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!).

Friday, September 26, 2008

A rose by any other name….

Every man is a man
I want you all to understand…
Every man is a man
In his own style and fashion…

--from Every Man is a Man by Johnny Osbourne

So what the heck is a metrosexual anyway? I asked Deb’s slightly-slutty-but-sweet friend Sandra (triple-S behind her back). Sandra is the data bank of all things carnal.

“Oh, that’s a guy who takes forever to get ready for a date. He can be gay or straight, but he’d be really into his hair and clothes. He’d be looking at himself as he walked by a mirror rather than looking at his partner.”

So I’m in no danger of being a metrosexual.

“Not in this lifetime,” giggled SSS.

I was getting an update on her latest escapades, as I hadn’t seen her for about six weeks. With Sandra this is kind of like Dog Years. A lot can happen in her universe in a short time. Hey, I forgot to ask, are you gay or straight at the moment?

“I’m back to guys, that thing with Tina didn’t really work out too well. By the way, what did you really think of her?”

Well, not to be too crude, but if you’re going to the trouble of dating another woman, I think you should have at least chosen a pretty one. The real truth, I think, is that Sandra is straight—but has, really, really, really bad taste in men. She got burned so many times she decided to try her luck as a lesbian. Unfortunately, she used the same bad selection process that lead her into trouble with men. She picked an egotistical, self centered, controlling, son-of-a-bitch who just happened to have breasts instead of a penis.

Then she starting telling me about this guy who caught her interest who turned out to be gay. “He wasn’t effeminate or anything, who knew?”

I don’t think there’s any requirements for gay men to be effeminate.

“That’s true. You’re straight and you’re pretty effeminate.”

Now-wait-a-minute!! That’s the second time in a month a female of the species has called me effeminate. The first was Deb’s hairdresser who was telling me about her new boy-friend and had said, “he’s not super macho, he’s more effeminate like you.” I blew off this comment because Deb’s hairdresser is notorious for using vocabulary beyond her….intelligence…so she’s often using less-than-appropriate words. She’s a riot to listen to. But triple-S is a smart lady with a Master’s Degree who does not misuse words.

I always thought of myself as pretty macho.

Triple-S laughed so hard she nearly drove off the road.

Now I know I’m testosterone-lite. Which I always viewed as a good thing. Testosterone is an intelligence inhibitor, after all. So I’m not US Marine studley. And they’ll never ask me to a Marlboro Man model. And it is true that strange bimbos don’t follow me down the street, damn it. But there is more to manliness than abs. At least I hope so.

Granted, I have spaghetti arms. But I’ve got nice chest hair (although the young female medical assistants tell me that’s out of fashion right now).

When I told Debbie about the two accusations of effeminateness she got quite prickly. “You aren’t effeminate at all. They are both out of their minds.”

Now is that the gospel truth, or does she not want to face up to being married to the 90-pound weakling of the old comic book ads?

“Neither one of them has ever met a man with a brain before,” snapped Deb.

Ah-ha. Now we are getting somewhere. Could it be that we lack a definition for the evolved male? The guy who is kind, faithful, and interested in things beyond the 24-hour sports channel?

I propose we need to add a new word to our social lexicon. A new definition of manliness. Well, an alternative form of manliness anyway. I think Macho is good for the strong of body sort. Military men. Cowboys. Weightlifters and assorted athletes. Firefighters and cops.

But what about the cranial heroes of science and medicine? Teachers, engineers, artists? Men of mind and soul. Isn’t that manly too?

So I was thinking of Macho-lectual (from macho + intellectual). I also toyed with Intella-macho; but I think Macho-lectual rolls off the tongue better.


Friday, September 19, 2008

Brain freeze

So here I am, the one-time high school drop-out, now a graduate student. And I have proof. It says “Graduate Student” on my university ID card. My boss is proud of me. My co-workers have all been congratulating me. I’m feeling pretty cocky. Until I opened my first assignment for Bio Stat:


What the fuck is that?!

Remember brain freeze? Yeah, you are 11-years-old and you go to Circle K for a Slushy. It is a hot day and you suck that puppy down. Suddenly your brain is caught in a vice. Ahhhhhhhhhhhhggggggg! That hurts!

When I saw that formula I got intellectual brain freeze. Ahhhhhhhhhhhhggggggg! That hurts!

As I sat at my computer, the life and enthusiasm for school draining out of me, Deb wandered in. She looked over my shoulder and studied the formula on the computer screen for a full three minutes, frozen like a deer in the head lights.

“I’d cry,” she said

I’m thinking about it, I said.

“No, I’m serious, I’d cry.”

This isn’t going to as easy as I thought.

I’m woefully unprepared for graduate level math. I flunked math in high school. And in junior high school too. And come to think of it, I don’t think I was much of a math scholar in grade school for that matter.

So after a bout of regretting getting myself into this whole grad school debacle, and briefly considering just eating rat poison and getting it over with, I pulled myself together.

Now here’s a secret: both my father and grandfather were Statisticians. The genes must be there. I can do this.

The formulas look like Greek shorthand of engineering diagrams. Which they pretty much are. I spent hours and hours and hours and hours and hours reading and re-reading and re-reading and re-reading and re-reading the PDF files my professor had sent me.

Slowly, very slowly, it began to make sense. Using his instruction, many pages from my legal pad, the internet, and Excel, I finally got an answer to the first sample question that I had at least some confidence was right. Ahhhhhhhhhhhhh….. .question 1.(a) is in the bag. Now on to question 1.(b).

What can you conclude from your answer in part (a)?

Other than the fact I’m an idiot, not much.

In my role as an on-line graduate student, I was grappling with standard deviation of data sets. The recipe is:

Believe it or not, I was able to decipher and actually comprehend most of this. But I’m such a mathematical idiot I couldn’t work out the very core of the formula. That side-ways M is the Greek capital letter Sigma and it means just-add-up-everything-that-follows-me. The X with the bar over the top is not a cattle brand, but stat short hand for the average of a data set. The X with the little ‘i’ is code for the data. So I needed to take the sum of the data points minus the average (technically the mean) and then square them. What I couldn’t fathom was if I did this individually or collectively before squaring them.

I surfed the internet in vain. I went to and (OK, I made those up, but for all I know they may exist). Bottom line, I had no luck at all. I needed to talk to my father. The problem is, of course, that he is dead.

I tried my Ouija board, but it works about as well as my cell phone.

Then it occurred to me that there was a way my father could talk to me from the grave in a loud, clear voice. I got up from my desk and started scanning through the titles on our library shelves. It has to be here somewhere…

I pulled a small book off one of our shelves. The dust cover was faded from time. First published when I was one-year-old, my father had written a ground-breaking college stat book. At a time when most stat books could be used for ship ballast in small numbers, at a time when computers took up entire buildings and were only owned by the government and IBM, at a time when hand-held calculators were not even a dream, my dad wrote a small, slim, 228-page book of statistical essentials. My father didn’t love to write, those genes come from my mother. My father lived and loved to teach. Thank God I got those genes too.

But my father existed in a publish-or-perish academic environment of large universities that don’t really value teaching. They value research. For my father, writing a text book was a short cut that allowed him to stay employed but spend his time doing what he really loved: teaching and inspiring the next generation.

In one of my many sad attempts at undergraduate schooling (which were ultimately cumulatively successful in getting me a bachelor’s degree a decade or two ago) I took a stat class that actually used his book. I think I got a D- in the class; but I still had the book.

It was my father’s voice--clear, professorly, kind, and re-assuring--that made me understand what I needed to do. For what it is worth, you calculate each one, square each one individually, then add ‘em up. Thanks Dad.

But the thing that really stuck with me about all of this is not the statistics, but the power of books. The ability of the written word to stand the test of time. To be able to speak to and learn from the brilliant minds who have left us.

Which lead me, egotistically, back to my own book. I can’t recall if I told all of you or not, but I finally did finish the book I’ve been working on for some time. It’s called The Born Again Diabetic; the hand book to help you get your diabetes in control (again).

I know most of you expected me to write a book on Continuous Glucose Monitoring, and I may still some day in all my spare time (sarcasm). But here’s the deal. Working in the field I saw we have a huge hole in our available literature. There are a ton of books for the newly dx’d. But what happens is people do great at first, then with time….well, you know.

My charter was to “remind you of the things you forgot, update you on things that have changed, and teach you the things you never learned.” It’s done. I even got a most-important MD/Endo to write a forward to balance my lack of formal credentials and I can’t get any publisher on the planet to even look at a sample chapter.

But now, I’m reminded of the power of books both in geographic scope and over the scope of time. A book allows me to touch more lives than I ever can on my own. A book allows me to continue to speak after I’m dead and gone.

With a new sense of purpose I vowed not to let the manuscript collect dust any longer. I’m going to get this son-of-a-bitch published if it kills me. And then, even though I’ll be dead, I will still be able to speak in a clear voice.

Complete with swearing. Hell yeah.

Friday, September 12, 2008

Why I had to buy cargo pants

So I have a new look, function dictating form this time. Here is how it happened.

Where to start? OK, nurses wear scrubs. The paramedics wear black pants with 2,000 pockets, combat boots and caduceus-emblazoned blue T-shirts. The Doctors wear white lab coats (sometimes hiding Hawaiian beach shirts underneath). I recently learned that the length of the lab coat signifies status. The longer it is, the greater the status. Med students get waist-length coats at their “coating” ceremony and get the longer ones on graduation. Hmmmm…no doubt a legacy of the penis-size approach to medicine of the AMA.

But what do un-certified diabetes educators wear?

It probably sounds silly. And it’s no doubt a vanity, but I’ve struggled with this for two years. We are generally a blue-jeans part of the world. And I’m under strict orders to never wear a tie at the clinic. Our medical director wants to keep us part of the community, not set ourselves apart from it.

Last December I got really depressed ‘cause no one wanted to come see me. After all, who the hell wants to see their diabetes educator at Carb-mass? So I sat in my office and ate brownies and felt sorry for myself all month long. During that period I tried wearing a sport coat to make myself feel more professional. It back fired when I was unable to connect with a very young, very poor kid who had just been Dx’d. A white guy who looks like a college professor was not what he needed at that moment.

So thanks to Wal-Mart, this spring and summer I’ve been wearing various muted colors of pseudo-safari shirts. Something like what UN aid workers in Darfur might be wearing. Cotton canvas, with roll up sleeves that button mid-bicep if I take the time to carefully roll up the cuffs, which I generally don’t. Interesting chest pockets for stuff I don’t carry. No epaulets, thank God, that would be just tooooooo much. I’ve got ever-so-pale grey, ever-so-pale green, ever-so-pale blue, and several colors of ever-so-pale earth-tones from adobe to nearly white with khaki in-between.

So before the story goes on I have to make a confession. I did something a bit unethical. How big a sin it is I’ll leave up to you. Shortly after the dummy OmniPod incident I mentioned last week their rep came calling. So I said something like I couldn’t possibly recommend a device this different to my patients unless I tried it out myself first…

And they said: “No problem, what are you doing Wednesday?”

And just like that I was pumping again. Pumping tubeless. I asked for, and received, six weeks worth of pods. I chose six weeks because that is the minimum amount of time to be fair to a device. Sometimes you have a great honeymoon and a lousy marriage. Other times you have a lousy honeymoon and a great marriage. Six weeks gives you time to work out bugs or recover from blinding euphoria.

So after much back and forth and discussions with Debbie, we decided together that it was unethical for me to blog my experiences starting out on the system. I did not buy it. It was not loaned to me for review. It was loaned to me to experience and decide if it has value for my patients, which it does. We’ve scripted out three of them so far and I called various colleagues and said “don’t script any pumps until we can talk. Everything has changed.”

But as regular readers know, I can find plenty of fault with even the best-engineered of devices. The same is true of the OmniPod. It does have its problems and issues, but they are far, far, far, far out-weighed by its advantages. I believe that in time all pumps will be tubeless or extinct.

Bottom line: the OmniPod is a very diabetic-friendly device. And I’m getting one of my very own as soon as our new health insurance kicks in (more on that in some future post).

Nuff said on that. Back to pants. So my loaner pump’s case is the one that carries the test strips and stuff you also need. It’s a bit large and has a Velcro strap to attach to your belt. One-half-of-a-square-inch of Velcro. As I already have my trusty Guardian on my waist I wore the OmniPod case over my wallet on the small of my back. Made me a nervous wreck for two days. I didn’t want to lose an insulin pump that did not belong to me. It was also less than comfortable in the car too.

On the weekend I drove to Wal-Mart in search of cargo pants. I expected them to look baggy and awful, but for now….

Actually, I found a line by Wrangler that have a nice cut. Seventeen bucks. They come in dark tan, light tan, black, and pale grey camo. They fit great in the waist, my butt looks pretty good if I say so myself, and they are very comfy to wear. By shear coincidence, they look perfect with my UN Aid worker shirts. Maybe this is how uncertified diabetes educators look.

I was pretty happy. At first. Now I love boots. But they do not love me. Especially when my sugar is doing the funky-chicken dance, I get horrible foot cramps. I’ve noticed these are worse when I wear boots; so as much as I hate them, I wear tennis shoes. Tennis shoes with blue jeans make you a 60% fashion victim, which I can live with. Tennis shoes with cargo pants make you a 95% fashion victim.

Deb said: “You look like a dufus.”

Ouch. When your own wife thinks you look like a dufus, you are in trouble.

Deb looked me up-and-down critically and said, “I think loafers might do the trick, I’ll check Zappos on the internet for you.”

Of course, that would involve shipping time, forcing me to either pony up nearly as much as the shoes cost for overnight shipping or looking like a dufus for a week. Plus they might not fit right or be uncomfortable or…

On my way home from work I detoured 20 miles in the wrong direction to Famous Footwear; located conveniently across the street from Starbucks.

There were an abundance to choose from. At the checkout counter I told the girl, My fashion consultant isn’t with me today. If my wife hates them can I return them?

“Sure, so long as they aren’t worn outside you can return them in 30 days.”

My wife says I look like a dufus in cargo pants and tennis shoes.

“You’re wife said that to you? Wow, that’s harsh.”

Of course now that fall is nipping at our heals it will soon be time for light jackets to fight the morning chill. Ut-oh. Will my baggy photo-J coats make me look like a dufus with my cargo pants?

Where the hell was that Burlington Coat Factory again?

Friday, September 05, 2008

My HDL medicine cabinet

The note is written in a brown ink sharpie and attached to a bottle of Cabernet Sauvignon in my fridge. It says “Take a Break.”

No, it’s not in my wife’s handwriting. It’s in my own.

Personally, I don’t think I drink too much, but over the last couple of months I’ve gone from not having a drop of alcohol for over a decade to drinking two glasses of red wine every night when I get home from work.

I don’t think I have a problem, and my HDL, in the mid-50s has never been better and is spectacular for a man. No elevations in liver function either. So what’s the problem?


My wife perceives that I drink too much. She’s Hispanic, remember, and the drunk husband fear probably exists on a genetic level for her after so many generations of that being a really big problem in these parts.

So I took a break. Do I miss the wine? A tiny bit. But it was no big deal.

Besides I still have women and song.

Well, song anyway.