but today I recognise the signs — if I am feeling anxious and my heart is beating fast it’s usually because my blood is hitting 15+. High blood sugar over a period of time starves your brain and as a result can affect your emotions and your judgement.

42 Factors that affect Blood Sugar

Living with diabetes is a numbers game. The magic blood glucose (BG) range to aim for is between 4 and 8mmol/L (similar to a non-diabetic). The game is to stick within those numbers as much as possible, go too high for too long and you increase the risk of long term complications, go too low and you go into hypoglycaemia and can pass out if you don’t catch the hypo fast enough.

Even after over a year of living with this condition and being razor-focused on my blood glucose, I’m still hypo-ing on average 3 times a week. Two times out of three, when taking a blood glucose reading I get the angry orange warning for high glucose. Learning that what you eat is one factor out of 42 that affect blood glucose has really helped me take a breath, be gentler with myself and laugh at the wonders of a functioning pancreas.

Do you think technology has enabled people suffering with chronic illness to find communities, share their stories and learn from one another?

Only one in every 127 people has type 1 diabetes in the UK. When I was diagnosed I didn’t know of anyone with the disease to speak to, it was incredibly isolating. Finding other type 1 sufferers on Instagram as well as communities like @beyondtype1 helped me get through the darkness of the first few months post-diagnosis.

Online communities and access to diabetic technologies like continuous glucose monitors are life-saving. I now wear a flash glucose monitor on my arm, it is the size of a watch face and, thanks to a flexible needle that sits under my skin, tells me what my blood glucose is doing every five minutes. I can simply scan it with my phone to see if my blood is dropping or rising and if I need to take an insulin shot or some smarties to stay in the safe range.

Today, whenever I see someone wearing a glucose monitor it takes all my self-control to not bound up to them pointing to my arm shouting, “me too! You are not alone!” It’s like being part of a secret cyborg club and it makes my heart sing when I come across another member.

How did Sketch enable you to share and communicate the difficulties of type 1 diabetes?

A year ago I lacked the words to communicate the emotional roller coaster that comes with being diagnosed with a chronic condition as an adult. Working in Sketch allowed me to quickly and playfully create images and push them out into the world.

This poster project has both enabled me to make sense of what it’s like living with type 1 and rebuild bridges with family and friends that I had been shutting out as well as reach across the world to other type 1s and bond over the obscure, funny and often ridiculous aspects of the disease.

At the beginning of November, Alex launched the Diabetes by Design exhibition — a week long public display featuring posters from the project.

How did you feel when you launched the exhibition?

I think as digital designers we rarely get to touch and feel our work. Standing in the exhibition space before the launch night and seeing all the prints in the real world was a really special moment.

Seeing people during the launch night and watching them reading the stories and reacting to the posters made the work and rush to make the exhibition a reality worthwhile.

What has the reaction to the project been like?

The exhibition was held in Custom Lane, a trendy design and making centre in Edinburgh. I choose that space because it wasn’t a hospital or education centre. I wanted to attract the general public with brightly coloured posters and “trick” them into learning about diabetes. I think it worked because the launch night sold out and the feedback section of the exhibition ran out of feedback cards.

Since then, I have been contacted by Diabetes Scotland for potential future collaborations, I’ve been interviewed by the BBC and I’ve started to speak to other Type 1 creatives about collaborating on future projects. My hope is that this project can keep growing and I’d particularly love to include the voices of others in my posters as well as work with health professionals to continue to inform, inspire and ignite new conversations around what it’s like to live and thrive with a chronic condition.

This article is part of our #madewithsketch series. If you missed it, the last piece followed Blake Stevenson’s process of creating our Ambassador print.

As part of that post we ran a giveaway for one of those prints. We had so many awesome entries that we decided to give away three posters instead of one! The winners were Grace Lee, Vidit Bhargava and Brian. You can see some of their work below.