Monthly Archives: April 2013

Manning Diabetes Symposium, part two.

Just in case you’re wondering, I did not receive anything for attending this symposium, or for writing about it. I paid my fee to attend, I drove to Charlottesville, and I made (and paid for) my own accommodations.

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Going to the Manning Diabetes Symposium at the University of Virginia Medical Center was an amazing experience. To be honest, I was a bit worried about being in the same room with all of the brainiacs in attendance. I was surprised when I received my badge for the symposium and saw that it had my name and my blog address on it. Instantly, I thought Oh No, they’re going to know I’m a writer! Then I thought… Cool!

I was speaking to someone about a month ago, and they were talking about being in meetings with industry executives and other very important people in their field, and wondering sometimes whether they really belonged. I said this, and I really believe it: We all deserve to be in the room. We deserve to be part of the discussion. We shouldn’t take our participation for granted, but we definitely deserve to be there. If you get a chance to attend something like this, I encourage you to go and be part of it. After all, they’re talking about things that are very important to you. Don’t you want to know what’s going on?

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Friday’s lectures began with information from three heavyweights in the diabetes research arena: Guillermo Arreaza, MD from the National Institutes of Health (NIH) and the National Institue of Diabetes and Digestive and Kidney Diseases (NIDDK); Dr. Richard Insel, Chief Scientific Officer at JDRF; and Marc Anderson, Senior Program Officer for the Helmsley Type 1 Diabetes Program, part of the Helmsley Charitable Trust. They all covered what they’re about and what they’re working on right now. Dr. Insel, in particular, gave a very compelling presentation. I’m very appreciative of what these three groups do to research and study diabetes, therapies, and new technology.

What they didn’t talk about, and what I’m concerned about for the future, is this: I have a good job, with good benefits. So I have access to new therapies and new technology when it’s available. But there are many in the USA who do not. And there are many around the world for whom a diabetes diagnosis amounts to a death sentence. I’d like to know what these three organizations are doing to study or address that.

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Then there were two compelling talks focused on genomics and diabetic complications. Jesus Flores, MD and PhD from Massachusetts General Hospital and Harvard Medical School, covered the work that his group is doing on research and analysis of genome-wide association studies of Type 2 Diabetes. In addition, he leads research for the Diabetes Prevention Program, studying genetic variants on the development of diabetes. And those are just two of the things he’s involved in.

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Rama Natarajan, PhD from City of Hope in California gave a super presentation on Epigenetics in Type 1 Diabetes and its Complications. That description sounds pretty nerdy, and it might be hard to understand, but trust me: I was hanging on every word. Honestly, if I was looking for someone to speak at a diabetes conference, she would be near the top of my list.

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Then it was on to Immunointerventions and Cellular Therapy. Presenting was Dr. Kevin Herold, Professor of Immunobiology and Medicine at Yale University; Dr. Camillo Ricordi from Diabetes Research Institue; and Dr. Matthias von Herrath, VP and Director of Novo Nordisk’s Type 1 Diabetes Research and Development Center. They each gave tons of information related to studies designed to identify potential targets for cellular and immune system therapies for the treatment of Type 1 Diabetes. I’m skeptical when it comes to this kind of research, but I’m glad that they’re all involved in it. We need to explore every available possibility, and this is one of those possibilities.

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So now, let me back up to Thursday evening. There was something called a Poster Session. Maybe you’ve heard of this, but I had never seen it before. Basically, there was a separate room containing about a dozen bulletin boards. On each side of the bulletin boards were posters containing information on diabetes studies recently completed or currently underway (including the one I’m participating in! I felt special). Next to about half of the posters were people who were leading or directly involved somehow in the studies. It was great to read about important investigations being done and then speak to the experts who were getting their hands dirty in the research. It was absolutely the best part of the symposium for me.

Here’s a tidbit: A study was done looking for a link between certain personality traits and management of blood glucose. The results? People who tested as “conscientious” has more lows and were at higher risk for lows than others in the study. People that tested as “industrious” had higher BG variability. People noted as “independent and achievement oriented” had fewer normal range BGs, had a higher BG risk, and had higher BG variability. People who tested as just “independent” had significantly lower BG variability. And people with “openness and understanding” had fewer lows, but fewer normal range values. They were at a lower risk for lows, but higher risk for highs. Didn’t see all that coming, did you?

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So that’s it. Thanks to everyone who organized and presented this sypmosium. I’m very glad I could be there. If you have any questions about any of the presentations or the presenters, please let me know.
 
 
 

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Manning Diabetes Symposium.

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I was back in Charlottesville last Thursday and Friday. Not because of my clinical trial or for medical screenings, or anything like that. This time I went to attend the Manning Diabetes Symposium. This is a meeting of very, very smart people who spent parts of two days talking about the great diabetes research taking place in various parts of the world.

Seriously, I was the only one there that didn’t have a ton of letters after their name. In the sessions, the speakers would cover their topic then take questions from the audience, many of whom were presenters at the conference too.

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Day one was devoted partly to islet beta cell stress and islet pathology and potential targets for therapy. Basically, they’ve nailed down the development of diabetes to beta cell stress, leading to insulitis (inflammation of the islets), which leads to pre-diabetes, then destruction of the beta cells resulting in diabetes. Can anything be done to stop this process, or possibly reverse it? They’re working on it. Interesting insights from Dr. Raghu Mirmira, Eli Lilly Professor of Pediatric Diabetes and Director of the Pediatric Diabetes Research Group at Indiana University, Indianapolis.

Also speaking was Dr. Alberto Pugliese, Head of the Immunogenetics Program at Diabetes Research Institute in Florida. He spent a lot of time talking about JDRF’s nPOD program, a program that provides, without cost, rare and difficult to obtain tissues beneficial to their work in (hopefully) curing Type 1 Diabetes. The nPOD acronym stands for Network for Pancreatic Organ Donors with Diabetes (don’t know what happened to the extra D, but what the hey). Anyway, it’s a very interesting looking program, and I invite you to check it out at
http://www.jdrfnpod.org.

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Also on Thursday was a lot of artificial pancreas talk. First off, from Dr. Bruce Buckingham, Professor of Pediatrics Endocrinology at Stanford University, information on camp and in-home studies designed to try and measure reductions in nocturnal hypoglycemia related to the AP. In short, they were successful and they plan to do more studies in the near future.

In addition to that, Ed Damiano, PhD from Boston University came and spoke about all of the great AP research and trials they’re doing up in Boston. This was mostly the same talk I heard back in February at the Children With Diabetes Focus on Technology conference in the D.C. area (you can read about it here). I really liked the fact that during the question-and-answer session afterward, he made a real point of saying that artificial pancreas technology is a great thing, but it’s far from the perfect solution. I liked the question-and-answer portion with him anyway. He’s very passionate about the work they’re doing up there, and he really is an intelligent person who seemed to be very forthcoming and a step ahead of the questioners the whole time.

Finally on Thursday, there was Dr. Eric Renard, who is doing AP work at Montpellier University in France. He brought us up to date on current developments in Artificial Pancreas technology and testing, including what’s happening in Europe, where their testing is a little further along than it is here in the USA.

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After the talks, there was something called a Poster Session, which I’ll talk a little more about tomorrow because it was very cool. I’ll also cover what was presented on Friday before the end of the conference. This was a very educational couple of days and I can’t wait to tell you about the second half.

Just in case you’re wondering, I did not receive anything for attending this symposium, or for writing about it. I paid my fee to attend, I drove to Charlottesville, and I made (and paid for) my own accommodations.
 
 
 

Post-mortem on Monday morning’s low.

I really wrestled with whether I should write again about my severe low early Monday morning. In the end, I’m writing this wrap-up because when something like this occurs, it’s important that I (and The Great Spousal Unit) examine what happened, and if I can, do something about it. Only then can I move on.

So here are some bullet points on Monday morning’s hypo event:
 
 
– First of all, many thank yous to everyone who left a comment here or on Facebook. I appreciate the fact that you were so concerned for my well being. Even when I’m making stupid mistakes. Read on…

– Looking back at my pump, I saw the most obvious problem… I bolused twice for dinner. Once before dinner (which I forgot about), and about an hour later. I remember thinking that I hadn’t bolused, and like an idiot, I didn’t check my pump and bolused again. Plus, my glucose was really climbing at that point, and I was very concerned after being high in the afternoon. On top of that, I bolused for a snack about an hour and a half after dinner. So yeah, I seriously stacked my boluses. I won’t ever bolus again without double-checking the pump first. I’m feeling really, really stupid about this. Really, there’s just no excuse.

– I was fighting really high BGs all day Sunday (in the 300s), with the breaks from that only coming just before meals. The morning spike was probably due to a high carb breakfast. I had a low carb lunch, but later found tubing that was clamped off by my pump’s belt clip. I changed the tubing, and worked on fighting the highs off the rest of the day. I was sinking pretty good before dinner, then had another large post-prandial spike an hour later. When I went to bed, I was still at something like 218 mg/dL, but I really had way too much insulin on board at that point.

– I slept through all of the Dexcom alarms. Or, I slept through turning them off. I don’t know. I do know I remember one alarm early on (probably around 1:00) that I heard. I turned it off, ate a few Glucolift tabs, and went back to sleep (I know, I didn’t check the BG). I don’t recall hearing another alarm. Maureen sleeps next to me, and she doesn’t recall hearing an alarm either. But she was sleeping as soundly as I was.

– Speaking of the Dexcom… I’m getting some very useful data on how my glucose trends through the day. That’s the good news. The bad news is that I’m obsessing over it too much. I don’t want to say I’m treating solely based on what I’m seeing on the receiver’s display. I’m not sure I’m ready to be honest with myself about that. But Maureen mentioned just today that I “need to stop paying so much attention to that thing”.

– I have a nice bruise on the side of my head, and a cut on my ear. Probably from falling out of bed, but I really don’t know. I guess I should be happy that’s all the physical reminders I have from this.
 
 
The final analysis: It was an epic fail on my part. I cowboyed my way through the day instead of being patient.

Many times, I’ve commented on blogs and told people in person that you can’t worry about the past. It’s only a reference point. What counts is making the most out of today and tomorrow.

Now I have to go practice what I’ve been preaching.
 
 
 

April DSMA Blog Carnival – Spring Exercise.

This month’s DSMA Blog Carnival gets us thinking about spring (here in North America anyway), and our workout routines as the weather changes.

Does the sunshine and warmth of Spring urge you to change up your exercise routine? If you don’t have an exercise routine, does it inspire you to start exercising? And if it’s not Spring in your corner of the world, what season are you heading into and how does it impact your fitness routine?

Last question first: It is Spring in my corner of the world, finally, and I’m looking forward to ramping up my workout routine in a big way. There are a couple of reasons for that.

To begin with, the obvious: The weather gets warmer and the days get longer. That means there is more time available for me to actually get outside and get some exercise in. These are the times when I’m looking for an hour here or an hour there to hop on my bike and go down the road a little. Plus, the warm weather just makes me feel better. I crave the warm sunshine on my back (or my front) while I head off to places I haven’t been for nearly six months.

Second, Spring usually begins the last major push for me to get in shape for various events I’m competing in this year. I’ve got a 55 mile ride scheduled in May, a triathlon (swim, bike, and run) in June, a 5K run in July, and a 65 mile bike ride scheduled for September. As I’ve gotten older, my goals for these events has diminished somewhat. But I’m still well aware that if I’m going to get in the best shape possible for any of these events, I will have to make an extra effort now. Now that the weather is warmer, I can get outside the confines of the gym and that always makes me feel better. When it comes to meeting your fitness goals, variety is always a good thing.

Those are definitely two reasons why I’ll be doing more now that Spring has finally arrived here in the USA. In addition to that, there are always tasks in the yard that require my attention at this time of year. Preparing and planting the vegetable garden, mowing the grass, or just walking the dog more often are always high on the list of priorities when weather permits. So even if I weren’t training for something, I’d be putting in the extra effort anyway just taking care of the regular things at this time of year.

Whatever the reasons, I hope that spring brings a renewed sense of hope and confidence that you can do whatever it takes to maximize your fitness routine this spring!

This post is my April entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2013/april-dsma-blog-carnival-3/
 
 
 

I fell out of bed.

A little bit before 3 o’clock this morning, I fell out of bed.

Hypoglycemia, of course.

I slept through all of the CGM alarms (set to “Attentive”). Maureen was unable to revive me, and she called 911. For the first time ever, I was completely unconscious through the entire episode, until I woke up with 5 Emergency Medical Technicians holding me down after injecting glucose into my IV.

It was, unquestionably, the most severe hypoglycemic event of my life.

Sometimes, I struggle to find words to describe how lonely it can be living with diabetes.

Today, I’ll explain it this way: A little before 3:00 a.m., I experienced a severe hypoglycemic reaction. After being revived by EMTs and spending another 45 minutes or so recovering, I climbed into bed to sleep for a little over an hour. Then I woke up, shaved, took a shower, got dressed, ate breakfast, made my lunch, brushed my teeth, and dragged myself into work, even though my head is pounding and I’m so tired I can barely hold my head up.

I rode on a train with hundreds of other people who had no idea why I sat there with my eyes closed and my head in my hands for twenty minutes.

I’m working in the middle of a city of over 600,000 people who have no awareness of what I experienced last night. Even if they did, most of them would not truly understand what it was like.

And I can’t escape the surreal feeling that right now, I sit at a desk in the middle of 15 colleagues who are blissfully unaware of the fact that a few hours ago, I nearly lost my life.
 
 
 

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