I'm still recovering from lost sleep due to the World Series. Remember I come from Ireland originally, so I'm still really learning about baseball. But having the Sox win in 2004 really got me interested.
And then there was the final game on Sunday. It's 11:30 at night and we're heading towards the end of the game.
Thanks to my Dexcom CGM, I'd watched my blood sugar heading lower. But I didn't want to miss the game to correct it. Finally I tested with my OneTouch, and it pretty much agreed with the Dexcom.
So I had to run downstairs to get some quick-acting carbohydrates to bring my blood sugar up to a normal range.
About 30 minutes later my blood sugar was closer to 100 mg/dL and the game was over. Victory for the Red Sox and a safe enough blood glucose reading that I could go to sleep.
There's no cure for diabetes. Yet.
If you've got diabetes and would like to show others what it's like to live with it, please join the diabetes365 photo project.
I've mentioned the super bolus before on this blog. This is a technique that only works for people who are using an insulin pump.
According to John Walsh's original note about the super bolus:
A Super Bolus is created when some of the basal insulin delivery is stopped or partially reduced, and delivered instead as additional bolus insulin on top of a normal carb or correction bolus. This shift of basal to bolus insulin creates a larger bolus that can have more impact in situations where more insulin is needed quickly. These situations may include but are not limited to covering high glycemic index foods, larger intakes of carbohydrate, and speeding the return of an elevated blood sugar to normal.
The super bolus boosts the effectiveness of a regular bolus by taking some of your basal insulin and delivering it early. For example, if your basal rate is 0.7 units per hour, you can temporarily turn off the basal delivery for one hour and then take the 0.7 units immediately. The trick is how you take that insulin. If you took it as a bolus then it would affect your insulin on board totals, so instead you take it by using the prime features that you'd normally use to fill the cannula after inserting a new infusion set.
I shot three short videos that show how to do a super bolus on different insulin pumps. This gives you a chance to compare these pumps in action and see how to use this useful technique which helps correct high blood sugars a little faster.
Here's how to take a super bolus with a Minimed 512 insulin pump.
Here's how to do it with an Animas 2020 insulin pump.
And here's how to do it on a Cozmo 1800 insulin pump.
One thing that diabetes has taught me is the importance of water. We all need it just to keep hydrated. But anyone with diabetes probably needs water even more.
Whenever my blood sugar goes high my kidney have to work harder to take that excess sugar out of my bloodstream. And the higher sugar concentration isn't good for many parts of my body. So anytime I get a number higher than 180 mg/dL, I try to drink extra water. If my numbers are over 220, I'll drink about a pint of water or more. It's refreshing, it helps my kidneys flush that extra sugar and it also (I like to think) dilutes the excess in my bloodstream just a little.
There is no cure for diabetes.
Yet.
There's a great collection of photos that reflect life with diabetes at the diabetes365 project.
Those of you in Red Sox nation will understand my late posting.
I spent three days last week at a technical conference. A reasonably large turnout and a lot of interesting sessions for a geek like me.
In the middle of one session my continuous glucose monitor let me know my blood sugar was going low.
Naturally, I always carry something with me to help me correct it. In this case I used Smarties. These contain a good deal of dextrose which is quickly absorbed by the body. And they taste reasonably good.
If anyone noticed me, they probably thought I was just snacking on some candy. But I was really stopping my blood sugar from going lower and causing more problems.
Call me crazy, but I've decided to participate in NaBloPoMo.
What does this mean for you?
I'll be posting something every day in the month of November. I'm hoping that I can do this without too much of a problem because I'm already in the Diabetes365 project and I'm posting almost every day already. But I'll also be visiting in Ireland over Thanksgiving, so there'll be some Irish posts around then.
If you're interested in saying hi during my three days in Ireland, I'll be staying in Dundrum directly south of Dublin and spending time with family in Bray, County Wicklow.
If you're feeling courageous about writing why not get involved in NaBloPoMo? It's only 30 blog posts!
I had to turn captcha back on again for comments to my blog.
This past Thursday someone posted comment spam to my blog on about 10 different blog posts. Blogger doesn't have a very efficient interface for fixing these types of problems, so removing the spam comments took most of 20 minutes.
I'll leave it in place for now, sorry for the inconvenience.
No, it's not a new Sam Beckett play. But today's the day my new Cozmo pump should arrive.
I'm so excited, it feels a little like my birthday with a really cool, geeky, present.
Once it's up and running I'll put up some video showing it in action. From trying one out in September I know that this pump can be customized a great deal. And I'm hoping to really take advantage of that.
I was baking some over the weekend and had lovely Irish brown soda bread as a result. Here's a picture of the results.
I can't easily get the right flour here to make this from scratch. So this is from an Odlum's mix that easy to put together. And in the US, there are several online sites that sell it.
I finally broke down today and made more pastry. We've had some gorgeous apple varieties in the house (including Northern Spy) and I couldn't stand another weekend without a pie in the house.
For pastry I use a modified version of a recipe from Cooks Illustrated. The original recipe is just gorgeous but absolutely loaded with fat. So I've cut it back. And what I ended up with is this recipe
Pie Crust Recipe (for two crusts)
3/4 cups white flour
1-3/4 cups whole wheat white flour
6 tablespoons stick margarine
8 tablespoons unsalted butter
3/4 teaspoon salt
1-1/2 tablespoons sugar
6-8 tablespoons chilled water
Mix the flours, sugar and salt together in a large bowl. Cut in the margarine and butter until the pieces are the size of peas. Add the water, it should be chilled and from the fridge. Mix with a spatula until it starts to stick together. Then finish mixing by hand.
Divide into two halves, each is enough for a single pie crust. Wrap tightly in cling wrap and store in fridge until ready for use. Let it warm up for at least 15 minutes before use.
Nutrition Analysis The two flours that I use are very different from each other. I thought you might be interested in seeing a quick analysis of the carb difference based on using the mix that I have, versus just plain white flour. Here are the nutrition labels for each type of flour. (Note I'm using King Arthur flours, which are just great for baking.)
The recipe contains ten 1/4 cups of flour.
If I use white flour the carb count would be ten times 21 effective grams for a total of 210 grams for all the pastry. I'm allowing for a full gram of fiber in each serving.
By using the proportion that I do I have three times 21 grams of carbohydrate from the white flour (total 63 grams) and seven times 15 grams for the whole wheat white (total of 105 grams). This gives me a total of 168 grams of carbohydrates or a 20% reduction in the overall carbs.
Each pie crust with my recipe is 84 grams of carbs. Using white flour each one would normally be 105 grams of carbs. Plus with my recipe you also get 21 grams of fiber per pie crust. And I think it tastes better with the whole wheat white flour.
Note that I've started using a single pie crust rolled very thin for an apple pie. There's enough pastry to fold over the apples and make a rustic type of pie. If each pie yields 8 slices then the carbs from the pastry add about 11 grams, instead of nearly 22 grams when I'm using a double pie crust for the pie.
In writing this post, I noticed an error in the nutrition label from King Arthur. The calorie count appears to be wrong for whole wheat white. The table below shows my calculations. Whole wheat white flour has only about 81 calories per serving, not the 100 calories per serving that's shown on the label. I'll contact King Arthur Flour during the week to let them know.
Recently I try to eat at least one good helping of salad every day. Fresh vegetables with a light balsamic dressing. Here's what I had before dinner on Thursday.
If I eat this before anything else it fills me up and helps me eat less of those troublesome carbohydrates. Plus the extra vegetables are good for my health overall.
Living with diabetes my life is full of minor adjustments like this. It's a life of small changes and compromises that reduce my risk of long term complications.
This is my blood glucose meter and some of the test strips that I've used over the last few days. I don't use that many strips now, thanks to my Dexcom continuous glucose monitor.
The reflection in the background is the first Red Sox World Series Game.
Because even when I'm relaxing at home focused on a game, I have to think about my diabetes and my blood sugar levels. I need to check my levels after eating because I don't want to go to sleep with a high reading.
And while I sleep I have diabetes. It's with me 24 hours a day and 365 days a year. I've had diabetes for more than 35 years so it's been with me for over 13,000 days. And counting.
I'm about to replace my out-of-warranty insulin pump. It's over 18 months old (replacing a Minimed 512 that broke down after 30 months) and I've worn it 24 hours a day for a total of at least 13,000 hours. Here's a picture of the little guy.
And for all that time my plastic pancreas has helped me control my blood sugars and live a closer to normal life. Trust me, it's no substitute for a real working pancreas.
For something that I've worn for that long, it's in good condition and doesn't look like it needs replacement. Insulin pump makers generally provide a 4-year warranty with their pump. And when the warranty's up I want to get a new model so I can take advantage of better features and (hopefully) the even better control.
Next week I should be getting my latest model, a Cozmo 1800. I promise to post some videos of its features and let you know what I think about it.
Insulin pumps are just one form of better treatment. There is no cure for diabetes. Yet.
The diabetes365 project is veryactive with new photos being added every day.
Note: When a pump is replaced because it broke, the replacement pump is typically a refurbished one. And the pump company doesn't restart the warranty clock with the replacement. So in my case, the replacement pump was only warrantied for an additional 18 months. This actually works to my advantage because I can now replace it without having to wait a total of 4 years.
Recently I was given a loaner Animas 2020 insulin pump to evaluate. My current Minimed 512 is out of warranty and is due for replacement. I evaluated the Animas and a Cozmo 1800 pump before deciding on a replacement that worked for me.
While I had the Animas I took some video that demonstrates how to use the Animas to take a bolus. I hope it gives you some idea of how this pump is to use.
Please note that in the video the screen flickers. In real life I found the screen bright and easy to read even in direct sunlight.
I really liked the built in food database that helps you when bolusing for meals. The Animas lets you bolus in 0.05 unit increments and set basal rates in 0.025 unit increments. So it's great for anyone who's really sensitive to insulin. It's fully waterproof, the O-rings on the battery cover and the insulin reservoir really emphasize this. It also delivers the insulin boluses very quickly compared to my old Minimed. And despite the bright screen it doesn't seem to drain the single AA battery too quickly.
On the down side. I didn't like the speed at which the up and down arrows worked. The numbers scroll extremely quickly and it's hard to stop at exactly the right spot. I also missed seeing the carb information on the summary screen that's shown just before you get a chance to take a bolus. The history on the pump is very insulin centric, with no information about carbohydrate consumption or blood glucose values. I also wish the daily summary showed the ratio of meal boluses to correction boluses. Finally the accompanying software has a very dated feel, the reports are pretty basic and there is no data export capability.
Even though I was just trying out the pump, Animas was very supportive any time I had a question. This was very refreshing when compared to some recent experiences I had with Minimed.
In the end, I chose the Cozmo 1800 pump and look forward to starting on it early next week.
If I told you I had diabetes and that I needed to inject something before meals, you might say "Oh yeah, insulin right?".
Well I'm wearing an insulin pump, so I don't actually inject insulin before meals, I use the pump to deliver it. But for about a year I've been injecting Symlin before most meals that I eat.
When I'm in the office, I just roll up my trouser leg and inject there shortly before eating.
Symlin is an artificial version of amylin, another hormone produced by the pancreas, in the beta cells. If you don't have type 1 diabetes, this hormone slows down the emptying of food from your stomach and makes you feel fuller (increasing satiety). It also seems to slow down the release of glucagon from your liver.
The net result is that my blood sugar doesn't go up as quickly as it normally would after eating. So it helps me maintain better control of my blood glucose levels.
Because it slows down food getting into your system, Symlin can cause severe lows that are difficult to treat. In my case I can also go low just from taking Symlin without mealtime insulin. This may be due to the glucagon suppression and a basal insulin level that's effectively too high when Symlin is being used.
I also had terrible nausea for the first month that I used Symlin. So bad that it made me not want to eat. But that's passed now. Even if I don't take Symlin for a few days, the nausea doesn't return.
There isn't a cure for diabetes, yet. But some of us are working to fix that.
I know this month you're focusing on raising awareness about a cure for cancer. And that's a great cause.
Well November 14th is World Diabetes Day and there are 2 million Americans that have Type 1 diabetes. Many of us get it as children and still have it when we grow into adulthood.
We'd love to have a cure, but because of insulin a lot of people think it HAS been cured. Trust me, it's not.
Check out our diabetes365 project at http://www.flickr.com/groups/mydiabetesathome/pool/ to see how diabetes affects us each and every day. Tell me how you'd feel if a child of yours was diagnosed at 3 and you had to give them multiple daily injections of insulin to keep them alive.
Please consider focusing on this terrible disease on your November 14th program.
Diabetes365 day 14 October 21, 2007 - Uisce Beatha
On an average day I take about 30 units of insulin. That's 1-3rd of a CC, or about 1/8th of a teaspoon. If you're a baker you know that's half the amount of nutmeg that you'd put in one apple pie.
It's a really small amount of liquid but for me it's essential to life. I think of the Irish for whiskey - uisce beatha or the water of life.
Because I have Type 1 diabetes, insulin is my water of life. If I wasn't able to take this small amount of precious fluid every day, I'd get extremely sick and die within a few weeks.
Because I have a broken pancreas I physically carry insulin with me every day of my life.
To control my type 1 diabetes, I use an insulin pump instead of taking injections.
Before each meal I use the pump to take additional insulin to cover the carbohydrates that are in the meal. The rest of the day (the whole 24 hours), the insulin pump delivers a small background dose (basal) of insulin.
And that's what normally happens for me. But this morning I was woken abruptly at 2:50 AM by a loud beeping and buzzing.
My insulin pump was displaying the error message No Delivery, which meant that it wasn't delivering insulin to me.
So I:
Get out of bed to capture this photo.
Get rid of the error message on the pump.
Take additional insulin to cover my blood glucose level (around 220 mg/dL).
Drink lots of water.
30 minutes later I'm back in bed asleep. Unlike my diabetes, which never sleeps.
Today officials at the American Diabetes Association expressed surprise that CRAP seems to have become the new name for what was previously known as Type 1 diabetes.
Speaking off the record a senior member of ADA staff was puzzled to know what CRAP even stood for.
Readers of this blog may know that the abbreviation was first coined in a discussion on the popular TuDiabetes social networking site. CRAP stands for "Catastrophic Ruthless Attack on the Pancreas"
It's rumored that someone started a Google bombing campaign to replace Google's normal results for the word CRAP with the ADA page for Type 1 diabetes. This was done as a protest against the ongoing problem that the media has in distinguishing between Type 1 and Type 2 diabetes.
To quote a top ADA official (name withheld) "If this disease renaming continues we'll be forced to change current medical texts so they now refer to the two primary types of diabetes as CRAP and Type 2. And what happens if someone then decides to rename Type 2 to Number 2? Imagine the confusion."
They fail to recognize that many people, including many media people, are already confused so much that they don't even realize there are two main forms of diabetes that are radically different to one another. Perhaps this renaming will clear things up - a bit.
Diabetes365 day 10 Wednesday, October 17, 2007 - Difficult Food
On Fridays we get free bagels and muffins for breakfast at work. It gives us an opportunity to spend time with colleagues and chat. A really nice idea.
Though I have diabetes I can eat pretty much anything I want. But I find both bagels and muffins are difficult food.
When I eat something that contains carbohydrates I need to take insulin. And bagels, especially yummy ones like this, have a lot of carbs. According to CalorieKing, about 56 grams of carbohydrate for one medium-sized plain bagel. That's like two of my normal breakfasts.
So if I eat one of the bagels I'll spend most of the morning trying to get my blood sugar levels back under control. And I just hate doing that, it's not worth the effort.
There is no cure for diabetes. Yet.
You can learn more about life with diabetes at the diabetes365 project site.
Today's Wall Street Journal has a front page article on Pfizer's decision to drop Exubera. It covers some of the history of Exubera development and also points out some of it's shortcomings
The Exubera device, which some compared unflatteringly to a bong for smoking marijuana, could also be embarrassing to use in public.
"I can teach someone how to use an insulin pen in five minutes, but it would take nearly an hour to teach a patient to use inhaled insulin," says Anastassios Pittas, an endocrinologist at Tufts-New England Medical Center.
The article also has a pointer to a (PDF) transcript of the Pfizer conference call about its 3rd quarter earnings. The Exubera part starts on page 4 of the transcript. I'm glad to see Jeff Kindler, the Pfizer CEO say:
We remain committed to finding and developing new treatments for diabetes, which is an area of enormous unmet medical need. Our R&D portfolio in this field spans the width of the diabetes disease continuum, from genetic susceptibility at birth to the onset of devastating complications. This is also an important focus for business development. In addition, we will continue to closely monitor developments in medical practice and technology as they relate to inhalation therapies and other innovative delivery systems both for insulin and for other medicines.
Despite the problems with Exubera it was a novel treatment for diabetes that might have really helped people who fail to treat their diabetes because of their fear of injections.
And while most of us hope for and work towards a cure for diabetes, it would be nice to have new treatment options while we're waiting.
The Diabetes365 project is really growing fast. We now have over 100 photos and more are being added every day.
One of the photographers is Dae and thanks to her blog I came across what may be the best blog for those of us who still like to eat pastry. (Because unfortunately my love of good food didn't disappear when I got diabetes.)
I've taken several baking classes over the years and I really love to make pies, cookies and bread. Generally I let the children eat most of it because there's too many carbs there.
But maybe, thanks to the Diabetic Pastry Chef, I can finally bake some things that are okay for me to eat.
You probably have seen the news on this from other blogs. The first I read about it today was on Scott Strumello's blog this morning.
Exubera is the inhaled insulin that Pfizer has been has been working hard to get people with diabetes to use. And I've always believed this would be a hard sell. There's not enough information about the long term consequences of inhaling this very new drug. And the inhaler itself has been commonly referred to as a bong, almost from the day it was released. This is one case where getting a true design team in to think about making something acceptable for most users would have helped a lot.
Anyway, there's a lot of news out there about this cancellation and I wanted to point out some of them. The Wall Street Journal Health Blog has several interesting posts:
Despite what I thought about the delivery mechanism, I did like the idea of a novel form of diabetes treatment. We're treating diabetes in the same way that Banting and Best did in the 1920s. Insulin is now purer and our dosing is more accurate, but otherwise not much has changed (except for Symlin/Byetta).
I do hope that this doesn't discourage drug makers from looking at other ways to help us treat and manage our diabetes. It would be a terrible shame if this decision by Pfizer had that kind of an effect.
Diabetes365 day 11 Thursday, October 18, 2007 - Fog
If you have Type 1 diabetes, you already know just how hard it is to control it. Every morning for breakfast you have the same things and you eat them at about the same time. When you test your blood sugar two hours later (a postprandial test) you get wildly different results.
And why is this? Well maybe you were stressed on one day and not on the other. Or you're coming down with a cold and that drives your blood sugar up. Or you ran for the bus and that made your blood sugar go down.
Managing diabetes is not a rigid, well-defined, set of instructions like a baking recipe. There are guidelines and lots of numbers and ratios. But a big dose of judgment is also needed.
When I see my endocrinologist (diabetes doctor) and they fill out that form with all the checkboxes afterwards, one of the boxes has the code 250.93 beside it. That's the one is normally marked for me.
It means "Type 1 diabetes - uncontrolled".
Well it's not that my diabetes is uncontrolled or out of control. It's just extremely hard to control it. The control is defined based on my blood sugar readings.
And what affects those readings? Food, exercise, sleep, illness, stress, menses. You know, the things of everyday life.
So I wander through a light fog trying to follow the markers and pretty much sticking to the path. And most days it's actually pretty good. As long as I don't think about it too much.
There's no cure for diabetes. And I really wish there was.
There's a great collection of photos that reflect life with diabetes at the diabetes365 project site.
Diabetes365 day 10 Wednesday, October 17, 2007 - Test before driving
Most days of the week I get into a car to drive at least twice. And before I drive I need to check my blood sugar and make sure it's both stable and at a value that's safe for driving.
This is one of many things that I do slightly differently because of my diabetes.
I have hypoglycemic unawareness so I can't tell when my blood sugar is low. Driving without testing might mean that I'd be driving while not fully in control of the car. My reaction speed would be lower as would my ability to safely judge situations.
Because of my Dexcom continuous glucose monitor testing only requires a button press. This is a lot easier than having to use a blood glucose monitor yet again during the day! And is one reason why I like that device so much.
There is no cure for diabetes. And most insurance companies don't count test strips before driving in their calculations of the number of strips you need a day.
Do you have diabetes and can you take photos? Maybe you'd like to take part in the diabetes365 photo project.
I don't know if you already use Twitter. On the surface it's a strange service where people leave messages (140 characters or less) about what they're doing.
Twitter gives you a simple web interface for posting messages, though you can also send them using text messaging on your phone. And you can Jott messages to Twitter. Plus Twitter allows you to follow the twitter messages (also called tweets) from other people.
And today I found out that the New York Times has Twitter accounts for various parts of the newspaper, including the Health section. So you can use Twitter to keep up with health updates from the New York Times.
Diabetes365 day 9 Tuesday, October 16, 2007 - Fire drill
I was sitting at my desk working this morning and the fire alarms went off! What a racket!
Whenever there's a fire alarm at work the first thing I reach for is my diabetes supplies. After that I'll take my camera and personal laptop, but those are a distance second in importance.
There's nothing worse than being stuck in an unusual situation without a means of testing my blood sugar and correcting it if it's low. That's why the diabetes supplies are so essential. If there was a real alarm and we were outside for more than 10 minutes those supplies might make the difference between a single alarm and two!
Over my lifetime with diabetes I've taken many ambulance rides as a result of severe low blood sugars (hypoglycemia). It's never pleasant waking up in a strange place and not knowing how you got there. So diabetes supplies are essential.
Yet another thing to think about because of diabetes. (And another reason why you're not likely to see me on a future episode of Survivor).
I've previously used Jott to blog here. And I use it all the time to send e-mail reminders to myself.
It's a great service where you call a toll-free number, leave a voice message and they transcribe it for you and send it wherever you say you want it to go.
Well now you can use Jott the Vote to send messages to a presidential candidate. I think this is a wonderful idea. Now if you've just collected your prescriptions and are sick of healthcare costs, you can call your favorite candidate and give them an earful.
Thanks Jott for making it really easy to get a message to our future president - whichever one of the seventeen candidates that turns out to be!
Oh, and if Jott should get your message slightly wrong, be sure to let the folks at Misjott know!
Today's New York Times has posted a long article In Diabetes, A Complex of Causes that describes interesting new research into how the body regulates blood sugar.
We already know that the pancreas and liver regulate blood sugar levels. This article also describes how a skeletal hormone, osteocalcin, can signal fat cells and the pancrease. Experiments show that it may be possible to boost ostecalcin and affect blood sugar levels, though this will only benefit those with Type 2 diabetes.
The latter part of the article also describes how the brain may actually work to affect blood glucose levels. They've been able to knock out certain receptors in the brain and cause diabetes in mice. And research seems to point to the hypothalamus.
The brain, therefore, appears to be listening to — and weighing and making sense of — a chorus of signals from insulin, leptin, free fatty acids and glucose itself. In response, it appears to send signals to liver and muscle cells by way of several nerves, though additional mechanisms are probably involved. The gut also seems to chime in, said Dr. Rizza, adding that for him, this aspect of sugar regulation came as “the biggest gee whiz of all.”
This article is a very interesting read into new diabetes research. The New York Times has been doing some great reporting on diabetes treatment and research this year. I'm impressed by the amount of attention they're giving to diabetes.
I've had diabetes for over 35 years, and it's really taught me about the value of endurance. Even though my pancreas is broken I'm still remarkably healthy. The insulin that I inject helps my body to absorb and process carbohydrates but it's not a cure for diabetes. Despite the continued high and low blood sugars I'm blessed by God with very few complications.
My hope and prayer for me and others with diabetes is that we all endure until a true cure is found for this expensive and deadly disease.
Are you planning on doing something for World Diabetes Day? If so, you've got about a month. Get your thinking hats on.
Diabetes365 day 7 Oct. 14th 2007 - Low carb breakfast
One of the problems with having diabetes is that carbohydrates taste way too good.
But there are great-tasting low carb alternatives to a breakfast of bagels, or fruit, or name your carb challenge.
We have chickens in our backyard and they give us wonderful eggs. The egg on the top is from one of our chickens, the other is store bought. Look at the difference in color and the height of the yolk.
And I was able to have a great breakfast with these eggs, a little ham and cheese. Less than 5 minutes to a yummy omelette.
If you've got diabetes, you may want to keep chickens. They give you better and healthier eggs. You get to appreciate chicken cliches in a whole new way. And they're hilarious to watch and laughing is good for your health.
There is no cure for diabetes at present. But comedy makes the time go by faster!
Surprisingly only about half of those with chronic illnesses (including diabetes) actually use the internet. But when they do find the internet, and the information they can get from it, they become 'avid' users. For those of use who read diabetes blogs, are members of TuDiabetes.com, and use resources like the diabetes search engine, or diabetes daily this must be surprising news.
The report is based on a survey of nearly 3,000 adults taken in August 2006. It defines E-patients with chronic conditions as "Internet users who have identified themselves as living with a disability or chronic disease and who search online for information on health and health care". And this group of people with chronic illness are empowered by what they find on the internet. According the published findings
75% of e-patients with chronic conditions say the information they found in their last search affected a decision about how to treat an illness or condition, compared with 55% of e-patients who report no disability or illness.
69% of e-patients with chronic conditions say the information led them to ask a doctor new questions or to get a second opinion from another doctor, compared with 52% of other e-patients.
57% of e-patients with chronic conditions say the information changed the way they cope with a chronic condition or manage pain, compared with 36% of other e-patients.
56% of e-patients with chronic conditions say the information changed the way they think about diet, exercise, or stress management, compared with 42% of other e-patients.
I think the numbers are interesting but the overall findings aren't too surprising. I've previously blogged about the importance of taking more control of our own health care. I think I'm pretty informed about diabetes, but since I started blogging in August 2006 I've found many better ways to deal with this disease and improve my overall control. Sites like TuDiabetes.com and the connections that I've made there have been invaluable.
I hope the news about this report gets out to a wider audience. And ultimately leads more people with chronic illnesses to the internet and to better outcomes and quality of life.
Diabetes365 day 6 Oct. 13th 2007 - Screening for diabetes
I went to a local health fair at our local middle school on Saturday. Among the various health-related booths I came across some women from a local hospital. They were conducting screening for diabetes and pulmonary issues.
It was early in the morning and they hadn't had any 'customers' yet for the diabetes screening. But I got talking with them and asked them how often they tested people that turned up positive for diabetes. It seems that at the larger health fairs they generally find 2 to 3 people with positive diabetes tests.
Maybe it's the continued unawareness of the dangers of diabetes. But generally when they tell someone they've tested positive for diabetes the reaction they get is a kind of 'so what?' response. They remember one man who had a blood glucose value of over 500 mg/dL (normal is around 100 mg/dL). When they advised him to go straight to the emergency room, he ignored their warning because "he didn't feel sick".
I know about the scary side effects of diabetes. And I frequently thank God that I got Type 1 diabetes and not Type 2. Because with Type 1 it's a lot harder to ignore the symptoms. For folks with Type 2 diabetes, they may not be diagnosed for a while and in the meantime the high blood sugars are damaging their bodies.
I could go on for many paragraphs. But if you're one of my frequent readers you probably already know all about the dangers of diabetes. If you're a new reader, take the time to learn the symptoms of diabetes. And if you're told you have diabetes, please take it seriously.
I couldn't resist this. Apparently B&O has a division called Medicom. They've designed a new inhaled insulin delivery device called the Insulair
This is clearly meant to steal the huge market share of the Exubera insulin bong. Personally I think the issues with the Exubera was the silly marketing name. Why not just come out and call it the exuberant bong. I can see the name designers say "We can use the slogan - Get a hit from your insulin!". Hah
B&O is well known for their product design, I can't help thinking this one might actually stand a chance. Though from a Google search it's not clear whether this is just a design concept like the Charmr or a real product that's not yet available.
Diabetes365 day 5 Oct. 12th 2007 - Diabetes Detritus
Diabetes is a high maintenance disease - it takes a lot to replace a working pancreas. For today's picture I took most of the stuff out that I either carry with me, or have as backup in my office.
As you can see, there's a lot of stuff there.
When I was a child I was into all sorts of gadgets. Now I get to live with these on a daily basis.
The standard cry when we're leaving the house to go anywhere is "do you have your kit" or "Dad can't find his kit". And everyone knows it's the Eagle Creek black bag that has all my stuff. We don't leave home without it.
All of this technology is needed to replace my non-working pancreas. I'm thrilled that it exists and that I have the health insurance coverage to afford it. But I'd trade it in for a real pancreas any day of the week.
Unfortunately currently there isn't a cure for diabetes. But I do my best to support the research for a cure.
Whenever I make an apple pie at night the children always want a slice for breakfast. And it's got fruit and other good things, so why not let them.
Today is day 4 of my diabetes365 project. And you can see the children's breakfast on the right and my oatmeal on the left.
Because of diabetes I've changed how I approach baking. I make the pie crust with a mixture of white and whole wheat white flour. It still tastes yummy and the addition of the whole wheat white lowers the glycemic index (a little) so the carbs don't hit my system as quickly. Recently I started making a pie with only a single pie crust which also lowers the total carbohydrate count for a slice of pie.
If you're interested, I made the pie with local Honeycrisp apples. These are wonderful for baking with and make really great pies.
Of course this morning all this work was a moot point, as I ended up having some oatmeal for breakfast! The things we do to control our blood sugars.
For now, I'm trying to take diabetes365 photos at slightly later times in my diabetes day. At some stage, I'll switch to a different approach to documenting what it's like to live with diabetes 24 by 7 by 365.
I have a small scales at home that I use mostly for breakfast. Most packaged food now has nutrition labels which lets me see the carbohydrate content for a specific weight. By adding the carbs for all the foods together and using an insulin to carbohydrate ratio (I:C) I can figure out how much insulin I need to take. The I:C value is different for everyone with diabetes, it can even vary for the same person at different times of the day.
I've been using Symlin for about a year. It's a drug that's I inject shortly before meals. It slows down the release of food from my stomach and makes me feel full. Both contribute to better blood sugar control, though it can cause terrible low blood sugar reactions.
Insulin (and Symlin) are not cures for diabetes. They just allow people with diabetes to control their blood sugars.
For some reason I was battling a low blood sugar from about 3 AM. I took two small amounts of carbohydrates during the early hours to try and get my blood sugar to come up. But I still ended up with a value of 59 mg/dL before breakfast.
This means I can't take Symlin so my after breakfast blood sugar readings will be higher. It also means that I can't drive until I'm sure my blood sugars are above 100 mg/dL. This is the lowest value at which I like to drive.
Remember there is no cure for diabetes. Those of us with Type 1 diabetes use insulin (and sometimes Symlin) to try and keep our blood glucose values within a reasonable range. This is really an imperfect approach.
This is the second photo in my diabetes365 series. You can find photos from others taking part in the diabetes365 photo project on flickr.
Yesterday was one of those excellent blood sugar days that I dream about. Here's the picture from the Dexcom software.
I can thank Symlin for the lack of any post meal highs during the day. The two horizontal lines are the limits (140 for a high and 80 for a low) that I like to use with my Dexcom CGMS. Trust me, I don't get enough days where the line stays within the limits so much. The big gap early in the day is when my 7-day sensor ran out. I had to reset it and then wait 2 hours to recalibrate. I'm now on day 9 of this sensor and so far it's still working well.
Diabetes365 is an idea that I got from Beth of insearchofbalance. She started her Diabetes365 photo project a few days ago and I couldn't think of a better way to inform people of what it's like to live with diabetes 365 days a year.
The idea behind this Diabetes365 project is that I'll take one picture every day of the year. I'll post it to the flickr Diabetes365 pool and blog about it briefly.
Would you like to take part in Diabetes365? You can join the flickr pool provided that you post a picture there each day (or wait a few days and post several pictures, one per day). Each picture must be tagged with diabetes365 and titled with the date taken and which day of your year of photos it is. If you'd like to blog your photos, feel free to do that also.
Let's see if we can't raise a little awareness about diabetes and what it takes to live 24x7x365 with this disease.
I recently came across MyCareTeam, a web-based diabetes management product. Based on the quicktour screenshots that they've posted online it certainly seems like an interesting product.
And as of today it's available from the American Diabetes Association for $12.99 per month, or $9.99 if you purchase a one-year subscription ($119.98). With the one-year subscription they'll also provide a free data cable for the meters that they support. Or you can buy the cable for $40. Based on the screenshot below, that's quite a long list of meters.
It certainly seems as if this product has some useful features. Here's another screenshot from the quick tour that shows the log screen from MyCareTeam.
As you can see, all my information about MyCareTeam is based on screenshots from their Quick Tour. That's one of the things that bothers me about this software. Why would I spend at least $12.99 to try it out and decide how useful it is?
For me, it makes more sense to have a 30-day free trial (with the option to purchase the download cable) and then see whether it's actually worth $100+ a year to me. After all there are already many free web-based diabetes tracking systems (Sugarstats.com, SweetSpot.dm, and others). And these are both useable and useful.
I see the benefit to both the ADA and MyCareTeam to charge for the product. It'll allow them to enhance the product and raise some funds for ADA. But I also understand web software a lot and I think that you need to let people try this software out first, before they'll commit to spending money to use it.
Do let me know what you think about this model. Have any of you used MyCareTeam? Did it seem like good value to you? Do you have any privacy concerns about using this or other web-based tracking software?
Amylin has announced today that the FDA has approved two Symlin pen models. The pens should be available by December 2007.
The SymlinPen 60 can deliver 15, 30, 45, or 60 micrograms per dose, so it's clearly targeted at people with Type 1 diabetes. These doses correspond to 2.5, 5, 7.5, and 10 units on a standard insulin syringe. The SymlinPen 120 can deliver 60 or 120 micrograms per dose. I like it that the pens can be stored at room temperature (up to 86 degrees).
Here's a picture of the new pens, courtesy of medGadget. For me, Symlin has effectively removed the blood sugar spikes that I see after meals. Learning to use Symlin takes time. First there's the nausea. It lasted about 4 weeks for me. Then there's the struggle to figure out how much to reduce your insulin and how long to spread the bolus over to avoid the lows that can be very hard to treat.
I'm excited to learn the pen version will be out before too long. That should make it a lot easier to use.
The Diabetes Technology Blog is focused on using technology to live life to the full with diabetes. I review new diabetes technology including: blood glucose monitors; continuous glucose monitors; blood sugar meters; diabetes software and living with diabetes.
About Me
Name: Bernard Farrell
Location: Massachusetts, United States
I was born in Ireland and now live in the US.
I have had Type 1 diabetes for over 36 years. I struggle with my blood sugar, the same as most people with diabetes.
I wear a Cozmo 1800 insulin pump and a Dexcom SEVEN Plus CGM to track my blood glucose levels.
I'm blessed by God, and every day brings the possibility of a cure.
