Rearview mirror

I’m lying in bed with the covers pulled up to my nose, debating about whether or not to get up. True, the sun is out, but according to my multifunction clock it’s 13 degrees outside and I can hear the wind howling. Inside my bedroom it’s 64 degrees.

Then my cell phone decides for me. By ringing.

There’s static on the other end. Then a rapid fire female voice, tinged with panic, disjointedly careening from English to Spanish to English again. I try to get my brain firing on all four cylinders.

What? Who? Where? When? How? Those were the key questions in the old days of journalism, now conveniently replaced with the more succinct and all-encompassing What-the-fuck?

I’m not clear what’s going on. But something about vomit, ketones, and blood sugar. So it can’t be good. The fading in-and-out of the phone is a good sign that the caller is barreling down the interstate towards the ER.

As the signal clears and my brain wakes up, it’s finally clear who I’m talking to.

Shirley Temple is on her way to the Emergency Room.

OK, so the real Shirley Temple isn’t my patient. But one of the little T-1s under my care is the spitting image of Ms. Temple back in the day. This child even has a penchant for pink.

Job One, in cases like this, is to calm mom the fuck down. Job Two is to get the what-the-fuck-facts. In this case it seems the kiddo was running on the high side most of the night. They had been taking corrections via the pump. First thing this morning, the kiddo complained of stomach pain, then promptly threw up.

“I checked her blood ketones when she threw up and the meter said 4.3” the mother told me. “I thought ‘that can’t be right’ so I washed her hands and checked again and it read 4.1. That’s when I threw up.”

So a super-quick blood ketone refresher for you readers. For those of us with Type-1 Diabetes, when you run out of insulin your cells can’t get the sugar they need to live from your blood, no matter how much sugar that there might be in your blood. Your body’s cells turn into a pack of savage cannibals. Rather than starve, they chop up your body fat and throw it into big iron kettles. Can you hear the African drums in the back ground? Thump-thump-thump. Thump-thump-thump. Thump-thump-thump.

The smoke from the cannibal’s cooking fires darkens the jungle’s sky. In your body, the smoke from cells eating fat is called ketones. Too many ketones in your blood will kill you. They are the cause of the “diabetic coma.”

Historically, we checked for ketones in the urine with little dip-sticks that turn pretty colors. You then had to try and match the color of the stick to the color chart on the side of the bottle. But don’t wait too long or check to early.

Nowadays, thanks for our friends at Abbott, we actually have a way to test ketones in the blood itself with special strips that work in the Precision Xtra® meter. Under normal circumstances if I check mine, they will always be at zero, but I’m told that below 0.6 mmd/L is considered “in the green,” or normal. Between 0.6 and 1.5 mmd/L is the “yellow zone,” which translates into you need medical attention. Right now. Above 1.5 is “red lined.” You are now in a world of hurt. You are going DKA. Your blood is turning to acid. By now your breath will be fruity. You will be throwing up. Atropos is sharpening her scissors. I actually never knew how high above 1.5 you can go. But now I know that it’s possible to clock a reading in the fours and live to tell the tale.

Meanwhile, back on the phone, I confirm the kid’s breath is fruity. How’s her breathing? I ask.

“I don’t really know… once I totally freaked out, she totally freaked out.”

It’s OK, I think you are doing great.

Job Three is a pro-active guilt-ectomy. No matter how bad you may think it is to have diabetes, it’s nothing, nothing, nothing even 1% as bad as being the mother of a Type-1 kiddo. The level of responsibility and guilt they carry over things they cannot control is astounding.

I acertain that the mom has givien the little one a 5 unit intramuscualar shot in the arm. Super. Awesome. I’m soooooo proud of you. You’re doing everything perfectly.

“I need to live closer to the hospital.”

Oh, nonsense. Your house is beautiful and you own it free and clear. Why would you want to move to Santa Fe and pay rent just to save time when going to the ER a couple of times per year? Diabetes is fast, but not that fast. You have plenty of time with these highs, and if she were to go really low and go lights-out the ER would just use the exact same glucagon kit you have to bring her back.

“What if I can’t find the kit? What if it’s in my purse? Damn! I should keep the house cleaner!”

Hey, don’t worry about it. Don’t worry about it. I’ll give you a second kit on Monday. You can double-sticky tape it to the wall above her bed.

A relaxed exhaling of breath, and a little laugh come through the static. “Right next to her Virgin Mary, huh?”

Yeah, our Lady of Low Blood Sugar.

“Best to keep the whole team together, we need all the help we can get.”

Amen.

“Oh… ah… did I remember to say ‘good morning?’”

I hit the bathroom for a speed shower, get dressed and call the mom back again. They’re now at the ER. Shirley Temple’s CGM is showing a drop. She’s drinking water. Her skin color is normalizing. The emergency shot in the arm her mother gave her is kicking in.

Do you want me to come over to the hospital?

“No. No need. But thanks for offering. And thanks for being there for us.”

You’re welcome.

“It’s been a pretty crappy year, huh?”

Yeah, but it’s almost in the rearview mirror now.

So speaking of the end of the year, Deb, Rio, and I have been invited to a “kick the old year in the ass” party tonight (as opposed to a “happy new year” party). I, for one, am looking forwards to seeing 2010 behind me.

That said, just the other day, one of my spiritually well-grounded friends made me focus on the GOOD things that happened over the last year, rather than the crap. Paraphrasing quite a bit, she basically said if you spend all year in the outhouse, of course you are going to see a lot of crap.

Like a police detective she interrogated me on good things. “How's your diabetes? You don't seem to be in the ICU at the moment.”

“How is your beautiful child? Oh, and I see you still have a house, and a car, and a job.”

And so on.

I think the whole world has been through such a bad time lately that many of us are chronically tense and waiting for the other shoe to drop.

So for the new year, my dear friends, let's all try to change what we focus on. What we dwell on. There is sunlight and shadows out there, and we can choose to sit in the sun or sit in the shadows.

Damn cold here today.

A patch of sunlight sounds lovely.

Calling all Tiger tamers

The “Free Tiger” project is going pretty well, thanks to all of you in the social media space. But now we enter phase 2 -- more tongues. Tiger is in English and Spanish. I’m working with a German diabetes advocate to translate and adapt it into his language and culture. Any of you advocates out there speak two languages well enough to help me start filling in other gaps in the tower of Bable?

According to the World Health Organization, these are the top ten countries for diabetes:

India
China
USA
Indonesia
Japan
Pakistan
Russia
Brazil
Italy
Bangladesh

I’m looking for folks who can translate not just words, but message and intent as well. I’ve just started reading Rio a fresh translation of Jules Vern’s 20,000 Leagues Under the Sea. I’ve always regarded the novel as technically interesting, but a ponderous book in the literary sense. Now it turns out I was the victim of bad translation. Vern was as brilliant a writer as he was a technologic visionary. He is a joy to read.

Any of you out there feel called to help me take this message to our brothers and sisters who talk, read, and think in other tongues?

The Saturday Share #6

Did you know that health topics are the number one internet search item, outstripping even porn? Uh… pardon the Freudian slip there...

So to do my part in trying to keep internet health information correct I’ve been two-timing my blog by writing over at Sharecare were I am one of their “Experts” answering diabetes questions posted by readers.

I’m having a blast, and I’ve decided that every week I’m going to share one of my favorite questions with you here.


Sharecare Question: What is a white blood cell (WBC)?


My “Expert” answer: White blood cells (WBC) are like an army. They patrol your body constantly, on the lookout for attacks from viruses, bacteria, and other infections. If the scouts find a problem, they sound the alarm and the troops swarm to the site of the attack.

And just like a military is made up of Army, Navy, Marines, and Air Forces, the WBC army also has specialists with names like Neutrophil, Esoniophil, Basophil, Lymphocyte, and Macrophage.

Each "branch" of the WBC military specializes in fighting different kinds of invaders.

One cool thing about blood cells in general is that, unlike most cells that reproduce by dividing, blood cells are manufactured in the bone marrow.

A WBC count is part of a blood test called a Complete Blood Count. An elevated WBC would serve as a marker of infection, as an unusual number of "troops" shows an invasion has taken place.

You can check out other Expert’s answers to this question, and my answers to many more questions by going here:

http://www.sharecare.com/user/william-lee-dubois

Then select the “Answers” tab near the top left.

Merck’s Glass beads

Like anybody, I would like to live a long life. Longevity has its place. But I'm not concerned about that now. I just want to do God's will. And He's allowed me to go up to the mountain. And I've looked over. And I've seen the promised land. I may not get there with you. But I want you to know tonight, that we, as a people will get to the promised land.

---Dr. Martin Luther King, Jr.

Memphis, Tennessee
1968



Back in the year 1626 an enterprising fellow named Peter Minuit made one of the greater real-estate deals in history, and for that act has been variously painted as either a genius or a rouge of the highest order.

Yeah, he’s the dude that bought Manhattan Island from the Natives.

For what it is worth, and totally off subject, this transaction is not what it first appears. I’d been taught in grade school that he got the real-estate for some glass beads worth a few bucks at most (those silly savages). Later, I often read that it was $24 in trade goods. Newer research has shown that, due to a historical translation error, the value was $37.98. Of course, a buck went a lot further in those days. In today’s dollars we’re looking at something like $1,500.

Even at that bargain rate, I still couldn’t afford to buy Manhattan.

But I digress. Did the Natives get swindled? Probably not. They didn’t get just some glass beads. They got the 1600’s equivalent of i-Phones and Dell computers. The trade goods included iron kettles and axe heads, hoes, and metal awls. Some historians have called this history’s first high-technology transfer.

And the money? Well, 384 years later Manhattan is worth something like 8 trillion bucks. Not too bad for a swamp between a couple of rivers. But before you flame me in comments, consider the brilliant compound interest analysis by Jeffrey Strain. He crunched the numbers and said (paraphrasing, of course), “well, what if the money had been cash? And what if the Natives had just parked it in a savings account?” Yeah, I know, no such thing at that time. Still, it is interesting to note that the Natives would be trillions ahead in the deal given the power of compound interest out-stripping the power of the rising value of real-estate.

So why are we talking about this? Because Merck just bought the future of the entire 116-billion-dollar-per-year diabetes business for a paltry 500 million bucks. This move makes the purchase of Manhattan for fifteen hundred bucks look like a bad deal by comparison.

I want you to remember the name Dr. Todd C. Zion. He’s the Dr. Frederick Banting of the future. As part of his doctoral thesis in chemical engineering from M.I.T., he developed something he calls SmartInsulin™.

I call it THE game changer.

So what the fuck is SmartInsulin™, you ask? Well, quoting from his company’s website, it’s “a layered, biocompatible and biodegradable polymer-therapeutic that is bound to an engineered glucose-binding molecule. Insulin is released from SmartInsulin only when the therapeutic is unbound by the presence of a specific glucose concentration.”

Don’t panic, I’ll translate that to English in a moment.

Oh, never mind. I’ll do it right now. SmartInsulin is the ultimate NPH. Remember NPH? In the pre-Lantus and pre-Levemir days it was the closest thing we had to long-acting insulin. It was an insulin suspension. In other words, bubble-wrapped insulin. Once injected, the bubble-wrap dissolved a bit at a time, releasing the insulin to do its thing. Both Lantus and Levemir are higher-tech, improved versions of the concept.

But SmartInsulin raises the bar. Instead of just dissolving at a set rate, the bubble-wrap is glucose sensitive. In effect, it’s insulin that only works when your blood sugar is high. And it stops working when your blood sugar is normal.

In short, SmartInsulin is a bio-chemical artificial pancreas. No pump needed. No CGM needed. No complicated algorithms. No gear at all. It’s an elegantly simple, self regulating system. As billed, it would be a once a day shot. The insulin stays nice and cozy and warm in its polymer blanket until your blood sugar begins to rise. Then the polymer dissolves, releasing some insulin. Which lowers you sugar again. Then the polymer stops dissolving.

Who knows? The next stage might be once a week shots. Or once a month.

Blood sugar automatically controlled. No matter what you eat. No matter how you move. It’ll be a therapy indistinguishable from a cure, except for the monthly payment to stay healthy.

And what will they charge? Pretty much as fucking much as they want. And this time insurance will pay. Because it will be all they have to pay. No more gear. No more durable medical supplies.

No more expensive complications.

If it works, they won’t even have to pay for eye exams any more, as there will be no risk of damage from high blood sugar.

In a Press Release over at PharmaTimes Online and SmartPlanet, Merck’s head of diabetes and obesity a research, Nancy Thornberry, is quoted as saying "if this investigational technology is ultimately approved for use with patients, it could provide an important new therapy [which] holds the potential to significantly impact the treatment of this disease." And reading between the lines, as she wipes the drool from her chin, I could have sworn I heard her add “plus it will make us and our shareholders sticking fucking rich!”

I realized the significance of SmartInsulin when I first read about it a few years ago. I just figured that if it worked, it would never see the light of day. Too many people had too much to lose. And actually, this is where Merck will come to our rescue. You see, of all the big players, Merck really doesn’t have much going on the diabetes arena. Right now all they have is the DDP-4 Inhibitor class med Januvia, which will be generic by the time SmartInsulin is ready for market. They haven’t got a product line to sell for the plague of the 21st century. They have nothing to lose and everything to gain by getting their mitts on a game-changing med.

If SmartInsulin gets approved, what does Merck get for their 500 million? Instant access to 30 million customers overnight. And if the CDC is right in their projections, fully one third of the US population could be Merck customers by 2050.

SmartInsulin will destroy the diabetes industry. All the other companies will go down in flames, their CEO’s will be running hot dog carts on Wall Street or pan-handling in Times Square.

If SmartInsulin lives up to its promise, there will be no need for other medications for our blood sugar.

There will be no need for meters. Or strips. Or lances.

There will be no need for CGMs.

Or pumps.

Or diabetes educators.

In short, SmartInsulin will be a de facto cure, but one with a perfect pharma edge. With their product we’ll live normal, healthy lives. Without it we’ll die. It’ll be the final evolution of insulin, probably just in time for the 100th Anniversary of its discovery. If it works, there will be no motivation, no incentive, for a real cure. We’ll forever be medicine addicts. Trapped like vampires.

It’s slavery, I think. Still… I would use it in a heartbeat.

If I were you, I’d sell the rest of your diabetes portfolio and buy Merck stock.

The Saturday Share #5

Did you know that health topics are the number one internet search item, outstripping even porn? Uh… pardon the Freudian slip there...

So to do my part in trying to keep internet health information correct I’ve been two-timing my blog by writing over at Sharecare were I am one of their “Experts” answering diabetes questions posted by readers.

I’m having a blast, and I’ve decided that every week I’m going to share one of my favorite questions with you here.


Sharecare Question: What causes diabetic foot problems?


My “Expert” answer: Scary but true story: a man with diabetes came home from work super-tired one day and decided to grab a quick nap. He sat down on his couch, took his shoes off, slipped his glasses into one of the shoes for safe-keeping and nodded off. (About half of you out there know where this is going….)

He was woken with a start by the phone ringing. His wife had just been in a car accident and was in the Emergency Room. He jumped off the couch, pulled his shoes on, and dashed off to the hospital. Don’t worry. She wasn’t badly hurt. But it was eight hours later before they both got home. When he took his shoes off again he found his glasses. In the shoe. For eight hours he'd worn a shoe with a pair of glasses in them and had no clue.

I saw his custom-molded shoe insert, still bearing the exact imprint of his glasses, sort of like fossilized dinosaur tracks.

So, to answer your question, diabetic foot problems actually happen because in some people, many years of high blood sugar causes them to lose all sensation in their feet. Most of us get annoyed when we get a pebble in our shoes. The hero of our story had an entire pair of glasses in his shoe and couldn’t feel it!

Lack of sensation is exactly half the story. The second half is that most people aren’t in the habit of looking at the bottom of their feet, largely because there is no real reason for most people to do so.

If you don’t feel pain when you injure your foot. And you don’t look at your feet, how would you know if you’d been hurt? Right. You wouldn’t.

And that’s exactly what causes 84,000 non-traumatic amputations every year in our county. Of course all amputations are traumatic to the amputee, but in this case we simply mean medically necessary amputations that aren’t the result be being run over by a riding mower or being in a car accident.

The exact progression is: injury, infection, ulcer, gangrene--a.k.a. tissue necrosis, literally the death of part of your body that is still attached to you--and finally, amputation.

So the single best thing you can do to prevent this from happening to you is to “kiss” your feet goodnight every night. Look at your feet at bedtime. If you are to… um…ah... too hefty to see your feet use a hand mirror placed on the floor. Make sure everything looks OK. Start doing this now, even if you have great sensation in your feet, that way if you lose it in the future you will already be in the habit of taking care of them.

You can check out other Expert’s answers to this question, and my answers to many more questions by going here:

http://www.sharecare.com/user/william-lee-dubois

Then select the “Answers” tab near the top left.

Don’t judge people by their organization

I’m the innocent bystander
Somehow I got stuck
Between the rock
And a hard place

And I’m down on my luck
Yes I’m down on my luck
Well I’m down on my luck

I’m hiding in Honduras
I’m a desperate man
Send lawyers, guns, and money
The shit has hit the fan

--Warren Zevon, 1978


The American Diabetes Association frequently pisses me off.

So much so, and so often, that I don’t even know why I keep expecting better of them. I’ve long maintained that all the ADA is interested in, if you are a diabetic, is your wallet.

Which would be OK, if they were more up front about it. They are, after all, an organization by, for, and about doctors. I guess my main issue is they market themselves as THE organization for people with diabetes, and frankly, that’s a lie.

Don’t get me wrong, I’m glad the ADA exists. They excel at what they excel at. Research. Setting standards. Educating doctors. And, when the shit has hit the fan, they are the lawyers, guns, and money folks.

Well, maybe just lawyers and money. But when you have a problem with the government and diabetes, they’ve got your back. Taking on “the man” is one of the things they are good at. Fired from your job ‘cause of the big D? School hassling your kid over taking shots at school? Cops throw you in jail for being hypo?

Call the ADA.

The ADA really is the White Hat Sherriff when it comes to laws that protect those of us with diabetes. They are also always on the lookout for new and wrongful laws that effect us, and their legislative advocacy has shot down many a law that would chill you to your bones before it even had a chance to take effect.

But where the hypocrisy hits the fan is in the way the ADA presents itself as a caring educational organization. In this arena, the ADA is like a law book with a dust jacket disguising itself as a romance.

A major failing of the ADA is what the rest of us learned in kindergarten: the world is a better place when we all place nice together in the sand box. Two appalling examples of this come to mind. First is the ADA’s refusal to really join in with the International Diabetes Federation on things of common interest, like, oh I don’t know…maybe World Diabetes Day?

The ADA has me seeing red by sticking with red (with no logo) as the color of diabetes while everyone else has gone United Nations blue with a cool circle logo. You all know the pink ribbon, right? Every year a little over 200,000 women in the U.S. are dx’d with breast cancer while well over one-and-a-half million Americans are dx’d with diabetes. I’m not trying to belittle the horrors of breast cancer. I’m just saying they have a better PR firm than we do. In terms of annual growth, we’ve got ten times the numbers but even most health care workers don’t recognize the blue circle. And having one of our flag ship organizations refuse to play with anyone else isn’t helping.

Anyway, I’ve gotten off track again. I had said there were two appalling examples of the ADA’s lack of kindergarten decorum. The second one pisses me off more, as it effects me personally as an author.

The ADA won’t in anyway promote a book that it didn’t publish.

I’ve known this for a long time. But I thought, stupidly, that maybe they might help out with promoting the free Tiger e-books for the newly diagnosed, seeing as they think they are the ultimate help-the-poor-diabetics organization.

So I crafted a plea and fired it off to them. 48 hours later I had my answer from a lady at their “Center for Information and Community Support.” I think I’ll just quote directly from the letter:

“Thank you for contacting the American Diabetes Association. We have received your e-mail regarding a resource.

Unfortunately, I am unable to assist you. As a rule we don’t promote or endorse non-ADA-published books. If you would like to advertise in our journals, please visit us at: www.diabetes.org/adrates”

Checking the rates in Diabetes Forecast, which the ADA modestly calls “the premier consumer publication of the world’s authority on diabetes,” I find that a single ad ranges in price from a low of $5,920 to a high of $25,990. Ummm…. OK, I don’t even make $25,990 per year in the first place (almost, but not quite). And of course, running an ad only once is pretty useless. It needs to be seen again and again. All the time. But even their smallest B&W ad, at almost 6 grand per month, for something that is free is just bad economics.

Oh yeah. Then they tried to sell me a membership and asked me to donate my time by “becoming an advocate or by getting involved through volunteering or participating in a local event.”

“Local event” is ADA slang for fund raiser.

OK. So let me get this straight. You won’t help me get the news out about something that’s free unless I pay you. But you want me to give you my time to help you raise money?

Huh.

Is there something wrong with this picture?

But before my blood pressure got too high, I got another email from the ADA. Different department. Different person. Different tone.

This person went to the Red Blood Cell Books site, and Amazon. And TuDiabetes. And Diabetes Living Today. This person read the reviews and commented that the Tiger books get “enthusiastic reviews” and seem “quite popular and effective.” The letter writer went on to say:

“I can tell that word will get out about the book. Unfortunately, the ADA is a bit more restrictive. Our current policy does not allow us to promote or distribute non-ADA-published books through our online resources or conference bookstores. We’ve had that policy for awhile and I know it won’t change in the near future.”

So I was still in the same sinking boat I was in before, but I felt better about it. It also served as a really important reminder. Organizations are like living organisms. Just as creatures are made up of individual cells with various functions, appearances, and personalities; so too organizations are made up of individual people. Each of those people has a mind of their own. They may not agree with the direction this ship is sailing in, but there is a limit to what they can do as a member of the crew.

What we need to remember is that any single person who works for an organization is not some kind of clone. We can (and should, must) fight to keep our organization’s feet to the fire. When an outfit like the ADA claims to be the “world’s authority on diabetes” we need to call them out on it. And keep calling them out on it until they become what they claim or stop lying about it.

But, but, but… We must never get personal about it. We must keep the high ground and remember that some (many, even most?) of the people in the organization may agree with us. Politics in our county has gotten revoltingly personal. We must be sure to not let our revolution fall to the same level. We need to speak with integrity about facts, and not fall to name calling.

Unlike those fuck-faces over at the ADA who… ah… oh…

Oops.

The Saturday Share #4

Did you know that health topics are the number one internet search item, outstripping even porn? Uh… pardon the Freudian slip there...

So to do my part in trying to keep internet health information correct I’ve been two-timing my blog by writing over at Sharecare were I am one of their “Experts” answering diabetes questions posted by readers.

I’m having a blast, and I’ve decided that every week I’m going to share one of my favorite questions with you here.


Sharecare Question: How is insulin related to blood sugar?


My “Expert” answer: In two words: inversely proportional. Picture insulin and blood sugar like two children on a teeter-totter on a playground. By moving forward or backwards on the balance beam, the two children can both hover above the ground, even if they don’t weigh the same.

Likewise, in your body, if the blood sugar goes up, the body releases insulin from the pancreas. Insulin moves sugar from the blood where it really does very little good, into your cells, which all use sugar for food. When blood sugar drops the body stops releasing insulin. If the blood sugar drops too much, the liver will release some sugar to balance things out.

If you take too much of some diabetes meds, like insulin or a class of drugs called the sulfonylureas, your blood sugar can go very much too low, more than the liver can handle. A low blood sugar can be life threatening, and is treated simply by adding sugar to the system to “soak up” the extra insulin.

If you have a low blood sugar, which is called hypoglycemia, drinking half a regular soda, or eating several hard candies can give you enough sugar to restore balance.

Now, let’s go play on the merry-go-round instead….


You can check out other Expert’s answers to this question, and my answers to many more questions by going here:

http://www.sharecare.com/user/william-lee-dubois

Then select the “Answers” tab near the top left.

I’m honored. Thank you.

I just this second got an email via Facebook from Gina Capone, the woman responsible for getting me into this whole blogging biz. (3G--I can’t decide whether to send you diamonds or black roses.)

It seems I’ve been nominated for one of the prestigious 2010 DOC Awards.

Wow.

I feel like a star!

So I logged on to see what I’d been nominated for. Actually, I’ve been dual nominated, but not necessarily for the categories I might have expected—although I didn’t actually expect to be nominated at all, so hadn’t really given it any thought whatsoever. Oh well, if I’d known what to expect today, I would have just stayed in bed. What’s the fun in life if you know what to expect?

So…. drum roll…. I’ve been nominated as the “Blogger who we wish would blog more.” Wow. I’m speechless. Well, momentarily anyway. I’m sure I’ll recover. This strikes me as a very high honor indeed. That readers want to read more of your work is, by far, the highest praise a writer can get.

I’ve also been nominated as “Best Photographer,” which I probably don’t deserve as I don’t put photos in my blogs that often, and when I do, about half the time I’ve just pulled some clip art or public domain photos off the web to illustrate a point.

To my surprise, in looking over the categories, I see I wasn’t fucking nominated for “Best use of Bad Language.” How on earth did that happen? Based on the shit-storm that was created by using a sprinkling of f-bombs (to Quote Amy T) in my books I figured I be a shoe-in here. Although, that might not be the best award to list prominently on a resume anyway. Maybe I need to get more creative in my use of the good ol’ Anglo Saxon slang.

But seriously, thank you. Thank you. Thank you from the bottom of my heart. It is a great honor to be nominated.

Check out all the nominees and the categories over at:

http://docawards.wordpress.com/2010/12/09/2010-doc-awards-voting-part-1/

Biology Breakfast

For three generations the men in my family have been the pancake makers, so much so that the thin crêpe-style family pancakes are known as “Daddy Pancakes.”

I make them for Rio about once a month. My father made them for me as a child, as did his father for him.

Of course, I’ve changed the recipe some, subbing Splenda for powdered sugar, and using sugar free syrup to lower the carb impact somewhat

Now, I can’t say for sure that grandpa made special shapes, but my Dad was a wizard when it came to artistic pancakes. Birds, flowers, rabbits. You name it. Once, as pancake master for a Kiwanis Pancake Breakfast fund raiser, he was actually able to make a pancake that looked like the Kiwanis logo.

No small feat. I wish I had a picture of the pancake.

But apparently I didn’t get the wizard genes from my father, at least not so far as pancakes are concerned. I am a closet artist at heart, but my pancake-art rarely comes out looking like anything I had intended it to. This has required me to become fast on my feet with coming up with explanations for what I’ve created.

That’s what happened today.

I usually duck the bullet by saying, what does it look like to you, Rio? To which, he’ll consider the pancake seriously and declare that it is a mockup of nuclear fusion in the engine of a starship. Exactly so! I’ll reply, slightly crestfallen that my mongoose came out so unrecognizable.

But every now and again Rio can’t divine a shape in the clouds of the cooking batter.

“What’s this Daddy?” he asked, nose so close to the griddle to risk burning it.




I fell back on the old ruse. What’s it look like, baby?

Rio shrugged one shoulder, “I have no idea what-so-ever.” And then he turned to me with those big brown eyes of his mother’s. Expectantly. Waiting for an answer.

One heart beat.
Two heart beats.
Three heart beats.

Cellular mitosis, I said.

Rio considered for a moment, then he turned to his mother, “Momma, does that really exist?”

His mother said, “Ummmmm… I think I’ll let your father explain that one to you.”

So while his mother buttered, syruped, jellied, and rolled his pancake up like a burrito, I sat with pen and paper and drew a cartoon sketch of how a single celled organism divides, cloning itself.

After breakfast we went on line and found pictures:


And even microscope video of mitosis in action. Very cool.

So what do you think of cellular mitosis? I asked Rio at the end.

“It’s pretty amazing,” he replied, eyes still locked on the screen.

Don’t you think your pancake looked like this?

A long pause, then, “Well… It was close enough, Daddy. It was close enough.”

Further proof of my guiding principal. If you don’t learn something new each day, you should have stayed in bed.

I rarely have a day I should have stayed in bed.

And I’m determined to make sure Rio’s life plays out the same way.

The Saturday Share #3

Did you know that health topics are the number one internet search item, outstripping even porn? Uh… pardon the Freudian slip there...

So to do my part in trying to keep internet health information correct I’ve been two-timing my blog by writing over at Sharecare were I am one of their “Experts” answering diabetes questions posted by readers.

I’m having a blast, and I’ve decided that every week I’m going to share one of my favorite questions with you here.


Sharecare Question: What is the right dosage of Lantus for patient with glucose reading of 200?


My “Expert” answer: Whoa! Hold it! Stop! Set down the syringe, back away, and no one gets hurt.

Lantus is in no way, shape, or form the right medication to fix a single high blood sugar. Lantus is a time release insulin that works a little at a time over 24 hours. It’s designed to create a good solid foundation for your diabetes control. Using it to try and fix a high would be like using napalm to kill mosquitoes.

High blood sugars can be lowered with fast-acting injections. Instead of working slowly over an entire day, fast insulins start working in 20 minutes, peak in two hours, and are gone and out of your system in four hours. How much you would need to take to fix a 200 is highly variable and depends on what type of diabetic you are, when you last ate, what your other medications are, how heavy you are, and whether the moon is in Mercury or Mars.

Fast-acting, used right, is a great med and does a great job. Talk to your doctor about whether fast-acting insulin is right for you.

But you don’t use a machete when a scalpel is required.


You can check out other Expert’s answers to this question, and my answers to many more questions by going here:

http://www.sharecare.com/user/william-lee-dubois

Then select the “Answers” tab near the top left.

The new Minutemen and a completely different kind of Tea Party

Well, if the government wants you dead, it’s a least good to know it in advance, right?

So you can prepare. Or decide how to respond.

You can just lay down and let them kill you. Or you can put your affairs in order, and then lay down.

Or… you can fight. Maybe even get others who love you, or love your ideals, to fight with you.

A fellow T-1 has decided to fight. And he has asked me to join him. And I’m asking you to join us.

It started with a fax from Dr. Steven Edelman of TCOYD (Taking Control Of Your Diabetes) Circus fame. It started off “Dear Friend.” Now, Dr. E and I have met a few times, and have even corresponded occasionally, but I doubt he would recognize my name, much less count me among his circle of friends.

It must be a form letter.

Still having nothing better to do—as no one wants to see their diabetes educator between T-day and X-mass—I read the fax. Who would have thought that five paragraphs would raise my blood pressure so much?

So first some background. Medicare is the 800 pound gorilla in health insurance. All of the smaller gorillas, like BlueCross, Presbyterian, and the like, look to Medicare to see what they can get away with and what they can’t get away with.

Of course, we are talking test strips again.

Right now Medicare’s “guidelines” allow for one strip per day for diabetics on oral meds and three strips per day for those of us who shoot up. Insulin that is. To get your one-or-three strips covered requires some pretty strange paperwork and record keeping on the part of your doc.

But these guidelines are not carved in stone. A doc can get you more by doing even stranger paperwork and record keeping. But now a proposed Medicare rule change would take this guideline and carve it into marble. Oh. No. That’s not quite right.

First it would reduce the number of strips even further. Then it would be carved in marble.

The “Draft LCD” Medicare rule would absolutely fix diabetes testing supplies at one strip per day for folks who pop pills and two strips per day for those of us who shoot up.
No exceptions.

Think this doesn’t affect you because you aren’t on Medicare? Think again. A quote from Martin Niemöller about the Holocaust comes to mind:

They came first for the Communists,
and I didn't speak up because I wasn't a Communist.

Then they came for the trade unionists,
and I didn't speak up because I wasn't a trade unionist.

Then they came for the Jews,
and I didn't speak up because I wasn't a Jew.

Then they came for me
and by that time no one was left to speak up.

Whatever Medicare does Medicaid does. Whatever Medicare and Medicaid do private insurance does. It’ll be a falling domino effect that’ll fall on your head faster than you can read this post.

I know that, even with a CGM, I cannot safely manage my diabetes with two strips per day.

Can you?

Dr. Edelman was calling on his fellow docs to “stand up as advocates for the rights of our patients to receive quality care and for our rights as physicians to practice appropriate medicine.” Amen.

Our docs are taking up arms to defend us. I think we should join the fight. Here’s Dr. E’s simple plan of attack. Call the Congressional Switchboard at 1-866-220-0044. If you give them your zip code they’ll connect you with your Senator’s office. Each Senator apparently has a Healthcare Liaison. Give that person an earful.

OK, I might have paraphrased that last line a little bit. Dr. Edelman isn’t quite as radical as I am.

Not yet.