Monthly Archives: March 2013

Enjoy your weekend.

To all of my friends everywhere: I want to wish you a great weekend.

To my friends Bob and Linda, thanks so much for welcoming us into your home for your seder every year. At this point, it really does feel like tradition. And it’s wonderful.

To my catholic friends and family, I wish a pleasant end to the lenten season. I hope the new pope brings stability and a newfound sense of faith. In God, not in the church. Churches are still led by people. Oh, sorry… forget that. Just have a happy Easter.

I’m going to be busy, and you may not hear from me as much over the next week. But I like writing, so it will be hard for me to be quiet for long.

Regardless of what you’re up to on Friday, Saturday, or Sunday, I hope that diabetes takes a back seat to your happiness. Do something fantastic. Make some special memories. Beginning… Now.

Enjoy.
 
 
 

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Endo recap.

Can’t believe that I’ve let almost two whole weeks go by without mentioning something about this. Too busy with other things, I suppose.

Here are some random moments from the appointment with my fabulous endocrinologist a couple of weeks ago:

– Hemoglobin A1c was pretty good. I’m again in the range where she’s worried that I’m encountering too many lows. It still feels weird after so many years of “Your numbers need to come down” to hear “This is a little lower number than I would like to see”.

– After reading about my adventurous week in January, she asked if I’m still eating gluten free. Umm, no… I’m not. But I do dig the pizza that I made, and the bread, and I felt pretty good that week, so if I can afford it, I’ll probably be doing at least some gluten free meal making in the future. Also, I’m eating a lot of salads right now, and I’ve been looking for gluten free salad dressings (Wish Bone makes some good ones).

– We talked about infusion sites. I had a stubborn high BG episode a few days prior to the visit, and we talked about whether it might have been site-related. I’m convinced that it was insulin that went bad after five days hanging on my hip. But I finally remembered to ask her opinion about whether sticking to the FDA-mandated 3 day limit to infusion sets would cause me to have too much scar tissue over time, as opposed to what I do now: keep the thing in until the insulin is gone (usually 4-6 days). Her opinion? If I’m careful about rotating my sites, I shouldn’t have to worry too much about changing out every three days. And there’s no evidence that keeping a set in longer is doing me any good anyway. I may have to rethink my position on this one.

So in conclusion: I have to tweak my basals ever so slightly, and stop aggressively blousing at every opportunity. I like eating gluten free, but haven’t moved all the way there yet. And I should consider going back to site changes every three days. Oh, and my other lab work came out okay too. No liver, cholesterol, or thyroid issues. I’m good for another three months!

Of course, I still have plenty to work on in the meantime.
 
 
 

A rare non-D post. With pictures!

Today, no talk about diabetes, really. Just some photos. The one at the end is for all of the DOC cupcake freaks out there.

We went to a play on Sunday afternoon. But first, we stopped off at the Howard Peters Rawlings Conservatory in Baltimore.

If you live in the USA, chances are that you live somewhere near a facility like this. A lot has been written about diabetes and depression, about winter and depression, about seasonal affective disorder (it’s actually a thing). I’m not going to say that a trip to your closest conservatory will cure these problems for you. But I can tell you that if you make a trip like this, even for a short time, you will definitely feel better. For me, it’s the perfect cure for Cabin Fever.

So without further ado, please enjoy these images from the Rawlings Conservatory.

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And one final photo… we stopped to have a little nosh at a local place after the play, and we indulged in this lovely treat (I ate about a third of it):
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I hope this brightens up your Tuesday. Or Wednesday. The trip to the conservatory certainly brightened up my day. Which is a good thing, ’cause we woke up to about four inches of snow on Monday morning. Come on Spring!
 
 
 

C’mon, CVS!

From the wonderful relationship that exists between employers and employees in the United States these days comes this little nugget. Go ahead, read it. I’ll wait.

http://www.cnbc.com/id/100573805

Does this bother you a bit? It bothers me a lot.

I’m not bothered by the fact that an employer wants to try to help their workforce get healthier. My employer does many of the same things that CVS is talking about here. In fact, I’ve written about it. Done correctly, these initiatives are a win-win: employees get help identifying and taking action against illnesses they might not have known about before screening. And employers, helping employees get healthier, mitigate some of their risk against future insurance claims. This is especially true if, like a lot of large employers, they are self-insured: meaning, they pay their own claims, but pay the insurance companies to leverage networks of doctors and handle claims processing and other administrative functions.

But that’s about the extent of the good stuff in what CVS is doing here.

If I were to ask questions of the CVS/Caremark CEO, and their benefits manager, the first question I would ask is: Why do you want to penalize employees for non-compliance with a policy, when you could be incentivizing employees to get healthy?

How much that might cost would be in the details of how and what kind of incentives you would deliver, but let’s be honest. The cost would be miniscule. How do I know this? Oh, why don’t you ask the thousands of employers who have been delivering incentives to employees for completing smoking cessation classes, weight loss programs, and medical/bio screenings for decades here in the USA?

Second, I would simply ask if they understood that by forcing their employees to comply (and they are forcing them—when you earn the kind of money the people at the retail store level are earning, you’re forcing them to comply), they are destroying their workforce?

Knowing what we know now about this issue, even if you’re 100 percent healthy… let’s see a show of hands: Who wants to go to work for CVS right now? Anyone? Bueller? That’s what I thought.

Certainly, if you’re a person with good skills and an ability to land a job elsewhere, CVS/Caremark is immediately going to the bottom of your list of prospects. Which means that the new employees they will be landing in the future will be bottom of the barrel talent who can’t get a job anywhere else. And existing employees who might have other choices (like maybe Walgreens or Rite-Aid or, oh… anyone else) are going to bolt the first chance they get too, even if it’s for no increase in pay. Which means the employees that remain after a couple of years under this program are again, bottom of the barrel talent. So, CVS/Caremark: What do you hope to gain here? And have you considered how much it will really cost you? Because it will cost you. You will not save money with this plan.

And you, dear reader, may ask, after 500 words or so, “Hey Stephen… what’s this got to do with Diabetes?”.

I don’t know. I guess I’m saying that I don’t trust a company that will force you to do these things. Because if they’ll do this, what’s next? Will they start denying coverage to people who are diagnosed with diabetes? Thankfully, under the Affordable Care Act, they won’t be able to. But will they try to cut back on what they cover? That, I think, is a very real possibility.

Their new policy says: “Going forward, you’ll be expected not just to know your numbers – but to manage them”. By who’s measure? Will they pay less in claims if a PWDs Hemoglobin A1c isn’t within range (and we all know how difficult that can be)? Will they (for example) try to push someone with diabetes, in their 50s, like me, toward the exit so they can avoid paying what they think will be larger and larger claims until the person is eligible for Medicare? And in doing so, try to justify their decision by pointing at this policy?

Maybe that seems far-fetched. But is it? I mean, they’re already willing to coerce their employees into complying with their demands or risk giving some of their pay back to their employer. Does this sound Anti-American to you? It does to me.

That’s the crux of the thing right there. CVS is portraying this as a wellness initiative, designed to keep employees as healthy as possible. I’m viewing this as being too heavy handed. Mostly, I see what they’re trying to accomplish, at least from their public statements, as possible– if they would just put a different spin on it and act like they actually cared about whether their employees are healthy. And happy. And if they did it without docking employees’ pay or using the information to penalize employees that they are trying to keep healthy in the first place.

By the way, I have a choice of major drugstore chains in my area. And guess what? CVS is not my retailer of choice anymore. They just don’t get it. And geez, these people are running a multi-billion dollar company.

Do you feel the same? Different? Feel free to let me know how you’re thinking.
 
 
 

Book Review.

I guess there really is a first time for everything, so here it is… my first book review. This book has already been written about in multiple places. Here is my take.

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When I attended the JDRF summit in Bethesda, Maryland a couple weeks back, I picked up Amy Ryan’s book Shot: Staying Alive with Diabetes.

Amy is a lawyer by trade, practicing in Washington, D.C. (why do they say practicing? Seems to me she’s working), specializing in the commercialization of new medical technologies. She was diagnosed with Type 1 Diabetes at age 29.

The book details her diagnosis, getting through law school, carrying her daughter through to full term delivery, surviving a pretty serious infection, and everything in between.

A lot of Type 1s will identify right away with Amy’s descriptions of high and low BGs, MDI versus pump decisions, and the general idea of living a meaningful life with diabetes. Especially if you’re a woman living with Type 1. That’s not a knock; it’s the truth. Amy is a woman, and she brings a perspective to the story that the fellas can’t.

But I think the most value in this book is in Amy’s clear descriptions of things like hypoglycemia, diabetes burnout, how an insulin pump works, and more. For this reason, I think it’s a terrific book for a parent, a spouse, or a co-worker of a Person With Diabetes. She explains things in terms that someone not living with diabetes can understand.

So while I can endorse the book for PWDs, I can most definitely endorse the book for any non-PWD who wants to understand us better. I’m making The Great Spousal Unit and The Live-In Niece read this book. Then I think we’ll talk about it a bit. Maybe have a question and answer session.

More information on Shot: Staying Alive with Diabetes, including an excerpt from the book and information on where to purchase, is available at http://www.amyryanshot.com/.

Disclosure: I bought the book, I read it, and now I’m writing about it. Nothing deeper than that.
 
 
 

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