Frustrated, but okay with it (sort of).

Do you ever experience a low where someone really goes out of their way to help you, when you don’t really need it, and it’s kind of annoying?

This wasn’t help during a low… this was, unfortunately, hindrance.

About three minutes earlier, I felt like I might be low, and tested out at 58 mg/dL. I started to eat some candy I keep in a jar on my desk at work. I suspended my pump, for what that was worth, and I was sitting quietly, not doing anything. Just concentrating on the one thing I needed to do in that moment, which was eat the candy (or, as some might call it, Stephen-eat-the-cheeseburger), and nothing else. Then someone came by, and noticed I was low. Before I knew it, I heard “Come with me… do you have something in your desk?… Here, I got your juice… drink it. NO, DRINK IT… NOW”.

My co-workers have come a long way in their understanding of diabetes, and especially their understanding of the dangers of hypoglycemia. But a few days ago, I came to the realization that there is a big difference between basic knowledge of highs and lows, and knowing about the nuances of diabetes.

I was definitely low in this instance. No doubt about that. But I was already treating, and as we all know, ingesting something now does not mean my BGs will come up at the very moment that fast-acting carbs are ingested. It takes fifteen minutes or so. Nothing I can do about that.

But it’s very hard for people who don’t live with diabetes to just sit there and wait, or even understand what it means to sit there and wait those fifteen precarious minutes. Especially when they’re worrying about you.

I have to tell you… it warms my heart to know that the people I work with are so eager to help when I hit a bad low. By the same token, it takes more than just literally shoving a juice box in my face and expecting me to be okay. The truth is, I would have been okay eventually, even if I was the only one there.

The thing is, it’s easy for me to be frustrated, because my low wouldn’t have been so difficult had I been left to my own devices. I was sitting in a chair at my desk, eating candy. My pump was off. I knew it was going to take a bit, but I knew I would eventually be okay. I didn’t need the extra grabbing and juice shoving and holding the juice so all I had to do was drink it. I also could have done without the “It’s because he’s stressed… the stress is making him low” comments.

But… how can I be unhappy about the level of concern and effort put into this moment? In reality, I cannot expect someone who doesn’t live with diabetes to know the difference between what 74 mg/dL feels like, and what 44 mg/dL feels like. And they really wanted to help me. How can I complain about that?

In the end, for all of the frustration, it’s just another brief episode in life with diabetes. I need to go through the mental checklist, examine the moment, and see if there’s anything I could have done better. To not do that would be folly. If it turns out it was just one of those crazy lows that happens from time to time despite our best efforts at diabetes management, then I just have to let it go. And thank everyone who tried to help me.

And be happy that there are people who want to help when I need it, even if I don’t need it all the time.

T2 Series: Mark your calendar.

Hey, did you know that TuDiabetes has a super live interview series? Every week, they’re interviewing someone new, talking about subjects that we all care deeply about.

During the month of October, TuDiabetes’ live events will focus on Type 2 Diabetes, featuring guests who really know what they’re talking about.
Yesterday’s guest was journalist and author Gary Taubes, whose books Why We Get Fat and What to Do About It, and Good Calories, Bad Calories (also known as The Diet Delusion in the UK) are widely read. He’s also co-founder of the not-for-profit Nutrition Science Initiative. In addition, he’s recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research, and he’s won a boatload of awards for his journalism.

Did you miss this interview? It’s okay. TuDiabetes will be posting a copy of the interview shortly, so you can watch it whenever you want. Isn’t technology great?
On October 7, TuDiabetes welcomes Susan Guzman, co-founder of the Behavioral Diabetes Institute. It’s the first non-profit organization devoted to the emotional and behavioral aspects of living with diabetes. By trade, she’s a clinical psychologist specializing in diabetes. Her main focus is on overcoming emotional challenges that interfere with managing your diabetes on a daily basis.

They’re going to be talking about dealing with and overcoming the stigma that people try to lay on Type 2s on a regular basis. This should be a really interesting talk, and I, for one, cannot wait to hear it.
On October 13, Ansley Dalbo will be welcomed to TuDiabetes to talk about DiabetesWhatToKnow, a great resource for Type 2s who are just getting started in their life with diabetes, or are looking for a little more information to help them manage their Type 2 lives better from here on out.
On October 15, noted Type 2 and major advocate Bennet Dunlap will appear, talking about the recent launch of Diabetes Patient Advocacy Coalition, and how each of us can take a hand in carving out a better life for everyone living with diabetes.
And Mike Durbin will be on! The author of My Diabetic Heart will stop by on October 22 to talk about living with Type 2 diabetes and congestive heart failure. Shame isn’t a part of his repertoire, and I’m thinking he might have some great advice for you and me too. This one has been already marked on my calendar.
Pretty good lineup, no? Want to be in on the happenings? Good. Here’s what you do:

CLICK HERE for a quick look at the calendar of events. Want to find out more about a topic? Click on the event. Can’t be more simple than that.
Hey, I’m not a Type 2, but I could stand to learn an awful lot about my brothers and sisters who are living with a type that’s not my own. Join TuDiabetes for the innovative T2 Series, and for heaven’s sake, be part of the discussion, learning, and empowerment that comes from being a member at TuDiabetes.

The Diabetes UnConference Scholarship Window Is Closing!

Here’s your friendly neighborhood reminder guy with a friendly diabetes neighborhood… reminder:

Time is running out for you to apply for a scholarship to the Diabetes Unconference in Las Vegas next March.

You must have your scholarship application in by September 30! That’s Wednesday, folks.
If you’re reading this, you’re probably living with diabetes, or you have someone very close to you who is living with diabetes. That means you never, ever get a break from the physical, and yes, mental aspects of having to survive the highs and lows, the stigma, the relationship issues, and everything else that diabetes lays at your feet.

The Diabetes Unconference is the only gathering that brings diabetes experts together (that’s you) in a safe, supportive environment to talk through all of the psychosocial issues we deal with in our walk with this disease.

You will find people who understand, people who will help, people who will let you know you are not alone. Take it from me: That is worth its weight in gold.

To make it easier for some to attend this important meetup, there are a number of scholarships available. Let me take a moment and let you know about them (from the Diabetes Unconference website):

Those Who Love Us Scholarship (1 available)
Available for a caregiver – significant other, spouse, family member, it includes air travel to and from Las Vegas, Nevada from the recipient’s area, The Diabetes UnConference registration for recipient, and two (2) nights stay at The Flamingo Las Vegas, including taxes and resort fee. Recipient will attend the sessions for caregivers. The recipient cannot have diabetes.

Type 1 Scholarship (1 available)
Available for individuals who have Type 1 diabetes/MODY/other, it includes air travel to and from Las Vegas, Nevada from the recipient’s area, The Diabetes UnConference registration for recipient, and two (2) nights stay at The Flamingo Las Vegas, including taxes and resort fee.

Type 2 Scholarship (1 available)
Available for individuals who have Type 2 diabetes, it includes air travel to and from Las Vegas, Nevada from the recipient’s area, The Diabetes UnConference registration for recipient, and two (2) nights stay at The Flamingo Las Vegas, including taxes and resort fee.

Room Scholarships (2 available)
You must already be registered to attend The Diabetes UnConference to receive this scholarship and must attend the entire conference to receive two (2) nights stay at The Flamingo Las Vegas.
It includes two (2) nights stay at The Flamingo Las Vegas, including taxes and resort fee.

Even better news: There will be an Alumni Scholarship awarded to a first-time attendee to the Diabetes UnConference. Those of us who attended the initial UnConference this past March have pooled our money to offer another person the opportunity to become part of the alumni for the first time. If that makes any sense at all. Anyway, this will include air travel to and from Las Vegas (unless the recipient is close enough to drive), conference registration, and two (2) nights stay at The Flamingo Las Vegas. More on this scholarship at a later date.
Now… what do you have to do?

CLICK HERE and complete the short scholarship application. Do it right now, because the application window closes at the end of the day on September 30.

I don’t think it’s a stretch to say that the Diabetes UnConference helped change a number of lives last year. It also helped create and sustain new and existing friendships. It was special in ways I still have trouble describing. But I feel it in my heart, so I know it’s true.

I would like it if you could be there too. If you think you’d like to go, and you want to apply for a scholarship… Act now. I hope to see you at The Flamingo Las Vegas in just a little over five(!) months.

Interview: Kevin Sayer, Dexcom President and CEO.

I had a super conversation this week with Kevin Sayer, President and Chief Executive Officer of Dexcom, the most popular continuous glucose monitor on the planet.

This was intended to be a podcast interview, but due to technical issues on my part, we were not able to record our conversation. Too bad, because it really was a good one.

Since I’m not very good at writing down things word for word (one of the many reasons I started a podcast), I will instead give you a synopsis of the questions I asked (in bold), and the answers that were given. Just imagine us talking, and it will be almost like being there.
First, I asked Kevin about his twenty-plus years of experience in the medical technology and medical device field. What has that experience taught him about the importance of what he does, and how it affects patients living with diabetes?

He answered this by telling me about a Facebook post he read earlier in the day. It was from a parent of a child with diabetes, who was in the hospital. The child was wearing a Dexcom CGM, and had a glucose check performed by a nurse. The check came in in the 240 mg/dL range, and about an hour later, the nurse came back to perform a correction bolus based on that amount. Only the Dexcom the child was wearing had shown that his BGs were coming down, and were still trending that way. After some pleading, the parents were able to convince the nurse to check again before blousing. That check resulted in a reading in the 60s. In this instance, the Dexcom, and the parent’s trust in what they were reading, helped to avoid an emergency, and possibly saved a child’s life. Cases like that help underscore what Mr. Sayer, and Dexcom, are trying to accomplish.

Dexcom has been pretty innovative over the years. In the past year, we’ve seen the rollout of Dexcom Share, and FDA approval of the Dexcom G5. A little over a week ago, they received the CE mark of approval in Europe for the G5, so they’ll be rolling out that product to Europe in the coming weeks. Has Dexcom started shipping the G5 to users in the USA?

The answer is: Yes! Just this week, the G5 started going out to users here in the USA.

FYI: If you are currently on the G4 Platinum product, there are low cost, and in limited cases, no cost upgrades so people can more easily move to the latest and greatest Dexcom system. Go to the Dexcom website for more details.

In the news release on the G5 in Europe, I noticed language that states:

“…the new Dexcom G5 Mobile CGM system does not require confirmatory finger sticks when making treatment decisions.”

Now, we know that’s a no-no here in the USA, and the G5 has not been approved for that here. But I also know there are clinical trials ongoing to help determine the efficacy, I guess, of People With Diabetes dosing insulin based on CGM numbers rather than fingersticks. Other than being the CGM involved in the studies, is Dexcom involved in those trials in any other way?

This elicited a passionate response I wasn’t expecting. Kevin Sayer is firmly behind the idea of using a properly-functioning, properly-calibrated CGM to inform insulin dosing decisions, independent of fingerstick confirmation. Dexcom has mounds of data, from multiple studies, and they are planning to go to FDA at some point to get the, I believe the term was, adjunctive exemption that would allow Dexcom to promote their CGM (either the G5 or a future generation product) in the same way that they are promoting it in Europe. He believes that trending data gathered over hours, rather than a one-time BG meter reading, is a more accurate way to determine insulin dosing decisions.

I’m really blown away by the amount of collaboration that Dexcom has been involved in over the years, and I’m talking several years, at least back to 2007. Most recently, we’ve seen Dexcom become part of the Animas Vibe system, and part of the T:Slim G5 system. In an industry that gets a lot of criticism for not playing well with others, what’s the secret to Dexcom’s success in making these partnerships happen time after time?

Mr. Sayer gave kind of a two part answer to this. In the beginning, Dexcom was very small, and collaborating with a bigger partner was a way to grow the business and forge relationships. Today, it’s about Dexcom being the CGM of choice, and making sure that if a Person With Diabetes wants to use a Dexcom as part of their overall diabetes management, they should be able to do that. And forming relationships years ago helped Dexcom have those conversations with other companies when the time came to branch out.

I also asked: Does he see Dexcom as a leader in collaboration as well as technology? The answer is yes. It happened the way it happened over the years, but yes, Dexcom sees collaboration as essential and good for Dexcom.

Finally, I asked about CGM coverage for Medicare patients here in the USA… rather than talk about what passage of such legislation would mean to his company, I wanted to ask: How does it make you feel knowing that patients on Medicare, some of whom were your customers a year or two ago, are unable to use CGM technology at all, without paying 100 percent out of pocket for it?

This, he admitted, is the biggest thorn in his side right now. It’s the biggest complaint that Dexcom gets on a regular basis. He mentioned that his most reliable customers, in addition to children using the G4 and G5, are those in their 40s, 50s, and 60s, who might be less hypo aware, and rely on the safety of CGM technology to help keep them out of the hospital. And have been steady CGM users for a long time. To take all that away just because you reach a certain age doesn’t make sense. Dexcom is working alongside others to try to convince lawmakers to add a category to Medicare coverage, allowing seniors in my country to continue using CGMs. The patient data and the dollar data backs it up. Dexcom will continue to fight for CGM coverage for patients on Medicare.
You know, the thing about Dexcom is, you can’t even blink hardly without seeing another announcement about a new product, upgraded technology, regulatory approvals, and continued partnerships. It has to have been an exciting almost nine months as CEO for Kevin Sayer. From my standpoint, I’m looking forward to what the next nine months and beyond will bring from Dexcom.

What does that mean, anyway?

After my interview with Rick Phillips for TuDiabetes Tuesday, I took some time to reflect on what we discussed. There were a lot of acronyms in there: CGM, DSMA, and a couple of others I can’t remember right now.

You can probably relate to this when I tell you: Before I found the Diabetes Online Community, I had absolutely no idea what those things meant. Or even that they existed.

Those of us that have been communicating about diabetes for some time, even people like me with just a high school education and a few years’ experience writing about diabetes, tend to shorten our words an awful lot sometimes. On one hand, that’s just the nature of communication these days. Why write out “been there, done that” on your phone when you can just tap out “BTDT”?

On the other: If you’re new, and all this is new to you, it can be a bit overwhelming at first. I wonder sometimes if we lose people with our thorough knowledge and discussion of the A1cs and BGs. I don’t think so, at least not all the time. But sometimes I worry that while I’m trying to make a point about IOB, or CDEs very quickly, I make it so quick that it’s easy to lose someone on the outside of the conversation, knowledge-wise. I don’t ever want to do that.

So if you ever see something I write, or hear something I say, and it doesn’t make sense to you, I hope you’ll ask me for an explanation. You deserve that.

And if you don’t want to ask me for an explanation, guess what? TuDiabetes is an amazing source of information. They even have this Diabetes Terminology Glossary that explains just about everything you’ll ever want to know about the acronyms that power our diabetes discussions.

I admit it: I’m a diabetes acronym-dropper. But don’t let it rattle you. And in the words of Bennet Dunlap, LYMI.
CGM: Continuous Glucose Monitor

DSMA: Diabetes Social Media Advocay (the #DSMA Twitter chat is every Wednesday at 9:00 ET)

DOC: Diabetes Online Community

A1c: According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), “The A1C test is sometimes called the hemoglobin A1c, HbA1c, or glycohemoglobin test. The A1C test is the primary test used for diabetes management and diabetes research.”

BG: Blood Glucose

IOB: Insulin On Board (the insulin still active in the body at any given time)

CDE: Certified Diabetes Educator

LYMI: Love Ya, Mean It.


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