On Tuesday, Brian Bosh (@bosh) tweeted, "Do you (as a #diabetic) avoid publicly announcing extreme blood sugars for fear of discrimination regarding future coverage? #bgnow private."

Insurance -- and jobs -- have been an issue for many people with diabetes. We worry if "going public" with our glycemic impairment will cause us to lose our jobs or our insurance, limit opportunities for promotion, or cost us more money to pay for health coverage. While overt discrimination against people with diabetes is illegal in many jurisdictions, it is not illegal to use that as an excuse to dig for something else for which it is legal to fire someone, deny insurance coverage, or exercise recision (retroactive refusal of insurance coverage). The "employment at will" clause in many hiring agreements is generally sufficient to release an employee without providing a specific reason.

The original idea of #bgnow (tweeting one's current blood glucose reading) was to show others with diabetes that it's OK to test publicly, that it's OK to have an out-of-range blood glucose reading, and it's (usually) the responsible thing to try to bring an out-of-range reading back into range. Tweets such as "#bgnow 59 chugging orange juice" and "#bgnow 250 administering correction" show that we are actively involved in managing our diabetes. Tweets such as "#bgnow 352 after three correction boluses, WTFructose, #diabetes?" show the public that the condition is not always as easily managed as our euglycemic colleagues would wish to believe. Readings that might otherwise seem high may be modified by upcoming activity -- such as "#bgnow 185 heading out for a run" -- and the effect of exercise on glycemic control is shown by the "before" and "after" readings of the World Diabetes Day Big Blue Test (#bigbluetest).

In contrast, the "diabetes etiquette" advocated by dLife^® and the Behavioral Diabetes Institute is that our blood glucose numbers are our own, private information -- akin to our weight, the number of sexual partners we've had in our lifetimes, and how many times we [censored] a night. What posting #bgnow -- especially in conjunction with Blood Glucose Wednesdays (#bgwed) -- advocates is being open about our diabetes. When our partners and bosses don't understand that the stubborn 280 might have something to do with a high-pressure deadline or a mandatory, do-not-refuse-the-bagels breakfast meeting, it is an opportunity for education (granted, you might not feel much like "educating" at that point) -- and a follow-up, public correction can go a long way towards getting people to understand that this is what diabetes does.

That said, one must also ask, "How many people without diabetes, who are not caregivers for someone with diabetes, know what a normal blood glucose level is -- much less what the Twitter hashtag #bgnow means?" and "How many of those are the decision-makers for your job and your insurance?" If the answer is, as I suspect, "Not nearly enough," then we need to continue to be open, to educate, and to push for cures.