LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Tuesday, December 27, 2005

The light bulb moment

I think this will be my most important post yet. It is long and deep, so if you only ever read and think about one of my posts in your life, this this is the one.

To set the stage you need to know that I'm on vacation. Most Pro-labs in the US close between Christmas and New Year. There are several reasons for this. First is there is not a lot of work to do during this time period. Second, it is the end of the year for bookkeeping, inventory and all those paperwork hassles. It gives us time to rest, look where the year went and plan for the next year. It gives us time to work on our machines, which are too key to our turn-around time to get the attention they deserve during the year. It is a time to rest, recharge, and get ready to go back into the fray.

It also has given me time to think. And I realized between breakfast and lunch today that I've been using the Guardian wrong. Totally wrong. It was truly one of those light-bulb moments. One second you are in the fog and then poooooof, the next second everything thing is crystal clear, like a frosty sub-zero winter morning. I was chatting with a friend of mine on the phone while reviewing Guardian data for the last few weeks when it hit. I guess the subconscious and the conscious linked up in a quick moment of clarity, inspiration, and mental nirvana. All of the sudden I internalized how the Guardian works, or how she can and ought to work. In short: I got it.

I've been using tomorrow's technology with today's mindset. That's worse than wearing blinders, it is like trying to put a DVD into a ViewMaster. The paradigm has shifted. This technology is so far advanced we can't use it like we use our old tools. We need to get smart and change the way we think. We need to adapt to the new tools at our disposal. No more knee jerk reaction to problems that come up: we have been given the crystal ball. We can prevent problems before they happen.

The Guardian is not merely better finger sticks. It is to finger sticks what a 747 is to the Wright Flyer. Yeah, they both fly, but the similarities pretty much end there. The Guardian is not super finger sticks, it is a whole new way of looking at Glucose data and responding to it.

When I first started using the Guardian I thought to myself: well this is great! It will let me know when I get out of control. Now I realize that is myopic. Why wait? The Guardian can be so much more. So very much more. It has the capacity to give me an advanced warning that things are going to get out of control before they are anywhere near that point.

This concept is different from how we deal with our diabestes now, or it can be. Now we can be alerted that we are leaving our normal range. Think about it for a moment. Instead responding when things have already gone to hell, we can think, plan, and respond as appropriate before they go to hell. We can be highly pro-active. I don't think I've been using the Guardian to her fullest potential.

Why did it take me so long to get it? It is partly the fault of the old ways of thinking and partly it is the fault of language. So part habit and part linguistics, lexicons? At any rate, the way we use words and the words we choose to use. Words are power. The words we choose force our minds to follow certain paths....and not always the best ones. I've been thinking a lot about words lately, and the power of words. Words often carry such baggage that they pre-bias our thinking. Words can lead to wars.

As we head quickly into a new year it occurs to me that we diabetics are headed not only into a new year, but a new era. Continuous glucose monitoring is going to change everything from the way we think about our condition, to how we treat it, to how we talk bout it. As one of the pioneers on this frontier I've decided to propose the first few new words of the language of the future. My chance to shape the conversations that will come.

First I want to talk about a BG reading that is not what we expected. Specifically a Guardian alarm that is not verified by a subsequent BG reading. Currently we all call these FALSE ALARMS. I've been thinking a great deal about this, and I think that is not entirely fair, accurate, or appropriate. I propose we hence forth call them what they are: pre-mature alerts.

If the sugar is trending downwards and the Guardian sets off an alarm before the BG actually reaches that level, is it really a false alarm? Or is it an advanced heads up? Even the word "alarm" is probably inappropriate. “Alert” is probably a more accurate word. An alarm suggests a situation that requires a response. An alert is a word that suggests you need to pay attention.

And that is the bottom line promise of continuous glucose monitoring. It is a way for us to pay attention. The idea is to provide us with a sense of heightened alertness when the tide starts going out or coming in too quickly.

Instead of using her to alarm when the shit has hit the fan I can use her to alert me before the shit hits the fan. This is where the power of language both benefits and burdens us. If we think in terms of alarms we are think about taking care of trouble that has already happened.

Example: you set off the fire alarm when the building is burning. A burglar alarm goes off once the burglar has set foot into your businesses. The Wal-mart inventory control alarms go off as the teenagers slip out the door. The car alarms fads off into the distance as the thief drives away with your car. Alarms not only require immediate action, they happen after what we are trying to prevent has already occurred.

However, look at alerts and warnings by contrast. A tornado warning tells you to get your ass into the basement. A severe weather alert tells you to get inside. The air force spent untold millions to install early warning radar across the frozen north to alert them to Soviet bombers or missiles. Alerts are proactive. Alarms are reactive.

Think about alerts. You don't have to respond to an alert. An alert merely tells you that you might be headed in a wrong direction. It is the yellow light. With conservative alert thresholds you don't even need to confirm with a finger stick in many cases. But you can be aware. Aware that maybe things are changing. You can check the trend. It is like the tickle on the back of your neck that warns you strangers are following you down the street. Hostile intent? Maybe. Maybe not. But you are alert, aware, and ready for action should it become necessary.

I had set my low "alarm" at 75 and my high "alarm" at 250. I've changed those. Now my below range alert (a BRA?) is set at 85 and my above range alert (ARA?) is set at 190. These aren't alarms. I don't need to DO anything when they go off. Their purpose is to alert me I've left my normal operating range. My blood sugar is beginning to change from it’s normal safe environment. What I do then depends on the computer in my head. That’s my brain, folks, not some new toy I ran out and bought.

If I get a below range alert half hour before dinner I don't really need to worry about it, do I? On the other hand, a below range alert a hour and a half after a meal is cause for great concern.

I've also re-set the alert repeat feature for lows from 20 minutes to 45. (If I've had a real low the pump will remind me to recheck in 15 minutes). On the high side I've left it at 2 hours.
When I get an alert I can scroll back 5...10...15...20...25 minutes. I can look at the trend and see how fast it is moving. I can think, plan, and react in a timely and safe manner.

It is a whole new world for me and the girl. Funny how guys always underestimate the fairer sex, isn’t it?

So my pre-New Year’s resolution is to try to stop using the words “Low Alarm” and “High Alarm” here at LifeAfterDx, and call them what they really are: alerts that my BG is leaving the range that my health team and I like to keep it in. I count on you to slap my hand if I slip up.


Anonymous Anonymous said...

Wil, this post is a true gem! Elizabeth and I talk about the Guardian RT regularly, and we're constantly struck by how much information it gives you.

Another great metaphor may be like 1980s business computers. If you want to know how many Ataris your other branch has, you need to pick up the phone and call.

Fast forward 30 years. Not only can you find out in a keystroke, but you can be alerted when your stock is dropping. You can map trends to guess when it might drop during the day.

Sure, you could have done the same modeling before - but who has the time or energy to crunch those numbers every day?

In the future, the Guardian RT will give people with diabetes enough information to do complex modeling. But there's still one major hold-up (and a wonderful business opportunity if someone out there has the skillset): the software hasn't been written yet.

7:55 AM  
Blogger Scott K. Johnson said...

I think you're really on to something with this.

Funny how our frame of mind makes such a difference.

3:02 PM  
Blogger Johnboy said...

Wil, this make a lot of sense. I'll be looking forward to seeing how operating in this new paradigm works for you as evidenced by number of true hyper and hypo events moving foward.

It's a new day and a new year!

3:14 PM  
Blogger Wil said...

To all three of you, I applogize for taking so long to repsond. Swamped with good things. This new approach is very exciting. As we head into the new year I'm going to be talking a lot more about it!

10:06 PM  

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