Monthly Archives: April 2018

Like these links: More of the DOC’s greatness.

It seems to me that I haven’t shared much of the Diabetes Online Community’s greatness with you lately. So let me try and rectify that. Here’s what I’ve been reading lately:
 
 
“That is where the silence comes in. When things are good, we have nothing to talk about. When things are bad, we are ashamed to talk about it. Why? Because the world is full of assholes.”
That’s from Brian at (Buzz, Buzz) Not my Cell. He’s talking about perspective, how the world could use a little more of it, and how sometimes, he recognizes his life is easier than others who have to contend with diabetes every day. I see a lot of truth in this:
Easier Said Than Done
 
 
Kate Cornell has an update on her experience as an insulin user. If you’re living with Type 2 Diabetes and thinking about talking to your doctor about insulin as part of your diabetes management, you just might want to hear what Kate has to say:
Insulin: An Update
 
 
Diabetes Dominator Daniele Hargenrader has a super diabetes life hack to share with you, and it’s a good one, especially if you use an Omnipod:
Diabetes Adulting Hack
 
 
This Diabetes Mine post about alcohol and diabetes is worth a look. It’s a good starting point if you’re looking for more information on mixing alcohol and insulin. And there are helpful links to additional resources included:
Yes, You Can: Safely Drink Alcohol with Diabetes
 
 
And Laddie Lindahl is about one year in on her experience with Medicare. Here, she talks about how it’s going. I’m taking notes from her Medicare posts so I have a roadmap for my own Medicare experience in about ten years:
One Year on Medicare: Advocacy Versus Acceptance
 
 
Renza used her 20th anniversary of living with diabetes to come up with a list of things she wishes she’d known when she was diagnosed. I don’t know if I could come up with twenty, let alone twenty seven:
Twenty things I wish I knew about diabetes
 
 
Finally, a reminder from Kelly Kunik via an experience at a local coffee shop. We could use a little more of this too:
Kindness Counts
 
 
One more thing… you may have noticed that my blogroll to the left has been updated. I took out the ones that are gone or where nothing has been posted in the past year. I also added a couple of new Blogs Worth Your Attention. If you have any others you’d like me to add, let me know. Thanks!

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Lists and Agendas and Diabetes.

This is the list of tasks I wanted to accomplish last weekend. I know, taxes. I’m not usually a last-minute filer, but after getting them nearly completed a week ago, I needed to get some additional information together before I could send them out.

The good thing about lists is that you can keep track of everything you want to do, or that you want to pick up at the grocery store. Plus, if you’re me, lists are valuable for not forgetting things. I am an unabashed list maker.

That’s where diabetes is different. You can’t make a list for diabetes.

You can make a list of prescriptions or supplies you need to refill. You can list the doctors you need to see this month. But when it comes to the everyday highs, lows, and in betweens of living with this thing on a never ending basis, there is simply no way to plan it out.

I’ve seen the internet memes where people draw schematics to map out their decision processes when their BG is high or low. For many, doing a design like this is cathartic, and for people who don’t live with diabetes, it’s even enlightening.

Speaking only for myself though, it’s neither. That’s not to say I think it’s useless. It’s a great tool. But it’s already been done, and I don’t think I could add much more to it, though it might be fun to try someday.

Also, I remember that there are no schematics, no lists, that can’t get blown away at a moment’s notice, just because diabetes wants to screw with you that day. So while it’s funny to imagine all the twists and turns of our decision-making that happens, the truth is, we often don’t know what’s going to happen during the course of a day with diabetes.

Remember when we read about the costs of diabetes beyond doctor visits and prescriptions? This is part of what they’re talking about. It’s where lives are changed and appointments are missed and meals are adjusted and where we all pay, all of us, everyone living with and not living with diabetes… it’s where all of us pay the cost of a condition that doesn’t care about lists and agendas.

I accomplished everything on my weekend list. That’s the product of a plan, a focused effort, and a diabetes that actually cooperated for once. What galls me is that I have to rely on more than a plan and focused effort to get the job done.

Not exactly Spielberg, but A.I. has arrived.

It is kinda cool, at least for starters.

Wednesday, the U.S. Food and Drug Administration (FDA) approved marketing of a device designed to use artificial intelligence to detect retinopathy in people living with diabetes.

There are several things to cover here. First of all, the FDA announcement is that it “permits marketing” of the device. In other words, it can be sold to practices as an artificial intelligence diagnostic tool. There was a fair amount of testing and back-and-forth in the development and rollout of this device, and I’ll get to that in a minute.

Simply put, this is a way for non-eye doctors to use a tool (actually, two tools) to take a photo, upload the photo, and get a retinopathy or not retinopathy diagnosis. It’s not designed to avoid the more detailed examination an ophthalmologist can perform. But it’s a way to perhaps get an early diagnosis of a potential issue with your eyes.

The tools used by the doctor (presumably, a primary care physician, or GP) are 1) The Topcon NW400 retinal camera. The doctor will take a photo with the retinal camera, then upload it to the cloud, where it will be analyzed by 2) The newly-marketing-permitted IDx-DR software to determine one of two outcomes (from the FDA press release… see link below):
(1) “more than mild diabetic retinopathy detected: refer to an eye care professional” or
(2) “negative for more than mild diabetic retinopathy; rescreen in 12 months.”

So, where’s the “artificial intelligence” angle here? I’m glad you asked.

This is the first device (the software is considered a device in FDA parlance) allowed to be marketed to provide a decision without getting a clinician involved in interpreting the results. In other words, the software, not a human, tells you whether there’s an issue or not.

How did the FDA arrive at the level of confidence needed to arrive at this decision? There were 900 diabetes patients in the clinical study, in ten different locations. The study revealed that the software made the right decision on “more than mild diabetic retinopathy” 87.4 percent of the time, and “not more than mild diabetic retinopathy” 89.5 percent of the time. That may not seem like a lot, but to this observer, that sounds pretty good for first generation software.

One of the other things I’m encouraged by is the way this rollout was handled through FDA’s De Novo premarket review pathway, designed to help new devices that are seen as being low to moderate risk get marketing approval. Through this, FDA granted the software Breakthrough Device designation, which provided a framework for greater interaction between developers and the FDA on guidance, testing, and documentation, so the developers could work more efficiently on FDA’s concerns, and the FDA could more effectively work on review.

Hey, look… I don’t know if this software and the retinal camera needed to make it work are going anywhere. But I think this story is important to pay attention to for the way it was handled by the developers and the FDA, particularly FDA’s Center for Devices and Radiological Health; and the fact that this is software that removes the human element from at least the initial diagnosis process.

How you feel about such a development is your choice.

Read the full FDA press release HERE.

Find out about the De Novo premarket submission process HERE.

Find out about the Expedited Access Pathway Program for Breakthrough Devices HERE.

How do you talk with loved ones about diabetes?

Relationships. We’ve all got ’em, of one kind or another. Parent-child, siblings, significant others, Friends, Romans, Countrymen. And when it comes to diabetes, communicating with the ones closest to us is not as straightforward as it may seem on the surface.

Let me ask you: Have you ever held something back from a loved one, or if your loved one lives with diabetes, have they ever held something back from you? Maybe what was conveyed was not the truth, the whole truth, and nothing but the truth. Maybe a detail was left out here or there.

Hey, you’re not alone. I’ve done it too, for differing reasons. I’ve left out details of a really bad low I had when I was traveling by myself. If my blood sugar was 65 mg/dL before lunch, maybe I said it was 95 mg/dL, even though the 95 was actually an hour and a half ago.

You might not know this, but that’s really hard for me to do. I tend to overshare, especially about my diabetes. The fact that I’ve not shared everything is a sign that I’ve taught myself to when to share and when not to share with the one person I should be willing to share anything with.

Excuse me while I pause for a moment of guilty reflection…

I worry sometimes that this means I’ve given up on getting The Great Spousal Unit to understand certain aspects of my diabetes. I’m sure there’s also an element of “I don’t want to worry her too much”, but let’s focus on the understanding right now because I want to ask:

How do you do it?

How do you decide what is worth sharing, what should be kept to yourself, what is important for your loved ones to know and not to know?

Do you ever get burned out talking about another high or low, another bad pump site, another failed CGM sensor?

What’s the dividing line between Tell and Don’t Tell?

Sure, if it’s important for Maureen to know so she can act on my behalf when I can’t speak for myself, I have to tell her. If it’s something that happened and she’s no worse off for not knowing about it, it’s probably okay to keep it to myself.

But there’s a lot of gray area in between there. And I’ve been doing a lot of personal examination lately to try and determine if I need to revamp my communication strategy with those closest to me.

It’s easy to get complacent when it comes to sharing, what we share, and how we share it. It’s easy to believe we’re sharing exactly the right amount at the right time, with the right person. But every once in a while, it’s okay to do some self-examination and reconsider how we’re talking to the people who mean the most to us.

We’re going to be covering this very topic tonight at 9:00 ET(US) during the weekly DSMA Twitter Chat. If you’d like to talk about it, follow the @DiabetesSocMed Twitter account and look for and use the #DSMA hashtag.

Join us, and let’s get a handle on this communication thing.

Another Blogabirthday.

Today, Happy Medium turns 6. Today, I turn 56 years old. And yes, even though I’m not close to retirement, I’m at least doing the math.

Another Blogabirthday is here.

The 788 blog posts I’ve shared, including this one, have meant so much. This website has given me an extended chance to speak about subjects that have been very important to me.

Okay, there have been recipes and vacation recollections I’ve shared too, but I keep coming back to the main purpose of this blog: To connect, to share my thoughts, to serve as a platform for learning and sharing what I’ve learned. Also, to serve as a personal journal of sorts, so people reading this after I’m gone can see what it was like living with diabetes in the mid 20-teens.

It can’t all be seriousness and clinical thinking though. If that’s what this was about, I think I would have lost my inspiration for it a long time ago. While posts have been a little less frequent in the past year, they’ve still been regular, and that brings me to this thought:

I really, really like writing here. If you write a blog too, you might have a sense of this, but if you don’t, I don’t know if there’s a way to describe how blissful I feel every time I sit down to write something. It never seems like a chore.

This is one of the only places in my life (maybe the only place in my life) where no one can tell me what to say or how to say it. Every time I think about that, I almost get chills thinking of how absolutely free that makes me feel.

There are still many of us writing out our thoughts, educating others, and chronicling our lives online. I’m not unique. I think if you were to ask all of us for a memorable moment from blogging or other social media activism, my guess is we’d all recall something that had a direct impact on the life of one individual.

Readership at Happy Medium has gone up and down and up again over the years. I don’t pay too much attention to the stats. What I pay attention to is when I can express something that makes someone feel better, either physically or emotionally. That makes me want to come back to the keyboard and do the same for someone else, because no one should have to feel like they’re alone living with diabetes.

It’s as true as when I wrote this almost five years ago:

“If you’re only reaching one person, that one person is the most important person in the world… Your story is the most important one in the world to the person moved by it. Don’t let down the one person who needs to hear you.”

Whether you make that connection online or off, this is what makes the Diabetes Community special. Share your story. Use your freedom. Never take it for granted.

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