Today on nytimes.com is an article, "Diabetics Confront a Tangle of Workplace Laws," by N.R. Kleinfield. The author describes cases of discrimination towards diabetics at the workplace, and the laws that may or may not protect them. For example, the article describes a UPS worker who, after being diagnosed with type 2 diabetes and starting insulin, was fired because he could no longer obtain an interstate commercial driving license. (At the time, diabetics on insulin were forbidden from obtaining these licenses.) Even though he had not actually needed one of these licenses in the 13 years as a mechanic for UPS, it was company policy and they would not make an exception for him.
I have been fortunate to have very understanding coworkers who accommodate my diabetes graciously. Also, I try to control it in such a way that it interferes minimally with my work. But I can see how these issues could arrive in a work environment different from my own.
Tuesday, December 26, 2006
Wednesday, December 20, 2006
It's Winter in San Francisco
And by winter, I mean cold December, not foggy August. We've had a couple weeks of really cold temp's here. This morning on our run, we even came across some black ice! This was in San Francisco! Although I grew up in Utah and lived on the East Coast for many years, I became a complete weather wimp after one year in California. I've decided that we near the coast out here just aren't ready for cold weather. I just don't believe that it can really be that cold, so I don't dress appropriately. Whereas, if I looked out the window and saw snow falling, I would know that a hat and heavy coat just might be appropriate. Maybe we just need a little snow around here.
On Saturday, we stopped by Ocean Beach down near the SF Zoo to watch storm clouds rolling in. The Big Storm actually stayed off shore, and we didn't get much rain as had been predicted. But it was really windy! Walking outside was a painful affair, with sand being blown off the beach into my face. I took a couple shots with my phone's camera. Here they are:
On Saturday, we stopped by Ocean Beach down near the SF Zoo to watch storm clouds rolling in. The Big Storm actually stayed off shore, and we didn't get much rain as had been predicted. But it was really windy! Walking outside was a painful affair, with sand being blown off the beach into my face. I took a couple shots with my phone's camera. Here they are:
Okay, Don't Blame the Syringes
Well, after my recent post quetioning why syringes these days seem so wimpy, I have reconsidered and now agree with others who suggest that it may be the rubber top on the Symlin that is the cause of the problem. I think it is thicker than that on insulin vials and it seems to dull the needle even with one pass-through. Amylin Pharmaceuticals may want to consider a re-design on that, since anyone using Symlin would be using the same syringes as they use for insulin. One may assume Type 1's are impervious to pain but I, for one, still cringe whenever I get the flu shot. Ouch! And let's make things as painfree as possible, no? There's enough needle-poking and blood-letting going on already.
Vent Your Road Rage
I saw this website mentioned in sfgate.com this morning: platewire.com. It's a site where you can leave comments, good or bad, about other drivers you may come across.
Here's an example from Nevada:
It may not make a difference to the guy in the Nissan, but let's hope that the guy who posted it can relax the next time he comes across this driver.
I was in a hit-and-run traffic accident on May 19, 2006, and a witness caught the license plate of the driver. I think my insurance made some feeble attempts to contact the car owner, but the police wouldn't even pursue it. They said I should feel lucky, because if they (the police) were pursuing the case, it would mean I was either missing a limb or dead. (Those were the detective's words.) I thought about pursuing a civil case against the car owner, but decided that it wasn't worth the stress. But I am careful whenever I see a red and grey early 90's GMC Suburban with California plates driving by. And I check for damage on the front left panel...
Here's an example from Nevada:
| | Nevada 804-XXX |
| | Wednesday, December 20, 2006 |
| | Blue NISSAN |
| | Las Vegas (Nevada) |
| | This guy drives in the leftmost lane of a three lane road for miles and miles every single day holding up traffic and making people pass him on the right over and over. MOVE OVER YOU IDIOT! Slower traffic keep right. Have you never heard that? |
It may not make a difference to the guy in the Nissan, but let's hope that the guy who posted it can relax the next time he comes across this driver.
I was in a hit-and-run traffic accident on May 19, 2006, and a witness caught the license plate of the driver. I think my insurance made some feeble attempts to contact the car owner, but the police wouldn't even pursue it. They said I should feel lucky, because if they (the police) were pursuing the case, it would mean I was either missing a limb or dead. (Those were the detective's words.) I thought about pursuing a civil case against the car owner, but decided that it wasn't worth the stress. But I am careful whenever I see a red and grey early 90's GMC Suburban with California plates driving by. And I check for damage on the front left panel...
Wednesday, December 13, 2006
What happened to syringes?
I've been on the pump since 1993 and hadn't used syringes much since then until I started using Symlin in October. What happened? I can hardly use one more than once without it becoming dull or even bending when I try to stick it into the vial. I used to be able to use a syringe for a week or more if I recall correctly. And these syringes hurt more, I swear. I do not ever recall feeling pain before. I don't think I've just suddenly become a syringe wimp, but I guess it's possible. The syringes in reference are a very popular brand, and the same ones I used to use back in the day. Despite the cost, who needs the extra trash?
Friday, December 08, 2006
Cookie Campaign
Earlier this week in San Francisco, the "Got Milk?" people launched a new campaign. The idea was to stick cookie-scented strips at bus stops that would get people thinking of cookies, and then, of course, of milk! The campaign was over in 36 hours. Some people complained about allergies. Some people said that homeless people would be sad because they would smell the cookies but couldn't eat them. Some said that this is all we need when we are fighting a losing (well we wish) battle against obesity. Some teenager said that the bus stops would smell like "cookies and bums." (Disclaimer: these are all rumors and I haven't verified any of them! But the campaign was real and I heard these rumors from other, mostly reliable news sources.)
My initial reaction was that it's just not fair to try and manipulate us with our sense of smell! But then, how is marketing using scent any different than imagery or sound? It's just another sense. But somehow it seems even more powerful. I vaguely remember from grad school learning how our sense of smell might be more closely linked to our memories by its the proximity of the olfactory bulb and cortex to the hippocampus. But I'm spreading rumors again. Anyway, here's a paper that might be a good starting point: "Odor Memory Induces Brain Activation as Measured by Functional MRI" (Levy, Lucien M.; Henkin, Robert I.; Lin, Chin S.; Hutter, Alf; Schellinger, Dieter).
I guess the more important question is this: would people really make the connection between cookies and milk, or would they just eat more cookies? When I see those huge chocolate chip cookies in the cafeteria at lunch, I don't think about milk. If they were Oreos, maybe I would. I guess at some point that one was drilled into me.
My initial reaction was that it's just not fair to try and manipulate us with our sense of smell! But then, how is marketing using scent any different than imagery or sound? It's just another sense. But somehow it seems even more powerful. I vaguely remember from grad school learning how our sense of smell might be more closely linked to our memories by its the proximity of the olfactory bulb and cortex to the hippocampus. But I'm spreading rumors again. Anyway, here's a paper that might be a good starting point: "Odor Memory Induces Brain Activation as Measured by Functional MRI" (Levy, Lucien M.; Henkin, Robert I.; Lin, Chin S.; Hutter, Alf; Schellinger, Dieter).
I guess the more important question is this: would people really make the connection between cookies and milk, or would they just eat more cookies? When I see those huge chocolate chip cookies in the cafeteria at lunch, I don't think about milk. If they were Oreos, maybe I would. I guess at some point that one was drilled into me.
Morning Ride
In anticipation of a rainy weekend, I decided to hit the road early this morning for one of my favorite rides. Yep, it was another Sunrise Over San Quentin.
How did D (Dexcom, diabetes) behave?
I put a new Dexcom sensor in last night, to replace the one that hadn't worked at all after 3 days. I was happy to see this morning that it had been spewing out readings during the night. I woke up really hungry around 3 AM with a BG of about 100. I decided to go ahead and eat a Luna Bar in anticipation of my ride. I took 1.15 U insulin. Shortly after, my BG had fallen to about 60. I ate a few Clif Blocks (or "cubes" as I like to call them) and went back to sleep. When I woke up at 5 AM, my BG was 228, so I guess I overdid it with the cubes. Anyway, I ate 4 more cubes and took 0.6 U insulin at about 5:10. When I got out the door at 5:30, my BG had gone up to 248. I chose to not take any additional insulin, since 0.6 U is a lot for me to have floating around on a ride. I could see an immediate rise at the beginning of my ride, but after about 30 minutes, it plateaued and then started a pretty rapid decline. It seemed to be leveling off around 160 about 1h45min into the ride. I probably should have eaten something here but I wanted to finish the loop around the Tiburon peninsula before eating a gel. (Sometimes I am too impatient to eat.) Once I got to Tiburon, I pulled out a Hammergel and also noted that my Dexcom was showing a not-so-gradual decline. I was somewhere around 140 then quickly to 130. Also, I was feeling a little low and I suspected that the Dexcom was reading higher than my actual BG, so I began to munch on another Luna Bar. By about 2 hours into the ride, I started to feel a little better but decided to shut the pump off for 30 minutes. This was probably a good idea, because after finishing my ride an hour later, my BG was 131. Nice! About 45 minutes later, it was 100.
Things I learned on this ride:
1) Don't wait to eat if you see a downward trend and have more than the normal amount of insulin floating around;
2) It's better to eat at least once an hour, anyway!
3) Remember that turning the pump off is an option to attack dropping BGs;
I was really pleased with the Dexcom on this ride. It allowed me to keep going without having to check my BG, which is a pain on the bike. I do have to keep it in a Ziplock baggie to keep it dry in my pocket, though! I wish I could somehow mount it on my bike, but where would it fit with my humongous light, my bike computer, and my extra-large Bento box (which is completely occupied by my bike light battery)?
Other notes from the ride
I saw a few interesting things on my ride.
At the southern entrance to the bridge, was a group of people singing Christmas songs. I don't know who the audience was at 5:50 AM but hey, it was nice all the same. Some TV truck was there recording the whole thing. One of the singers, in a Santa hat, gave me a strange look, like he knew that the whole thing was a little odd.
Once on the bridge, I noticed a pedestrian, who just seemed a little out of place. He seemed a little despondent and I started wondering if he was planning to jump. I said, "Hi there," and he gave me no reaction (which could have been just because he thinks people who ride bikes in bike clothes are weird). I thought I was probably over-reacting but considered stopping at one of the many emergency phones on the side of the sidewalk. I passed one but stopped at the next and spoke to the bridge patrol. I mentioned the pedestrian and he asked, "What are you doing on the bridge?" "Biking," I said and then he cheered up. He said that the guy shouldn't be there and that he would check it out. I guess pedestrians aren't allowed on the bridge that early in the day.
But the best part of the ride was definitely sunrise. This picture from my cellphone didn't capture how brilliantly orange everything was glowing. But it's scenes like this that keep me riding and keep me paying my ridiculous rent (which actually isn't nearly as bad as it could be around here).
Oh, and the Christmas singers were still there when I crossed back over the bridge!
How did D (Dexcom, diabetes) behave?
I put a new Dexcom sensor in last night, to replace the one that hadn't worked at all after 3 days. I was happy to see this morning that it had been spewing out readings during the night. I woke up really hungry around 3 AM with a BG of about 100. I decided to go ahead and eat a Luna Bar in anticipation of my ride. I took 1.15 U insulin. Shortly after, my BG had fallen to about 60. I ate a few Clif Blocks (or "cubes" as I like to call them) and went back to sleep. When I woke up at 5 AM, my BG was 228, so I guess I overdid it with the cubes. Anyway, I ate 4 more cubes and took 0.6 U insulin at about 5:10. When I got out the door at 5:30, my BG had gone up to 248. I chose to not take any additional insulin, since 0.6 U is a lot for me to have floating around on a ride. I could see an immediate rise at the beginning of my ride, but after about 30 minutes, it plateaued and then started a pretty rapid decline. It seemed to be leveling off around 160 about 1h45min into the ride. I probably should have eaten something here but I wanted to finish the loop around the Tiburon peninsula before eating a gel. (Sometimes I am too impatient to eat.) Once I got to Tiburon, I pulled out a Hammergel and also noted that my Dexcom was showing a not-so-gradual decline. I was somewhere around 140 then quickly to 130. Also, I was feeling a little low and I suspected that the Dexcom was reading higher than my actual BG, so I began to munch on another Luna Bar. By about 2 hours into the ride, I started to feel a little better but decided to shut the pump off for 30 minutes. This was probably a good idea, because after finishing my ride an hour later, my BG was 131. Nice! About 45 minutes later, it was 100.
Things I learned on this ride:
1) Don't wait to eat if you see a downward trend and have more than the normal amount of insulin floating around;
2) It's better to eat at least once an hour, anyway!
3) Remember that turning the pump off is an option to attack dropping BGs;
I was really pleased with the Dexcom on this ride. It allowed me to keep going without having to check my BG, which is a pain on the bike. I do have to keep it in a Ziplock baggie to keep it dry in my pocket, though! I wish I could somehow mount it on my bike, but where would it fit with my humongous light, my bike computer, and my extra-large Bento box (which is completely occupied by my bike light battery)?
Other notes from the ride
I saw a few interesting things on my ride.
At the southern entrance to the bridge, was a group of people singing Christmas songs. I don't know who the audience was at 5:50 AM but hey, it was nice all the same. Some TV truck was there recording the whole thing. One of the singers, in a Santa hat, gave me a strange look, like he knew that the whole thing was a little odd.
Once on the bridge, I noticed a pedestrian, who just seemed a little out of place. He seemed a little despondent and I started wondering if he was planning to jump. I said, "Hi there," and he gave me no reaction (which could have been just because he thinks people who ride bikes in bike clothes are weird). I thought I was probably over-reacting but considered stopping at one of the many emergency phones on the side of the sidewalk. I passed one but stopped at the next and spoke to the bridge patrol. I mentioned the pedestrian and he asked, "What are you doing on the bridge?" "Biking," I said and then he cheered up. He said that the guy shouldn't be there and that he would check it out. I guess pedestrians aren't allowed on the bridge that early in the day.
But the best part of the ride was definitely sunrise. This picture from my cellphone didn't capture how brilliantly orange everything was glowing. But it's scenes like this that keep me riding and keep me paying my ridiculous rent (which actually isn't nearly as bad as it could be around here).
Oh, and the Christmas singers were still there when I crossed back over the bridge!
Friday, November 17, 2006
Update on CGMS, Symlin
So now that it's been over a month since I started using the Dex and nearly a month since starting Symlin, I thought I would give an update.
Dexcom
I have enjoyed having the Dexcom, but have also experienced frustration with it. When it works well, I don't have to check my BG as much, and I use the data to reign in my BG swings and uncover trends. But when it is not working well, I want to hurl it across the room. I get pouty and refuse to look at it. But then I put in a new sensor and, lo and behold, it is working well again. I love it! Right now Dex and I aren't talking. Or, rather, Dex isn't talking to me because all I see on the screen is "---" meaning that for some reason, the sensor isn't picking up any readings fit to report. Ask me again in a few days and I'll probably tell you it's the best diabetes gadget since the pump. (Note: Dexcom has been very good about replacing sensors that don't work well, whatever the cause.)
I have been able to use it successfully on many bike rides at this point, and it has tipped me off to rising BG's long before I would have caught it with my BG meter. Also, it has helped to uncover some high BG trends that I have following swimming. I discovered that, although my BG could be decent immediately following a 70-minute swim workout, it then tends to rise rapidly. This is due to the fact that I disconnect my pump while I swim and shower, so I go about 1h40min without any insulin (other than the small bolus I take immediately prior to disconnecting). I have modified my regimen to take a larger bolus after swimming, and am experimenting with taking a larger bolus before I get in the water.
Also, I have been able to get a lot more overnight data, which has helped me to bring my overnight highs in a bit better.
This all, in principle, should make my A1c better, right? Unfortunately, after a recent check, it seems to have risen in the same period of time since I got my Dexcom. That was a sad day for me. But I suspect that part of the reason is that I have been fiddling around a lot with basal rates and Symlin, which leads me to my next update.
Symlin
I have tolerated the Symlin well. I increased the dosages as recommended and am now taking the full 10 unit (60 ug) dose, 1-2 times per day. I never experienced any nausea or other symptoms at the lower dosages, but do sometimes experience it at the current dose. When I do, it is very mild and is more of a feeling of fullness than nausea. I went out to eat one night and, after an amount of food that I would typically eat at this restaurant, felt like I would seriously throw up if I ate even one more bite. This is not a typical feeling for me. So, in general, I would say that it has mildly suppressed my appetite after a meal. I wonder if this will be a lasting effect, or if it will fade with time.
With regard to keeping my post-meal BGs under better control, I'm not so convinced. I need to do a few more controlled tests to see how it is working. It may be helping after breakfast, but there are other variables, such as insulin delivery timing, that might also be playing a role.
I did realize though that I have gotten used to not taking shots! I hate it! And it seems to hurt more than I remember. What happened? I used to not think twice about it. I'm convinced the needles are less sharp than they used to be! And why am I dutifully following the instructions to use a new syringe for every injection? I never used to do that.
So far I haven't been able to decrease my insulin bolus for breakfast; when I review my total daily dose history on my pump, though, it does show a reduction since I started on Symlin. I suspect this is due more to a reduced appetite than to a reduction of insulin for a given amount of carbohydrate.
I'm hoping the claim that Symlin reduces the amount of glycogen released by the liver is true and will somehow save me more energy for exercise! I suspect any effect would be minimal.
I have noticed on 4-5 occasions a sort of strange feeling in my chest approximately 5-10 minutes after taking a Symlin shot and have had some paranoid diabetic hypochondriac thoughts that it is going to give me a heart attack or somehow result in cardiac complications. But maybe this is more likely to be the result of me keeping my heart rate at 185 for 20 minutes while climbing King's Mountain on my bike! It is a new drug, though, and sometimes I do worry about unknown side effects.
Dexcom
I have enjoyed having the Dexcom, but have also experienced frustration with it. When it works well, I don't have to check my BG as much, and I use the data to reign in my BG swings and uncover trends. But when it is not working well, I want to hurl it across the room. I get pouty and refuse to look at it. But then I put in a new sensor and, lo and behold, it is working well again. I love it! Right now Dex and I aren't talking. Or, rather, Dex isn't talking to me because all I see on the screen is "---" meaning that for some reason, the sensor isn't picking up any readings fit to report. Ask me again in a few days and I'll probably tell you it's the best diabetes gadget since the pump. (Note: Dexcom has been very good about replacing sensors that don't work well, whatever the cause.)
I have been able to use it successfully on many bike rides at this point, and it has tipped me off to rising BG's long before I would have caught it with my BG meter. Also, it has helped to uncover some high BG trends that I have following swimming. I discovered that, although my BG could be decent immediately following a 70-minute swim workout, it then tends to rise rapidly. This is due to the fact that I disconnect my pump while I swim and shower, so I go about 1h40min without any insulin (other than the small bolus I take immediately prior to disconnecting). I have modified my regimen to take a larger bolus after swimming, and am experimenting with taking a larger bolus before I get in the water.
Also, I have been able to get a lot more overnight data, which has helped me to bring my overnight highs in a bit better.
This all, in principle, should make my A1c better, right? Unfortunately, after a recent check, it seems to have risen in the same period of time since I got my Dexcom. That was a sad day for me. But I suspect that part of the reason is that I have been fiddling around a lot with basal rates and Symlin, which leads me to my next update.
Symlin
I have tolerated the Symlin well. I increased the dosages as recommended and am now taking the full 10 unit (60 ug) dose, 1-2 times per day. I never experienced any nausea or other symptoms at the lower dosages, but do sometimes experience it at the current dose. When I do, it is very mild and is more of a feeling of fullness than nausea. I went out to eat one night and, after an amount of food that I would typically eat at this restaurant, felt like I would seriously throw up if I ate even one more bite. This is not a typical feeling for me. So, in general, I would say that it has mildly suppressed my appetite after a meal. I wonder if this will be a lasting effect, or if it will fade with time.
With regard to keeping my post-meal BGs under better control, I'm not so convinced. I need to do a few more controlled tests to see how it is working. It may be helping after breakfast, but there are other variables, such as insulin delivery timing, that might also be playing a role.
I did realize though that I have gotten used to not taking shots! I hate it! And it seems to hurt more than I remember. What happened? I used to not think twice about it. I'm convinced the needles are less sharp than they used to be! And why am I dutifully following the instructions to use a new syringe for every injection? I never used to do that.
So far I haven't been able to decrease my insulin bolus for breakfast; when I review my total daily dose history on my pump, though, it does show a reduction since I started on Symlin. I suspect this is due more to a reduced appetite than to a reduction of insulin for a given amount of carbohydrate.
I'm hoping the claim that Symlin reduces the amount of glycogen released by the liver is true and will somehow save me more energy for exercise! I suspect any effect would be minimal.
I have noticed on 4-5 occasions a sort of strange feeling in my chest approximately 5-10 minutes after taking a Symlin shot and have had some paranoid diabetic hypochondriac thoughts that it is going to give me a heart attack or somehow result in cardiac complications. But maybe this is more likely to be the result of me keeping my heart rate at 185 for 20 minutes while climbing King's Mountain on my bike! It is a new drug, though, and sometimes I do worry about unknown side effects.
Tuesday, October 24, 2006
Symlin, Day 1
I finally started taking the Symlin with my meals today. I took the recommended dose (2.5 U) and reduced my mealtime Humalog boluses to 50% of normal. The net result after breakfast and lunch was that my BG's rose to a level that was corrected with almost precisely the other 50% of my insulin dose. I didn't feel any nausea or other side effects; essentially, the Symlin appeared to have no effect whatsoever. The dose is small since they recommend building up gradually to reduce the likelihood of experiencing unpleasant side effects. So I will try to be patient.
Monday, October 23, 2006
Symlin Begins...
Well, sort of. I honestly haven't dared use it yet. I read so much about the side effects, and potential for severe hypoglycemia, that I am looking for that "perfect" time to start. That time is not tonight, since I really need some good sleep and I don't want to be nauseated/vomiting for who knows how long. And my Dexcom is recalibrating for the next two hours so I wouldn't have that added protection against severe lows. Tomorrow is the day, I think. Breakfast is my trouble meal, anyway.
The great news is that my doctor worked some magic with my HMO and when I went to pick up the Symlin from the pharmacy for the second time last week, I only had to pay my regular prescription drug co-pay. I was fairly dumb-founded but decided to pay politely and make no fuss. I was already formulating my angry letter regarding their denial of coverage for my Dexcom, but now I am feeling more friendly towards them. Maybe they were just trying to butter me up! Hmm... At any rate, I was very surprised and happy!
The great news is that my doctor worked some magic with my HMO and when I went to pick up the Symlin from the pharmacy for the second time last week, I only had to pay my regular prescription drug co-pay. I was fairly dumb-founded but decided to pay politely and make no fuss. I was already formulating my angry letter regarding their denial of coverage for my Dexcom, but now I am feeling more friendly towards them. Maybe they were just trying to butter me up! Hmm... At any rate, I was very surprised and happy!
Monday, October 16, 2006
Biking with Dex
One of my major motivations for purchasing a DexCom was to help me improve my BG management during my training for and racing of Ironman Couer d'Alene. I've been able to use it on a few bike rides now, and a couple of runs. I am withholding final judgement on its performance at this time; although I can say I have experienced both enthusiasm and disappointment.
This past weekend, I had a wonderful ride in the Bay Area, starting near Woodside, CA, riding up and over Skyline, down to the Pacific Ocean, and back up and over and down again, back to Woodside. The ride starts out with about 15 miles of rolling, mild grades, followed by about 4-5 miles of a moderately steep climb (Old La Honda for those who know the area). Once up on Skyline, the descent is long and fast and fabulous (maybe about 15 miles)! We kept up a pretty high cadence during the descent along 84W. After a quick ride along Highway 1-North, we started back up the mountain through Tunitas Creek--a very steep 3-mile climb followed by another 3 miles of climbing a more moderate pitch. Down we went on King's Mountain Road and then wound our way a few miles through Woodside and back to the start along Canada Road. The total distance was about 52 miles.
I'm including a graph showing the DexCom values and my BG values during the ride. I ate a banana around 8 AM and took about half of my regular dose. Later, after noticing that my BG's were rising more than I was happy with, I took my full dose. We started riding around 9:20 AM. Unfortunately, the software doesn't have any other graphing options for the time axis, but somewhere around 10 AM I noticed that my BG was falling, much more than represented by the DexCom. I ate a Luna bar + 1 GU and didn't take any insulin. You can see the large peak from this snack. I am so worried about dropping low when I exercise that I often end up having some hyperglycemia. I didn't take any insulin for the rest of the ride, but did eat another Luna bar and a couple more GU's at some point. We finished riding sometime around 1:30 PM.
What I might do next time is eat just the Luna bar or the GU and then eat again in another 40 minutes. I've learned that I do often overreact to falling BG's and that it doesn't always take a huge intake of carbohydrates to correct it. I have had an experience in a race where I ate several GU's, a PowerBar and a bag of Skittles and still had a hard time keeping my BG in a decent range. But this was probably due to eating too little earlier on, given the intensity of my ride. I think that, as long as I haven't had a huge insulin bolus recently, I can probably keep my BG's stable on an ride with carb intake every 30-60 minutes, depending on the intensity of the ride.
Diabetes and Stem Cells: UCSF Mini Med School
I'm not exactly sure how I will be able to view this, but I thought I would announce that the UCSF Mini Med School is giving a lecture tonight on stem cells and the potential for treating diabetes. It is being broadcast on UCTV.
From the link:
"Join Dr. Michael German, the clinical director of UC San Francisco's Diabetes Center, as he explores the steps human embryonic stem cells take to become insulin producing pancreatic islet cells, and the goal of clinicians to transplant these cells to treat diabetes."
I think you can watch UCTV online.
From the link:
"Join Dr. Michael German, the clinical director of UC San Francisco's Diabetes Center, as he explores the steps human embryonic stem cells take to become insulin producing pancreatic islet cells, and the goal of clinicians to transplant these cells to treat diabetes."
I think you can watch UCTV online.
Friday, October 13, 2006
Inspiration
As we move through the last few months of 2006, my training for Ironman Couer d'Alene is beginning to pick up. Although I am usually highly motivated to train, it can get frustrating sometimes dealing with the diabetes stuff, and just trying to balance the training with everything else that is important in my life.
A friend recently showed me this video about Team Hoyt: a father-and-son team that competes in marathons and triathlons. They became most well-known for competing annually in the Boston Marathon, and I saw them race when I was a student in Boston. The unique thing about Team Hoyt is that Dick Hoyt, the father, pushes or pulls his son, Rick, the entire distance.
So when I get frustrated that my run is getting sidelined by a low BG (which doesn't actually happen often), I can remember these guys. Here's a video from YouTube.
A friend recently showed me this video about Team Hoyt: a father-and-son team that competes in marathons and triathlons. They became most well-known for competing annually in the Boston Marathon, and I saw them race when I was a student in Boston. The unique thing about Team Hoyt is that Dick Hoyt, the father, pushes or pulls his son, Rick, the entire distance.
So when I get frustrated that my run is getting sidelined by a low BG (which doesn't actually happen often), I can remember these guys. Here's a video from YouTube.
Thursday, October 12, 2006
No Symlin Yet
I went to pick up my prescription from Kaiser today and was handed a bill for $658. Needless to say, I declined the prescription. I was really disappointed, because I was excited to give this a try. I guess Kaiser doesn't cover Symlin for some reason. The $658 would have purchased 6 vials of 5 mL each, which, from my rough estimation, would last me 3 months at the very minimum. So the cost of Symlin would be more or less on par with Humalog. Additionally, I would need less Humalog so that cost would be reduced. I am going to try and appeal this decision. If Kaiser wants to live up to their "Thive" campaign, one would think that they would be supportive of those patients who are really eager to take preventive measures.
Not Perfect
So some days are better than others when it comes to diabetes management. I put a new sensor in for my DexCom 2 nights ago, and expected it to work as accurately as the first. By the way, the only reason I removed the first sensor after 7 days (instead of the billed 3 days per sensor) was that my skin started to get irritated around the sensor, and I was worried about infection. Actually, when I removed the sensor, I decided that I probably could have left it in longer. The skin under the tape looked fine and the site where the sensor wire had been also looked fine (although there was and still is a very small bump there under my skin). Anyway, after putting in the new sensor, I started the 2-hour calibration period and went to sleep. I woke up around 2 AM to the beeping sound of the Dexcom, prompting for two BG samples. I uploaded those and went back to sleep. When I woke up in the morning, I was sad to see that my meter hadn't read any values all night, but relieved that they started showing up after I input another BG value.
Unfortunately, sporadically during the day, the DexCom would fail to pick up some readings, even though I kept the meter close by. On two occasions since yesterday, my BG dropped to the 40's while the DexCom still read >100. I have my low alarm set for 90 because there can be some delay in the CGMS reading, especially when the BG is changing rapidly. After both of these lows I input the BG value and got major calibration errors, suggesting that I replace the sensor. I decided to wait it out and see if it would start working again, which it did both times. After it failed again right before my track workout, I threw it in my bag and later reset the sensor entirely (which requires another 2-hour calibration period). I just finished that and it seems to be reading okay again so far. We'll see how it goes.
I do feel that the DexCom company is very willing to help me sort out these problems, and am optimistic that as time goes by, I will be able to figure out how to make this technology work better for me. I at least had one really good week with the DexCom, which gives me hope that it will be useful still. I guess I am disappointed with this sensor because I had already grown accustomed to having the CGMS info, and feel at a loss without it. I am also happy that I can apparently get at least 6 or 7 days out of each sensor, which will cut down on the costs significantly.
Unfortunately, sporadically during the day, the DexCom would fail to pick up some readings, even though I kept the meter close by. On two occasions since yesterday, my BG dropped to the 40's while the DexCom still read >100. I have my low alarm set for 90 because there can be some delay in the CGMS reading, especially when the BG is changing rapidly. After both of these lows I input the BG value and got major calibration errors, suggesting that I replace the sensor. I decided to wait it out and see if it would start working again, which it did both times. After it failed again right before my track workout, I threw it in my bag and later reset the sensor entirely (which requires another 2-hour calibration period). I just finished that and it seems to be reading okay again so far. We'll see how it goes.
I do feel that the DexCom company is very willing to help me sort out these problems, and am optimistic that as time goes by, I will be able to figure out how to make this technology work better for me. I at least had one really good week with the DexCom, which gives me hope that it will be useful still. I guess I am disappointed with this sensor because I had already grown accustomed to having the CGMS info, and feel at a loss without it. I am also happy that I can apparently get at least 6 or 7 days out of each sensor, which will cut down on the costs significantly.
Monday, October 09, 2006
Overnight Highs...
Here is one day from the DexCom, using the software that arrived in the mail today. As you can see, I had a bit of trouble overnight on this date. Since I often get up very early--around 5 AM is not uncommon--I am considering starting my early morning basal rate increase a few hours earlier. I've noticed this same pattern on other days; although, it isn't completely consistent. I've only been on the DexCom for a week now and am gaining new insights into my glucose management every day.
Also, I should mention that I am now beginning day 7 on my first sensor, and it seems to be as accurate, if not more so, than day one. So the costs of using the Dex may be much less than initially feared. Plus, I am learning how to trust it more, and am gradually reducing the number of BG measurements to a more reasonable amount. I think I burned through a whole vial of test strips on day 1.
Having a CGMS allows me to really use the fine dosing capabilities. I wouldn't have had the confidence to correct for a BG of 150 previously. But if I can float along at 100 instead of 150, why not?
Friday, October 06, 2006
My Kind of Crackberry?
If you haven't heard, many people give the popular phone/PDA Blackberry device the nickname of "Crackberry." Here is a good description of why the Blackberry earned such a nickname: "CRACKBERRY: Another name for the Blackberry that refers to its addictive nature and the inability of its users to focus on anything else for more than 10 seconds." Another article by ABC compares the Blackberry addiction to other serious addictions like alcohol or drug abuse. There are even rehab programs developed for people with email addictions.
It's been 2 days with the DexCom now and I have to wonder if I can leave it alone for more than 10 seconds... or at least long enough to check my email.
It's been 2 days with the DexCom now and I have to wonder if I can leave it alone for more than 10 seconds... or at least long enough to check my email.
Tuesday, October 03, 2006
Go to Bed!
I noticed an article on cnn.com about getting enough sleep. The basic gist of it is that inadequate sleep adversely affects one's health; specifically, it can make it easier to gain weight due to hormonal changes that occur with sleep deprivation. I don't think it's a big suprise to most people that lack of sleep increases daytime fatigue, irritability, and likelihood of getting sick. With all of the media attention and health advice on weight management, I am surprised that the need for enough sleep hasn't been given more emphasis.
Day One on the DexCom
After a somewhat horrendous night of BG's ricocheting from very high to very low in the space of 4 hours, I was eager to get the DexCom going. I waited for a time late this afternoon when my BG's were relatively stable and inserted the sensor. (Note: this was my second attempt. My first attempt yesterday was a failure and with $35 riding on each of these sensors, I was nervous about messing it up again somehow.) Everything went smoothly and I started the calibration procedure, which lasts about 2 hours. After work, about 20 minutes into my bike trainer workout, I heard a little beeping noise and checked the screen. Bingo! The receiver was asking for some BG readings from my Ultra meter, which I measured and uploaded onto the DexCom receiver. I had a big smile on my face when I checked it a bit later and saw the glucose numbers popping up on the screen.
The DexCom has alerts that go off when the glucose values go over or below certain thresholds. This means that nights like last night should be a thing of the past.
I might start holding bake sales to raise money for the sensors, though. Would it be hypocritical for me to sell cookies in order to be able to use my CGMS all the time? Somehow, it doesn't seem right.
The DexCom has alerts that go off when the glucose values go over or below certain thresholds. This means that nights like last night should be a thing of the past.
I might start holding bake sales to raise money for the sensors, though. Would it be hypocritical for me to sell cookies in order to be able to use my CGMS all the time? Somehow, it doesn't seem right.
CGMS begins
I was excited to see a big box from DexCom on my desk when I arrived at work this morning. I had been expecting it to arrive Tuesday. What I didn't know when purchasing the DexCom was that it requires calibration with the LifeScan OneTouch Ultra meter, which I had left at home today. (I have another version of the Ultra--the "UltraSmart"--that I have been using since the Honu Ironman 70.3 triathlon in June.) Lucky for me, my health insurance HMO covers this particular meter (and this meter only, as far as I know), so I will be able to continue to have my BG meter test strips covered by my health insurance.
The DexCom consists of 3 main parts: the sensor, the transmitter, and the receiver. The sensor is the part that is inserted under the skin; DexCom has devised a pretty nifty inserter that makes the procedure painless and quick. However, I wonder if the contraption might be part of the reason that each 3-day-use sensor costs $35. I also wonder if the reason for the insterter has to do with FDA concerns that ordinary diabetics couldn't safely insert the sensor without an inserter already attached. (Recall that Medtronic wasn't able to initially release their CGMS with real-time data because the FDA thought diabetics might not know how to handle so much information.) Never you mind that diabetics are quite adept at handling medical devices and have gone far beyond mastering the simple insulin syringe. But this is just speculation on my part...
At any rate, the second device, the transmitter, snaps easily into place on top of the sensor, and communicates with the receiver, which is an oval-shaped device with a screen for displaying glucose values. It is quite sleek-looking and recharges like a cell phone after about 5 days of use.
Compared to the Guardian RT, the DexCom STS is much less obtrusive, since the transmitter is tiny. From a comfort point of view, I would definitely go with the DexCom.
But the most important test will come tomorrow, after the DexCom has had its 12-hour calibration period. Will the information be accurate, or at least accurate enough to be helpful? We shall see!
I'm just happy I didn't waste a sensor by messing up the insertion!
The DexCom consists of 3 main parts: the sensor, the transmitter, and the receiver. The sensor is the part that is inserted under the skin; DexCom has devised a pretty nifty inserter that makes the procedure painless and quick. However, I wonder if the contraption might be part of the reason that each 3-day-use sensor costs $35. I also wonder if the reason for the insterter has to do with FDA concerns that ordinary diabetics couldn't safely insert the sensor without an inserter already attached. (Recall that Medtronic wasn't able to initially release their CGMS with real-time data because the FDA thought diabetics might not know how to handle so much information.) Never you mind that diabetics are quite adept at handling medical devices and have gone far beyond mastering the simple insulin syringe. But this is just speculation on my part...
At any rate, the second device, the transmitter, snaps easily into place on top of the sensor, and communicates with the receiver, which is an oval-shaped device with a screen for displaying glucose values. It is quite sleek-looking and recharges like a cell phone after about 5 days of use.
Compared to the Guardian RT, the DexCom STS is much less obtrusive, since the transmitter is tiny. From a comfort point of view, I would definitely go with the DexCom.
But the most important test will come tomorrow, after the DexCom has had its 12-hour calibration period. Will the information be accurate, or at least accurate enough to be helpful? We shall see!
I'm just happy I didn't waste a sensor by messing up the insertion!
Friday, September 29, 2006
I bought a Dexcom!
After using the Medtronic Guardian RT at the Boston Marathon and during the Honu Ironman 70.3 (half-ironman) triathlon this year, I felt pretty sad to be without my own continuous glucose monitoring system (CGMS). Medtronic's CGMS won't be available in the U.S. until "sometime early near year," and who knows what that really means. Abbott has a system that is still under FDA review. Dexcom currently has a system available for purchase in the United States: the Dexcom STS. A careful review of all three would probably have been the most prudent choice, but I just don't want to wait any longer! The cost is expensive: to buy the device itself was $400 (sale price--it's normally $800), plus another $35 for each 3-day sensor. So, if I used the CGMS continually, it would cost me about $350/month! Yikes! Yikes again! I imagine that I will use it for a few days each week until the insurances realize how valuable this technology is, and decide to chip in a few bucks. Let's hope that's not too far off.
I spoke with a few people about the Dexcom, and have received some good reviews, as well as some mixed reviews. I think, at this point, all reviews of CGMS's are somewhat mixed, because they simply aren't yet as accurate as regular blood glucose meters. However, I believe that the glucose trend info that does seem to be pretty reliable with the CGMS, coupled with regular BG measurements, will provide a tremendous benefit in my ability to regulate my diabetes.
I spoke with a few people about the Dexcom, and have received some good reviews, as well as some mixed reviews. I think, at this point, all reviews of CGMS's are somewhat mixed, because they simply aren't yet as accurate as regular blood glucose meters. However, I believe that the glucose trend info that does seem to be pretty reliable with the CGMS, coupled with regular BG measurements, will provide a tremendous benefit in my ability to regulate my diabetes.
Tuesday, September 26, 2006
An Inconvenient Truth
I saw the movie, An Inconvenient Truth, over the weekend. I had resisted seeing it because the thought of listening to Al Gore lecture was not that appealing to me. Although I did find the obvious self-promotional bits annoying, I am glad that I saw it, and feel motivated to make some changes and work for changes to fight against rising CO2 levels. The data presented in the film seems quite convincing. There are two points that I especially continue to reflect on: 1) for some reason, the media has presented the causes or the reality of global warming as a controversy, which left me wondering whether the mainstream scientific community was unanimous on the issue, and 2) that fighting global warming was somewhat hopeless. On the contrary to both points, there is basically no doubt within the mainstream scientific community that the planet is warming in an unprecedented fashion (at least within the last 50 million years--see National Geographic article), and that the warming and cooling of the planet in the past (and present) has been correlated with CO2 levels in the atmosphere. Secondly, there are things that can be done, especially in the United States, given that we produce 30% of the CO2 released into the atmosphere every year. Action needs to occur now, though.
I would recommend that everyone puts his or her political leanings aside, and goes to see the movie or read the book. Check out climatecrisis.net to get more information.
I would recommend that everyone puts his or her political leanings aside, and goes to see the movie or read the book. Check out climatecrisis.net to get more information.
Tuesday, July 18, 2006
Coeur d'Alene
After doing a bunch of Olympic distance triathlons and two half-Ironman distance races, I decided to bite the bullet and enter Ironman Coeur d'Alene next year. Race day is June 24, 2007, which gives me about 11 months to train. I have great respect for this event and know it will require dedication and intelligent training. Maybe I will periodically post some updates on my training here. So far my plan is to spend the next several months improving my swim technique and continuing to build a strong base.
Friday, May 19, 2006
Lactic Acid Is Your Friend?
A friend sent me two links to articles describing recent research suggesting that lactic acid, the much-aligned molecule among athletes, is actually used as fuel by the muscle cells. Previously, it was preached that at a certain point, the "lactate threhold," the body started producing too much lactic acid, resulting in a significant decline in athletic performance. To quote the Berkeley article, this research suggests that
The links are:
Berkeley Article
New York Times Article
- muscle cells use carbohydrates anaerobically for energy, producing lactate as a byproduct, but then burn the lactate with oxygen to create far more energy. The first process, called the glycolytic pathway, dominates during normal exertion, and the lactate seeps out of the muscle cells into the blood to be used elsewhere. During intense exercise, however, the second ramps up to oxidatively remove the rapidly accumulating lactate and create more energy.
- Training helps people get rid of the lactic acid before it can build to the point where it causes muscle fatigue, and at the cellular level, Brooks said, training means growing the mitochondria in muscle cells. The mitochondria - often called the powerhouse of the cell - is where lactate is burned for energy.
The links are:
Berkeley Article
New York Times Article
Monday, May 08, 2006
Swim start at the Wildflower Triathlon, 2006
This is one of the early waves of the Wildflower Triathlon, long course, starting in the morning on May 6, 2006. The water at Lake San Antonio was the highest it has been in anyone's recent memory and was also pleasantly warm.
Wildflower Triathlon, Long Course 2006
Last weekend, I went down to compete in the Wildflower triathlons. Saturday, I did the bike leg in a relay for the long course, which turned out to be quite challenging. I had a bit of difficultly with my blood sugars around mile 30, which really sapped my energy for the rest of the hilly ride. But I finally made it in a slow time of 3:51. After that sad performance, I decided to go ahead and race the next day in the Olympic course, which went much better. I managed to keep my blood sugars stable throughout the race and even enjoyed myself a bit. I had decided not to worry too much about my time and just enjoy the day.
This picture shows the transition area of the long course race. You can see the swim course as well; competitors race in a clockwise direction around the buoys. It is farther than it looks!
This picture shows the transition area of the long course race. You can see the swim course as well; competitors race in a clockwise direction around the buoys. It is farther than it looks!
Friday, March 10, 2006
Snow!
After checking the forecast early this morning, I felt confident that going on a bike ride would be relatively safe; i.e., the forecast didn't call for constant rain but only intermittent showers. I headed out on my favorite quick ride, up through Sausalito and around the Tiburon peninsula. This ride is known as the "Paradise Loop" and is a regular ride for many cyclists in San Francisco. It was a bit chilly--about 40 degrees when I left. The most exciting part of the ride was when I was coming around on the Sausalito Bike Path, and looked up to see a white dusting of snow on Mount Tam and a nearby peak! We have been experiencing a pretty significant cold spell here in the Bay Area, and today we even have the snow to prove it. I'm sure anyone from Alaska or any other snowy state would laugh at me about getting excited about a little snow, but it is very unusual for us here! And even though I spent the first 28 or so years of my life living with snowy winters, I quickly adapted to the moderate climate here and complain about the cold when it's below 50, like any proper Californian.
I've included a picture from my phone camera, which doesn't really show the snow very well, if at all! I forgot to take the snow-filter off I guess.
Oh, and by the way, it didn't rain and for most of my ride, the sun was shining. It was chilly, though!
Sunday, January 01, 2006
Snowslide, Utah County, Utah
My dad and I drove down to Ephraim today to pick up my grandparents. On our way home, we passed by the old Thistle mudslide from 1983. This slide created a dam which caused the flooding of the town of Thistle under 50 feet of water, more or less. Homes, roads and the railroad tracks were all damaged. Here it is on January 1, 2006, covered in snow. The tracks have been moved to higher ground, but the homes have not been rebuilt. Rooftops covering mud-buried homes are still visible in some places.
Subscribe to:
Posts (Atom)