A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2103
- Name: Wil
- 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 and I’m a community faculty member for the University of New Mexico School of Medicine’s Project ECHO. 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!).
Wednesday, September 29, 2010
Wednesday, September 22, 2010
It looks so harmless.
Next, I tear the tip off of a squeeze tube of sterile water. Squeezing at the middle I fill the bottle cap half full of water, add a wee tightly spun cotton ball, and I’m ready to go.
Holding the “works” in my right hand, I flip a Bic, and begin cooking, holding the tip of flame under the bottom of the cap. Its silver surface turns sooty. In half a minute, bubbles appear. The handle is getting hot in my fingers. The solution starts to boil. I’m supposed to cook it at least 45 seconds.
I always thought that if I did something like this, it would be under a dark bridge somewhere on a foggy night, not a brightly lit conference room on a work day.
Life is full of surprises.
The power dissolved, it’s time. I uncap an insulin syringe, harpoon the mini cotton ball with the tip of the needle, and draw up the warm fluid. The cotton ball is a low tech filter, keeping any un-dissolved crystals out of the syringe.
I roll the syringe between my fingers, feeling it’s warmth. The cold, sterile plastic has become a living thing. I marvel at the feel. How many cold syringes and room temperature syringes have I held in my hands in my life? Too many to count. But this one . . . wow. It’s special. Alluring. Magical. Wonderful.
Even the ritual is addictive.
I tap out the bubbles to the top of the syringe with an expert thump of my finger and gently advance the plunger to get them out without wasting too much of the clear fluid.
I swab the inside of my elbow with an alcohol pad, starting above the vein and swirling outwards. Quickly, I grip the end of the tourniquet in my teeth, wrapping the other end around my bicep, around, under, over. The baby-blue tourniquet is tight around my arm. The vein bulges. It’s ready. It’s time.
I hold the syringe in my left hand, bevel of the needle upwards, 45 degree angle to my arm, and then I slowly lower the needle. It gently kisses my skin above the swollen vein . . .
“Good!” shouts the instructor, “now if this was real, you’d slide the needle into the vein, pull back on the plunger until you see a flash of blood, release the tourniquet (I pull back on the tourniquet by pulling my head up and to the side—the tourniquet snaps off), and shoot up.”
Yep. The State of New Mexico is teaching me how to shoot heroin.
OK, remember how I told you the world is not black and white? But rather, it is a million shades of gray? Well, my world just got grayer.
My clinic is in the process of becoming a certified needle exchange center for intravenous drug abusers. Now hear me out before you freak out. I’ll be first to admit that this is a controversial subject, and it took my boss a full year to convince our community board to go along with it.
So what is needle exchange? Well, it’s what it sounds like. We give junkies brand new clean, sterile needles in exchange for used ones.
Why on earth would we do that?
Because junkies share needles. And sharing needles shares blood. And you should never, ever, ever share blood with anybody. Ever. All kinds of bad shit lives in blood. Hepatitis lives in blood. All three kinds. HIV lives in blood. Need I go on?
And like you can’t judge a book by its cover, you can’t judge a persons’ blood by their looks. There are skuzzy folks with clean blood and sweet little old ladies with AIDS.
Our state has done needle exchange since 1997. Of course we’re not idiots. We call it “Harm Reduction,” instead of “needle exchange.”
Last year we gave out 2.9 million BD insulin syringes to IV drug users. Yeah, that blew my mind too. We also give out pocket sharps holders. We used to give out tourniquets, cookers, cotton balls—everything a proper junkie needs. It’s almost as much paraphernalia as it takes to be diabetic. But State budget cuts have us reduced to the bare-bones basics right now.
So why was I being trained how to properly shoot up heroin? So I can teach others, of course. OK, here’s the thing. There is a right way and a wrong way to shoot heroin into your veins. Do it wrong and you trash your body more than just the heroin alone will do. You blow out your veins. You get ulcers. You cost the tax payers extra money at the ER.
One of my nurses was outraged. She felt we were encouraging drug use. A lot of people feel that way. But you know what? If people choose to use heroin, they are going to do it. With access to help or not.
Now, I used the word “junkie” for dramatic effect in this post. I don’t really feel that way about drug users. They’re just people. And people get addicted to all kinds of things that are bad for them. Tobacco, too much alcohol, excess food, sex with strangers. But they—we—are all still just people. I don’t care what color your skin is. I don’t care what your sex or age is. I don’t care how much or little school you’ve had. If you are a member of the human race, you deserve something as basic as health care.
So needle exchange actually is harm reduction. If we accept you as you are, and treat you to minimize the harm you are doing to yourself, we help us as much as we help you. We lower our society’s health care costs by keeping you as healthy as possible. We reduce the spread of pathogens that may someday spread to us if we ignore you. Or to our children. The availability of clean needles reduces the risk our children will play with dirty ones they find in our parks, our alleys, and our vacant lots.
Users can enroll in our program anonymously. They are literally just a number. They also get a “get out of jail free” card. Any one enrolled with the state’s Harm Reduction program can’t be arrested for carrying their gear. We also give out Narcan, a nasal mist that brings an overdose back from the other side. It’s the opiate addicts’ version of Glucagon.
The State’s program has also had an unexpected consequence. Every site that has been established sees a drop in drug use within 18 months.
Because junkies become people. They develop relationships and trust with the staff at the clinics. While we give needles we have the chance to bandage scraped knees, treat illnesses, and begin to mend broken hearts and minds. We have a chance, one little step at a time to bring those on our fringes back into the fold. And when they are ready, and not a second before, we will be there to help them beat their addictions.
Wednesday, September 15, 2010
LifeAfterDx: the movie
Yeah, I’ll get right on that.
The film crew came twice, documenting the story of one patient’s odyssey through New Mexico diabetes treatment.
The film was being made for Project ECHO, a University of New Mexico sponsored program that (quoting their web page) uses technology to bridge “the gap between urban healthcare specialists and providers in rural settings,” to show how their program works.
So the movie isn’t about me. I’m just a bit player.
But at the same time, the movie is about more than just project ECHO. The movie is about teamwork. It’s about the diabetes epidemic. It’s about how one state which is short on resources and large on territory is overcoming the treatment challenges. And sadly, it’s also about the differences in outcomes for patients who have access to education and resources, and those that don’t.
You also get to hear and see Dr. Colleran, who wrote the foreword for The Born-Again Diabetic, in action. Actually, due to a typo, she wrote the “foreward,” and will never let me forget it.
And you get to see my clinic, my boss, and my previous office.
Oh, yeah, and you get to see me in action too. Somewhere towards the end of the show.
The film actually came out right after the first of the year this year, and is called Tackling Diabetes is a Team Sport: A Project ECHO Initiative. But it was just recently put online at the UNM School of Medicine web site at http://echo.unm.edu/videos.shtml so I wanted to share it all with you.
So pop some popcorn. Crack open a diet Dr. Pepper. And join me at the movies.
Sunday, September 12, 2010
Update on soulless bastards
We frequently hear in the press that the reason health insurance premiums keep going up, up, up, up is that the cost of health care keeps going up, up, up, up.
True, but not as true as the insurance companies would have us believe. Between patients last week I was thumbing through a recent copy of The New England Journal of Medicine. Well, actually, I was reading it on my Kindle, so I guess I wasn’t thumbing so much as clicking… but I digress.
This from an article by Ann Mills: “Over the past decade, the largest health insurance companies have seen a disproportionate increase in profits of 250%, or 10 times the rate of inflation. During the past year alone, there has been a double-digit increase in health insurance premiums.”
So even though health care costs are going up, up, up, up the insurance industry has found a way to not simply maintain their profits, but to more than double them.
Black Beard the pirate would be proud.
The same day I read in Time magazine that a Kaiser Family Foundation report shows that over the last decade the average annual premium for family policies increased 114% each year. That means it doubles every year, folks. At the same time, the report shows the deductibles have increased to $1,000 for over a quarter of insured workers.
So that means:
1) Every year we pay twice as much.
2) Every year the insurance companies make more money.
And, from personal experience I can give you two more nuggets:
1) Every year less is covered (meds, gear, procedures).
2) Every year your doctor gets paid less.
Revolution in the street, anyone?
Wednesday, September 08, 2010
And then, of course, film itself all but disappeared.
But just before film went on the endangered species list, a wave of retro cameras hit the market. Back to chrome and leather. Yum. A song to the eyes, the fingertips, the heart.
For a while.
But, you know, it’s hard to beat basic black. It’s serious. Elegantly functional. And it matches everything.
One of my T-1 patients, Rick, was in my office yesterday. We downloaded his Med-T pump and CGM. I spun my large square computer screen towards him (it’s mounted on a Lazy Susan for that purpose) and we started chatting about his numbers. Then his CGM squawked at him and he had to check his blood sugar.
He whipped out a dark metallic purple OneTouch UltraMini. This was a new color for me. I had seen silver, green, red, and black. But never the purple. A quick Google also shows metallic blue has joined the family.
Of course, not being an interior designer, I was mistaken on the colors. Green is actually “Limelight®,” and red is actually “Pink Glow™,” and silver isn’t silver, its “Silver Moon™,” black can’t be basic black (although clearly I’d better run out and ™ or ® “Basic Black” right away), for Minis it is “Jet Black™,” the new purple my patient is carrying turns out to be “Purple Twilight®,” and the new blue is, of course, “Blue Comet®.”
I feel like I’m at the paint department at Home Depot, planning a home makeover, rather than talking about diabetes. Don’t get me wrong. I’m thrilled that the consumer electronic craze of wild colors has made it to medical devices. Like computers came in Blah-Beige® for a decade or two, early meters seem to have gotten stuck in white until the FreeStyle Flash, then they were all silver for the next five years. Now we’re really getting some choice.
In addition to his purple mini he had a black lancing device I’d never seen before, and I fell in love with his “Basic Black®©™∑∞☻” colored lancing device the second I saw it. It reminded me of my first black Nikon camera. Actually, at first glance, I thought his lancing device was the new “Delica” that OneTouch (a.k.a. LifeScan, Inc., a Johnson & Johnson Company) has been pushing at trade shows recently. But no, it was the older one-handed nine-depth, short, slim, and sexy lancing device that I’ve been using since it was introduced. In my opinion, the best lancing device ever made. So far.
But now it was dressed for the opera.
In Basic Black.
I guess I started to drool, because Rick insisted I keep it. I frantically dug though my box of lancing devices to find him a fair trade: a traditional off-white and blue. Same model, but more dressed for a tennis match. Rick insisted he didn’t care about color (but I bet you’d have to pry his new Purple Twilight® UltraMini from his cold dead hands).
Yeah, sometimes it is the little things in life that make you happy.
As soon as I got home I velco’d my new Basic Black OneTouch lancing device on to my “Chrome Blood®©™” Presto meter.
Sharp combo. Very fitting for a professional blood sugar tester.