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Appreciation For A Heroine

Appreciation For A Heroine

Friday the 26th of August 2016 was the celebration of Dog Day. It is a day to honor the bond between people and canines. The realization of this day brought a set of prior feelings for me regarding the impact of Maggie Mae our family miniature schnauzer. She arrived as a puppy in 1999 and became an outstanding heroine for me.

I was diagnosed as a type 1 diabetic, T1D, in 1966. One of the biggest challenges facing a T1D is the extremes of two general comments. The first is the fact that all a diabetic needs to do is simple manage their food, insulin and exercise. The opposite extreme is the complexity of this condition. Maggie lived an exciting life and a great friend and heroine. Maggie entered our lives as a puppy with a twinkle. We just had to explore the world. We walked and walked. She smelled the surrounding and I spoke to neighbors, friends and children.

One of the biggest challenges and fears facing a T1D is the ability to go to sleep with a normal blood glucose level and awaken with a normal blood glucose level. Dead in bed is a real fear due to the fact that during sleep we are not cogent to our feelings and environment. There were numerous times that Maggie would come flying onto our bed in the early morning or late evenings to awaken me from a low glucose level. She would immediately begin to lick my face to awaken me from slumber. Wet kisses can do that! Maggie had a sense that sometime was afoot and would spring into action.

After nine plus years Maggie gave this morning monitoring review over to me. What happened was that Maggie was diagnosed as a type 1 diabetic dog in 2009! Now, to any of you that suggest that T1D is just the balancing act of the management of food, insulin, and exercise needs to take the opportunity to live with a type 1 diabetic dog. Oh, on a side note the data indicates that 1 in 10 dogs and cats will develop T1D. Our agriculture community needs help as well with diabetic animals! What does it mean to live with a T1D dog? It means living a life that I lived prior to the development of blood glucose meters, insulin pumps and continuous glucose meters. Urine samples were collected. The urine was tested with Urine Diastixs. Food was measured. There was a waiting period to determine how much she would eat. Maggie received two shots per day. The amount of insulin was quantified based upon the food she consumed and the value of the Diastix readings. Her meals were scheduled for the morning and evening. The insulin choice was Humalog N. But, the fun comes when she would decide to not eat all of her meal.   The changes in exercise patterns would also impact her control. Smaller dogs do not like to get wet in the rain.   Now, I slept with one eye opened for possible sleep hypoglycemic events by her or myself. Momma said there would be days like this.

So, for almost four years we diligently monitored Maggie. My advantage was that I have such days as Maggie. The best laid plans of mice and men can go astray! We stayed the path to live and share a very eventful life. I took the time to give to Maggie what she had given me for ten years . . . a managed life and staying focused on the present (which she shared with me) and utilizing the knowledge of the day or period with the smell of roses, flowers, other dogs and cats, friends, snow, etc.

Here is the fun activity. Arise when the temperature is 20 degrees Fahrenheit and carry a Glad container to collect a urine sample. Oh, we would walk for 20 minutes. She was a real snow dog. Maggie was a dog who loved to walk. We knew the houses, adults, children and other animals. The simple act of walking some four to six times a day for thirteen plus years expanded my exercise too. The Vets we surprised with her general health up to the last six months which ended in July 2012.

For all that you shared with me, our family and sharing our type 1 diabetes together. Looking forward to walking with you again.   A special thanks to a real heroine.

 

Friday the 26th of August 2016 was the celebration of Dog Day. It is a day to honor the bond between people and canines. The realization of this day brought a set of prior feelings for me regarding the impact of Maggie Mae our family miniature schnauzer. She arrived as a puppy in 1999 and became an outstanding heroine for me.

I was diagnosed as a type 1 diabetic, T1D, in 1966. One of the biggest challenges facing a T1D is the extremes of two general comments. The first is the fact that all a diabetic needs to do is simple manage their food, insulin and exercise. The opposite extreme is the complexity of this condition. Maggie lived an exciting life and a great friend and heroine. Maggie entered our lives as a puppy with a twinkle. We just had to explore the world. We walked and walked. She smelled the surrounding and I spoke to neighbors, friends and children.

One of the biggest challenges and fears facing a T1D is the ability to go to sleep with a normal blood glucose level and awaken with a normal blood glucose level. Dead in bed is a real fear due to the fact that during sleep we are not cogent to our feelings and environment. There were numerous times that Maggie would come flying onto our bed in the early morning or late evenings to awaken me from a low glucose level. She would immediately begin to lick my face to awaken me from slumber. Wet kisses can do that! Maggie had a sense that sometime was afoot and would spring into action.

After nine plus years Maggie gave this morning monitoring review over to me. What happened was that Maggie was diagnosed as a type 1 diabetic dog in 2009! Now, to any of you that suggest that T1D is just the balancing act of the management of food, insulin, and exercise needs to take the opportunity to live with a type 1 diabetic dog. Oh, on a side note the data indicates that 1 in 10 dogs and cats will develop T1D. Our agriculture community needs help as well with diabetic animals! What does it mean to live with a T1D dog? It means living a life that I lived prior to the development of blood glucose meters, insulin pumps and continuous glucose meters. Urine samples were collected. The urine was tested with Urine Diastixs. Food was measured. There was a waiting period to determine how much she would eat. Maggie received two shots per day. The amount of insulin was quantified based upon the food she consumed and the value of the Diastix readings. Her meals were scheduled for the morning and evening. The insulin choice was Humalog N. But, the fun comes when she would decide to not eat all of her meal.   The changes in exercise patterns would also impact her control. Smaller dogs do not like to get wet in the rain.   Now, I slept with one eye opened for possible sleep hypoglycemic events by her or myself. Momma said there would be days like this.

So, for almost four years we diligently monitored Maggie. My advantage was that I have such days as Maggie. The best laid plans of mice and men can go astray! We stayed the path to live and share a very eventful life. I took the time to give to Maggie what she had given me for ten years . . . a managed life and staying focused on the present (which she shared with me) and utilizing the knowledge of the day or period with the smell of roses, flowers, other dogs and cats, friends, snow, etc.

Here is the fun activity. Arise when the temperature is 20 degrees Fahrenheit and carry a Glad container to collect a urine sample. Oh, we would walk for 20 minutes. She was a real snow dog. Maggie was a dog who loved to walk. We knew the houses, adults, children and other animals. The simple act of walking some four to six times a day for thirteen plus years expanded my exercise too. The Vets we surprised with her general health up to the last six months which ended in July 2012.

For all that you shared with me, our family and sharing our type 1 diabetes together. Looking forward to walking with you again.   A special thanks to a real heroine.

 

BASEBALL AND DIABETES!

 

During my pre-teen years, I grew up as a baseball fan of the local team the Cleveland Indians. To set the tone for a discussion of diabetic data, a review of the volume of baseball data is an excellent comparison. It is September. Baseball teams are focused on the goal of playing in the postseason.

Oh, for the sisters, wives, parents, grandparents and friends of Type 1 Diabetics, T1D, some of the guys you know spent too much time pouring over reams of data regarding fantasy sports teams. Guys are you taking care of yourself and managing your personal health conditions including your diabetes with the same tenacity?

Guys it is time to focus on the facts, data and figures regarding your daily health with better management practices for living with Diabetes. Take the time to collect and analyze your own data. Reviewing our own data, facts, figures, graphs and charts can facilitate better discussions with our health care providers. Just is in a baseball game the little differences lead directly to enormous differences in making the postseason!

Hey guys too many of you are quitting too soon. Now, here is a link to a discussion of baseball stats. George Will is a noted columnist, historian and a lover of baseball. The link is to a recent YouTube discussion on the value of baseball and all the numbers.

What does it mean to be have a 0.300 batting average? The real fact is that the batter will be unsuccessful and fail 70% of the time at bat! The real objective is to master the sport.   Have you taken the time to develop a plan and implement the plan to succeed with a healthier life as a diabetic? We all have bad days. It is time to work on achieving better days.

The start of each new day can bring the download of the collection of the data from the previous day, only if you collect the data. The blood glucose meter, the insulin pump, the continuous glucose meter and my fitbit chargehr are uploaded into the individual company programs and posted to the Diasend Program. The choice to use Diasend was based upon the fact that my endocrinologist is part of a major teaching hospital which has been using the Diasend program for some time. By uploading data saves me from printing a stack of paper reports for a doctor’s appointment. Not fair for the doctor. We are all able to review the stats from yesterday’s baseball results today. My ability to succeed with the management of my diabetes is improved by presenting my medical staff with timely data. A great team is composed of a great coaching staff and players striving to succeed. My medical team is comprised with an outstanding head coach, the endocrinologist as manager with a compliment of multiple assistant coaches when needed. I view the volume of data as a game.   Can this individual and my medical team discern small subtle facts and events that over time could improve control and success in living a healthy life as a diabetic?

You may ask why? Just as in baseball it is the little differences over time that will have an enormous difference in the outcome of our lives.

After fifty plus years as a type 1 diabetic, T1D continues to present ongoing challenges with new changes and opportunities.  Yesterday is history, we cannot re-play that day. However, we do have the opportunity to review the results and view the best and worst of the prior days. Each day is the beginning of a new day with the choice to succeed or fail. If today becomes a failure we need to pick ourselves up and start again. Go team.

Life can present each of us with opportunities to learn from other venues for living with diabetes. In conclusion, a special thanks to George Will and Prager University for the salient points about baseball and life.

Diabetes Outcomes Measures Beyond Hemoglobin A1c (HbA1c).

The FDA will be holding a public workshop regarding the above title.  This public workshop will be held on August 29, 2016.  Listed below is my letter to the FDA regarding this particular matter.

I am writing to express my comments and opinions to the Food and Drug Administration (“FDA” or “Agency”) regarding the August 29th meeting to discuss “Diabetes Outcome Measures Beyond Hemoglobin A1c (HbA1c).

 

One particular question is the direct relevance and the importance to all patients living with diabetes. Improved timely outcomes need measured data to confirm that given causal actions are having on improved outcomes. We have reached a new period where we are facing a multi-generational issue. The possibility now exists for great-grand-parent(s) with seventy-five (75) years as type 1 diabetics, grandparent(s) with fifty (50) years as type 1 diabetics, parent(s) with twenty-five (25) years as type 1 diabetic(s) with a type 1 diabetic child. The number one desire is to live the healthiest life and minimize complications for all generations!

One size from the age of 2 months to 90 years makes no sense.

Are the choices for the management of diabetes Patient-Centered with consultation of our medical professionals still valid?

How many of us use a ninety day average for your local temperature to determine what to wear today?

Our baby shoes cannot be worn for our lifetime

What data needs to be collected?  When should the data be collected and how should the data be collected? This is only the start. What is missing are analytical tools and analysis to discover and observe subtle changes. One way to build confidence is to identify improvements in patients’ personal health.  Mike Hoskins wrote an excellent article entitled’ “Manipulating My A1c and Looking Beyond that Number”.   (http://www.healthline.com/diabetesmine/looking-beyond-my-A1C). His conclusions were to add the criteria of Time In-Range, Hypos, and Glucose Variability. My salient point to each of you is the following: Blood flows through the body like a moving river. A river will ebb and flow over time. We need current succinct data to make micro adjustments and maintain a “normal glucose range”.   How quickly can a directional signal of an approaching hypoglycemic state be stopped, blocked and turned around to return to a normal blood glucose level as quickly as possible, ASAP! In May 2014, I complied with Medicare and signed up. As a Dexcom CGM user. I found myself in a fight to overcome the position that a CGM was precautionary. My experiences are documented in the following article. (http://www.ajmc.com/journals/evidence-based-diabetes-management/2016/may-2016/a-medicare-appeal-for-cgm-coverage-one-patients-never-ending-story). At the end of the article on page 3, go to the pdf and review the five (5) Figures. Figures 4 and 5 are the critical graphs prepared from the earlier supporting data contained in Figures 1-3. Two of the graphs are at the end of the article. One item that did not appear in the article is the fact that my A1c on 2-24-2016 was 7.0%.Based upon my fifty-year history. It is the lack of collection of what I refer to as soft data. The operative questions in need of analysis are: What, When and How have given me a personal insight in the challenges to live a healthy life with diabetes. As one example, I have found that exercise in the early morning, late morning, early afternoon, late afternoon, early evening and late evening can have very different impacts on my insulin needs and the ability to maintain a normal range.   This is just one example of the variability of life. The real objective is the need to make timely micro adjustments with new tools to maintain or return to a normal glucose level in the same manner as a non-diabetic.      The size of the data base has exploded. How many of you have observed the comprehensive statistical reports from Diasend. Individual data reports or individual diabetic equipment which measures only a certain set of variables can present a major challenge in attempting to coordinate and quantify patient data.

Diabetes is a highly burdensome, 24/7 disease with no time off. It is my position that having multiple backup systems should any one of the units fail for whatever reason. Failure of equipment is unacceptable. The coordination of tools should be focused on the best possible outcomes for the individual patient and determined in conjunction with one’s physician.

It is my position that my endocrinologist is the head coach of my medical team. When I step on the field of life, it is my desire to be prepared with the best equipment and life plan to successfully navigate the personal daily, hourly and each and every minute which I confront as a type 1 diabetic. I will do and I (along with my medical team) will understand. Meaning as a diabetic patient, I need to take the best, appropriate action at a given moment in time. My action precedes the understanding which comes with documentation over time and can be best managed with a doctor patient relationship regardless of the age of the diabetic patient.

The operative question before the FDA should be patient based. How can patients in consultation with their doctors determine a choice of action that has the highest probability of success? Again one size does not fit all the time for all the diabetic people.

The FDA decisions should not be centered on the choice of an either or, binary choice. Meaning, it is not a choice between new single item(s). Coordination and sharing of data, information, will reduce time and facilitate the review of the data.

 

The operative question before the FDA should be patient based. How can patients in consultation with their doctors determine a choice of action that has the highest probability of success? Again one size does not fit all the time for all the diabetic people.

It is my position that my endocrinologist is the head coach of my medical team. When I step on the field of life, it is my desire to be prepared with the best equipment and life plan to successfully navigate the personal daily, hourly and each and every minute which I confront as a type 1 diabetic. I will do and I (along with my medical team) will understand. Meaning as a diabetic patient, I need to take the best, appropriate action at a given moment in time. My action precedes the understanding which comes with documentation over time and can be best managed with a doctor patient relationship regardless of the age of the diabetic patient.

Diabetes is a highly burdensome, 24/7 disease with no time off. It is my position that having multiple backup systems should any one of the units fail for whatever reason. Failure of equipment is unacceptable. The coordination of tools should be focused on the best possible outcomes for the individual patient and determined in conjunction with one’s physician.

Respectfully submitted,

 

The post below is from the http://diatribe.org/BeyondA1c . It has the links for following this meeting on August 29th.  A special thanks to all the members of the Diabetes Online Community for their support on this important matter.  As always have a great day.

To learn more about the FDA Public Workshop on Diabetes Outcome Measures Beyond Hemoglobin A1c, click here for a blog post by the diaTribe team. Stay tuned for event updates on Monday evening, and check out diaTribe’s Facebook Livestream feed, direct from the FDA, on August 29. We’ll also be live-tweeting the day, along with numerous other diabetes advocates from all over the country – keep an eye on #beyondA1c and #DOCasksFDA. We’ll be very excited to see so many patient opinions shared through a video, patient impressions, and a patient survey – stay tuned and be sure to let us know of any questions or comments you have! – See more at: http://diatribe.org/BeyondA1c#sthash.6xMAl80N.dpuf

 

 

 

 

Challenges

One of the interesting challenges facing type 1 diabetes can be the variability of daily life.  Many Online Diabetes Community members have written articles on preparing for travel and vacations.  The new variable that I just faced revolved around the need for surgery.  My daily routine includes the use of an insulin pump which is coordinated with my blood glucose meter, a fitbit and a Dexcom G4 CGM.  As part of the Hospital protocol’s I started with a Perioperative review.  My reporting of my CGM made for some interesting discussions.

The Perioperative review did discover another issue that would require an examination during my scheduled surgery stay.  Ok.  Listed under the comments of the Pre-Anesthesia Instructions was to leave the insulin pump and Dexcom unit in place.  Good!!  Use Glucose tabs as needed after Midnight for scheduled surgery on Tuesday August 9th

As a type 1 diabetic for over 50 years and a Joslin Medal holder, it was my sense that the entire surgery team appreciated the ability to monitor my glucose levels through my Dexcom unit to be very helpful.  Their only concern was that the unit was marked as my personal unit.  It was.

I, for the most part monitored my blood glucose and maintained my CGM values which were shared with the nursing staff during my four day visit.  As a Dexcom volunteer, I was given the opportunity to share my thoughts and feelings regarding the additional help and assistance of the implementation of a CGM in my diabetic care routine with various members of the hospital staff.

Now, the unexpected challenge.  After surgery and a day to stabilize, the decision was made to perform a CT scan.  Both my insulin pump and my Dexcom unit have 24 hour phone lines.  I placed calls and was informed that both pieces of equipment should not be near a CT or MRI machine,.  I was prepared to change my inset line after two days, but was not prepared to change a CGM sensor.  Both were removed and the CT tests were completed.  A CGM sensor was replaced and my family brought a replacement sensor to the hospital.  However, right after the CT test the nursing staff took a blood glucose which hit over 400.  I found the greatest challenge to be the continual monitoring and the ability to change temporary basal flows to be a major assistance during my stay.  It made no sense to me to attempt to figure out what was causing a rise in blood glucose levels.  Just respond as quickly as possible.

I found the hospital had a major plus for a diabetic patient.  I was supplied with a menu and ordered meals.  The food service staff had knowledge of the fact that I was a diabetic patient and had a set of maximum carbs for three meals and an evening snack.  They let me know when I order too much!  The true help came when the meal arrived with the counted carbs!  The opportunity to plan ahead for my meal bolus was not attempted by me and delivery time of ordered meals was dependent upon the time of day.

Now, I am recovering at home and looking forward to returning to a less challenging environment.  The IV lines with fluid and meds are gone!  Surgery and the recovery period can bring a set of challenges that as a diabetic we normally do not face.  I am thankful for all  of the assistance of a great hospital staff and look forward to a return to normal activity.

 

 

 

 

 

 

 

 

 

PERSONAL COMMENTS TO THE FDA REGARDING CGM DOSING

I am thankful for all the members of the diabetic community and members of the Diabetic Online Community, D.O.C. for the output of support regarding dosing based upon our CGM readings to the FDA.  As a Medicare individual, this was a critical first step.  This is a copy of my letter to the FDA.

 

I am writing to express my comments and opinion to the Food and Drug Administration (“FDA” or “Agency”) regarding the July 21st meeting to discuss a change in intended use of Dexcom G5 Mobile, Continuous Glucose Monitoring System, CGM, with all the required functional working component units including the collection, storage and retrieval of actual personal medical information. It is the improved timely information which facilitates choices for healthier outcomes.

I strongly support the application for approval to enable patients to use a Dexcom G5 device as a replacement for their blood glucose meters (BGM) and to make treatment decisions based on the interstitial fluid glucose concentration reported by the CGM.

Based upon my historical experience, neither my BGM nor my Dexcom G4 Platinum CGM are perfect devices. The caveat to my approval and factual experience is the fact that neither a CGM nor a Blood Glucose Meter reading has an absolute certainty with 100% precision. The FDA decision should not be centered on the choice of an either or, binary choice. Meaning, it is not a choice between using either a CGM readings or a blood glucose reading via a BGM.

I am a Joslin Fifty-Year Medal recipient. The technical equipment employed to manage my diabetes via blood glucose levels are an insulin pump, a blood glucose meter, a Dexcom G4 Platinum CGM system and a Fitbit Charge HR.

There have been times for convenience, quickness, and other reasons which result in an inability to perform a blood glucose test. The ability to rely on a CGM reading substantiated a logical choice for a decision regarding insulin dosing. It is important to point out the fact that the converse is also true. Meaning a reading is not available from a CGM and the need was addressed with a blood glucose reading.

The choice of an outcome based upon a CGM glucose value have resulted in successful maintenance or assisted in quicker returns to a normal blood glucose range. The outcome desired by any diabetic is to have near normal glucose levels all the time.   Such ongoing actions can and do improve A1c values with reductions in complications and death based upon severe hyper or hypoglycemic events.  A BGM only tells me my current blood sugar is at a particular point in time, not where it is going and how fast. This is the essential difference between a BGM reading and a CGM reading. There is simply no comparison!

The operative question before the FDA is patient based. How can patients in consultation with their doctors determine a choice of action that has a high probability of success? There are sufficient studies to support the use of a CGM and do include patients over 65 years of age. I find the position of Medicare to be an unscientific argument without supporting documentation to substantiate the Medicare position of Precautionary as the reason for non-coverage of CGM for Medicare patients. In the Whitcomb v. Burwell, Case No. 13-CV-990, United District Court, E.D. Wisconsin.   The director of health and human services, DHHS, was asked to supply clinical studies supporting precautionary. DHHS has yet to supply such documentation. A CGM is no more precautionary than putting working brakes on a car. A blood glucose meter can be compared to a photograph. It is a set picture at a given point of time. The number is a static point. On average, ten blood glucose readings per day can be compared against the possibility of 288 glucose readings over a 24 hour period. With 6-8 hours of sleep this represents 25% – 33% percent of the time per day is missing documentation to support a management decision of my blood glucose levels with the use of a BGM only. Dead in bed is a serious factor facing type 1 diabetics due to narrow range and highly toxic range of insulin. A CGM has proved to be an additional safety layer of protection. It has reduced the extremes of severe hypoglycemic and severe hyperglycemic events with improved A1c values. 

Blood glucose meters are not currently FDA approved for dosing insulin or making treatment decisions and some were cleared over 10 years ago under more lenient accuracy criteria. Why are CGM devices held to a higher standard?

Personal experience of each and every patient is critical. Type 1 diabetics now exists in the range of ages from 2 months after birth and have reached 80 years as a type 1 diabetic. The balancing act of our lives swing around insulin and other meds, food and exercise.

  1. One size from the age of 2 months to 90 years makes no sense.
  2. Are the choices for the management of diabetes Patient-Centered?            The body is driven to establish a dynamic equilibrium between blood glucose, BG, and interstitial glucose levels, IG. During events and periods of an imbalance between BG and IG, I have found the use of my BGM and my Dexcom present the opportunity to determine choice of action(s) to the lack of a balanced equilibrium between BG and IG levels. At such times, there is a difference in BG verses CGM readings. The consumption of food, the introduction of a new medication and intense exercise can separate the dynamic equilibrium between BG and IG. The outcome desired is a normal BG equal to IG. As diabetes this is the management challenge and the coordination of both add to the level of safety.             It is my position that my endocrinologist is the head coach of my medical team. When I step on the field of life, it is my desire to be prepared with the best equipment and life plan to successfully navigate the personal daily, hourly and each and every minute which I confront as a type 1 diabetic. I will do and I (along with my medical team) will understand. Meaning as a diabetic patient, I need to take the best, appropriate action at a given time. My action precedes the understanding which comes with documentation over time and can be best managed with a doctor patient relationship regardless of the age of the diabetic patient.             Diabetes is a highly burdensome, 24/7 disease with no time off. It is my position that having both a BGM and CGM comprise a multiple backup system should one of the units fail. The coordination of tools should be focused on the best possible outcomes for the individual patient and determined in conjunction with one’s physician.

 

 

AN APPROACH FOR SHARING AND CARING DIABETES

 

I recently received an e-mail regarding the “JDRF Funded Researchers Talk about Listening”. The main point of the article focuses on helping children and young adults with T1D. As a tech guy, I understand and appreciate the importance of data and information to assist in the analysis of a challenge. The JDRF blog of 2016/06/15 is entitled; At ADA, JDRF-Funded Researchers Talk About Listening. Here is the link. The children and young adults are sharing concerns they have about their individual T1D.

https://mail.google.com/mail/?ui=2&ik=b465fbfb7e&view=att&th=1564c5a7d1a3590c&attid=0.1&disp=safe&zw

One particular management approach is the question of what is being measured. What improved outcomes have been demonstrated which facilitates success by young T1Ds? My position is based upon fifty years as a type 1 diabetic, T1D. Small improvements over time assist each of us in confidence building and success in the management of our diabetes. We cannot give up and need to continue to improve our outcomes.   In this case, how can each of us, as senior T1Ds, help children and young adults with T1D? This is a very important and noble cause. I am suggesting a new direction to this issue.

As a 50 year T1D Joslin Medal recipient, I am suggesting the following: Link 50 year Joslin medal winners with children and young adults with T1D.   This shared listening and communication is very similar to the communications between a grandparent and a grandchild. Another example of this model is the use of sponsors in Alcoholics Anonymous. This direction can mitigate and reduce the fear in a medical facility with other T1Ds. In an interesting turn of events, I observed my grandmother measuring food on a scale and give my dad’s father, my grandfather daily shots when I was about 10 – 12 years old. I was diagnosed in April 1966, one month prior to my seventeenth birthday. It was my ethic grandmother who modified her approach with me. She changed the conversational actions regarding food. How? By her actions! As an ethic Grandmother, she no longer measured my love for her based upon how much of her great dishes and recipes of food, which I should have eaten to demonstrate my love for her. Sound familiar?!#

Fifty year Joslin metal winners have accomplished something relative to the challenges facing young T1D patients. We are numerous examples of everyday people, besides famous people in the media.   We are everyday examples that the opportunity exists for T1D children to live a long fulfilling life with diabetes.

 

The first slice of my diabetes.

Relationships are an experience that we deal with on a daily basis.  They range from personal, professional, social, economic and many other forms in the daily give and take of life.  One relationship which has been a cornerstone on my view of the world.  It revolves around the personal mental, physical, emotional  matters.  Walking with an attitude of gratitude about being blessed with diabetes, prior to my seventeenth birthday was influenced by the times during my hospital stay.

My relationship with my diabetes has been and continues to be influenced by music.

This is MY VIEW OF DIABETES THROUGH A THIS GUY’S EYES

In 1965, at the start of my high school junior year, a very unique and special relationship emerged in my life. It was consummated later in April of the same academic year when I was diagnosed with juvenile (Type 1) diabetes. The experts at the time informed my parents, but not me, that this relationship would be lethal within ten to fifteen years. Through trial and error, I came to realize over time that the success of this new relationship with my “It Girl”, diabetes, would be based upon my choice of actions. She is a riddle wrapped in a mystery inside an enigma. The responsibility of stabilizing our relationship was mine and mine alone.

The challenge for me was to find ways to measure my successes for a budding healthy relationship with my “It Girl”. At the start of this relationship, she was the quiet one, but if she was ignored, there was a serious price to pay.

My biggest ongoing fear has been best expressed in a very special song for me.  The song search is:  will you love me tomorrow the shirelles.  Just copy and paste for an internet search.  A link to the song and the group, the in a prior posting, has been blocked.  The poignant concerns are mirrored in the line, “Tonight the light of love is in my (eyes) But will I (be there) to love her (my “It Girl”) tomorrow”. In my mind, the lyrics are: will glucose be normal through the night and will I see her tomorrow? 

My overriding desire has been and still is for successful outcomes with this relationship. It is driven by my desire to quantify successes in our relationship.

Measuring timely information was a major roadblock for our first twenty-five years together. I had failures which were hard lessons to learn, especially the speed of a hypo event during exercise as well as developing hidden hyper events. Originally, the data from single point visual urine tests and later blood glucose tests were the only measurement I had. These have a delayed factor and are static. The timeliness of urine and followed by blood glucose tests are similar to photographs developed after serious auto accidents-too little and too late. Improved information technology with the introduction of blood glucose meters and insulin pumps began to bring visualization and clarity to the roller coaster challenges of everyday life of hypos and hyper events. In 1989, the introduction of the family puppy became my daily exercise teammate and my sleeping continuous glucose monitor.   She proved to be a major improvement in the timing for corrective actions while sleeping. It was uncanny how she accomplished such an accurate feat by licking my face to awaken me prior to hypoglycemic events with time for corrective actions. The passing of our family dog in 2012, lead me to add a real time continuous glucose monitoring system, CGM, which I continue to wear. These improvements in information technology and accuracy via coordinated blood glucose meter, pump, food carb levels and CGM reports have helped to keep this “It Girl” happy and has improved our kindred relationship.

Guys can be very selective about the data we absorb and share. The time has come for guys to understand the importance and insights from the real time stream of information from continuous glucose meters concerning our diabetes. Choices of actions are improved because of timely measured data trends indicating whether to quickly increase, decrease or stop insulin flow, exercise, and/or food intake. Various combinations of action can also achieve stability within normal blood glucose levels. This leads to measured improved hemoglobin A1c outcomes. The result for me has been reaching a fifty-year relationship with my “It Girl”-one the doctors predicted would never happen.

Dan

On February 14, 2015

A Slice of Life with Diabetes

Welcome to A Slice of Life with Diabetes.  The posting are personal thoughts, comments and suggestions.  I am not a doctor or medical professional and do not offer any medical opinions or advise.  A word of advise, always consult with you personal medical team should you find a posting related to the challenges that you are facing in your walk with diabetes.  I was diagnosed with type 1 diabetes in April 1966 and received a Certificate of Achievement and the Joslin Fifty-Year Medal in April 2016.