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, October 10, 2008

History repeats itself

Dateline: Boston
Thursday, December 16, 1773
at the Bloody Fingertip Pub

Bill Woods, my improbable psychic ancestor, has had one too many steins of grog. He is venting about British taxation of tea and says, his voice slurring...

“Ya know what we oughta do? Do ya? Do ya? What we oughta do is… What we ougthta do is just go down there to the harbor and just throw all that tea into the bay! Thas what we ougthta do…” He drains the stein in one long gulp, looks around smugly at his drinking buddies, and then passes out, his head making a resounding thunk on the table.

His friends, also drunk, but not as drunk as Bill, look at each other. “Thas not a bad idea at’ll,” says one of them. The others all nod in agreement.

The next day:

“Honestly, honey, I didn’t think they’d take me seriously,” Bill tries to explain to his wife Debbie, who is not at all amused.

Two-hundred and thirty five years later…..

You just never know what will start a revolution. I’m willing to bet that most of the greatest revolts in human history were the result of some poor sod saying the wrong thing at the wrong time. Sometimes drunk, sometimes innocently opening their mouths at the wrong time, at the wrong place, to the right people; and setting events into motion far beyond anything that they expected.

In my defense, I wasn’t drunk. I just said the wrong thing, in front of the wrong people, at the right time, and found myself in the middle of a diabetes tea party.

So this is a great story I have to tell, but I’m trying to figure out how to tell it without making any more enemies than I already have in the last couple of weeks.

So being intentionally vague here, I’m a new member of the board of a diabetes organization that used to be part of a State Agency; but is now its very own non-profit. I hope I covered my ass enough here….

Every year for the past who-knows-how-many years, this Agency has sponsored a diabetes awareness event at a public place. A very public place.

Two years ago I got an email about three months before the event from the Agency stating that 10 booths would be available to clinics on a first-come-first serve basis. I was in Superman Mode the day I got the email and responded at once and scored one of the booths. Then I put it out of my mind. I got a reminder a week before the event.

By then I was in my December-Blues Mode and was trying to find the container of rat poison that I keep in my desk drawer so that I could just put myself out of my various miseries. I had no idea what to do with the booth. In desperation I went to my boss for ideas.

“Why don’t you take some patients with you,” she suggested, “not in chains and cages, of course,” she joked. Then she suggested we use any leftover tests trips from our school screening to offer a public blood sugar screening.

And so we did. And we screened, I don’t remember, something like 300 people. The next year we did it again and screened over 400.

Now background: the American Diabetes Association does not believe in screening for diabetes out in the world. I find that kind of like not believing in gravity. But it wouldn’t be the first time the ADA and I didn’t see eye-to-eye.

Now for those of you who think like I do, you are probably wondering: why would anyone NOT support screening? The argument against goes something like this: well, if you found a diabetic (or two, or three, or four-dozen) they might get away. They might just walk away and never get cared for. Therefore, you should only screen inside a clinic where you can lock the door and keep the new diabetic from leaving.

To which I say: yeah. True. They might just walk away. So what? These are not people who would have come to a clinic to get screened anyway. At least now they know. And some, I believe even many, will follow up with a doc. And on top of all of that, public screening raises awareness, which is always a good thing.

So at this board meeting the Very Important head of this state Agency that spawned the little organization whose board I just joined was plugging the upcoming event. After draining my stein of grog I innocently say, “Oh yeah, it is a great event. We had a booth there the last two years and did screenings.”

Then the shit hit the fan.

Reader’s digest version: the Very Important person went on a virtual rant. Not being a complete idiot, and not knowing where anyone else in the room stood on this issue, I kept my mouth mostly shut and only offered the weakest defense of the value of screening. It was quite clear to me I would be deleted from the email list this year. If by some miracle we got a booth I would not be so foolhardy as to try and screen anyone. I might, however, make a huge sign that said: Ask me why the State won’t let me screen you for diabetes.

I figured that was the end of it.


The next week, myself and all the board members get a lengthy email from said Very Important person detailing the evils of screening, the State’s official dim-view of such activity, and many links to various obscure places on the ADA’s web site. I deleted it without responding and went back to things that matter. Like taking care of my patients.

Then the next week after that, I get an email from my new organization asking us to vote on whether the organization should, in defiance of the State Agency, support screening. I put my vote where my beliefs are.

David threw the first stone, but Goliath was not done yet. What followed was a blizzard of emails from various parts of this State Agency to all the board members. They grew increasingly belligerent to the point of first threatening funding and eventually threatening to cancel said very public event.

As a side note, I find it interesting that the head of this Agency who sponsors this diabetes event was unaware we had been happily screening the last two years. Clearly this person had not attended the event themself.

I was alarmed at the tone of the email. I was alarmed that on my first day on the board that I had triggered a firestorm. I had no idea how the other members felt or how they would react to the barley masked aggression of the State. I had no idea if the assorted threats would make them dig in their heels or if it would scare them off.

If my fellow board members vote the way I did we will pay for non-State funded booths at the event and screen. If the event is cancelled, we’ll host an alternate one. If the others vote to support the State view of the evils of public screening then that will be the law of the land, as it were.

I just got an email. The vote is in; 10-to-2 the board voted to support public screenings.
In the face of power we will do the right thing.

The tea is in the harbor.

Saturday, October 04, 2008

From the mouths of babes

So first thing this morning my little one says to me, "Daddy, when do you take your test?"

What test? I ask him.

"The one you are on the computer studying for," he says.

Oh, it's not a test, it's a program. I'll be studying for three years.

A very long face, then: "Oh....I guess it will be a long time before we can do anything together on weekends then."

Maybe school isn't so important after all.

Friday, October 03, 2008

She shopped until I dropped

I really wanted to die at home. Not at Sam’s Club.

I’m not doing too well, babe, I told my wife. Of course, this was a self-inflected injury. We’d taken Rio to the dentist in Santa Fe for two fillings, poor thing. He was an absolute trooper. No fussing. No complaining. Staying calm and still while the barbarous dentist and his assistant prodded, drilled, scrapped, suctioned, and sprayed.

I was very proud of him, so when we were done it was off to Target for a reward. He choose a build-your-own-light-saber kit. My BGL was coasting around 100 so I set the OmniPod to deliver a 50% reduced basal rate for the hike around the superstore.

It worked like a charm; when we arrived at Applebee’s, the dental-victim’s choice for lunch, I was at 104. No crash, no spike. Then I got cocky.

Rio selected Kraft Mac and Cheese. What nerve these restaurants have charging four bucks for a third of a 75-cent box of pseudo-food! Oh well. Deb and I chose Quesada burgers. Yum. I forgot to order side-salad instead of fries and made the mistake of eating just one fry when my food arrived….

Potatoes turn to sugar in your blood fasting than pure cane sugar. I think they must also trigger endorphins or something. It is true: you can’t have just one. Well, whatthefuck. I’ve got a pump. I’ll just bolus for those puppies. As I was thumbing through Calorie King’s pocket guide (courtesy my friends at Roche Diagnostics) to get an estimate on Applebee’s fries when the Blue Ribbon Brownie caught my eye, all 107 carbs of it. Hmmmmmmm…the exact carb count for a huge desert. I fingered the pod on my bicep. Hmmmmmmmmm…

Of course, like the idiot I am, I ordered and ate the whole thing. Both brownies. Both scoops of ice cream. All of the fudge sauce. I even licked the plate. I think I’ve mentioned before that I’m a poor role model. My arm ached from the volume of insulin the pod forced into the limited subcutaneous fat on my arm.

Everything was fine. For 15 minutes. Then the excursion started. The thirst set in. My head was pounding. The Guardian alarmed. Then the stomach cramps set in.

“OK,” said my mate of 20 years and partner in diabetes since the beginning, “let me just grab a few quick things and we’ll go.”

I sat in a Serta desk chair on display at the end of the long aisle of office supplies. I had a commanding view of the produce and wine sections. I felt like crap. Rio hovered over me, his dark-brown eyes filled with worry. “Do you need candy, Daddy?” He reached out and gently stroked my cheek with his finger.

No baby, I’m high, not low.

“Maybe you should take some more insulin,” he suggested.

The stomach cramps are really bad now. I unzip the front of my go-bag and pull out the Abbott Precision Extra meter that is stowed there. Break glass incase of emergency. I break the glass. This could be an emergency.

I unwrap one of the purple-foiled strips that cost $8 each. I set the lancing device deep. Snap! Squeeze. Darn it, my vision is getting blurry. BIG blood drop for the thirsty ketone strip.

“Where is that mother of ours?” asks Rio, looking frantically left-then-right-then-left again—still murky on the difference between wives and mothers and where everyone is supposed to fit into the family tree.

The count down starts. I close my eyes for a minute. Even when my sugar is really high, I rarely clock ketones at all. But this feels different.


These blood ketone meters take a while, but it tells you how acidic your blood is right now.


So much better than the old way: peeing on a strip and comparing to color to the chart on the bottle that tells you where you were at two hours ago.


If you are a T-1 you should have one of these, even if you have to pay for it. And you probably will, insurance companies being what they are.


Positive for ketones. Big time positive. Not enough to kill me. Not yet. But double the amount I’d ever seen on my ketone meter before. The highest I’ve ever been. Ever. I hold the meter in my hand, trying to make sense out of the number. Trying to process in my mind. Like a cold wind from the north fear sweeps down on me.

It’s OK, I tell myself. Takes hours and hours and hours to go into DKA. I’ve got time. Take more insulin. Stay calm. Let it work. If the ice doesn’t break you’ll take an IM shot straight into the muscle. You’ve got two deep-needle syringes in your bag just for such emergencies.

An hour later Deb returns with a basket full of “necessities.” You’re going to have to drive, I tell her.

It takes forever to check out. Then Rio is hungry again. I collapse at the food court to wait. To my surprise one of our nurses comes by. She comes over and gives me a quick hug. “I saw Deb and she said you aren’t feeling well, hope you feel better soon, sweetie.”

Thanks, I’ll be OK.

The next person who comes by is our medical director. I can’t fucking believe this. I guess the whole staff is a Sam’s Club today.

Rio tells him, “Daddy has a stomach ache.”

Our head Doc pauses, steps forward, then back, and frowns. “I left my wife in a hot car,” he tells me sheepishly. He has a huge sack of dog food and a huge sack of bird seed in his cart. I didn’t know he had a dog.

Don’t worry about me, sir, I’ll be fine. Damn if I’m going to tell him his insulin pump enabled Diabetic Educator is ketonic from eating French-fries, two brownies, two scoops of ice cream, and hot fudge sauce.

I don’t remember much after that. In the car I drank all of the water in my traveling cup. And all of the water in Deb’s traveling cup. And all of the water in the back-up bottle we use to refill the traveling cups. Then I passed out. Not a coma, just exhaustion.

The next six hours are a blur of fluids, correction boli, and finger sticks. I got it down from nearly 400 into the low 200s and there my sugar stuck. For hours. Bolus after bolus hammered away at the sugar with little effect.

I sat on our back porch where the monsoon rain-bread mosquitoes that had been plaguing us the last few weeks paid no attention to me; my blood too acidic for their taste, I guess.

I pissed away another 8 bucks and found the ketones had been cut in half. This would end OK.

The sun setting over distant mesa tops drained my stress away. I puffed on my pipe and relished the feeling of my body recovering. Cramps fading, vision sharpening, mind clearing.

Every once in a while I entertain the fantasy that the doctors got it all wrong. That I’m not really diabetic. But it is just a passing fantasy, and when I push the limits I pay.

They did get it right.