Category Archives: Diabetes

Somehow, diabetes is diabetes.

January 15, 2016 – 9:05 am

Edmund Burke once said, “People must be taken as they are, and we should never try to make them or ourselves better by quarreling with them“.

The same holds true for diabetes.

Regardless of what I’m involved in at the moment, good or bad, diabetes is there. Work, gym, party, driving, it doesn’t matter. Hey, I’m like everyone else… I like out of sight, out of mind thinking. But diabetes just won’t allow me to do that.

When my BGs were running low the other night, right at the end of work, I just wanted to power through it, finish up, walk to the train, and head home. But… as you can probably imagine, I wound up sucking back juice boxes, staying later, and getting home about an hour later than usual.

Part of the secret to managing diabetes, I think, is in realizing that the same diligence is required for those moments when we may not feel high or low. We might not always feel it, but we know it if we’re checking. And if we know it, and it seems like the numbers are consistently not what we need to live a healthy life, then we know we need to make changes.

And once we make the changes, then we have to deal with verifying that our changes are actually working. So that requires staying on top of the part of our diabetes management that wasn’t so perfect before the change. Maybe we need to make additional changes after the first one to get our BGs back where they need to be. That’s life, and that’s diabetes.

Burned out yet? I know, I know.

Listen, making changes is tough for me. Dealing with stress because my changes don’t seem to be working right away can make me very cranky. If there’s ever a time when I want to curse diabetes, this is it.

But… somehow, diabetes is diabetes. It doesn’t care if you’ve made changes, and it doesn’t account for how hard you’re trying. It’s really not doing anything at all. It’s requiring you to do everything. We can quarrel with this disease all we want, and then we wind up right where we were before the argument began.

Although he wasn’t speaking specifically about diabetes, Edmund Burke also said “Our patience will achieve more than our force“. I think that applies pretty well to diabetes too. It’s with us for the rest of our lives, probably. If we can make meaningful changes to our overall lives, and give it a little patience, we just might be okay after all. Doing what we can to work with our diabetes, rather than rage at our diabetes, makes us healthier. And it might just give us a chance to live longer too.

I’ll settle for that.
 

By StephenS | Tagged , | Comments (3)

Interview: Kevin Sayer, Dexcom President and CEO.

September 23, 2015 – 10:10 am

I had a super conversation this week with Kevin Sayer, President and Chief Executive Officer of Dexcom, the most popular continuous glucose monitor on the planet.

This was intended to be a podcast interview, but due to technical issues on my part, we were not able to record our conversation. Too bad, because it really was a good one.

Since I’m not very good at writing down things word for word (one of the many reasons I started a podcast), I will instead give you a synopsis of the questions I asked (in bold), and the answers that were given. Just imagine us talking, and it will be almost like being there.
 
 
First, I asked Kevin about his twenty-plus years of experience in the medical technology and medical device field. What has that experience taught him about the importance of what he does, and how it affects patients living with diabetes?

He answered this by telling me about a Facebook post he read earlier in the day. It was from a parent of a child with diabetes, who was in the hospital. The child was wearing a Dexcom CGM, and had a glucose check performed by a nurse. The check came in in the 240 mg/dL range, and about an hour later, the nurse came back to perform a correction bolus based on that amount. Only the Dexcom the child was wearing had shown that his BGs were coming down, and were still trending that way. After some pleading, the parents were able to convince the nurse to check again before blousing. That check resulted in a reading in the 60s. In this instance, the Dexcom, and the parent’s trust in what they were reading, helped to avoid an emergency, and possibly saved a child’s life. Cases like that help underscore what Mr. Sayer, and Dexcom, are trying to accomplish.

Dexcom has been pretty innovative over the years. In the past year, we’ve seen the rollout of Dexcom Share, and FDA approval of the Dexcom G5. A little over a week ago, they received the CE mark of approval in Europe for the G5, so they’ll be rolling out that product to Europe in the coming weeks. Has Dexcom started shipping the G5 to users in the USA?

The answer is: Yes! Just this week, the G5 started going out to users here in the USA.

FYI: If you are currently on the G4 Platinum product, there are low cost, and in limited cases, no cost upgrades so people can more easily move to the latest and greatest Dexcom system. Go to the Dexcom website for more details.

In the news release on the G5 in Europe, I noticed language that states:

“…the new Dexcom G5 Mobile CGM system does not require confirmatory finger sticks when making treatment decisions.”

Now, we know that’s a no-no here in the USA, and the G5 has not been approved for that here. But I also know there are clinical trials ongoing to help determine the efficacy, I guess, of People With Diabetes dosing insulin based on CGM numbers rather than fingersticks. Other than being the CGM involved in the studies, is Dexcom involved in those trials in any other way?

This elicited a passionate response I wasn’t expecting. Kevin Sayer is firmly behind the idea of using a properly-functioning, properly-calibrated CGM to inform insulin dosing decisions, independent of fingerstick confirmation. Dexcom has mounds of data, from multiple studies, and they are planning to go to FDA at some point to get the, I believe the term was, adjunctive exemption that would allow Dexcom to promote their CGM (either the G5 or a future generation product) in the same way that they are promoting it in Europe. He believes that trending data gathered over hours, rather than a one-time BG meter reading, is a more accurate way to determine insulin dosing decisions.

I’m really blown away by the amount of collaboration that Dexcom has been involved in over the years, and I’m talking several years, at least back to 2007. Most recently, we’ve seen Dexcom become part of the Animas Vibe system, and part of the T:Slim G5 system. In an industry that gets a lot of criticism for not playing well with others, what’s the secret to Dexcom’s success in making these partnerships happen time after time?

Mr. Sayer gave kind of a two part answer to this. In the beginning, Dexcom was very small, and collaborating with a bigger partner was a way to grow the business and forge relationships. Today, it’s about Dexcom being the CGM of choice, and making sure that if a Person With Diabetes wants to use a Dexcom as part of their overall diabetes management, they should be able to do that. And forming relationships years ago helped Dexcom have those conversations with other companies when the time came to branch out.

I also asked: Does he see Dexcom as a leader in collaboration as well as technology? The answer is yes. It happened the way it happened over the years, but yes, Dexcom sees collaboration as essential and good for Dexcom.

Finally, I asked about CGM coverage for Medicare patients here in the USA… rather than talk about what passage of such legislation would mean to his company, I wanted to ask: How does it make you feel knowing that patients on Medicare, some of whom were your customers a year or two ago, are unable to use CGM technology at all, without paying 100 percent out of pocket for it?

This, he admitted, is the biggest thorn in his side right now. It’s the biggest complaint that Dexcom gets on a regular basis. He mentioned that his most reliable customers, in addition to children using the G4 and G5, are those in their 40s, 50s, and 60s, who might be less hypo aware, and rely on the safety of CGM technology to help keep them out of the hospital. And have been steady CGM users for a long time. To take all that away just because you reach a certain age doesn’t make sense. Dexcom is working alongside others to try to convince lawmakers to add a category to Medicare coverage, allowing seniors in my country to continue using CGMs. The patient data and the dollar data backs it up. Dexcom will continue to fight for CGM coverage for patients on Medicare.
 
 
You know, the thing about Dexcom is, you can’t even blink hardly without seeing another announcement about a new product, upgraded technology, regulatory approvals, and continued partnerships. It has to have been an exciting almost nine months as CEO for Kevin Sayer. From my standpoint, I’m looking forward to what the next nine months and beyond will bring from Dexcom.
 

By StephenS | Tagged , , , , | Comments (4)

The blog post I did not want to write.

August 26, 2015 – 9:11 am

This is the blog post I did not want to write.

I love writing here. Actually, I love writing. I enjoy being a part of the Diabetes Online Community, and I enjoy writing (and now podcasting) maybe more than anything else I’ve done in the past few years. It’s a constant source of enlightenment (yes, I learn from you). It’s a constant source of joy to look at a topic and write something meaningful. It’s fun. A lot of why I do this is because it’s fun. It’s a gift to be able do this, and it’s one I’m grateful for every day.

But my paying job needs me right now. Until the end of the year, my work weeks that usually total around 40 or so hours are now totaling around 55 hours or so. That’s not so much when you’re 25, but it’s a lot when you’re 53. Also, The Great Spousal Unit has been away almost as much as she’s been home over the last few months, and I really feel like, you know, since I made this commitment to her 22 years ago, I should actually spend time with her when she’s here. Both of those things have seriously cut into my time to write and podcast.

Let me be clear: I am not closing up shop. I will continue to write. I will be delivering new episodes of Diabetes By The Numbers. If you write to me requesting a Champion Athlete With Diabetes medal, I will be happy to send one out. I still plan to participate in the #DSMA Twitter conversations every Wednesday night. I’m not saying no to anything, and I will try to fit whatever I can into my schedule any way I can. I am not going away.

But, though it really hurts my heart to say it, unless something changes, my pretty much three-times-per-week posts will be less frequent through the end of the year. Once we reach January, I suspect that will change and I will be able to go back to something a little more regular again. That’s what I want, and that’s what I like. I write here for you, but I write here for me too. Can you get endorphins from writing?

The really good news is that there are still plenty of other diabetes blogs to read, and even more coming online all the time. I get so much reading about others living with diabetes, their experiences, their challenges, and how they’ve met them with bravery and resilience. That should hold me for a while, and I hope it will hold you too in the times when you don’t see something new here.

I’ll talk to you soon… I promise.
 

By StephenS | Comments (18)

Imagine this:

August 18, 2015 – 8:44 am

This post is for everyone who does not live with diabetes.

Hi there… thanks for taking a few minutes out of your day to visit my space on the internet. Today, I’d like you to close your eyes and imagine this:
 
 
Imagine that you’ve just gotten a life-altering diagnosis from your doctor. You’ve been told that you have an incurable disease. You can manage your disease, enough to stay alive, but it’s still an inexact science and often, just when you think you have things well in hand, you face a life-threatening situation. Completely out of the blue. Even though you’re “doing everything right”. Like I said, an inexact science.

Imagine voluntarily poking your finger multiple times each day, just so you can have a benchmark from which to apply your inexact science. Imagine having to do it more often on the days when you feel your worst, like when you have the flu, or after you’ve had a terrible bout with hypoglycemia this morning.

Imagine you’re an insulin pumper. To be able to get the one thing that keeps you alive, you have to be willing to abuse your body every three days, injecting a thick needle with a spring loaded device. Once you remove the needle, a little plastic cannula is left behind. Having a foreign object in your midsection, your behind, your thigh, or your arm for 72 hours means you’ll eventually develop scar tissue that will make it even harder to abuse your body every three days.

Imagine you’re using a continuous glucose monitor, or CGM, to help keep abreast of how your blood sugar is trending throughout the day. Great tool… but there’s another injectable, this one every seven days.

Now, imagine you’re not an insulin pumper. Great. Now you have to inject your insulin using a syringe several times each day.

Imagine having to fight to get insurance to cover even part of this, including the very drug you need to stay alive. Oh, maybe you can get that drug, but it’s not the version of the drug that works best for you, because your insurance carrier has decided they can make more money by steering you to another version. The brand that’s covered doesn’t work as well for you? When you’re on the brand of insulin we cover, your glucose runs high all the time, potentially causing co-morbidities to become a reality? So what… we make more money with it, so you’ll use it. And pay us for the privelege.

Imagine a state legislature and a congress that allows this to happen.

Imagine being told, at the age of 65, when you’re eligible for Medicare, that you’ll have to give up your CGM because it’s not covered. Imagine a congress that allows this to happen.

Imagine living with the threat of all of the things that might happen to you as a result of living with diabetes 24 hours a day, 7 days a week, 365 days a year, without a vacation, whether or not you were able to manage your diabetes well over the years.
 
 
The point here isn’t to guilt you, dear reader, into feeling sorry for all of us living with and affected by diabetes. Instead, the point is to show you how much we endure, and how strong we really are, even at our weakest.

People With Diabetes are your friends and neighbors. Family. Co-workers. Teachers and students. Infants, teenagers, adults, and seniors.

Imagine a world where one is not stigmatized by nature of the disease they live with, but rather recognized for their endurance despite the nature of the disease they live with.
 

By StephenS | Comments (3)

Look at this list!

August 12, 2015 – 8:44 am

Today is a glass half full day. Why? Because I want it to be a glass half full day today. It’s my blog… do I need another reason?

I was thinking last night of how far diabetes tools have come since my diagnosis over 24 years ago. See what I mean? Glass half full. I came up with twelve (okay, really, eleven). Check out this list:
 
 
1. When I was diagnosed in 1991, the number of glucose meters available to People With Diabetes was very limited. Today, even though they’re not always the best choices, there are many more glucose meters for PWDs to choose from.

2. And let me state the obvious: My first glucose meter took 45 seconds to give me a reading. Today, I get a reading in just five seconds. Very few things have actually saved us time over the years, so I think this is a lot bigger than many people realize.

3. Unfortunately, the cost of test strips has been, and continues to be, ridiculously high. But it’s a glass half full day today, so… moving on…

4. Continuous Glucose Monitors! Gotta love CGM technology. Real-time readings of how your BGs are trending? Who doesn’t love that? Glass half full, baby!

5. Insulin pumps. Hey, I know that insulin pumps were developed earlier than my diagnosis, but the prevalence of insulin pumps, and the technology in insulin pumps, has definitely improved over time. And…

6. I didn’t start on an insulin pump until just over five years ago. For the first 19 years after diagnosis, I injected insulin first with a needle that was, I don’t know, maybe an inch and a half long? Then I went to smaller gauge needles, then I went to shorter lengths, and now, of course, we have insulin pens that are easier to carry and actually contain our insulin too. There’s something to be said for reducing the burden of diabetes, and better insulin delivery devices via injection are another step in the right direction.

7. And how about that insulin? It’s come a long way since 1991. We have long acting insulin like Lantus and Levemir. We have more reactive shorter acting insulin (is that the term?) like Apidra, Novolog, and Humalog. And we even have Afrezza now, inhalable insulin, and I guarantee hardly anyone was thinking about that back in 1991. We’ve seen incredible improvements in our most necessary synthetic hormone over the last 24 years. Now if they can just find a way to make it affordable.

8. No list like this can exist without mention of the wonderful Diabetes Online Community. How many of us would be forced to live our diabetes lives alone, out of touch with the latest news, unable to communicate with even one other soul who understands what we go through on a daily basis? It is not in any way an understatement to say that the DOC has been a lifesaver for many, literally and figuratively.

9. Uploading, sharing, and analyzing your data. By the time I was diagnosed, I hadn’t even purchased my first computer. Today, I’m sharing information with my endocrinologist, and she’s uploading my pump information every 90 days. Many, many more are using Nightscout or Dexcom Share to provide real-time CGM data to their loved ones for peace of mind and added safety. Such a simple idea, such a huge advancement.

10. Apps! Apps! Apps! From bolus calculator apps to fitness apps to apps designed to help us tame the diabetes monster, there are more ways than ever to help us crunch all the numbers and do better than we might have done all on our own.

11. The number of gatherings and conferences about diabetes and for People With Diabetes has really increased, even since I found the Diabetes Online Community, let alone since I was diagnosed. Here’s to more chances to learn, meet, and grow at gatherings around the world.

12. We’re giving more, and in more diverse ways than ever before. We may not be any closer to a cure (or we may be closer), but Spare A Rose/Save a Child, Big Blue Test, JDRF and ADA bike rides, and much more have all helped to provide additional revenue and additional ways for all of us to invest in improvements in the lives of PWDs, and certainly, hopefully, a cure.
 
 
That’s a heck of a list, and I’ll bet I haven’t thought of everything yet. Care to add something? Turn on the glass half full side of your brain and think about it. What improvements have you seen since your diagnosis?
 

By StephenS | Comments (2)