I was having a conversation with a buddy at work today about the A1C test. We started with A1C and ended up talking about many aspects of diabetes.
Afterwards I was thinking about all the stuff that I know about Type 1 diabetes. Sometimes the amount of things that I carry around all day is scary in a geeky kind of way.
Remember that I'm not a medical doctor.
I know that:
insulin lowers my blood glucose levels.
ideally my blood glucose (BG) level should be about 100 mg/dL.
there are lots of different blood glucose meters out there. None of them are truly accurate.
eating food with any carbohydrates raises my BG.
but I can eat almost anything I want, including candies, cakes, and ice cream, as long as I do it in moderation.
stress, or illness, also raise my BG. Sometimes a lot.
some medicines that I take when I'm sick raise my BG.
exercise is a great way to reduce my BG.
but too much exercise can cause me to have a low BG (less than 80 mg/dL).
then I have to eat more. But not too much more.
when travelling I need to pack a lot of stuff so I can take care of my diabetes.
there are several types of diabetes. And many people get confused about them.
because of diabetes my cholesterol level needs to be kept much lower.
my risk of have eye damage is significantly increased.
there's a lot of diabetes technology out there, but
there's no cure for diabetes.
when my BG is not 'normal' I can feel: sad, tired, angry, lousy, argumentative. I'm not myself.
I need to check my BG level before I drive. Every time.
I need to have my eyes checked at least once a year. Out of control diabetes is a leading cause of eye problems.
I'm at increased risk for gum disease, so I need to see a dental hygienist at least twice a year. Ideally every quarter/
I need to wear something on my feet at all times, because diabetes can cause foot problems.
diabetes (all types) are the cause of a lot of complications. And I worry more than I should about getting one of these.
I can now inject myself many times a day. Before I was 15 I would not have thought this possible.
if I do the same things every day I will not get the same BG levels. Sometimes these things just change randomly.
The picture shows an already available chip that's about the size of a grain of rice and that contains some patient identification information. There are no details about the size of the planned glucose sensor device, but the company claims
"This system will allow for one injection every 4-6 months (approximate) that permits the diabetic to externally scan the device and retrieve a blood sugar reading as often as necessary."
Today Technology Review has an article about a Massachusetts company that's also working on implantable devices. MicroCHIPS is working on a device for osteoporosis treatment that provides daily delivery of a drug for treating that condition.
They are also working on an implantable glucose sensing device that contains an array of individual sensors. So when one sensor degrades, the device can turn a new one on and continue monitoring. The device will transmit the readings to an external monitor. The article claims that this information could be sent to an insulin pump.
My guess is that either of these devices are several years away. And when available not everyone will be comfortable with the idea of implanting something. For example what happens with MRIs or when passing through X-ray systems at airports?
So there's a need for education that covers the benefits and the likely issues with this type of device. Maybe these companies can look at how pacemaker companies have succeeded in getting their devices accepted.
Technology review has an interesting article about a new compound that may soon be tested as a treatment for Type 2 diabetes.
The drug is being developed by Sirtris Pharmaceuticals. It's essentially a super strong version of resveratrol, which is normally found in plants and is contained in red wine.
The drug activates an enzyme called SIRT1 possibly producing an effect in the body that's similar to reducing caloric intake substantially.
Tests on mice with the new compound found the drug "improved insulin sensitivity and blood glucose levels in three rodent models: diet-induced obese mice, genetically obese mice, and a rat model of type 2 diabetes." According to the article clinical testing may start in 2008.
I've recently started drinking an occasional glass of red wine because of the possible health benefits. Maybe in about five years I can just pop a pill instead! Though I think I'll likely stick with the red wine.
It's a short read that outlines the ways in which healthcare may change in the future.
What's interesting to me is that a lot of the things mentioned in the Empowerment through Internet Technologies part of the article are already available.
For social networking look at the success of the excellent TuDiabetes.com site. I see a lot of members that are thrilled to find others with diabetes and that are actually learning about better ways to treat the disease and are getting lots of support from others.
For Twitter and updates via e-mail, you can look at the wonderful SugarStats.com site that lets you track blood sugars and other things related to diabetes care by sending messages via e-mail, SMS or Twitter.
From my perspective there are many ways to improve care for chronic illnesses. But thanks to the internet and the work of some great people the future is looking a lot better for many of us who work hard to have normal lives despite our imperfect bodies.
I was back at home in Ireland last week for a few days. Traveling overseas during Thanksgiving is fairly easy and it's a good time to see Ireland. The weather is generally nicer than the Northeastern US, and in Ireland everyone is getting ready for Christmas.
This time I was able to borrow some family slides and I've started scanning them in. I thought I'd share a two of me as a child. I'm surprised how well they've held up despite the lack of special attention to them.
For now I'm going to try and scan them in using a printer/scanner combo we have at home. I did find a company called ScanCafe that will scan slides for $0.24 per slide. But it takes 4-6 weeks and the photos are sent overseas for processing. Let me know if you have any experience with these folks.
Our presidential candidates
Even though the US presidential election is almost a year away, things are starting to heat up over here. Mostly because of the early primaries and caucus races in January (yes, that's only about 5 weeks away).
Have any of looked at what our candidates are saying about healthcare? Does any of this sound like they've even thought about chronic illnesses and how to take care of these? Do let me know what you're thinking about the current field.
Right now I'm favoring Mike Huckabee slightly for two reasons. First he knows about Type 2 diabetes personally and has worked hard to overcome it. Secondly this recent advert of his really gave me a good laugh. And any candidate who can take shots at himself is worth considering to some extent.
Authoring this blog for the last 15 months has given me a good excuse to work on my writing skills.
I know that I'll never be a novelist or poet. But that doesn't mean that I can't improve how I explain things or write about something that happened to me. I know that I'll benefit from this, and hopefully you will also.
Recently I've been reading, or listening to, some books on writing. And I thought I'd share these with you. You should find most of these at your local library. So all you may need is an investment of time to improve your writing abilities.
I like Anne Lamott's style and she's written several books that just make me laugh. I borrowed an audio version of her book Bird by Bird and I've enjoyed listening to it several times. She writes it around how she teaches students to write and to approach tackling the challenges of writing. I especially like sections on first drafts and getting down to actually producing writing. With these tips I might even feel up to tackling NaNoWriMo in a few years!
I just finished reading Writing Down the Bones by Natalie Goldberg. Then I was chatting with one of my sisters in Ireland and she's also in the middle of reading this one. We both like it a lot. It's got very short chapters with gentle advice on writing, how to think of topics to write about and how to get help in improving your writing. She's also got an interesting idea about having a writing booth at fairs and other public events. I'll definitely read this again.
Finally I'm almost through Mary Pipher's book Writing to Change the World. This book is really a combination of tips about writing and gentle activism, combined with thinking about where you've come from. One example from a section called Finding Your Voice is
Your self-exploration is a way to pay attention to the world, within yourself and outside yourself, and to experience what Allen Ginsberg called "surprise mind".
Try answering these questions on paper: What makes you laugh, cry, and open your heart? What points do you repeatedly make to those you love? What topics keep you up at night, or help you fall asleep? ...
These books have a good deal of overlap. So reading them has helped me attack some basic writing problems and improve slightly.
All that's needed to finish is a lot of practice in both writing and reading. This blog gives a great opportunity for the former and others help me with the latter.
Have you read any good books that have helped you to improve your writing?
I'm guilty. Even though I'm in NaBloPoMo, I didn't get a chance to post yesterday.
Like most of you, I was travelling late on Wednesday. And I was changing time zones. As I got on my plane, I had to chance the time settings on my insulin pump, my Dexcom and my blood glucose meter. One of the many joys of a diabetes geek. And when I'm travelling home on Sunday, I'll be setting them all back.
So besides the toll on my body, I guess my insulin devices will be out of sorts for a while. It could be a lot worse.
As I'm on the road, I have to keep my posts on the short side. But I'm taking a few different pictures for diabetes365 and I'll post these with a longer update early next week.
One note for Dexcom users. The new Dexcom sensor sets off the security wand at the airport if they decide to wand you. I don't know whether it also sets off the security scan as I had several things that might be the culprit there.
If you've read this blog for a while you may know that I've done some fundraising to support the research by Dr. Denise Faustman into a possible cure for Type 1 diabetes.
I'm subscribed to the Yahoo! newsgroup about this work and today they posted a pointer to a brief USA Daily article with a small amount of news.
This is slow work and Dr. Faustman is conducting it in a careful and rigorous way. Which makes some of us impatient for results. But I'm eternally optimistic about it all.
In early January I'll be at the lab to get some blood drawn that will be used in the research. A good friend from work will also be there as a healthy volunteer! What a guy. While I'm there I hope to meet with Dr. Faustman and ask her some questions about the work. I'll post what I learn online (mid-January).
Updates: I did meeting with Dr. Faustman in January. In March there was an announcement about the start of clinical trials for a possible cure for type 1 diabetes, based on her work.
"Medingo is developing a disposable insulin pump that is significantly smaller than the leading pumps on the market. In contrast to current pumps, it resembles a patch rather than a pacemaker. The product has one main competitor, Insulet Inc. (Nasdaq:PODD). Insulet broke through the market for us, and we believe that we have the better product. It's half the volume, and discrete, so it can be worn even with a close-fitting shirt. We also think that the user interface is better."
This is such an American holiday, and yet it's one for the world. Everyone has reasons to be thankful, even if they're not always obvious. And a holiday that revolves around family and a chance to be thankful is a great blessing.
Growing up in Ireland, we always relished Christmas. That was a time for families to get together and enjoy the long break from work, good food and tall tales from our past.
In our case it was horror stories. Like the time my Mum was making fondue for a dinner party and I handed her bread soda instead of cornstarch. I remember the pot of fondue boiling over on the stove and the smell of burning cheese.
So it wasn't the best of dinner parties. But it did make for a great Christmas story.
We had a stove called an Aga. As you can see from the picture it was like a range and not really a traditional way of cooking. In our kitchen we had a stool to the right of the stove where you could sit by it in the winter time and be nicely warmed.
It was definitely the focal point of our kitchen and so the kitchen was the focus of the house.
Another random Farrell story, maybe even a bit of family legend. When my sister heard that we had chickens, she reminded me of an aunt of my mothers.
This aunt was a wonderfully colorful woman who owned a small farm on the northside of Dublin. She was a heavy smoker and when we visited her we'd often find her sitting in the kitchen beside her Aga with a cigarette in her hand.
And on her lap would be a big red hen. As she talked she'd stroke the hen, who was clearly used to this treatment.
This is not a family tradition we've carried over here with us. Though our Aunt Betsy certainly seemed to find it relaxing, I'm not sure whether it was the cigarette or the hen relaxing on her lap.
I wish you all safe travels for Thanksgiving and much to be thankful for.
Those of us living with diabetes already know how much it impacts our lives.
Too many times each and every day we have to pause in what we're doing to make some allowance for diabetes. And this is just as true when we're being romantic with a loved one.
The Well blog on the New York Times site has a post today about a new book, Sex and Diabetes, that examines how diabetes affects our romantic lives and gives various strategies for dealing with it.
I’ve been tagged by Beth to write 7 random things about me that some folks might not know.
Thanks Beth. I don't normally have to think this hard during Thanksgiving week.
The Rules. 1. Link to the person’s blog who tagged you. 2. Post these rules on your blog. 3. List seven random and/or weird facts about yourself. 4. Tag seven random people at the end of your post and include links to their blogs. 5. Let each person know that they have been tagged by posting a comment on their blog.
Fact the First. I like silly verse. For example the limericks written by Edward Lear. Or The Hunting of the Snark by Lewis Carroll, which is broken into Fits (instead of chapters, starting with Fit the First.
Fact the Second. I used to do a lot of skin diving and scuba diving. When I was younger I could swim underwater for over 3 minutes while holding my breath.
Fact the Third. In high school I studied a lot of languages over a six year period. Irish, English, French, German, Greek, and Latin. I often made a cena canis of my homework. That's Latin for dog's dinner.
Fact the Fourth. I have six siblings, three brothers and three sisters. Besides me, only one of them has type 1 diabetes.
Fact the Sixth. My great grandfather was John Dillon, a well-known Irish politician from the 1800's. He spent some time in jail in England. (A practice followed by many Irish politicians of the time.)
Fact the Seventh. I like to bake. And I especially like to bake and eat(Dum Dum Dummm scary music) fruitcake. I use a recipe that I've had for over thirty years and I lace it liberally with Brandy, or Irish Whiskey.
It has about 2,000 carbs per small slice so I need to bolus a 4-day supply of insulin just to eat some crumbs. Ok, ok, only kidding.
(Picture is borrowed from Johan Potgieter. It looks similar to the type of cake I make.)
Was it because our ancestors for many previous generations gathered round fires to share companionship and food? Or maybe because collecting ingredients and making food used to occupy so much of our lives.
Whatever it is, I think many of us like baking, or at least consuming freshly baked food.
Or maybe it's just me. Because of nasal problems I really have no sense of smell, but I still love to bake. And this evening I used a really old recipe from my teenager days to make rough puff pastry as an essential part of sausage rolls.
The sausage meat is from some imported Irish sausages, so these are almost like the sausage rolls that I grew up with.
Mix the ingredients together. A quick knead. Five rollings to get the flakiness up, with some resting of the pastry in the fridge, 20 minutes in the oven and yum.
Unfortunately they're for a Thanksgiving party tomorrow. But that's OK. I get to relax while I'm focused almost solely on these. And then I don't have to worry about how much insulin I need to take if I want to eat one.
It's kind of the best of both worlds.
Almost.
It would be better if I didn't have diabetes and I could eat them without thinking.
Looking on the bright side, that wouldn't be all that good for me. So here's where having diabetes saves me from myself! That's something to be thankful about.
Beth is the person who started the wonderful diabetes365 project. As of today we have over 800 inspired pictures that will help you understand more about living with diabetes.
And she's offering some beautiful diabetes buttons. Check her blog for more details.
If you have a camera and you'd like to explain a little of what it feels like to live with diabetes, please consider joining us on the Diabetes365 project. You'll need a flickr account, which is free. And you'll be in good company because we have several new photo-takers in the last week alone.
Here are some of the stranger searches that folks used to get to my blog [and my responses to some of them]. In no particular order.
medical benifits(sic) of beer and the name of it [Catch me after I've had a few]
she's my bride [Great, coz I've already got one of my own]
guinness diabetes [Tastes way better than insulin]
most outrageous pictures of diabetes [You'd need to see BAD George for those]
too much tv is not good for you [Agreed]
what day was october 8 2007 [The day after Sunday, October 7th]
diabetic "for breakfast" [OK. But remember to bolus properly]
show me the cool pictures related to diabetes month [At the diabetes365 site]
what is lazy?
type 1 diabetes new name [CRAP, I can't remember it]
what bongs better carb or no carb [Carbs man]
is there a cure for diabetes coming anytime soon [Unfortunately not.]
on september 28,2007 what did the moon look like in china [About the same as here, only earlier in the day]
Details, details
Anne wonders how I did this. I use Google Analytics to track visitors to my blog and web site.
One of the feature in Analytics allows you to see the Keywords that brought people to the site. Most of these are the usual suspects, but then there are the gems above.
Analytics is also useful to see traffic flow. For example I have few readers on the weekend, but a spike every Monday morning.
I got a telephone call from the American Diabetes Association (ADA) the other evening. The caller wanted to see if I'd like to renew my membership.
Bad question to ask me.
Richard Kahn is the Chief Scientific Officer of the ADA. And at a recent conference he made a speech(PDF) on Diabetes Technology, where he started by admitting
...I am far from being an expert on this subject, which all of you know much better than I.
He then spoke at length about the lack of clear evidence than much diabetes technology provides benefits that justify its costs.
Amy Tenderich has already given her analysis of this speech together with an e-mail from Mr. Kahn.
In reading both her commentary and the original speech I question if Mr. Kahn is in touch with the realities of diabetes control and management for anyone with Type 1 diabetes. Does he know anything about the challenges of dealing with insurance companies to try and maintain a semblance of good control?
I spent years trying to get an insulin pump before my insurance would cover the costs. My recent insulin pump purchase cost me over $500 and the pump company said my coverage was 'very good'. That's a huge price to pay for reasonable diabetes control. And I lived for years with multiple daily injections (MDI), so I really understand the difference.
So back to the ADA and my membership.
I joined the ADA many years ago and have acted as an ADA diabetes advocate in the past. I've also been fortunate enough to raise thousands of dollars for the ADA in various walks and bike rides.
Well no more. Until the ADA senior membership can demonstrate that it's focused on the best needs of those living with diabetes, I can't associate myself with them.
In future my focus will be on other diabetes fund-raising efforts. And I won't depend on ADA's view of the world for diabetes treatment and research, because it's clearly not in my interests to do so.
Instead I'll work with my many friends in the Diabetes blogosphere, groups like TuDiabetes.com and the Diabetes365 project to help educate others on new options in diabetes treatment and in better ways to use these to improve our lives as we live with this terrible disease.
Dexcom SEVEN is cleared to calibrate with any meter
Dexcom announced today that it had received clearance from the FDA to calibrate its Dexcom SEVEN continuous glucose monitoring system using any approved blood glucose meter.
Once this feature is made available, Dexcom users will no longer need the dreaded six foot plus calibration cable. It'll need a software update to allow input of the glucose meter values. I hope they use a good algorithm to let us input those numbers!
Dexcom expects to make this feature available on new systems by the end of the first quarter of 2008, and to upgrade existing users during the second quarter of 2008.
I know that they've already started trials on their 3rd generation system, but so far there's no news about the upcoming features in the 3rd generation or the likely date for the system.
Not a huge number, a la Martha Stewart. But something between 4 and 6 depending on whether some have been taken by critters, or just passed on.
Early the other morning as I went get something from the garage I spotted the chickens already out for the day. It was bitterly cold, so their feathers are all fluffed up for extra insulation. And it was too dark to start picking around for food.
Yet they're still out there, instead of being a little warmer inside the enclosed part of our home-made coop.
If you're wondering why, then you clearly don't know chickens.
In the five years since we started keeping chickens I've learned a lot about them, and a little more about myself. Chickens are just plain stupid. They can't figure out even the simplest of things.
Thankfully we don't keep them for their brains. Initially we wanted them for their eggs and to teach the children about where some of their food comes from.
But over time I've learned that chickens are just a delight to have. They don't need much care and feeding. They'll eat table scraps, so we're not throwing out as much food.
And they make me laugh. Big belly laughs when I watch them run around the yard.
So in a way having chickens is also good for my diabetes. Because anything that gives you healthy fresh eggs and makes you laugh can't possibly be bad for you.
Oh, and they've also trained me very well. If I look at the coop and the chickens see me, they crowd at the door. Most of the time this is enough to get me to go out there and feed them some cracked corn.
According to the International Diabetes Federation, diabetes is the fifth leading cause of death worldwide, it's expected to cause 3.7 million deaths this year alone.
Maybe you know someone who has diabetes, why not call or contact them in honor of today and learn a little more about what this disease is all about?
Most people with diabetes have Type 2, and often the symptoms are not recognized in time to stop complications from damaging their body. Do you know the symptoms of diabetes?
And if you'd like to know a little about what it's like to live with diabetes, check out some of the pictures from the diabetes365 project. They'll give you a glimpse into how diabetes impacts our lives.
Richard Kahn of the ADA recently gave a speech where he seemed to be against the technology that I depend on every day to keep me alive and well. Amy Tenderich and others have blogged about his comments.
I'm not saying much on the topic because his speech(PDF) makes me so mad. It strikes me that he has a lot of nerve for someone who doesn't seem to have diabetes and therefore doesn't need these devices to maintain his health or quality of life.
Here's where I stand on this.
I wear and use several diabetes devices that have really given me my life back.
The first of these was my blood glucose meter. Before I had one of these I used urine testing. I called this the "closing the stable after the horse had bolted" test. Because all it told me was a value after my blood glucose was high enough to spill into my urine. So the test might say I was 'negative', but my blood glucose could have been 190 mg/dl. And the thing was stinky and a pain to use.
About nine years ago I started using an insulin pump. Before that I was on multiple daily injections. On a good day I only had about 6 injections. On a bad day, 9 shots or more. My blood sugar control was pretty lousy. And before the pump I really couldn't exercise because it's impossible to undo an insulin injection.
In the last year I got a continuous glucose monitor. This has freed me from a lot of worry. No nighttime lows without a warning. Long distance driving? No problem.
Life is a lot easier with all of these. But they do have challenges.
It's extra stuff to carry, to program, and to download information from. The cables alone are a pain. And when the pump and CGMS alarm multiple times in the middle of the night, I want to throw them away.
But you'd have to pry them from my cold dead hands before I'd give them up.
World Diabetes Day only a few days away. And I think this is the high point of National Diabetes Month for me.
You've possibly seen these links on other blogs, but just in case.
Allison of Lemonade Life has opened the voting for 3rd Annual Diabetes O.C. Awards. So get over there and vote for your favorite diabetes blogs and resources. Read's Allison's blog post for more details.
Manny of TuDiabetes fame has posted the video that was created from the submissions for the word in your hand project. It's a thoughtful video that helps people understand what it's like to live with diabetes, and it's worth watching.
It's produced so that it contains less digestible carbohydrates, so you don't need as much insulin when eating it. Here's what they say on their website.
Dreamfields Pasta has largely the same level of durum semolina as traditional pastas, with a low level of our unique blend of fibers and proteins and no soy fillers. The Dreamfields approach means fewer carbohydrates get digested that will increase blood glucose response. So you get the authentic taste and texture you expect from pasta, but with only 5 grams of digestible carbs. Dreamfields also contains twice the fiber of regular pasta, including a special fiber called Inulin that has been shown scientifically to promote digestive health and support a healthy immune system, while enhancing calcium absorption for strong bones and teeth.
I spotted a box in my local supermarket. First thought, it's expensive - about 4 times as much as box of similar regular pasta. So when we next had pasta at home, I just cooked myself one portion of Dreamfields. It tasted pretty good and definitely gave me a smaller spike. So I'll be using it sparingly in the future in place of regular pasta.
I've already written a few times about Symlin on this blog. Recently I got a long comment/question about how to use Symlin effectively. So I thought I'd share more of what I've figured out about Symlin and how I use it.
Warning to reader: this is how I use Symlin and generally it works for me. But the same approach may not work for you. Please use extreme care when using Symlin, the lows can be extremely bad, and they're difficult to treat.
I use an insulin pump and that's important because I don't know how I could use Symlin if I was injecting insulin. More on that in a moment. You can find some great information about Symlin on Children with Diabetes, and there's also a discussion group for Symlin users on TuDiabetes. Finally the makers of Symlin, the companyAmylin, has a Symlin website.
Symlin Facts
Symlin, or pramlintide, helps to reduce the blood sugar increase that you get after eating meals (postprandial high or postprandial excursion). It's an artificial version of the hormone amylin. Like insulin, amylin is produced by your pancreas in its beta cells. It works in three ways to reduce the amount of insulin you need to take after a meal.
It makes you feel full more quickly (increased satiety)
It slows down how food empties from your stomach, and
It reduces glucagon production, which slows down glucose conversion by your liver
Symlin is intended for people with Type 1 diabetes. For Type 2 diabetes I understand that Byetta is similar in effet.
It's recommended that you don't take Symlin unless your meal contains at least 30 grams of carbohydrates. Symlin seems to last for about 2 hours after you inject it.
Symlin dosages are in micrograms (mcg). I use an insulin syringe to inject Symlin, so I think of dosing in terms of units like insulin. It's currently only available in 5ml vials, half the size of insulin vials. The FDA approved a Symlin pen recently and these should be available in December 2007.
How I use Symlin
I now take Symlin before most of my meals.
Initially I started with a 3-unit dose, and I've gradually increased that. I had terrible nausea for about the first 4 weeks that I used Symlin. This was so bad that I didn't want to take it sometimes and couldn't always finish my meals. While that was happening I couldn't take even a reduced dose of insulin until after my meal was over since I didn't know how much insulin I'd need.
Gary Scheiner of Integrated Diabetes Services suggested working on the breakfast dose. And once that was right, trying to get the same dose to work on other meals. That was really helpful because treating a Symlin low at bedtime is too scary to think about. So I used this advice to gradually increase the amount I injected until I got to a dose that worked for me.
Now I generally take 16 units of Symlin 10-15 minutes before I eat. I'll usually inject insulin using an extended (square wave) bolus about an hour after eating to take 20% less insulin over a 90 minute period.
This is why I can't imagine injecting insulin and using Symlin. Because timing a single injection right would be too difficult for me. Maybe it's possible to take Symlin, eat a meal and 30 minutes to an hour later take a single injection with a reduced dosage.
If my carb counting is reasonable, I'll see no blood sugar rise after eating. But most days what I end up seeing is a blood glucose rise of about 50mg/dL about 2 hours after I've eaten. So my blood sugars might go from 110 to 160, and then come back down fairly quickly.
I never take Symlin if I have more than about a unit of insulin on board from a previous bolus. If I'm about to eat and my blood sugar is high, then I'll partially correct for that with a regular bolus and then use my extended bolus after eating.
For me, Symlin has also caused my blood sugar to drop even if I don't inject at all. From talking with Gary Scheiner and Amylin, this is possibly due to the slowdown of glucose production from my liver. On my Dexcom I can watch this happening and I've even verified it by taking Symlin without eating and while I was doing basal testing so there was no additional bolus insulin on board.
Overall I really like the impact Symlin has on my blood sugar control. In April 2007 my A1C was 8.4, by July it had dropped to 7.0. I attribute this to a combination of using Symlin and my Dexcom CGM. In October 2007 my A1C has drifted up to 8.0 (blast!), but I'm retaking it to see if this is simply a lab error.
With the recent interest in glycemic variability, I think Symlin is an important tool for smoothing out after meal highs. My hope is that the Symlin pen is the first step on providing different ways to take Symlin and I expect to see more Symlin users in the future.
Update: I wrote a review of the Symlin Pen in January. I like the overall design and it's much easier than carrying round a vial of Symlin and a syringe.
Note:I have purchased shares on Amylin in the past and I may do so in the future. I work not to let my investments influence what I say on this blog.
Yesterday I was able to experience the D-blogging community uniting around D-Blog day. When you have a chance, take a moment to look at what people posted about the day. It's inspirational and moving, sharing and supportive. For me it's a great example of an online community in action.
And this morning I was blessed that I could attend a pumpers group meeting that happens on the 2nd Saturday of each month in Woburn, MA. This is a strong group of caring folks that get together so they can learn about some aspect of diabetes care. That's the months when there's an organized presenter.
But some months we get together to see how everyone is doing and share experiences and anecdotes about life with diabetes.
If you've never had a chance to be with a group of folks who all have Type 1 diabetes it's hard to explain the instant connection that you have with each other. There's also a freedom that comes with no having to explain why you're fiddling with a pump on your belt, or sticking your finger to take a blood glucose test.
This is community in action in the best sense of the word.
Maybe you'd like to get a group like this going in your area. Sounds impossible? Well why not join one of the local groups in TuDiabetes and see whether you can't find other folks nearby and just start with a few of you.
You might be surprised at the benefit and support you can get and give from time with good friends sharing a common diabetes connection.
I'm in bed as I type, courtesy of some bug that's been floating around the family and the office.
Despite diabetes I'm usually fairly healthy, but diabetes means my immune system doesn't work as well as it should. My blood sugars have been high all day, and wouldn't go down even with extra insulin. That gave me a chance to think about how I felt, and I had to admit to having caught something. Oh well, hopefully I'll be back on my feet before the weekend is out.
So here are a few links for Friday. I hope everyone has a wonderful Veteran's Day weekend. Keep our military men and women in your prayers, they need our support.
Today is D-blog day. If you're new to the blogosphere, you'll find lots of great bloggers writing about diabetes-related issues.
I've mentioned the diabetes search engine before. Right now it uses Google technology to search over 750 sites for information about diabetes. I'm probably adding around 20 sites a week to the engine so hopefully it's getting more useful over time. And the money that's raised by advertising revenue goes to diabetes research causes. Please try it out and let me know what you think. If you know of a good diabetes site that's not in there let know about that too.
Recently I found the SafeSittings web site. (The owner is a member of TuDiabetes.) What do they do?
SAFESITTINGS is a nationwide website that makes available teens with Type 1 diabetes as babysitters for children with diabetes. These teens have been managing their own care for many years. They understand the dangerous highs ands lows inherent in the disease and have the skills to test blood sugars, give insulin injections, adjust insulin pumps and treat hypoglycemia.
I imagine that for parents of children with diabetes, this might be a great service. And for teens with diabetes, it might be way to earn useful babysitting money and feel good about helping out a family. What a great concept!
I've been reading the Wall Street Journal Health Blog a lot. Good short articles about health-related issues. One of the recent posts is about the increase in use of adult meds by overweight children.
A small but growing number of children are taking medicines for high blood pressure, cholesterol and especially diabetes[my emphasis], according to an analysis presented at the American Public Health Association’s annual meeting in Washington this week. One big reason: childhood obesity. ... Among the findings: America’s tweens, kids ages 10 to 14 more than doubled their use of type 2 diabetes meds during the studied period. Girls ages 10 to 14 showed a 166% increase. Still, the prevalence of use is still pretty low. For kids aged 15 to 19, the use of type 2 diabetes meds was only a tad more than one kid in a thousand in 2005.
So the bad news is that type 2 diabetes is on the rise in children. The good news (such as it is) that it's not a huge proportion, yet.
I wish there was an easy way to improve these statistics.
to be the resource on the web for anything about CGMS reimbursement.
And on Monday the Centers for Medicare & Medicaid Services (CMS) finally approved billing codes for continuous glucose monitor systems.
In theory this means it will become a little easier to claim for these systems from your insurance company. In reality, it's not such a slam dunk. Until there is more proof that use of a continuous glucose monitor improves blood sugar control, insurance companies are not going to cover these devices as a matter of course.
While we're waiting for better coverage, if you've got any information about insurance coverage for CGMS based on your experience, do visit CGMS Central and share the information with others.
Why would anyone want to take one picture every day for a year? And what good does it do?
Beth of the in search of balance blog first came up with the idea in early October. And when I read her post I saw this as a great way to explain to those who don't have diabetes what it's like to live with this disease.
It's been a little over a month now, we've got an official web site, and almost 30 photographers who are telling a little part of their story. In pictures and in words.
Because often there's more to the story than you can see at first glance. Like this shot of my foot protectors.
You see a pair of well-worn slippers. But because of my diabetes, I see my trusty foot protection.
When you have diabetes, your circulation is often affected. And that means that any damage to your feet can take a long time to heal. Even minor cuts, bruises, or blisters. In fact diabetes is responsible for "more than half of all lower limb amputations in the US" according to the NIDDK.
Maybe you already knew this.
But I'll bet that if you look through some of the over 500 pictures in the diabetes365 project you'll learn things about diabetes that will surprise you and may even move you.
I was diagnosed with diabetes 35 year ago, at the end of a summer spent on the west coast of Ireland. It's hard to describe just how magical that summer was. I had taken lessons scuba diving and a large group of friends spent almost every day in the water.
In the afternoons we'd head back to my house and devour a huge chocolate pound cake that my Mum made. (We took to calling these tombstones because of their size and shape.)
Back home in Dublin after a week of getting sicker, I was sent to hospital and given the official diagnosis of diabetes. I can't really describe how this felt.
I think it's as if I was sailing along on beautiful country roads with blue skies and no delays. Then I turned a corner and I was on a highway, in a rainstorm, with horrible traffic and nothing but red tail lights stretching ahead of me.
Anyone watching wouldn't have seen changes in me, but inside I always expected the inevitable onset of diabetes complications. I sort of expected the worst.
It was almost 20 years before those tail lights went away. Thanks to a wonderful and patient endocrinologist at the Joslin Clinic, a lot of those clouds were lifted.
Now most days are easier. And I've mentioned elsewhere all I've been able to do despite (or because of) diabetes.
It's still a lousy disease, that requires constant work every day of my life. But I've learned about acceptance and endurance and blessings from God.
There is no cure for diabetes.
Yet.
Learn more about what living with diabetes is really like at the diabetes365 project.
-737135.JPG "Picture of the book cover for Sex and Diabetes")
One of the feature in Analytics allows you to see the Keywords that brought people to the site. Most of these are the usual suspects, but then there are the gems above.
