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February 9th, 2012
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As people with diabetes, we are tasked by our medical teams with conducting our lives in a manner such as to minimize or mitigate the destructive effects of our medical condition. A lot of press is given to the concepts of "patient compliance" and "patient adherence" -- enough to raise the blood pressures of many of us past the levels covered by our antihypertensive, renal-protective pharmaceuticals. The idea of being "a diabetic in control" (or "out of control") has also been known to raise the hackles of a number of the T1s among us, whose blood glucose levels vary with the tempo and dynamic (but none of the grace) of a Mahler symphony.

 

Like the four movements of a symphony, or the members of a string quartet, the cornerstones of diabetes self-care are:

 

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The first week in August marked the start of the 2010 run of the New York Renaissance Faire, an event in which the most popular exhibitions involve aiming long, pointy objects at impossibly small, circular targets. Whether it's an 8-foot-long lance hooking a three-inch-diameter ring, or a 26" arrow aimed at a bull's eye 100 yards away, or a sword or spear looking to unhinge a 1/2"-diameter ring of chain-mail armour, these are impressive displays of marksmanship and control -- kind of like trying to keep one's blood glucose levels between the mythical "102" and "104" (mg/dl) of glucometer-packaging displays, regardless of what one eats and when. (READ MORE)


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On Tuesday, Brian Bosh (@bosh) tweeted, "Do you (as a #diabetic) avoid publicly announcing extreme blood sugars for fear of discrimination regarding future coverage? #bgnow private."

 

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Don't go swimming right after eating lest you drown. -- Advice to schoolchildren, circa 1970.

 

When our gradeschool teachers started teaching us the basics of physiology, they taught us that blood brought oxygen and nutrients to our brains, our digestive systems (simplified to "stomachs"), and our limbs, and that these three systems were constantly battling for better allocation of resources.

 

According to our teachers, our brains always won out because they had to control the rest of our bodies.

 

Our legs came second, for survival reasons. The concepts of "adrenaline rush" and "fight or flight" were simplified to our grade level.

 

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Several people have told me lately how A1c results aren't all that important. I agree that A1c's aren't the ONLY lab test or number that diabetics need to be concerned over in their diabetes management. But it's also ingrained into me that A1c's are a very important number in diabetes control.

 

For about ten years, I went to a doctor who was directly involved in the DCCT trial. I researched the DCCT for a science fair project in 7th grade. I've seen the results. I've heard the stories. A1c results are valued by most endocrinologists in this field. Obviously, there is something to this.

 

For me, my A1c is one of the telling factors about my control. It's the guiding light at the end of the tunnel. There is an ultimate goal in my mind regarding my diabetes and regarding that number. It's important to me. I'd rather have a lower A1c than risk running at a higher result and increase my chances of diabetic complications.

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It's the end of my logging week again, so I'm sitting down to examine the logbook that I hold so dearly close to my diabetes management's heart. The time that I set apart for this goes something like this. First, I update the logbook with my most recent numbers, Lantus doses, and any important comments including new prescriptions, strange food choices, or exercise. Next, I tally daily averages as well as averages for time of day. After that, I analyze those averages compared to the last weeks averages and look for any resounding patterns that might need changing.

 

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There are enough issues with the data from our diabetes devices to make the average PWD's head spin.

 

First off, there's the sheer volume of it. Consider that the average glucometer burns through 1500 readings a year -- which hikes up somewhere closer to 6000 if you have type 1 diabetes and don't have a continuous monitor you can rely on. Then there are the carb counts, food data bases, multiple basal rates, special basal rates, bolus wizards, special bolus calculations, and the smartphone calendar alarm to manage them all. Those of us with type 2 diabetes may not have all the insulin data to collect, but we have instead the blood pressure data, and along with the caloric impact of the foods we eat, we have to capture the fat distribution and the sodium levels. For all of us who exercise regularly, there are the heart-rate monitor data, the treadmill, elliptical, and cyclocomputer statistics, and the rep charts for weights.

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Yesterday, I merged inspiration from Ecclesiastes with the liturgical forms of responses and contrasts to highlight some of the variables that make each person's experience of living with diabetes unique.

 

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Over the past few posts, you've seen me comment about diabetes technology -- mostly hardware and supplies -- in the context of a particular issue (hot weather or availability), but nothing really in terms of what I would like to see healthcare providers do in terms of better using existing technology, as well as what I should like to see pharmaceutical companies, software companies, and device manufacturers develop going forward. Because of the length of my wish list, I'm going to break this up into two posts.

 

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The topic for July's DSMA blog carnival is "diabetes technology", springing from a discussion in which we dissed the downsides of our Borgified selves and collated a wishlist of things we'd like the diabetes device industry to provide us with. Topping the list were more accurate glucometers, more reliable CGMs, sensors, and infusion sets, more accurate (smart?) insulins, and affordable (read: under ten cents each) glucose test strips. Somewhat further in dreamland were noninvasive testing methods (tattoos, retina scanners, "mood" watches, and so on).

 

The more interesting question is that of disillusioning those who think some of this technology wishlist is already here.

 

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Lindsey Guerin
Lindsey GuerinLindsey is a typical, yet unique, Texas girl who loves shopping, movies and reading. She loves to travel and take risks. She dreams of diabetes cures, never-ending cheesecake and her own airplane. The rest you can discover in her blog! (Read More)
Kim Doty
Kim DotyKim is a computer systems administrator for a major food manufacturer and lives in Colorado with her husband, Steve, and their children. She currently battles the bulge and tries to develop an exercise habit to better manage her blood sugars. (Read More)
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