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!).

Wednesday, October 31, 2012

My new office

Today’s CGM Primer: “At the end of the week you sit down with all this information and you break into tears. Because there is too much data, and none of it makes sense, and having diabetes sucks and most likely you’ll resort to either medical marijuana or medical whiskey.”

--Beyond Fingersticks

My new office is on the second floor of a building that was built in 1892. Right outside my door is a stunning view of the atrium, an art deco triangle of open space rising up eight stories to a massive stained glass ceiling bigger than most people’s homes.

My office itself has no view at all. It’s narrow and deep, like a ship’s galley. But it’s comfy. I have three computers to choose from, fast internet, and a delightful rust-colored suede chair that’s a joy to sit in. I have a laser printer, a trash can, and a phone. All I’m missing is a coffee pot.

Still, not bad for a refugee.

A castaway.

A victim of Blue Screen of Death.

Yeah, my aging laptop finally bit the dust. Within an hour, the first pangs of Writer’s Withdrawal were setting in. I knew it would advance to full blown typing tremens in no time at all. I was about to re-draw the day’s plans to include shop-for-the-cheapest-fucking-laptop-you-can-find, although I never use a laptop at home and rarely travel when I have to write, so I’m not sure how much sense it would have made to get a new one. Plus, I hate computer shopping. It stresses me out.

Then it occurred to me that the grand old hotel I’m staying in might have a business center. And sure enough it did. And I always carry a flash drive in my Go-bag, so I had everything I needed to blog away in exile.

So, speaking of computers and the failure of technology, this seems like the perfect day to talk about CGM software. Because, historically, this has been an area of major failure from all the folks who’ve made CGMs since day one.

Needless to say, I got my hopes down about the new software that came out with the new CGM in town. Because, in case you hadn’t heard, the new way to look back on what your G4 has been up to is called Dexcom Studio, which you can download for free from the Dex home page. I’m told it will also download the Seven Plus receivers too, but I’m only going to focus on the G4 today.

Getting your data from your receiver to your computer is a snap. The button-end of the G4 has a USB port hiding under a sliding cap that reminds me of the gun port on a pirate ship. Slide open the gun port and plug a cable into your receiver, then plug the other end into your PC. The software starts downloading data. It’s that fast and that easy.

Wait. Did you say PC? What about Mac users? Well, you Mac users are still screwed, but you should be used to that by now.

And when the download is complete you get:

As one would expect from a software named Studio, the graph has lots of pretty colors. It’s nearly a work of art. But is it useful? In a word: Yes. I think it is. Actually, I knew it was the second I saw the best part. And the best part is the rather clunkily named “Pattern Insights Summary” found on the upper right-hand side of the “patterns” graph.

I would have called it artificial almost-intelligence. And until now, only docs and a handful of sneaky folks like me have had access to anything like this. Look, think about the volume of data a CGM is creating. It’s checking your blood glucose 288 times a day. That’s 2,016 times a week. That’s 8,760 times per month. Over 100,000 times per year….don’t you think computers have come far enough to give us a little more than just pretty pictures? For God’s sake, help us understand all this information! Help us search this haystack for the needle!

Actually, the Other Guys did it first, a while back. There’s a clinical decision support tool built into Med-T’s CareLink Pro, the doctor-version of their pump and CGM software. It’s cool, but it’s of limited use, and it was clearly written by lawyers. At best, it feeds us an ass-covering trail of bread crumbs and vague hints, rather than concrete observations based on the ton of data. Words like consider, assess, and counsel dominate the conversation.

And even this very limited tool isn’t available in the “consumer” version CareLink. Why? Doesn’t Medtronic care? No doubt the suits were worried that somebody would get hurt following the advice of the software. But you know what? I guarantee you that many people are getting hurt by not having any help with all this information. Why do you think we’re building dialysis centers faster than we’re building prisons?

But with Studio, Dexcom has boldly brought some computer power to the masses. Take a look:

Sorry I didn’t have a more exciting week for you to look at. But see what it says: “Most significant pattern of highs found between 11:10 PM and 3:55 AM.”

No consider, no assess, no counsel.
Dexcom has jumped right in and boldly pointed out where the trouble is. Now, I could probably have figured that out myself by staring at the picture long enough, but it’s handy to have someone bluntly tell me where to look.

Of course the new software has other features, and many different ways of looking at the 100,000 data points regurgitated by your receiver. And we’ll talk about it in more detail on another day, but for now know that your new blood sugar GPS comes equipped with a simple compass to help you find your way through the forest of data it generates. A blunt, forthright, straightforward, no bullshit way of telling you where to start when you sit down with your data.

So, as they say, “alls well that ends well.” Kudos to Dex for taking a bold step with the new software for the G4, and kudos to the Brown Palace in downtown Denver for giving me a way to keep up with my writing despite the death of my laptop. I actually like “my” new office, even though I’ll only use it for a day.

But damn, I still wish it had a coffee pot.

Tuesday, October 30, 2012

Catching the low-hanging fruit

Today’s CGM Primer: “If you set your CGM’s low threshold alarm at 75 you will never, ever, ever get an alarm when you are 75. By the time you get your alarm the horse is out of the barn and the barn has burned to the ground. You might actually be at 65, 55, or lower.”

----from Beyond Fingersticks

Truth be told, both girls missed it. With two CGMs, I figured I was pretty low-proof. But the stupid little Roche Nano was the first to break the news to me. I did a fingerstick right before lunch and was at 78 mg/dL. Shit.

I checked new Dex and she thought I was at 87. Old Dex thought 97. Well, it was a slow coasting low. Nothing dramatic. That’s how it works with CGM: the blood gets ahead of the interstitial fluid. CGM, like my wife, is frequently running late.

Here’s how it works (with CGM, not with my wife— I have no idea why my wife is always late). Recall that CGMs don’t do blood. They look at sugar in the water between your cells. Where blood goes, that water will follow. Think of it like a roller coaster ride. Every car in the train will follow the track (barring a very unfortunate incident, anyway), but no two cars are at the same place on the track at the same time.

Capillary glucose is in the front car. Alternate-site testing glucose is in the middle car. CGM is sitting in the back car. In a blood sugar low, the fingertips can report the news first. This is important ‘cause your fingertips and your brain are wired much the same. What happens at the tips tells you what’s happening in your mind. Literally. Not enough sugar in your pinkie and your brain is shutting down, too.

While this time lag vexes many CGMers, it’s really not as big a problem as it sounds like. Not generally, anyway. If you’re sitting in the back car of a roller coaster, you can still see a peak coming. Or a drop. You can see the lead car screaming down the track towards the bottom. It’ll get there first. But you’ll get there, too. Soon.

CGM is the same way. We can’t expect the CGM readings and the fingerstick readings to line up in a fast drop. But if we’re paying attention, we can watch the direction the train is going and know what’s about to happen.

Of course, I wasn’t paying attention. And as the low was a slow-moving one, no rate-of-change alarm went off to tell me to pay attention. And truth be told, even though I don’t like being in the 70s, I really wasn’t in any danger, and now had an excuse to raid the sack of chocolate-covered blueberries on the carb table near the nurse’s office. (Anti-oxidants and stuff, it must be healthy, right?)

I pop a few of the yummy morsels in my mouth and start my lunch. Half way through, with the meter showing a mild rise established, I feel a vibration on my waist. The G4 is finally on the case of the mild low. The lead car of my blood sugar roller coaster is already headed back up, but the tail-end car has reached the bottom arc of the track.

The vibration is a mild tugging, like an insistent small child pulling on your hand for attention. Hmmmm…. Old Dex had a vibration that shook the foundations of the universe. A deep-resonate buzz that rattled your teeth and could wake you at night. If you’re awake, you’ll notice G4’s vibration. But asleep?

Can the new girl’s buzz wake me at night, like her older sister does? If not, I’ve got a problem. The Dex CGMs, old and new, use good vibrations as their first-phase alarms, no matter what noise-making options you’ve chosen. They don’t go audio until five minutes later. In the middle of the night, if you sleep through the vibe, you’ll be five more minutes into an emergency before anyone “talks” to you about it.

I may have to review my threshold settings with that in mind…. I may have to set them higher to give myself more time to respond to a low. Oh, and speaking of threshold alarms, this is one area where The Other Guys still trump Dexcom. Both the old Seven Plus and the G4 have very limited options when it comes to threshold alarms. We can only choose one low threshold and one high threshold for the entire day. Med-T systems allow us to program different alarm thresholds for different times of the day, much like basal rates on a pump. Frankly, this is one of the strongest features (along with predictive alarms) that the Med-T system has going for it. I was disappointed that the G4 doesn’t have this option. It seems like such an easy thing to add.

Why does it matter? Well, if you are the mom of a little type 1, you might want a higher nocturnal low threshold to give you more time to deal with a night-time emergency. Or if you’re an over-exhausted college student, you might want a higher upper-end alarm at night. Sleep might be more important than fixing a 200 mg/dL, but when you’re up and about, you might want to keep tighter control.

Anyway, back to the lunch table. I decide not to acknowledge the alarm. I let it ride. I want to hear the new girl’s voice in the real world. I don’t warn my colleagues, who are in a lively discussion about the latest polling numbers.

I squirm in my chair. I’m having a hard time paying attention to the conversation. I’m waiting for the alarm. It’s like Chinese water torture. Hasn’t it been well over five minutes already?

Bee-Bee-Dee-Me-Ree-da-da-da. Electro-Latin-American-Pop kindergarten band. Musical, simple, electronic, unique. Not quite child’s toy. Not quite muffled ring tone. A little bit playful. The G4’s low alarm debuts.

Startled, the nurses are patting their pockets, looking around, reaching for their cell phones. Is that you? Is that me? Only our social worker, mom of a little type 1, turns sharply and fixes her piercing blue eyes on me, “Is that a low alarm?” she snaps, her mamma bear anti-diabetes maternal protective instincts rearing up in an instant.

I laugh at her, and tell her, This is a test of the emergency low blood sugar system. Had this been a real low blood sugar emergency, you would have found your clinic’s diabetes educator lying in a pool of drool on the floor.

I take the Dex off my belt, open the case and show her the pretty red graph. Everyone crowds around to see the latest and greatest.

One of the things Dexcom is bragging on is the G4’s supposed improved performance in lows. It’s supposed to be something like 17% more accurate than the old one. In this case, which was hardly the poster-child for a hypoglycemic event, G-4 did recognize the slow-coasting low. Granted, I had found and fixed it with a the help of an old-fashioned meter before it did, but still…

And the old girl?

Old Dex never caught the slow low at all.

Monday, October 29, 2012

Origami in black leather (not like you’re thinking)

Today’s CGM Primer: “I guess it comes down to this: Do you wear a dress? Now I didn’t ask if you were a boy or a girl, I only want to know about your wardrobe. If you wear a belt, your life will be easier with CGM.”

---- Excerpted from Beyond Fingersticks

I don’t get it. The belt case is origami. Black leather and clear plastic origami, folding over itself like a sandwich baggie. How on earth is one supposed to get one’s CGM monitor out and look at it.?


Do I have to start my G4 adventure with a BestBuy run for a functional case? The G4 looks like some sort of music player. Would it fit in a music player case? Or is it too thick? Maybe a cell phone case?

Well, this is not too unexpected. Dex, like much of the rest of the industry, has a long history of supplying crappy cases with their products. The original Dex case had a belt clip made from recycled Budweiser beer cans. The clip was weak, thin, crummy, and people’s monitors fell off and sometimes got lost! One of my patients lost hers in the woods, no kidding, and her insurance plan refused to replace it. EVER. Even once the warranty was up, they would not get her a new one.

Replacement of lost or stolen medical devices is not a covered benefit on her health plan. All hail Wall Street. She’s still CGMless. You’d better lock up your frickin’ C-PAP, oxygen tanks, and put a chain around your power scooter from the Scooter Store—you only get these things once in your life, apparently.

Anyway, for the last few years my personal carry solution for my Dex has been to use a Verizon case for the LG Chocolate cell phone, circa 2009. I think that was the original Chocolate, for you history buffs. It had a circular control panel. In fact, they might have pioneered that look, but I’m not sure. The point is this cell phone case had a nice little round hole in it that lined up to the Dex 7’s round control buttons, and a nice clear rectangular window that lined up to the Dex’s rectangular window, and best of all, a belt clip that hung on like a pissed-off rabid badger. Like the badger from the movie “The Gods Must Be Crazy.”

And it was elastic that made it all work. The Verizon case. Not the badger. Because the Dex seven, with its squashed Rubenesque physique would never have squeezed her wide hips into a LG Chocolate’s skinny jeans. But the Verizon case I found had elastic sides. The Dex fit. Tight at first, but over time the case loosened up enough that I could easily slide the monitor out to look at my blood sugar, but stayed tight enough that I didn’t live in fear of my insurance.

Well, that’s a lie. I always live in fear of my insurance. But I didn’t live in fear of my Dex getting lost. Or my next Dex. Or my third one. Each new monitor moved in and took up residence in the trusty case.

Meanwhile, each new monitor came with a slightly changed, but still pathetic-looking case from Dex. The second one I got was the worst: A clear plastic bag with a zipper all the way around it. A 1970’s-era kitchen appliance cover with a belt clip super-glued onto the back of it.


Oh, but back to the Verizon case. The clip not only never once in all these years let go of my belt, but it also rotated. The Dex could be worn either horizontally, parallel to the waist, or vertically. I’ve been in the habit of wearing mine vertically for the last several years and I always chuckle to myself when I see some dufus wearing a cell phone case or glasses case parallel to the belt. To my eye, a fashion faux pa.

Well, now I’m the dufus. The new Dex G-4 case, not only is wrapped up in itself, but the clip doesn’t rotate.

Still. I’m obviously not getting something here. Unlike the earlier ones, the new G4’s case screams quality. It’s black leather. It has a sturdy, solid belt clip that would make the Marine Corps proud. But it also has two snaps, some strange loops, and two hinges. There’s evidence of intelligent design here, some brain power must have been exhausted to come up with something that shows this much engineering.

Maybe I can make more sense out of this thing if I put it on.


Wait a minute.

That’s really quite brilliant. Isn’t it?

You don’t need to take the G4 out of its case to view it. It’s like a baby kangaroo. It lives in its pouch. And in turn, the pouch lives on your waist. To check your blood sugar, look down, un-snap, un-fold. Presto! Your blood sugar is 145 mg/dL.

Oh. This is clever indeed.

Except for checking while driving, this seems pretty workable. But it will void my friend Dina’s Rule Number 1 of Modern Social Anthropology: If someone is looking at their crotch and smiling they’re probably texting.

Of course, I can’t say how well it will work for me yet, but I’m not driving to BestBuy after work today. I’m going to give this a try. I’m still not sure how I feel about the horizontal placement, but dicking around with it on my belt as I write this, it seems natural enough. Unsnap. Unfold. Look. Smile (or frown). Refold, resnap. Simple enough. And the hinge drops the G4 to a nice 90 degree angle off the waist, making viewing simple.

But what’s up with the funky bonus strap that surrounds the belt clip? It’s stitched tightly at the bottom of the clip, then snaps to the top of the case. Actually, it snaps to the tongue of the case, the flap that you unsnap to lower the drawbridge and view the CGM.

Maybe it’s a safety loop? It doesn’t work on my belt (it’s too wide), but on a thinner belt, it might wrap up and behind the belt then snap at the top to serve as a back-up oh-God-don’t-let-my-CGM-get-lost insurance plan. I’m not sure how well that would work. The leather is pretty thin and it could still unsnap, but it might just help hold it on a dress belt. I’ll have to find a dress belt to test that theory out on… I think I have one buried at the back of a drawer somewhere… I’ll get back to you on that on another day.

My spies tell me that Dexcom is planning to partner with third parties to offer a range of case and carry options in the future. I have no idea when that might come to pass, but at least out-of-the-box we are being offered something that appears to be functional. I like the way the clip squeezes my belt tightly. The un-snap, un-fold action appeals to me. I think this just might work.

I guess it’s better to be a fashion victim in touch with his blood sugar than a snappy dresser two breaths from a killer hypo. But I wish I could be both (in touch and snappy). Still, I’m willing to take this case on a test drive.

Sunday, October 28, 2012

Interrupting our regularly scheduled program to brag on Sweet Sixteen

My first (diabetes) book, The Born-Again Diabetic, is the most widely loved.

My second, Taming the Tiger, is the most widely admired.

My third, Beyond Fingersticks, is the most award-winning.

But I’m pretty sure that my latest (and last?) title, Diabetes Warrior: Be your own knight in shining armor, is my biggest flop. It’s my least-popular title, it doesn’t sell particularly well in paper or Kindle, and it gets mixed reviews… when it gets reviewed at all. And by mixed, I mean people pretty much either hate it 100% or love it 100%. And by people, I mean the two who reviewed it.   ;-)

It’s kind of the black sheep of the family. Why?

Now, I admit, I’ve never sat down and re-read any of my books cover-to-cover after I was done with them. Once I finish writing, revising, editing, re-writing, and proofing them, I’d had enough of them. So I don’t know which one I like best, but poor Warrior is a charming and funny book. My most funny. Maybe diabetes isn’t supposed to be funny. But why the fuck not?

Maybe no one understood what it was about. One reviewer trashed it by saying it didn’t say anything new. Guilty as charged. But it wasn’t supposed to say anything new. It was supposed to say what needs to be said, but in a funnier, more entertaining, and accessible format than anyone else had said it.

Warrior is the sequel to Tiger. For review, Tiger is a new diagnosis handbook. It was an intentionally small, intentionally simple, intentionally upbeat introduction to diabetes, aimed at the very sick and overwhelmed type 2 who just got diagnosed. It was a guidebook through the first year. A survival manual.

Of course, diabetes lasts more than a year. So I felt I kinda left people hanging.

In my desire to make the first year a mountain anyone could climb, I left out a lot of important stuff. So I decided a sequel was in order. I looked around to see where the biggest problems, issues, and concerns lay beyond the first year. And beyond the basic how-the-fuck do I keep my head above water questions, most type 2s seemed to have a difficult time getting their heads around what docs call “the Standards of Care.” These are all the things the experts say you should do to keep healthy with diabetes long-term.

Things like, take your blood sugar meds, take a ACE even in your blood pressure is OK, take a statin even if you don’t need to, take a baby aspirin… no wait, we changed our minds on that one… get your eyes dilated, lose weight, quit smoking, get a flu shot, and a whole lot more. It’s such a boring list that if I hadn’t had two cups of French Roast coffee this morning, even just writing that paragraph would have put me to sleep. Needless to say most books on the subject have a similar sleeping pill effect. I thought I could do better.

But how?

At some point it occurred to me that all these little things that make up the Standards of Care don’t really amount to much individually, but collectivity they offered tremendous protection. Just the way all the various components of a suit of armor don’t matter much onesie-twosie, but add up to some kick-butt protection when assembled.

So I wrote a little pocket book that translated all the Standard of Care items into components of a medieval suit of armor, threw in some diabetes dragons for fun, and had a lighthearted romp through the medical standards of care that I thought was pretty clever and fun. Example, if I may quote myself:

Let’s suppose for a moment that Sir Careless-a-lot was out without any armor on this fine spring day, wooing a fair maiden, and happened to bump into a dragon. The dust has now settled, and we are surveying the little bits and pieces of him that are strewn across the meadow. If we look at his assorted dismembered chunks, we’ll easily be able to identify the macrovascular structures. They are big enough to see with the naked eye. We might even be able to see some of the plaque buildup inside the vessels if we wanted to pick up a piece and study it. (That assumes we’re not all throwing up from the sight of this grisly scene.)

To see his microvascular vessels, on the other hand, we’ll have to wait a few hundred years until the invention of the microscope. The very smallest, called capillaries, are so small that individual red blood cells have to hunch their shoulders to get through them. Capillaries abound in several places in your body, but in particular they’re found in your kidneys, where they’re a key element of your body’s critical filtering system.

You know, I think the King forgot to mention this, too, but dragons just love, love, love kidney pie. Yep, your kidneys will be the first thing the dragon will eat if it can get through your armor.

Damage to your kidneys caused by high blood sugar is called nephropathy. It starts slowly and ends very badly at Castle Dialysis. I gotta tell you, Castle Dialysis is a grim, dark, dank, cold, moldy place. You really don’t want to live there.

OK. So maybe I have a dark sense of humor, but I think that’s both entertaining and educational. But, like I said. It’s the black sheep of the book family. Actually, I had pretty much given up on it.

That’s when I got the email. Close to home, where it’s hardest to get any respect, Warrior just slayed a host of other heath books to emerge victorious as one of three finalists in the New Mexico-Arizona Book Awards.

My tarnished little Knight finally got some much-longed for love.

And I just got my 16th Book Award. Sweet indeed.

Not that anyone other than my mother and I are counting…

Saturday, October 27, 2012

Gimmie blood!

Today’s CGM Primer: “Don’t fool yourself into thinking a CGM is smart. It isn’t. It uses the magic of science to determine if your glucose is higher now than it was 20 minutes ago, and in some cases, how rapid that change is—but the CGM doesn’t actually know what your blood sugar is. It has no frickin’ clue what-so-ever. In this way, without your help, it’s as useless as a blind seeing-eye dog.”

---- Excerpted from Beyond Fingersticks: The Art of Control with Continuous Glucose Monitoring

A good vibration. I look down at my desk. Two glowing red blood drops greet me. It’s time to calibrate. To feed the G4 its first compass setting. To tell it what my blood sugar is so it can get on the job of tracking changes and keeping me in the loop

Excuse me, I tell my patient. I gotta…umm… do this diabetes thing. And… umm… this will look strange, but I need to take a picture of it, too.

“Oh. Are your writing an article on it?” she asks, sitting up a little straighter. “I really liked your one on VialSafe at dLife.”
Holy crap. I always forget that people I actually work with read what I actually write. For some reason, I blush. Zorro unmasked.

My beloved iBG Star now a thing of the past, I dig out my new meter case from one of my cargo pants pockets. Have you noticed none of these cases comes with a loop to carry it on a belt anymore? I’ve caved to my health plan’s evil desires and am now (under protest) using an Accu-Chek Nano. Actually, it seems like a harmless little machine, but I’m infuriated every time I use it that the test strip vial is so fucking big. It’s taller than the meter, for crying out loud, and is much, much, much larger in diameter than pretty much every other strip vial on the planet. Of course the Accu-Chek strips are big mothers. The vial is so large I’ve been unable to find any kind of small camera belt pouch that I can stuff the stupid things into without busting a zipper.

Sorry… got distracted. So Dexcom knows that test strips suck. They know that if a strip used for a first calibration runs high, then the sensor will start off running high for half a day. And they know that if a strip used for a first calibration runs low, then the sensor will start off running low for half a day. What’s a CGM manufacturer to do?

Their elegant solution is to take the average of two readings for the first calibration at the start of a sensor run. From there on out, the sensor has at least some notion of where on the map it is, and single fingersticks can be used. If you’re stuck with really crappy strips, you can still do dual sticks and average them for all calibrations going forward, but you’re not required to.

My Nano clocks the first stick at 116 mg/dL. I enter it in the receiver and repeat the fingerstick testing process. My Nano clocks the second stick at 120 mg/dL. I enter it in the receiver and that’s it: The sensor is live. On the job. Reporting its opinion on my blood sugar. My spies tell me to expect the first day to be a little rocky, like with all current state of the art CGMs, but that I should expect to be impressed on days two-through-seven.

I can’t wait. I’m also eager to hear it’s voice for real (it has a way to “sample” the various sounds, but that’s not the same as getting a real alarm when you don’t expect it). I’m also dying to know how close the two CGMs track to each other in highs, lows, excursions, and dips. I had just put a new Dex Seven sensor in before the G4 arrived. I figured I might as well wear them both simultaneously for the first week. Hmmmm…. Simultaneous CGMing. Sounds kinky.

But, alas. No kink. No excitement. At all. In fact, wouldn’t you know it? My first three hours of running the Dexcom G4 Platinum have been the most boring blood sugar I’ve seen for months (damn it).

Friday, October 26, 2012

To insert or to applicate?

Here’s today’s CGM Primer: “Does it hurt[to put in a CGM sensor]? Hmmm . . . sometimes. I guess it depends on your pain threshold. It’s not like having bamboo shoots shoved under your fingernails . . . well, actually I don’t know that because, lucky for me, I’ve never had bamboo shoots shoved under my fingernails. But I don’t think that putting in a CGM sensor is torture by any means, and it only happens about once per week in any event. Also, any insertion pain you may experience dissolves after the guide needle is removed (seconds after insertion). The actual wearing of a properly placed sensor is absolutely painless.”

---- Excerpted from Beyond Fingersticks: The Art of Control with Continuous Glucose Monitoring, with permission of the author.

The change is there is no change. Not to the naked eye, anyway. I’m sure if you had an electron microscope and a mass spectrometer you could see the difference. But to look at them, you can’t tell the difference between the Dexcom Seven Plus sensor and applicator and the Dexcom G4 sensor and applicator. Look for yourself. Can you tell the difference?

The only difference is under the hood. They are the same car, but the G4 is turbo charged in the accuracy department. At least that’s what Dex claims. I’ll need to experience that for myself to “certify” it. And you’ve got a front-row seat to the process.

But backing up, just what the hell is a sensor applicator in the first place, you ask? Personally, I don’t like the word applicator. It sounds too much like a feminine hygiene product for my chromosomal comfort. To me it’s an insertion device… But come to think of it, that sounds vaguely like something that belongs in an S&M dungeon—so clearly we need a better name for these things that are the tools to help you place a sensor under your skin.

Until I come up with something better, we’ll call it: The sensor thingy. And why do we need a sensor thingy at all?

Well, sensors are just high-tech fish line soaked in enzymes. They require a firm guide needle to help slip them through the skin and get where they belong: In the fat layer between your skin and your muscle, the same place insulin goes. Sensors don’t actually read the sugar in blood, they estimate blood sugar by proxy, looking instead to interstitial fluid. We’ll talk more about that on another day.

Anyway, the guide needle is removed as soon as it places the sensor, and only the flexible sensor stays behind. For any of you pumpers out there, it’s the same process as putting in an insulin pump infusion set, except the needle is bigger.

The Dex sensor thingy looks like the dental tool from hell. Or a high-tech space age torture device. I bet if Darth Vader had come into Princess Leia’s cell with a Dexcom sensor applicator she would’a spilled the beans on the location of the hidden rebel base in two seconds.

But appearances are deceiving in this case. Because while it looks frightening, and while the Dex thingy won’t win any awards for ease of use (I once heard that using it takes eleven steps, but I haven’t counted them), it does its job pretty well. Once you get the hang of it, it’s simple and generally painless. I remember I spent a lot of time trying to make sense of the first one I ever did. I pored over the manual for hours, studying the pictures and trying to figure out how the hell to use it. Once I did it, it made sense. But if you’ve never done one, I urge you to search for a YouTube video first.

If you’ve been using the current Dex sensors, nothing changes. The thingy looks, works and acts the same as the ones you’ve been using. You just need to keep your shit together so you don’t confuse your old stock with your new stock. The two look so much alike that you could. Reminder: Seven Plus sensors won’t work on a G4.

My receiver hasn’t been plugged in for the full five hours yet, but I’ve got a big, fat, battery icon glowing solid green, so I decide it’s time to get this show on the road. I slip the receiver into my pants pocket, fish a new G4 sensor out of the box, and head into the main clinic.

I swing past the nurse’s station and into the lab. I grab an alcohol pad, and sensor in hand, slip into the unisex bathroom (the one my boss mistakenly called a “bi-sexual” bathroom when the men’s room was converted into an office for the I.T. guy—we are rather short on space—and the women’s room became a staff bathroom).

I pull off my shirt and drape it over the paper towel holder, rip open the alcohol pad, and swab my arm down. An email yesterday gave me a head’s up that the G-4 was on its way, so this morning in the shower I ran a Quarto over the top of my upper arm to clear off any hair that might get in the way.

While the alcohol evaporates (and for God’s sake don’t blow on it—it defeats the purpose to blow germs all over skin you just cleaned), I open the sensor sack. You pull the two halves apart, just like opening a snack-sized bag of Nacho Cheese Doritos. A $75 bag of Doritos.

I pull the sensor thingy out. At the base of the sensor is a sticky pad that holds the transmitter cradle (“sensor pod” in Dexspeak) on your skin. It’s covered with two pieces of slick paper backing that never want to come off. They stress me out every week because one week, years ago, the sticky pad folded over and stuck to itself like super glue. I was not able to untangle it successfully and I lost a sensor. Talk about being kicked in the checkbook.

With slightly shaking hands, and with a limited number of new sensors adding to the stress, I pull one half of the backing slightly loose, then the other half partly off. Finally I strip both off, being careful not to fold the pad, steady the applicator above my arm, then plant it firmly downward onto my skin.

I let go of the applicator and smooth the sticky pad onto my skin with my fingertip. The handle of the applicator rocks back and forth like a dog wagging its tail. I pull the safety lever out and chuck it in the trash (you are supposed to save it to help you remove the transmitter later, but I have a different trick for that I’ll teach you another day). The bomb is armed.

Now, I’ve got skinny arms. I could ask one of the nurses to help me, but being half-naked in the “bisexual” bathroom with a nurse will make people talk, and my life is already complicated enough as it is. Gripping the applicator like a cigar, with my fingers upstream from the collar and my thumb on the white button at the top, I lean against the towel holder mounted on the wall next to the sink, squeezing my bicep between my chest and the cold plastic to “pinch up” some skin. I ram the inserter button down. It stings. A little. Keeping my thumb on the base of the handle, I slip my index and middle fingers over the collar and pull it back towards my thumb. The guide needle retracts back out of my body, leaving only the sensor behind. The stinging drops in volume.

Next I squeeze the clips at the base of the handle (“applicator barrel” in Dexspeak) to remove it. It comes out easily. Excalibur from the stone. I chuck it across the room at the trash can and miss. It ricochets off the wall and falls to the floor with a clatter.

I take the grey transmitter, smooth and aerodynamic, unlike its oddly angular predecessor, and click its nose into the top of the sensor hub, then using the tab at the base as a lever, force the transmitter down into its carriage with a satisfying Click-Click. I twist the handle to break it off. Done and ready. Now that the new transmitter is on my body, I can see that it rises quite a ways higher off of the skin than the old one did. Like maybe twice as high. It’s noticeable to me, although I can’t say yet if it will be annoying.

The new transmitter’s shelf life, at six months, is only half that of the original, but it’s bigger. That seems ass-backwards to me. Or should I say bass-ackwards? Hmmmm… could this be for future capabilities? Dex has stated that they hope move the “brains” of the CGM system from the receiver to the transmitter in the future. What’s the benefit of a thinking transmitter? Well, if all the FDA-approved mathematics happens right on your skin, the data could be transmitted to just about anything. Like a smart phone.

Oh. Wait. Never mind. I bet I know what it is. The old Dex had a very limited transmission range, even line-of-site on a clear, calm day, much less in the real world. It wasn’t as bad as the Other Guys, but I always made sure to wear my Dex receiver on the same side of my body as the sensor and transmitter. Now we’re supposed to have a range of something like 20 feet or more. No doubt the beefier transmitter is what had to be done to boost the signal. I’ll have to design a clever science experiment to test the real-world range.

A project for another day.

I flex my arm and rub it gently. Still achy. Bad luck no doubt. Some insertions hurt more than others. I don’t think the new sensors will necessarily be more painful just because this one was.

Hey, why the arm, you ask? Not in the tummy, like you are “supposed” to? Well, I’ve been wearing CGMs for 8 years. And looking at downloads of other people’s for 6 years—more and more over the last few years. And I’ve noticed that stomach sets have more jagged sensor trace lines. In fact, I can look at a sensor trace and predict with pretty good accuracy where on the body the sensor is worn. My personal theory to explain this is that sensors in the midriff get “jostled” around more as we move through our days, standing, sitting, turning, getting in and out of cars. I think this creates “static” that shows up like little earth-quake lines on the CGM traces. Arm and leg sets give smoother downloads. It’s that simple to me.

I pull the receiver from my pocket, navigate to the “start sensor” screen and boot up the new sensor. On the home screen, a little slice of green pie shows up. The countdown has begun.

Now I have to wait two hours. The sensor needs to soak in my tissues. The insertion site needs to settle down. It’s called the warm up period. I call it the fear factor period. Yeah, it’s only two hours once per week, but I’m naked in a swamp full of alligators during this time. Being totally hypo unaware, this is my most vulnerable time. I usually burn through more than a few test strips during new sensor warm up. But today Old Dex is still watching over me. I can relax. I’m bristling with sensors. Well, OK. I guess two sensors doesn’t qualify for a bristle…

As the countdown nears its end, the pie is supposed to become two pieces, then three, then four, then six. When it’s a full green circle, it’ll be time to rock and roll.

But in the meantime, I have work to do… my next patient is waiting…

Thursday, October 25, 2012

Dexcom G-4 Platinum—quick start or not?

For those of you who don’t already know the basics of CGM, it occurred to me that I’ll be throwing around a lot of new concepts and terms that might confuse you. Like what the eff are all the parts of the system called in the first place?! So here’s today’s super-brief CGM Primer to help you acclimate yourself to the new world (and word) order:

“What, exactly, is CGM in the first place? Good question. A good question with no simple answer. A medical dictionary might tell us that CGM is a high-tech system for frequently checking and reporting on the blood sugar level of the human body, all with minimal input from the user. A lively technical manual might tell us that CGM is a technological ménage à trios of integrated components: A sensor to measure our glucose; a transmitter to make the system wireless; and a monitor to receive signals from the sensor and alert us to changes in our blood sugar.” -- Excerpted from “Beyond Fingersticks: The Art of Control with Continuous Glucose Monitoring” with permission of the author. Who is me. (I asked me if it was OK, and I said yes.)

Now, on to today’s post…

Expeditious. Snappy. Speedy. Rapid. Brief. Fast. Pronto. Lickity split. In short, as advertised, the quick start guide gets you going quickly. Oh. Wait. I misspoke. It’s not a quick start guide at all, it’s a “simple start guide.” I guess any two-sided quad-folded document that measures 14 x 20 inches can’t be classified as quick, now can it?

Oh. Wait again. The complete title is “7 Simple Steps to Start Quick Start Guide.” The title alone took up half the document. Just try to say that five times really fast.

Anyway, the seven-step program to Hooking-up and Heading-out the Dexcom way is:

1) Getting to know your device
2) Setting up your device
3) Setting your alert profile
4) Inserting your sensor
5) Starting you sensor session
6) Calibrating
7) Ending your sensor session

Ummm…. OK, those chapter tiles aren’t exactly going to win the Pulitzer for Letters, are they?

There are also some trouble-shooting tips, a breakdown of the receiver’s display, some calibration “dos” and “don’ts,” a summary of advanced features, and a FAQs section. Apparently, there are only six frequently asked questions. Oddly, all seem to have been asked and answered by lawyers.

Now, I’m all for disguising education as entertainment (I’m frequently guilty of that misdemeanor myself), but I maintain that FAQs are not the way to do it. Still. I’ve seen worse gear guides.

Did I like it? Did I use it? OK. I gotta be honest. I watched the movie before I read the book. Well that’s a lie. I haven’t read the book yet. I watched the movie before I read the Cliff Notes, and I wish I’d just gone straight to the Cliff Notes.

My advice to Dexcom vets: When you upgrade, just use the 7 Simple Steps to Start Quick Start Guide (the 7S³ Quick Guide from now on) to get up and running. For Dex newbies, take 45 minutes and watch the movie. There are some solid basics in there that will help you get your CGM career off to a good start. Oh, and I know this great CGM book you can buy….
But back to the movie new CGMers, it won’t win an Oscar, but it will be worth your time. Actually, you don’t even need to watch it in advance, like I did. It’s designed to be watched in real time with the CGM in your hot little hands. It even has built-in breaks. Go charge your receiver. See ya in five hours.

Speaking of the receiver, you could probably figure out how to operate it by holding it in your lap and pressing its buttons. No movie. No quickie guide. The receiver is pretty well engineered with simple and straightforward controls and menus. The machine is “driven” by a large select button surrounded by a ring of up/down/left/right buttons that eat up about a third of the landscape on the face of the device. It, by the way, is a right-handed device, damn it. Sad. I don’t think it would have taken a team of rocket scientists to have a motion detector like the iStuff does to flip the screen for us lefties. Except for screen orientation, the layout of the machine is ambidextrous.


Anyway, Step One of the 7S³ Quick Guide is the “getting to know you” phase, dedicated to introducing you to the receiver and its constant companions, the transmitter and the sensor/sensor inserter (in Dexspeak: Applicator). I can summarize the content for you: Hi. This is your monitor. Hi. This is your transmitter. Hi. This is your sensor applicator.

Did you just yawn? That’s OK. So did I.

Step Two guides you through the basic setup of the system, and it’s worth looking at.
There are things you’d never know if you didn’t watch the movie or read the quickie guide. For instance, who knew that the transmitter has to be removed from its box and left out in the open air for ten minutes to turn itself on? The 7S³ Quick Guide also helpfully reminds us not the throw away the very expensive transmitter. Don’t laugh. It’s happened. I know at least two people who have done it. (Don’t worry. Your identities are safe with me.)

While the transmitter is taking its air bath, you need to key its ID number into the receiver. I’ve had three Dex 7 Plus units, and all came with the receiver and transmitter mated to each other out of the box. Not the case this time. No big deal, but just remember you need to do it or your first sensor run will be very short (’cause your receiver will never hear a word the sensor and transmitter say to it).

You’ll also need to set the date and time. Mine knew the day, month, and year, but didn’t realize that it had moved to the Rocky Mountains. It’s a simple fix. One I’ll be doing again in the next week or so when we fall back. I hate this biennial time-change thing. I think we should all just spring forward half an hour and forget about it.

The 7S³ Quick Guide also guides you through setting up the CGM’s alarms, of which, realistically, there are four: A high threshold; a low threshold; a rise rate; and a fall rate. There are a few others that deal with loss of signal, calibration, some “snooze” alarms, and more. But this is such an important topic that I think we’ll come back to it another day. Hey, if you’ve got a brand-new G4 burning a hole in your hand, by all means set it up with the factory defaults for now. The alarms can be changed later.

Another subject I’m going to put off is Step Three, choosing an “alert profile.” This is new. And exciting. You have five fully different choruses to choose from, all of whom can sing your blood sugar to you in a different key. Briefly they are: vibrate; soft; normal; attentive; and hypo-repeat. Each has a different volume and different combinations of melodies to keep you in tune with your glucose. I confess I was a little disappointed, as on a beta unit I saw a menu with a sound level called “annoying.” I loved that. But I think attentive is the new annoying, as annoying was nowhere to be found. And yes, if you are dying to know, I find that the “attentive” is loud enough to make me happy—and you all know that too-low alarm volume was my biggest complaint about the CGM from the Other Guys.
The rest of the 7S³ Quick Guide takes you through your first sensor run. But rather than tell the tale from the point of view of the quick start guide, I think I’ll tell you the tale of a real sensor instead.

So, next time: Firing up my first G4 sensor.

Wednesday, October 24, 2012

Dexcom G4 Platinum—first impressions, Part 1

Thank God my patient was a no-show. It gave me time to wipe the drool from my chin and rip into the FedEx Priority Overnight box. The one from Dexcom.

Inside: three boxes. One for the receiver, one for the transmitter, and one with a big green numeral 4 on it for the sensors. My Dex G4 Platinum had arrived.

I’d watched the video last night, so I knew the first thing I had to do before I could Hook-up and Head-out was to Plug-in. For five hours into a wall, or seven hours into a computer’s USB port. Don’t panic, that’s just first-time-out-of-the-box charging.

The wall is faster and I’m eager to get started. Plus, to charge on a computer you must first have the next-gen Dex software installed. As I’m at work, I can’t do that. It’s a big no-no to install anything on work computers without the blessings of the I.T. Overlords.

It’s too nice a day to get fired, so it’s plugged into the wall now—sitting on the little table my phone lives on. I’m studying it the way a Victorian scientist might make initial observations of a strange new bug—cautious observation with no touching.

Visually, the build quality shows. It looks expensive, well-made, strong, and high-tech. It’s a small, sleek, thin device. It kinda reminds me of the monolith in 2001 a Space Odyssey. Same proportions. Only smaller, of course.

What’s not to love so far?

I hated, hated, hated, hated the squashed-football look of the older generations of Dexcoms. They were big, ugly, and awkward. Plus, the old ones had a sense of cheapness to them. I can’t really put my finger on what it was. Let’s just say they didn’t scream quality.

But the platinum does scream quality. I got mine in black. I’m not man enough for a pink CGM, and while the blue was pretty, I thought it might be a shade of blue I’d get sick of too quickly. Besides, basic black matches everything in my wardrobe. Still, I’m glad there’s choice.

You’ll be happy to know the G4 doesn’t look like a medical device, either. It’s not pump-like or metereseque. G4 looks more like a consumer-lust electronic device. Something that the company with the fruit logo might make. Maybe a digital music player.

But this is a player for the opera of your glucose.

I set my old Dex next to the new one to compare. Mentally, the old style completely dwarfed the new one. But side-by-side, the old style isn’t really as big as I like to complain that it is. The footprint of the two machines is very close.

The biggest difference is in the thickness, with old Dex being nearly twice a thick. That feeling of thinness is what makes the G4 seem so much smaller. Of course, this isn’t just an optical illusion. Slimmer can equal easier-to-wear. Size matters in every dimension.

The bottom edges of the G4 are smooth and the corners are gently rounded. OK, OK, OK I confess, I’m fondling it now.

Speaking of rounded corners, the new G4 transmitter is more aerodynamic than the old one. Maybe I’ll snag fewer sweaters on it. The sensor and the dental tool from hell that inserts it look identical to the old ones, but be warned: None of the 7 Plus gear and supplies is compatible with G4. I’m told that down the road, we’ll have an easier, faster inserter. But truth be told, even though it looks intimidating, the sensor inserter is easy, is painless to use, and beats the pants off the one from the Other Guys.

I have no problems at all using it to put sensors in all kinds of non-FDA approved places, like on the bottom side of my upper arms.

Which I can’t wait to do. But first, this baby needs a full charge. And there are some setup things to do. The transmitter has to be linked to the receiver. Alarm thresholds need to be chosen. Apparently, I have some different alarm sounds to choose from as well.

Ah. Rats. I see my next patient has arrived. Time to go help someone else with their diabetes. I’ll get back to mine, and yours, tomorrow.

Tuesday, October 23, 2012

The Adventure Begins!

It's here!!! It's charging as I write this... Oh boy, oh boy, oh boy. Can't wait to fire this puppy up!

Monday, October 22, 2012

Return of the Death Panel

Sarah Palin was right. Wow. Never in my worst nightmares did I think I’d write those words. But she was. Death panels have been set up. But it’s not Grandma they’re after. It’s me. Me and my kind. Which is you. They’re after those of us with chronic illnesses. After all, we’re a bigger threat than Grandma. We’re young(er), sick and expensive, but technology—that double-edge sword—is poised to keep us alive (and expensive) for years and years and years to come.

And it’s not our government who wants us dead. It’s our health insurance companies. Circle the investors. Roll out the death panels. Wall Street must be protected at all costs.

Do you have any idea how hard I struggle to keep healthy? Well of course you do. You walk in my shoes every day and every night. I guess I addressed that to everyone who doesn’t have diabetes.

It takes an incredible amount of time, attention, concentration, effort, energy, and self-motivation to do this. And, like the rest of you, I still have multiple jobs, a wife and child, and an elderly mother and mother-in-law to care for. I’m worn out. I’m tired. In fact, most days I feel like Grandma.

So when I found a simple and effective tool that could help me make my life a little bit easier, remove just a hair of my daily burden, and make my diabetes control better, I rejoiced. A device, I might add, that was free for me and my health insurance company. A device whose supplies to keep it running cost no more than any comparable supplies.

Win/Win, right? Wrong. Read on.

Yes. Of course. It was a meter. And, yes, we are talking about test strips, all of which, frankly, cost about the same. And yes, I am talking about the new iBG Star, a meter that plugs into a device (iPod Touch) that I’m required to carry for work anyway. I mooched some sample strips to test drive it, and then liked it so much that I paid out of pocket for strips for a month until I could see my doctor. Liked it? OK. Understatement. I fell in love. Me, the meter whore, was finally ready to settle down and commit to a single device.

Why? I think it comes down mainly to reduced gear burden. It also helps that it’s very accurate. And that it shares a device with my insulin tracking system (the RapidCalc App). If you like it and its easy, you’ll use it, right? It sounds lame on paper, but the results are scientific proof. Because, unfuckingbelievably, I kicked my A1C out of the sevens and down to a solid 6.5, in control for the first time in years. The SD of my readings, the measure of how wild the ride is between my lowest lows and highest highs dropped like a boat anchor.

To top it all off, I felt better than I have in years. More energy. Better mood.

But like a man lost in the desert, teased by a mirage, it was yet another cruel joke of the universe.

Naturally, my doc prescribed the strips. And my health insurance said no. They won’t pay for the strips. Not even at a higher copay (which I would have been more than willing to pay). And to add insult to injury…. or perhaps injury to insult… the denial letter, no shit, started out with “Presbyterian exists to improve the health of the patients, members, and communities we serve.” And then it went on to say I was fucked.

They say they only pay for Roche strips. Nothing else. Period. End of sentence. End of paragraph. End of chapter. End of story. No exceptions. No upper-tier choices. It’s the Roche way or the highway (I smell a kick-back here).

But that’s not quite true. I know that there’s at least one exception: strips that talk to pumps. If you have a Med-T pump, they’ll cover Bayer strips for the meter that is part of the pump system. Likewise they’ll cover FreeStyle for OmniPoders and OneTouch strips for Animas pumpers. Why? Well, they are medically necessary as part of an integrated system.

So what’s the difference between that integration and the integration of the iBG Star? My iPod Touch has my insulin tracking, my carb data base, my timers and alarms, and my blood sugar data. You can’t get much more fucking integrated than that.

And not that I’m sulking, well yes I am, but this summer I choose to stop pumping and start using shots again for a lot of different reasons. That has saved fucking Presbyterian Health Insurance a boat load of money right there. Don’t you think strip-of-choice is a good quid-pro-quo?

I’m told, of course, that I may pay out of pocket. Let’s see, $1.30 per strip x 10 tests a day x 365 days in the year is $4,745.00. Is my good health worth five grand to me? That’s what Sarah Palin would probably ask. But her book sells better than my five books do. I don’t have five grand not dedicated to gas, power, light, and food.

But my doctor was so impressed with how much better I’ve been doing with the convenient-to-carry-and-use meter, that he offered to appeal the denial of coverage for me.

Let the games begin.

So in round one, he sent progress notes, lab results, and 12 pages of clinical data from my CGM, RapidCalc, and the iBG Star itself showing the before and after improvements. Hell, even I was impressed when I looked at the downloads. He had two arguments, first: What’s the difference between my patient’s integration and a pump system integration? And second: Are you people fucking crazy???! My patient is healthier. This saves you money. Not to mention it’s the right thing to do.

A week went by. Then two. Perhaps they were actually carefully reviewing the labs, downloads, and data painstakingly assembled and submitted by my doctor. Finally, I got a letter. Even though my doctor submitted the appeal to the denial of the prescription that he wrote, I had not signed the form. I had 10 days from the date of the letter to sign the form or the appeal would be automatically denied. Looking at the date on the letter, then looking at the cancelled stamp, I could see that the insurance company waited five days to send the letter. With transit time, I had 48 hours left. Nice. So this is how the game is played.

I signed and Faxed.

Then waited. And waited. And waited.

Then I got another letter. I had to sign a records release. Really? Give me a fucking break. An insurance company has a legal right to poke its nose into your medical records any fucking time they want.

And on it goes. One delay after another. Each time I have a tick-tock deadline, and each time they reset their clock to 30 businesses days. Clearly, they are hoping I’ll drop dead before they actually have to review the evidence.

I don’t think I’ll die. Well, of course I’ll die, but not soon enough to make my insurance company happy. Lucky for me we aren’t trying to get a cancer drug approved. Many people are complaining about the lack of technological innovation in tools for diabetes. But maybe we’re focused on the wrong thing. What good do tools do us if no one will help us pay for them? This is why we need insurance reform. Any of you out there who are happy with your health insurance have never used it.

But as to me, I’m out of test strip funds. I’m on my last vial of iBG Star strips. I’m bitter and angry. Angry about how much of my precious time and energy I’m wasting with this fight. Bitter that I devote every waking hour to helping fight the diabetes epidemic and I can’t even get the tools I need to stay in the fight.

The death panel wins.


Thursday, October 18, 2012

Why your kidneys are a Spaghetti Western waiting to happen

What do Tombstone, Arizona, in 1881 and a dialysis center have in common?

Under my pen, quite a lot.

I’m riding a wild analogy again and you might be surprised to find out that diabetes doesn’t really wear a black hat, Lisinopril rides shotgun, and that nephrons gets stressed out. Oh. And did I mention the Hole in the Kidney Gang? Sorry. Not Paul Newman or Robert Redford in this story, but I do have an Ace or two up my sleeve at the saloon’s poker table.

Of course you know that I can totally succeed in getting away with all of this, in fact, the only hard part was trying to figure out how to set The Good, the Bad and the Ugly theme whistle to words…

Read all about it here.

Thursday, October 11, 2012

Almost good enough for an artificial pancreas

I don’t think I told you yet, but I touched the future this summer. I held it in my hands. Stroked its buttons. A gem-like CGM prototype that’s absolutely frickin’ amazing. How amazing? Well, let me detour for a moment into (gasp!) math so you can understand. Don’t panic, it’s more math vocabulary, than math. I want you to meet my friend, MARD.

MARD stands for Mean Absolute Relative Difference. Crudely put, when it comes to Continuous Glucose Monitors, MARD is the difference between what blood sugar really is and what the CGM thinks it is. So basically, it’s a measurement of how accurate any CGM system is.

How accurate does a CGM need to be? It depends on what you want to do with it. CGM wiz Dr. Howard Zisser told me a while back “Give me a MARD of 10% and I’ll give you an artificial pancreas.” So that’s our bench mark. 10% gives you what your heart desires most. Short of a cure.

The jewel I touched, held, fondled, worshipped (and was tempted to steal) this summer had a MARD of 13%. Not good enough for an artificial pancreas, but damn fucking good. Better than most test strips, actually.

And when will we eventually see this wonder of new technology?

Well, how does next week sound to you?

Or maybe the week after next. But it’s here. It’s FDA approved. It’s shipping soon.

Want to know more about it? Want to know all about it? Stay tuned for an in-depth day-by-day month-long review of the latest and greatest CGM like only LifeAfterDx can bring you. The Dexcom G-4 Platinum review is coming soon to a computer screen near you. (Right. That would be the one right in front of your face.)

Thursday, October 04, 2012

Sex and drugs and rock and roll

Oh. Wait. I didn’t write about rock and roll. But I did write about sex and drugs for the supersite Diabetes Mine recently. Specifically, about the drugs one might use to have sex while avoiding procreation so you can stick with rock and roll rather than an unexpected rock-a-by-baby.

And being… um… you know, male… I had no idea how complicated the whole subject of contraception is for my diabetic sisters. There are pills of assorted types. Devices of assorted types. And patches and foams and rings and…

Holy cow. And each of these options carries its own unique set of risk factors for FWDs (Females With Diabetes). After extensive research—not that kind of research—I complied a fairly complete list of birth control options for my d-Sisters along with the diabetes-unique risk factors that each method comes with.

Read all about it here.