Category Archives: Diabetes

Diabetes University

December 17, 2013 – 9:23 am

The Great Spousal Unit is thinking of taking a few adult learning classes next year, and she picked up a course listing from the local community college. She knows what she wants to study, so her choices were obvious.

When I pick up a catalog like that, I can’t help but peruse the variety of classes offered by an institution. Everything from A+ Certified PC Repair Technician to Veterinary Assistant. I love reading course descriptions about HVAC repair and Kung Fu and wondering, could I really do that? Kind of like when I was a kid, looking at maps and wondering, could I go there? What would that be like? Oh hell… I still do that.

This time, as I thumbed through the courses a few things under Health, Fitness, and Wellness caught my eye. Classes like “Healing with Crystals and Gemstones”. If that’s something you’re really into, you can also take “Advanced Crystals: Healing with Crystals and Gemstones”. How about “Awaken Your Purpose Through Numerology”? My brain is filled with numbers all day already, so I’m not sure how much my purpose needs to be awakened (Awoke? Wakened? How about “Awaken Your Purpose Through Proper Grammar and Spelling”?). There’s also “Think Yourself Healthy”. That caused a V-8 slap to the forehead and an exclamation of “Whyyyy didn’t I think of that?”.

These course offerings did make me think about diabetes, though (admit it—you knew I was going there). What kind of wellness courses could be offered by People With Diabetes, for People With Diabetes?

A few of these are serious… the ones under Alternate Choices are just for fun. My apologies to anyone who may already be teaching courses like these. Honest, I’m not stealing your idea.

Serious Courses

Social Media and Diabetes – You Are Not Alone
Learn how to find online resources who are discussing subjects of particular interest to you and your diabetes. Explore real-life experiences told on blogs, Twitter, Facebook, and more. Course includes membership at TuDiabetes.org and MyGlu, as well as participation in the weekly DSMA Twitter Chat. Requirements: Internet access, empathy, and a willingness to tell your story too.

Diabetes Math 101
Learn why math is so important to managing your diabetes. Instructors will cover everything from calculating bolus amounts to determining the proper insulin to carb ratio, and how exercise and diet affect your ability to use insulin. By the end of the course, students should be able to manage glucose readings, CGM data, and pump information to help maintain an optimum balance between 80 mg/dL and 120 mg/dL as often as possible.

Pregnancy with Diabetes
In this course, prospective mothers and fathers learn how to prepare for, and how to manage through, pregnancy with diabetes. Course includes history of diabetes/pregnancy myths (“I am not Shelby”), and why preparation and micro-managing your glucose is the key to delivering a healthy baby.

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Alternate Choices

Interpreting Hypoglycemic Dreams
Our minds work overtime when we’re suffering a low, especially while sleeping. Learn from a “certified” astrologer what it means when your glucose is under 50 and you’re imagining your spouse riding a purple elephant on the wall of your living room. Course materials include a diary to log your most disturbed unconscious thoughts while you’re bottoming out.

Guide to Alternate Infusion Set/CGM Sites
Learn that your arm isn’t just for picking up your child or driving. Find out why your hips are not just for doing the salsa. Experts detail the use of those “other sites” that manufacturers and the FDA won’t tell you about. Warning: This course is not for credit. Students must sign a release exonerating the instructors and the university from all liability before starting class.

Mastering Glucose Food Enemies (Foodemies?)
We all have those foods that are so yummy, yet so crummy to our BGs. Students in this class will learn the basics of the square wave, dual wave, and super bolus. Begin to get the upper hand on foods like pizza, ice cream, and more. As always, moderation is key. Final class includes cupcakes! Prerequisite: Diabetes Math 101.

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Okay, now it’s your turn. What are some of the course offerings you’d like to see at Diabetes University?
 
 
 

By StephenS | Tagged , , | Comments (6)

Holiday goodness.. and badness, all at the same time.

December 9, 2013 – 10:03 am

DSC00478

Man, the holidays can be tough sometimes.

I’m talking about the difficulty of keeping your glucose in a good range despite all of the festive cheer that adorns plates and cups and crock pots full of cider and filing cabinets at the office with cookies, and lions, and tigers, and bears… oh my!

I don’t have any great advice for you on how to avoid the temptations and spikes to your glucose that giving in to those temptations means at this time of year.

Instead, I’ll tell you what works for me (most of the time—not always). Hopefully, there will be a nugget or two for you in here.

First of all, I try to perform BG checks a lot during this time. There are two reasons for this: 1) If I check, I know how to bolus, or adjust basal rates, of course. And 2) If I check, and I’m not in an optimal place, I know I have to wait. This doesn’t always work for everyone, I know, so it’s not advice. But for me, a high number often shames me into just saying no.

That said… Second, I try to never say never to anything. But in my case, I really try to think of less. If I think, “hey, I’d like to have some crab dip on some of that great bread in the basket there”, I’ll give myself about 15 minutes before I actually go for it. Often, that 15 minutes makes the difference, and I don’t go for the crab dip, or maybe I just forego the bread. I don’t do this all day, but if I do it here and there, and it works, I wind up eating or drinking less than I might have in the first place. Every little bit helps. Oh… if I do all this and I still have trouble with my glucose, I try to remind myself where I’d be if I hadn’t done all of this in the first place.

Third, I remind myself that there are certain truths regarding the holiday goodies. They are good. Because they are often things I don’t have the rest of the year, they’re harder to bolus for. Other than a snack in the evening, eating at any time other than mealtime is just not my thing (though, truthfully, you wouldn’t know that by looking at me). And I know that I won’t be tempted by this stuff a month from now. It is the holiday season after all, not the holiday year. It makes sense if our numbers are off from time to time in December. Which makes having a number that’s in a good place really fulfilling right now. I hope you get more than a few of those 80 mg/dL – 120 mg/dL readings this month.

Thanks for letting me write this out. It feels good getting this out of my head. Again, it’s not advice, it’s just what works for me. I’m just trying to enjoy the holidays without a ton of guilt, while keeping the BGs in a place I’m comfortable with. That’s like climbing an icy roof this time of year. But keeping track of where I am, making do with less, not none, and understanding the realities of holiday fare makes things a little easier for me to handle.

I wish you luck with your holiday indulgences. Have any great tips for me?
 
 
 

By StephenS | Tagged , , , | Comments (2)

Medical IDs– Update your info.

November 6, 2013 – 8:54 am

I’ve seen a few #dblog posts recently (like this one) from writers talking (and asking) about medical ID gear. So I thought I would weigh in on the subject too.

Officially, I’m still wearing my Medic Alert necklace that I purchased about 15 years ago (click here to see– no, I don’t have the beaded chain). The reasons are simple: I’m okay with how it looks, it’s durable, and it’s always around my neck. I really only take it off to swim.

But it’s not that simple. Medic Alert keeps a profile on you containing lots of information like your emergency contacts, your medical team, and more. The idea is that responders can call the number on the back of my ID, give the serial number on the back, and get all of this info in a flash. While I’ve had my necklace for a long time, I recognize that some of the important information is out of date.

How out of date? Really, really out of date.

I logged onto the Medic Alert site. Well, no, that’s not exactly what I did. I went to the site and had to create a user ID and password. It’s been so long since I updated my information that Medic Alert has gotten into the 21st Century and actually created an online way for you to update your information. For all I know, this could have occurred back in 1999, because it’s been that long since I last updated my info.

Since then, I’ve changed doctors (3 times), I’ve changed insulins (twice), I’ve added an insulin pump, and I actually got a mobile phone!

Moral of the story: It’s great to have something that alerts responders of your condition, and who to contact when you can’t do it yourself. Extra points if it looks good too. But something new and bright and shiny doesn’t help if the information associated with it is stale.
 
 
 

By StephenS | Tagged , | Comments (2)

The people we look up to.

October 28, 2013 – 1:18 pm

It was three weeks ago that Tom Hanks revealed he’s living with Type 2 diabetes.

Tom Hanks is maybe my favorite living actor. Everything I’ve ever seen him in… He plays all of his roles so well that I have no trouble believing him as the character he portrays on stage and screen. I’ve got to think that’s exactly what an actor is going for when they play a part. If there was a movie star I’d really like to meet (other than maybe Sandra Bullock– for obvious reasons), it would probably be Tom Hanks. So the news of his diagnosis really hit me. And since then, I’ve been trying to find something profound to say about it.

Then, last Monday, Karmel Allison, who writes over at asweetlife.org, has lived with Type 1 diabetes since age 9, and is now 21 weeks pregnant, nearly passed out while standing behind the President of the United States. She was there because she wrote a fantastic post about how she views the Patient Protection and Affordable Care Act (AKA Obamacare) as a Person With Diabetes. The President’s speech was about his signature piece of legislation. I haven’t seen anything from her that specifically says it was hypoglycemia, but in the video it sure looks like hypoglycemia to me. Anyway, that part really doesn’t matter… does it?

At any rate, I was on the road from Charlottesville to Baltimore when all this happened, so I didn’t even find out about it until the next day. And yes, I read the comments after many of the stories about the event posted on the web.

I was shocked. I was horrified at the mean, awful, hateful things written. Democrat or Republican, Liberal or Conservative, you have to admit that the vitriol spewed in her direction was ridiculously mean. Other than what I saw posted from the Diabetes Online Community, I did not see one positive, one semi-empathetic comment. Not one.

Meanwhile, Karmel has kept from writing awful, vindictive things in response to these hate filled attacks on her and our President. Her Twitter account has been almost silent since the event. Even though she has a right to be angry and lash out at people who hate her only because of her proximity to the leader of the free world during a speech in the rose garden, she appears to have taken the high road.

What does this have to do with Tom Hanks’ diagnosis from two weeks earlier? And what do these two events tell me? Just this:

Our heroes can and do develop diabetes.

Our heroes can be and are affected by diabetes.

Our heroes remain strong and retain our respect despite diabetes.

These words apply to everyone out there telling their story through laughter, advocacy, sadness, athleticism, schools, careers, successes, and failures too. Tell your story honestly, with empathy for all and resilience against all odds, and I will always look up to you.

And no amount of hate can take that away.
 
 
 

By StephenS | Also posted in Additional Inspiration | Tagged , , | Comments (2)

Minimed® 530G with Enlite®. Five questions.

October 2, 2013 – 9:50 am

So the Medtronic 530G and Enlite sensor are here, featuring a new pump and a new CGM (continuous glucose monitor) that talk to each other, with a never-before-available-to-the-public Low Glucose Suspend (LGS) feature. Essentially, when your CGM hits a pre-determined threshold, the new Med-T pump will suspend itself for two hours (or less, if you’ve recovered from a hypo event before the two hours are up).

This is a super development. It’s great that advances in glucose monitoring and insulin delivery and interaction between the two are making their way to the market.

Being the inquisitive sort, after I got excited about the news, I started asking myself questions. Five came to mind in about ten minutes. I don’t have answers to these questions. Maybe no one does. But since it’s my blog, I thought I would ask them here.

A couple of my questions came after reading a fine piece on the 530G at Diabetes Mine. They interviewed company officials and provided some information that I’ll be referencing here. If you’d like, feel free to read their story, then come back here.
http://www.diabetesmine.com/2013/09/new-medtronic-device-gets-fdas-nod-but-dont-call-it-the-veo.html
 
 
Now, the questions:

1. Who gets priority when the orders start coming in?
Will it be new Medtronic customers? Replacements? Upgrades? Influence-peddlers (bloggers, diabetes organization muckety-mucks, etc.)? In all honesty, this is kind of a non-starter for me, because a)There’s really no way for me to find out, and b)The supply will probably outstrip the demand for the product within the first year anyway. By then, we’ll forget how bad some folks wanted it right now back in October 2013.

2. In replacement/upgrade scenarios, what happens to used pumps?
I could (and should) have asked this long ago, but what happens to the old pumps? If the 530G is the greatest system out there, I certainly would like to upgrade. But if someone can’t do that, either because of cost or other factors, I would feel great knowing my Revel™ pump is still going strong, working its magic for another patient. Is that even possible? If not, will the pump’s material be recycled somehow? How does this work today?

3. New users of the 530G will work with a trainer, like they do when starting on other Minimed pumps. What kind of education will 530G users get?
I ask this question because while I was trained, I was not educated about insulin pumps and pump therapy in general before starting on my pump. I was good at getting my A1c down, but there was still a lot I didn’t know. Thanks to my fantastic endocrinologist, I was able to get up to speed pretty quickly. Still, I did not know what insulin on board meant until I read about it online. So theoretically, I could have had the 530G, stacked my boluses up to the ceiling one evening, had the threshold suspend feature kick in on my pump, and still had plenty more insulin acting in my system for a while. Without knowing what was happening to me or why.

I don’t want a new user of the 530G to find out about IOB the hard way like I did.

4. The Diabetes Mine piece mentions that the 530G will not communicate with Medtronic’s MySentry remote monitoring system because the FDA didn’t clear it to communicate wirelessly. Isn’t the CGM communicating wirelessly already? And why do they need FDA approval for something like that?
I remember being at the JDRF Research Summit in Bethesda, Maryland back in March. People working on artificial pancreas technology at the University of Virginia’s Center for Diabetes Technology presented, and among the things they revealed was a remote monitoring feature. Parents in attendance were super-interested in this, and they asked the presenters about whether something like that might be available soon. I remember the UVA presenters said that they didn’t anticipate rolling out the remote monitoring ahead of any device they might be working on. But they also said that they didn’t believe something like that needed FDA approval, because it wasn’t doing anything medical. It was just reflecting what was already going on with the AP system, and the remote monitoring itself wasn’t being used to make any medical decisions for patients.

And like I said above, the Enlite CGM will be communicating wirelessly with the pump already. Shouldn’t be too hard to get it to talk to the MySentry too.

5. Finally: What’s all this artificial pancreas posturing about?
You knew I would ask this, right? This is a little touchy for me. Rhonda at FifteenWaitFifteen wrote about being uncomfortable about this too. Medtronic, and by extension now, many in the media, are using the term “Artificial Pancreas” when referring to this system. The LGS feature in this system is very AP-like. But after seeing numerous talks about artificial pancreas technology, from more than one source in the past year and a half, I can tell you that the 530G is not an artificial pancreas device in the way I think of one.

Last time I checked, no one copyrighted the term “artificial pancreas”, so Med-T is within their rights to tout it as an AP device if they want to. But I worry about two things: First, will using the term with this device, which doesn’t have all of the features of artificial pancreas technology, cause non-D friends, family, and co-workers to think this is the holy grail, and now we shouldn’t have any trouble with our diabetes from here on out? Second, will using the term “artificial pancreas” like this eventually dilute the term for all of us, to the point where just a CGM that talks to a pump will be considered an AP device? We’re just now making big strides in technology that will benefit many with diabetes. When an outfit uses the term “artificial pancreas”, I don’t want it to be less than I’ve been led to believe it will be. Just my two cents. Feel free to disagree.

Full disclosure: Okay, half disclosure. I have a particular interest in this topic, especially right now, and I recognize that this may skew my viewpoint. More about that next week.
 
 
So those are my five (plus) questions on the Minimed 530G with Enlite. As with almost everything, time will probably provide the answers. Do you have any questions of your own? Have any answers for mine?
 
 
 

By StephenS | Tagged , , | Comments (8)