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!).

Monday, June 18, 2012

A Founder’s Lament

I don’t like the flavor of the conversation anymore. And I haven’t for a while. It tastes more bitter than sweet. I see battle lines being drawn between fighters who’re on the same side. I fear civil war that we can ill-afford.

I’m talking about the growing divide between those of us branded as “leading bloggers” and the rest of the Diabetes Online Community (DOC). A divide between those few of us who always seem to be in the headlines, and at conferences; and the many, many more who don’t get the same opportunities.

Let me be clear: I don’t personally view myself as a leading blogger at all. I just see myself as one of the Founders of the DOC. And I’m not a Founder because I’m a brilliant fucking visionary, but simply because I was at the right place at the right time in the flow of history. Nothing more.

But as time has passed, this accidental status has taken on some power. By being a Founder, I find that people look to me for leadership, and that my opinions and actions carry some degree of weight.

And it’s my opinion now that we must not create “cliques.” Or even the appearance of cliques. We must not allow any part of our movement to become some sort of elite; or be viewed that way from either within or from without. I hear bitter rumblings…it’s always the same few bloggers at these DOC events. Division is poison. The DOC is huge, and we Founders cannot and must not speak for our population forever.

I propose that we need term limits. I’ve served three terms at Roche Social Media Summits. I think that’s enough. It’s time for me to step aside and let other voices be heard. As a Founder, I think it’s my responsibility to set an example with my actions. So I’m giving up my seat. I have un-RSVP’d to Roche, and have asked them to please extend my invitation to someone else.

I suggested a blogger I really don’t know very well, and have never met before. A person who is very much not me, but who is an awesome writer with a passion for helping others. Someone who I think is deserving of a seat at the table as much, or perhaps even more, than I am.

This was no easy thing for me to do. Stepping aside means missing out on fun, fame, and family. It means a high risk of diluting what influence I have, and have worked hard to earn. It’s perhaps taking away my own microphone when I’m facing the largest crowd I’ve ever spoken to. It might even be career-a-cide for me as an advocate with any influence.

But, it is right thing to do.

I can’t say if any other the other Founders will join me. I hope so. But by giving up my seat, at least one fresh voice will added to the “high profile” chorus. Hopefully that turns down the volume of the dissent among the noisy jealous that see the Founders of the DOC as spoiled ambassadors who are only out for ourselves rather than speaking for the community.

And…. incredibly selfishly… I hope my choice doesn’t move my voice into the shadows. The outfield. The back-forty; where it becomes heard no more.

But for the right thing—for the greater good of the DOC—that’s a risk I decided to take.

Wednesday, June 13, 2012

Pulled plug

The things I miss the most are physical. I miss her body, more than her mind or spirit. Sounds shallow, doesn’t it?

How like a man.

But Revel’s body was slim and hip-hugging. CoZmo is pretty clunky.

CoZmo, however, is the smarter girl. So when you have to spend a lot of time with a girl, I find that, if I have to choose, I’m happier with one that’s smarter, rather than one who’s prettier. (Lucky for me I married one who is both.)

Overall, I think from a pump ONLY perspective, I like attempting to manage my diabetes with CoZmo better. The way insulin on board is tracked and displayed, the site change reminders, the increases in corrections with increases in blood sugar, on-computer programing, and the day of the week auto basals all trump Revel. Trump, hell. Trounce is more like it.

But from a system perspective, Med-T would have been the better marriage. Having a pump that was also a CGM was awesome. Less on the belt, for one thing, but even better was the integration of the components. The meters talked to the CGM. The CGM talked to the pump. It was all incredibly labor saving, and for those of you who don’t know, diabetes is labor intensive. Anything that buys me a few moments diabetes-wise, gives me those moments to do something else with. Like spend a few more seconds with my family. Hey, my time on earth is shorter than anyone who doesn’t have diabetes. I need to use it wisely.

And then there is Sentry. I was surprised that I didn’t miss him as much as I thought I would. Debbie, on the other hand, is less than happy. She really, really, really likes the Sentry. She’d much prefer that I was on Med-T CGM with Sentry than on the Dex.

Oh, and speaking of the Dex, how is that going, you ask? What’s it like returning to Dex after a couple month affair with the Med-T CGM? Well… Dex is big. It’s ugly. It’s dumb. The monitor, that is. But there are things that I like about the system. Or had forgotten that I like about it.

First and foremost, I like the sensor insertion. Dex’s dental-tool-from-hell inserter device actually works really well. I never bleed, and I rarely feel any pain putting in a sensor. And I never have sensors crap out early with Dex. I also like running seven days. It keeps my life simple. Oh, today is Friday. Time for a new sensor. With Med-T you need to pretend to change it at three days, then actually change it at six. Or, if you want to go seven, you have to pull the transmitter and reset it, along with that whole two and a half hour startup thing. And, to pull the transmitter, you must first pull up your Tegaderm. If you’re going to go to all that trouble, you might as well start over and put in a new sensor.

Oh, right. And speaking of Tegaderm, that’s another Dex plus. No need for an over-bandage. The Dex sensor stays on just fine. And the smaller sensor size means I can wear the CGM on my arms, which I prefer to the leg sets needed for the Med-T, although I couldn’t tell you why I prefer it.

Of course, I miss Revel’s predictive alarms, and it’s variable alarm thresholds, but not as much as I expected I would.

Dex is loud enough to wake me at night, but I do miss that big, beautiful Sentry screen that let me take in my blood sugar status at a glance.

Oh, and another thing I hate about the Dex monitor (come to think of it, there’s nothing that I like about the Dex monitor other than its capacity to generate a lot of noise) is the fact the inside of the screen gets filled with dust.

Which makes it hard to read in some light. The Revel is somewhat water-tight. No dust. Revel will also stay on all the time. Dex makes me press a button to look at my blood sugar. I don’t have time for button pressing, damn it. Can you imagine a watch you had to press to see the time? Oh. Wait. We used to have those. In the early 80’s. Remember LED watches? Yeah. The black-glass with bright red digital readouts? You don’t see those around anymore. Why? Because high-tech space-odyssey charm aside, you had to press a fucking button to find out what time it was, and frankly who has time for that? It got old very, very fast, and people stopped using them. I’m surprised it didn’t kill the digital watch as a product altogether.

After all, since the invention of the wrist watch, all you had to do was glance at your wrist to tell the time. Pressing a button is taking a step down the evolutionary ladder.

What else? I think I prefer Med-T’s approach to electricity, although you can learn to live with either system. For the monitor, Revel takes a AAA battery. Easy to carry a spare with you, should you be away from home for a longer-than-expected time period. Who knows? You might be standing on a street corner minding your own businesses when the Swedish Bikini Team’s tour bus pulls up and they invite you to travel with them.

Hey, it could happen.

The guy with the spare AAA battery is clearly at the advantage over the guy with the spare plug and spare wall in this circumstance. Yes, Dex needs a wall to recharge. And quite frequently at that, especially for a device that won’t fucking stay on.

As for the transmitters, the Med-T CGM transmitter is rechargeable. If you keep it charged (including during any breaks you may take for CGM vacations); it will work for years. The Dex transmitter is sealed. They promise it will last a year. But when it dies, it does so by getting funky, which is very frustrating. Even more frustrating is the company’s business model. You can buy a replacement transmitter, for $800, but they won’t guarantee it unless you buy a new monitor to go with it, too. Basically, if you buy into the Dex system, you’re on a treadmill of new system annually. That wouldn’t be so bad if there was a new wiz-bang gee-wiz model every year like with cell phones, but I’ve been on Dex since…. 2009… worn two… three? And they’re all the same fat, lazy, ugly girl.

That reminds me. My year was up May 17th. Oh dear. I’m going to need to make a CGM replacement decision very, very soon. I’ll take Tough Decisions for $250, Alex.

But, all things being equal, except for one itsy bitsy tennie weenie little thing, I could have been very happy with the Revel system. That one fatal stumbling block? The Motor Errors, of course.

Now I want to make it clear that I really do believe that this is unique to me or my environment—even though the root cause remains a mystery. Don’t you think, given our Twitterfied and Facebooked world, that if someone else was having epic Motor Error issues, you would have heard about it? Yeah, I think that if even one other person were having these issues (unless some poor Amish guy is having motor errors, and would an Amish diabetic use a pump?), I think we’d all know about it.

But for that, I would get out my check book and write Med-T a check for $3,000 for the Sentry right this very second. Ah… umm… of course the check would bounce, because I don’t have 3K to my name. But still, I’d find a way. My insurance will cover a new pump for me, and a new CGM, so I wouldn’t have to worry about paying for Revel and the CGM transmitter.

But I only get one new pump in the next four years. So I’m not going to use my “pump money” from the insurance to buy a pump that won’t work for me. Chronic motor errors would stress me out so much I’d have a stroke within a year. And I’m not going to pay $9,997.00 for a CGM monitor; the cost of buying a pump to use only for its CGM. Remember, Sentry only talks to Revel, if you want a Sentry, you need a Revel.

So for me, I guess it’s back to Dex and CoZmo. If my antique phone’s brass bell announces a break-through from Med-T before I finish packing up Sentry and Outpost and Pump the Fifth to send them back to Med-T, I’ll reconsider. But frankly, I don’t think the hard working Ghostbusters will ever solve this mystery.

So, how will I spend my pump money? Good question. I wasn’t too impressed with the Animas pump when I test drove it, but maybe I need to give it a second look. I always knock OmniPods off, so I think I’d rather stick with traditional pumps with tubing. The new tSlim might be worth a look (although, being old fashioned, I really prefer buttons to touch screens), and I know Roche has a new pump over the pond. I wonder when the frickin’ FDA will approve that?

And then there’s the CGM issue. My Dex could crap all over me at any minute now. I’ll need to choose a new CGM, like soon. Guardian isn’t an option. Not loud enough and doesn’t talk to Sentry. And Revel, for whatever reason, won’t work for me.

Oh. I guess I don’t have a choice after all. Unless Med-T figures out what’s up with their pump and I pretty damn quick, I’ll need to sign up for another year of Dexcoming.

Wednesday, June 06, 2012

Thinking about the Supreme Court


noun \ˈher-ə-ˌtik, ˈhe-rə-\
: a dissenter from established religious dogma
: one who dissents from an accepted belief or doctrine : nonconformist

I’m not sure how I went from True Believer to Heretic. I don’t think there was any one event, rather I think it was a gradual process. An erosion of the soul.

What? Oh. No, no, no. I’m not talking about my religion. My religion, diabetes, remains as strong as ever. I’m talking about healthcare reform. The badly media-named ObamaCare. (Stupid name, he didn’t create it. It should be called Congress Doesn’t Care, instead.) And actually, we all need to quit calling it healthcare reform. It’s not. It’s nothing more than health insurance reform.

Anyway, as all of you should know, the Affordable Care Act has been trussed up with a rope and delivered to the gallows where nine potential executioners wearing long black robes instead of long black hoods will decide whether to execute it, disembowel it, cut its hands off, or maybe even let it go free.

American democracy in action.

Everyone in the country has their fingers crossed. Those that support the law have their fingers crossed that the Supreme Court will show supreme mercy and let the Act become the law of the land. Those idiots who’ve never used their health insurance, and think it’s just peachy-keen the way it is, have their fingers crossed that the court will strike the act down.

Sorry, that wasn’t very journalistic of me, was it?

Even the un-insured are split. Some want the law, as they are desperate for coverage. Others fear it, as the government is going to require them to give more money to Wall Street.

And what are my fingers crossed for? You think you know, but you’re wrong. I’m crossing my fingers the Court strikes it down.

Whoa, whoa, whoa. Hold on. Settle down. Let me finish before you flame me.

I hope they strike it down because it’s a bad law. And it’s a bad law because it doesn’t go far enough. It’s fucking Band-Aid on an ruptured aortic aneurysm. It simply won’t do. At all. But if we have it, if it survives, it allows our elected leaders to proclaim “mission accomplished” and turn their backs on the problem. And this law won’t fix the problem of healthcare in our country.

Don’t get me wrong. I believe in universal coverage. With all my heart. I believe in banning pre-existing conditions. I believe in making everyone take some finical responsibility for their health and healthcare.

But I do not believe in leaving the wolves in charge of the henhouse. And that’s what this law does. Frankly, I surprised that the Conservatives hate it. A law that requires every man, woman, and child in the country purchase a commercial product, with virtually no checks, balances, and oversight? My God! What a gift to the insurance industry! The latest estimates are that just over 17% of Americans are currently without health insurance. That’s more than 53 million people. What’s a typical health insurance policy cost per year? About 6K? The Affordable Care Act would inject three hundred eighteen billion dollars into the Swiss bank accounts of the health insurance industry.

What a sweet deal.

This Act is a disaster. It doesn’t address the cracks in the foundation of American healthcare. It doesn’t fix the problems of greed and waste and injustices that make us some of the sickest people on the planet, while still paying more for healthcare than any other people. All it does is put off the inevitable brick wall that we are screaming towards at top speed. How much longer can our fragile economy keep absorbing double-digit increases in all things related to health?

I promise you, healthcare, left unfixed, will accomplish what the sub-prime fiasco failed to do: bring us to our knees and leave us in economic ruin. Politicians like to fear monger and talk bullshit about who will pay for reform. None ask the real question: who will pay the much, much, much higher cost of doing nothing?

If the six old men and three old women strike the Affordable Care Act down, it may be a blessing. Oh, I know. It will be a disaster in the short term. Both human and economic. A metaphorical asteroid strike.

But from the ashes maybe we’ll do it right.