Monthly Archives: January 2018

This is what 27 looks like.

Aaaaand, just like that, I’ve hit the 27 year mark of living with Type 1 Diabetes.

No use burying the lead here. It is what it is. A cliché is a cliché. However, there is something unique about this coming year that makes it different from any other year living with this condition.

This next year is the last year I can say that I’ve lived more than half my life without diabetes. If you’re doing the math… I was diagnosed at age 28, so next year, I’ll officially be even diabetes- and non-diabetes-wise.

”It is not the strongest of the species that survives, nor the most intelligent, but rather the one most adaptable to change.” – Clarence Darrow

Yet, I feel particularly good about this. In fact, I feel pretty good in general. I know I’ve had my medical issues in the past… knee surgery, pneumonia, and an appendectomy all in the past three years. But right now, in this moment, I feel strong.

I haven’t come down with the flu yet. And I got the vaccine back in October, so suck it all you vaccine naysayers. I’m getting a fair amount of rest lately, and I’m handling things at work pretty well during a very busy time.

”Keeping an active mind has been vital to my survival, as has been maintaining a sense of humor.” – Stephen Hawking

I don’t know how much interaction I’ll get with my fellow friends living with diabetes this year. I really hope I do. But I have plenty of demands on my time anyway, so I’m going to hope, but not worry about it.

In many ways, I’m going to treat this year as I’ve treated the past several years: do my best, accomplish what I can, don’t worry about the rest. Something is everything, if you know what I mean. I’ve got goals like everyone else, but goals are internal, while accomplishments tend to be outward. That’s the way I think about it anyway.

“It’s crazy, how similar we are. Here’s both of us, working through our stuff, trying to make something positive out of something really bad.” – Jenny Han

I will say that I’m excited about getting the podcast going again. There are many stories waiting to be told, and I can’t wait to get back to listening to people tell them.

You know, it’s funny… here I am talking as if my diabetes is wrapped up in my diabetes social media exploits. It’s not. There are many places where they intertwine, but one is not exactly the other.

”Extinction is the rule. Survival is the exception.” – Carl Sagan

Really, what I want to do today is reflect on the past 27 years. I want to remember what those early days were like. I want to remember the terribly difficult times, and how I got through them. I want to take a moment and be grateful I survived it all. Because you know that with this disease, nothing is guaranteed, decade to decade, year to year, month to month, day to day, or even minute to minute.

27 feels really good today. 28 would be better. 29, 30, and beyond are waiting for me.

”Survival is how I got here. Resilience is how I’ll remain.” – Stephen Shaul

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Quantifying my eyesight.

I don’t talk about medical appointments much lately. After blogging for almost six years, how many times can I write about going to see the doctor?

My quarterly endocrinologist appointments, checking in with my primary doctor a couple of times each year (if I don’t get sick), maybe a podiatrist or dermatologist appointment now and then.

And… my yearly check-in with my ophthalmologist.

In less than a week, I will celebrate 27 years with Type 1 Diabetes. Every year, for 27 years, that meeting with the eye doc is the one I’m probably least prepared for.

Ask me about my diabetes? No problem! Ask me for data on glucose trends, or whether I’ve been in range lately, and I can knock it out of the park. I still have diabetes, but at least I can quantify it.

But eye visits are different. All I know is that my vision hasn’t been as good the past few months as it had been before that. My preparation for this appointment was basically to clean my glasses really well and hope for the best.

That’s my problem. I’m generally the guy who doesn’t want to worry about bad news until he actually hears it. But when you don’t really know what’s going on until you get there, every year hearing ”No sign of retinopathy”, while welcome, makes me think about how many more bullets I’ll be able to dodge until the diagnosis comes.

The flip side of all this is that if you worry, when you hear everything’s okay, you want to kick yourself for worrying so much. We can’t have it both ways. Or can we? This time, I was worrying a little, but carrying myself like it was no big deal. Fake it ‘til you make it, baby.

So it was a tremendous relief to hear “No cataracts, no glaucoma, no sign of retinopathy”. In the end, my real problem was that I worried too much.

I have a new prescription. I’ll probably get new frames this year too. I’ll also try to remember to take better care of the body I’ve got, eyes included. And if I can, I’ll work on worrying less, and using the gift of eyesight to see things clearer than ever before.

The Dog Days of January.

How about those dog days of… January?

In the grand American game of baseball, August is the month known as the dog days of summer. It’s when writers and broadcasters wax philosophically about needing to stay focused, stay the course, and stay on a winning trajectory. The season is long, say the pundits. In August, you’re already five months into the regular season, with still another month of the season to play in September. You can’t let down now. Bear down. This is when champions are made.

In real life, we often concentrate on May, as Mental Health Awareness Month, or on December, because we know that a lot of people feel left out or are feeling troubled during the holidays. But what about January?

In North America and Europe, January is the first full month of winter. The sun is low in the sky, and there aren’t many hours of sunlight each day. We’re going to work in the dark and coming home in the dark. The temperature dips. Even when we’re off of work, we tend to stay home, where at least it’s warm.

Where we can easily be forgotten. It’s where we can easily fall prey to inaction and eating poorly and every other factor that makes us care less for our diabetes and our overall well-being. And before we know it, we feel like crap.

It even happens to people like me, who generally have an upbeat outlook on things. I generally don’t let things get me down. I mean, what do I have to feel down about anyway?

Yet, I have to admit, when I looked in the mirror last week, my look reminded me of the dog days, winter edition.

Unlike baseball, when this happens to us the fix is more than just staying the course, bearing down, playing like a champion. It involves a number of things. If you’re not exactly feeling spectacular right now, I hope you might find a few of these helpful:
 
 
Find time for sunshine. Weatherwise, it’s been nothing but gray in my city lately. I’ve been working a lot. When I’m off, I have things to do, appointments to keep. What I needed was a chance to stop and breathe, and feel the sunshine. Change my viewpoint.

So over the weekend, I went to the local conservatory. Not exactly out in the sun, but it’s warm, and every room is a greenhouse. It is not over exaggeration to say that sometimes, just fifteen minutes in a quiet corner there can change my whole outlook on life. It’s just what I needed.

Activity activates. This is where that endorphin thing comes in. Even if you’re only taking a walk, being active can give you a sense of purpose, a sense that you’re fighting back. I don’t know if it helps cure more serious illnesses, but in my case, being more active this time of year really perks me up.

Writing and Reading. If you think of writing as self-expression, you begin to understand why the term “Get something off my chest” carries so much sway. Writing helps me do that, whether it’s here or in a forum that no one else can see.

And we’re not the only ones writing great things. If we can’t find the motivation to inspire ourselves, there’s nothing that says we can’t find inspiration elsewhere. Sometimes, it’s where we least expect to find it. But we won’t find it if we don’t look.

Help someone else. We’re likely not the only ones we know feeling a little down this time of year. Even if you don’t know someone who needs a pick me up, there are plenty of others who need mentoring… need a meal… need something warm to wear out in the cold. Often, doing something for others results in something that helps us too.
 
 
One additional thing I should mention is that it’s important to give yourself the time for all these things. Often, just the act of granting yourself time to think or explore again is just what we need.

I don’t want anyone to think that these are cure-alls for more serious forms of depression or anxiety. There are many cases where care from a professional, or even a prescription might help your day have a little more sunshine too. Like time, granting yourself permission to seek help may be the greatest gift you can give yourself.

Wherever you are, whatever you’re feeling, and however your life unfolds, I hope that you can find the happiness and peace you deserve. No matter what happens, I support you… no conditions.
 
 
We’ll be discussing the January Blues and what each of us does and can do about them on Twitter Wednesday night at 9:00 p.m. ET(US). Follow @DiabetesSocMed, @StephenSType1, and the #DSMA hashtag and join the conversation!

Prickless.

No, this is not a story about removing the president of the United States from office.

Instead, this is about something I did recently.

I went a full day without doing any fingersticks. Twice.

I got the idea when a Dexcom sensor ended, and I still had about four days left in my trial of the Freestyle Libre (Disclosure: Abbott paid for the reader and two sensors. Opinions are my own).

At first, I wasn’t sure about only wearing a CGM that I didn’t have a lot of experience with. But during the trial, it had been pretty reliable. Then I thought, “the Libre doesn’t require fingersticks, even for calibration… what if someone didn’t want to do one?”. So I spent an entire day, a Sunday, not using my meter even once.

Then, once I got through a day using only the Libre, I knew I had to do the same thing with my Dexcom G5. The Dexcom only requires fingersticks for calibration, so in theory at least, after calibration, I could go quite a long time managing my diabetes with only the Dex. Dexcom’s turn came earlier this week.

I don’t know a single person using either of these systems who ever actually does this. I’m sure there are, but I haven’t seen anything about it anywhere. How was my experience?

In a word, I was terrified. When you rely on pricking your finger with a sharp (okay, blunt) object multiple times per day for years on end, drawing blood and using that blood to give you a handle on your diabetes, you get used to it enough to rely on it first. For me, my meter is my truth teller.

Occasionally, my CGM will give me a weird reading I just can’t believe. When it does, it’s important, even comforting, to know that I can grab my meter and trust what it tells me. But the thing is… more often than ever before, even in these moments, the meter and the CGM are very close.

I didn’t have any notable moments during the two days. No big highs, no major lows. I just lived my life, checking my BGs only via my CGM display. Managing insulin dosing and carb intake accordingly. Out of sheer instinct, I took out the meter a couple of times each day, nearly checked, but then put it back in the drawer with a laugh.

Since things worked so well over these two days, you may be wondering if I might want to ditch the meter entirely. The answer is No. As I said, when it comes to blood sugar, I’ve come to rely on my meter as the one bastion of truth above all others.

But… I could see backing off on glucose checks in my future. Maybe I won’t check seven to ten times each day. Maybe four or five, or even three or four might do the job. Maybe it’s time to think of my CGM as more than just an emergency alert system.

What this experience has done is give me the feeling that I can step back and reassess whether I need to give my continuous glucose monitor more of a place at my diabetes table. I would have never guessed that I might do that. I’ll still keep my meter handy. But going forward, I’ll be just as likely to rely on my CGM.

The Freestyle Libre (part 2): Final Analysis.

Disclosure first: I was given the Freestyle Libre continuous glucose monitor to try at home. Abbott is covering the cost of the device and two sensors. I am not being compensated in any other way. All opinions on my brief experience with this device are my own, as always.

My trial run of the Freestyle Libre CGM was pretty smooth sailing.

There are a number of things I should cover, so let me give you the rundown of what I’ve observed:
 
 
– First of all, as I mentioned earlier, the sensor warmup period is a lengthy 12 hours. It’s great that there are no finger sticks involved, but there certainly are when you have to wait 12 hours for your first CGM reading. You still have to know what’s happening with your blood sugar over the course of 12 hours. So even though I’m not using them to calibrate (the Libre is self-calibrating), I’m doing a fair amount of fingersticks during that 12 hour warmup period.

It’s been mentioned elsewhere that the warm up time in other countries is significantly less than 12 hours, so here’s hoping that gets ironed out soon (also, more on the “careful” versus “full gusto” submission processes with FDA below).
 
 
– Unlike what I’ve been reading from others who have been doing the same trial, the numbers I saw from the Freestyle Libre were almost always higher than what I saw from my Dexcom or my Accu-Chek Guide meter. When my numbers were lower, they were pretty much in sync, single digits separating the numbers on the screens. When the number got over, say, 140 mg/dL, the numbers on the Libre were higher.

In these situations, the Dexcom always showed the lower number, and the Libre the higher number. The number from my glucose meter was somewhere in the middle. Like this:

Obviously, I don’t know this for sure, but to me, this would indicate not a failure, but a difference in how the glucose data is being interpreted by each individual CGM. As many will tell you, it’s not usually the number, but the trend that’s important. Plus, if glucose is being interpreted a specific way on a regular basis, it’s easy to account for that, or at least understand when to do a BG meter check to make sure.
 
 
– The size of the sensor is very small compared to any other CGM sensor on the market (for those of us in the USA, about the size of a half dollar). Insertion was easy (don’t forget, my user guide was in Spanish, so I did my insertion based on online tutorials). The comfort level wearing this on my upper arm is without compare. And it stayed on, without the need for extra adhesion.

This might be a factor to keep track of down the road… If they get enough competition, I can foresee Dexcom breaking the mold, so to speak, and speeding up work on a smaller sensor and transmitter option.
 
 
– There is certainly a convenience factor in being able to take the reader, scan it over the sensor on your arm, and see a new reading instantly. Even less than a minute apart. For the record, Dexcom gives you a new reading every five minutes.

This is not a big deal to me, but I have to admit that sometimes, I found it easier to have the reader next to me when I slept, and instead of reaching for my phone and getting the number in the middle of the night, I just scanned and saw the number on the Libre reader.
 
 
– That said, I have my phone with me throughout the entirety of my waking hours. To roll out a medical device in this day and age, and not have a Bluetooth/Mobile option of some kind attached to it is a real shortcoming. Especially considering the reader options are significantly limited. There is a mobile app for Freestyle Libre available in other countries (known as LibreLink), but not yet in the USA.

I get it… Abbott either wanted to make sure they got the Freestyle Libre approved as a standalone without having to get the mobile app approved at the same time, or they couldn’t get it approved right away and went instead for just the sensor and reader. They’re probably working feverishly to get the mobile app okayed as soon as possible. I’m only speaking for myself here, but that’s a dealbreaker. Double dealbreaker if the mobile app eventually comes out only on an Apple platform (LibreLink is available in other countries on Android, so yay).

You might wonder why, in this case, I seem to be holding Abbott to a higher standard than maybe I held Dexcom a few years back. Why? Because it’s 2018. In case you haven’t noticed, we’re in a digital, mobile-manipulated world, and yes, I’m expecting industry to keep up with the times. Is that asking too much?
 
 
– One additional item: There have been rumblings about the lack of alarms with the Freestyle Libre. That’s true in a sense, because alarms are not part of this package, unless you’re actually scanning the sensor. You, as an individual user, will have to figure out whether that’s important to you or not. I’ve also heard a lot about alarm fatigue from the Dexcom, so I will leave it up to you to decide what is best for you.
 
 
Overall, I think the Freestyle Libre is a good option for People With Diabetes. The cost is less than the Dexcom, the readings are accurate enough for this cowboy, and you can’t beat the size and comfort of the sensor. I also think this might be a super option for some (if they can get it approved by insurance), because of the longer sensor life (10 days versus 7 days for Dex), and the fact that finger sticks are not required (other than sensor calibration, finger sticks are not required for Dexcom either).

Bottom line: For now, I’m not moving away from my Dexcom. If there’s a mobile app that allows me to see the reading on my phone, and helps me share data? Then I’ll be happy to take a second look.

Again, and I don’t think I can say this enough, it is wonderful to have an additional CGM option, and one that isn’t forced to be linked with a specific insulin pump. There are plenty of reasons to like the Freestyle Libre, and only a couple of reasons for me to hold off on a full throated endorsement (for now).

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