Diabetes Mine - the all things diabetes blog

Creatures of Habit

It always kind of ticks me off when people say that managing your diabetes is "like brushing your teeth." It's a helluva lot more work than that.  But the one similarity is that it is kind of habit-forming.  I always hold the toothbrush at a certain angle, and pretty much get the same (however effective or ineffective) results every time I brush.  I guess the same is probably true for most of my diabetes habits:

- Unzip the carry case, lean on knee

- Grab a test strip while cocking the lancing device

- Hold my OmniPod "just so" to get the blood on there just right

- Lick finger (hey, it's a habit!)

- Stare at results and conduct brain scan of last few hours (what did I eat or do to make that number appear?)

- Stuff used test strip into carry case pocket, while pressing pump buttons accordingly

- Repeat about every 2 hours throughout the day (no s**t)

Our buddy Scott J wrote a great dLife column recently about D-habits and how a change in the public restrooms at his workplace actually upset his balance.  "It is all in an effort to be more environmentally friendly and cheaper to maintain. I’m all for efforts to be more green and economical, but I am having a hell of a time adjusting to these new 'friendly' (paper towel and soap) devices...  So far, it has been a really interesting reminder of just how ingrained habits become after a short time," he writes.

Heck, yeah. Science tells us that it takes just approximately 21 days to develop a habit.  In that case, our habits and routines for "doing diabetes" must be pretty well hard-wired into all of us by now.

As I once again stuff a plastic vial of glucose tabs down my sports bra for my afternoon jog, like Scott, I find myself wondering: "How many little D-habits or routines do we have, knowingly or not?  And are these habits mostly constructive or destructive?  Do they build us up or tear us down, or are they just there...?"  For example: does excessive use of alcohol wipes make us really sterile, or just paranoid?  Is it OK to use your teeth to clamp off your pump tubing? (If it ain't broke...?)

What the authorities call "effective diabetes habits" is really a laundry list of How To Be a Perfect Diabetic. NOT. 

What I'm thinkin' about now are the not-so-helpful habits that make us human -- things like margarine dependence, reading while eating, noshing while cooking, and changing your lancet needle only once every few months.  I'm thinkin' about skipping the gym whenever the gym clothes are still in the wash, whenever there's too much mail piled up, or whenever it rains.  I'm thinkin' about any number of semi-destructive habitual behaviors that everybody falls prey to -- that are so disproportionately awful when you're living with diabetes.  Darn it.

Preparing for the Worst

When it comes to natural disasters and other potential crises, diabetes makes me feel frighteningly vulnerable.  I mentioned before that the images of Katrina had me clacking my teeth, as I wondered how I might stay alive sans fresh insulin in the event of being stranded.  "Really quite my nightmare..." 

Well, that hasn't changed a bit.  And now this recent disturbing report from CNN could put any diabetic over the edge to paranoia: "an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated."  The list includes, quite prominently, "those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes."

Kassie was one of the first to point this out to the OC. And Michelle K over at Blogabetes was one of the first to ask, "Who's to say what exactly consitutes 'poorly controlled'?"  Is it enough, in the event of an emergency, for the doctor to know that you have diabetes in order to deem you un-save-worthy?  Or is it only those with an A1c over 7?  (Who's admitting to that in the midst of a flood or hurricane?)  Or anyone already experiencing any kind of complications?  What if you're sick as a consequence of the disaster at hand, and your sugars are out of control?  Does that render you not worthy?

The bottom line is, we don't want to wait to find out. My husband and I have this frontier-mentality (do-it-yourself-or-don't-do-it) friend who lives nearby, whose been bugging us for the longest time about getting our home disaster-ready.  In our neck of the woods, that mainly means Earthquake preparedness.  But no matter. A disaster is a disaster. 

So now our backyard shed is full up with canned turkey, bottled water, camping tools and paper towels.  And most importantly, in the outdoor fridge: my Diabetes Survival Kit, which my husband and Frontier Guy absolutely insisted on.  Yes, I know, the fridge will be of no use in the event of an emergency; it's just keeping my insulin cool until then.

The contents of this pack so far are as follows:

2 vials of Lantus insulin

1 pack of 4 NovoLog pen cartridges

1 Novo Nordisk Junior insulin pen device

1 pack of 10 sterile syringes

1 baggie full of about 45 pen needles

1 OneTouch Ultra 2 meter with lancing device & quick start guide

3 vials of 25 test strips each (see, now that IS a problem - there should be MORE in each vial)

3 packs of 10 Glucose Tablets (grape, raspberry and orange)

Enough to keep me alive for about two months I guess -- without being able to test too often, and depending on how warm the weather gets, of course.  Better than nothing, but I'm still feeling vulnerable.

Anybody have any solid D-disaster-prep advice they'd like to share?

Diabetes Design Contest: Updates, Updates, Updates!

Big updates today to the ...

2nd Annual DiabetesMine™ Design Challenge

* a competition designed to foster innovation in diabetes design and encourage creative new tools that will improve life with diabetes *

In order to spread the word about this competition, we've issued a press release today, highlighting three exciting changes:

* increased prize money -- we now have an additional $200 donation from our friends at DexCom, along with an additional $1,000 from two anonymous sponsors who are very dedicated to supporting this cause.  This brings the total prize purse to $3,200, or $1600 each for one adult and one under 18 winner.

* we're now opening up the competition to "paper" submissions as well as YouTube videos.  So if you're not such a video whiz, all you need to do with your concept is craft a 2-3 page written “elevator pitch” plus supporting graphics, all of which can be submitted to us via email.

* extension of the submission deadline to midnight PST on Monday, June 16, 2008.  Winners will be now be announced on Friday, June 20, 2008.  So you have a little more time to get your concept pitch-ready and get it submitted.

Click HERE to read the original post announcing the contest, submission guidelines, and details. 

For inspiration, I encourage you all to have a look at some of last year's prototypes, designs, and ideas.  We know you're out there innovating for diabetes, so step forth and be heard (and win!)

DBMine Contest Press Release - Upload a doc

Read this doc on Scribd: DBMine Contest Press Release

Bloodless Update: May 08 Edition

We're all waiting for some truly bloodless glucose monitoring technology, of which there is much on the horizon.  The wait, however, is long and tedious.  Still, we love to hear about what's coming, don't we?  I stamped this post "May 08 edition," because I'm quite sure the Bloodless Update will be an ongoing series.

[Editor's note: Do excuse the skeptical tone of this post, but as interesting as all these developments are, I'll really believe them first when I see them actually become available to us]

* At the moment, there's this one, the Symphony System from Echo Therapeutics, which is undergoing a pilot study with two dozen patients in the intensive-care unit at Tufts Medical Center in Boston. It's a disc reportedly about the size of a half dollar, designed to read glucose levels through the skin and transmit the information wirelessly to a nearby computer or hand-held meter.  The company's hoping for FDA approval as soon as late next year, when it hopes to "market the device to both hospitals and diabetics for home use."

* There's also the GlucoTrack, being developed by Integrity Applications in Israel. This one will be clipped to your earlobe, believe it or not. "The GlucoTrack uses ultrasonic, conductivity and heat capacity technologies to non-invasively measure glucose levels in the blood. The device is battery-operated and includes a Main Unit (UMU), which contains display and control features, as well as transmitter, receiver and processor, and a Personal Ear Clip (PEC), which contains sensors and calibration electronics. The device is small, light and easy to handle...  The Main Unit can be shared by up to three patients, although each will require a Personal Ear Clip. The device includes a USB port for downloading data for off-line analysis, as well as an IR (Infra Red) interface for downloading data to hand-held computers."  Wow. Yet press reports indicated the company expected their device to reach the US market in the second half of 2007.  NOT.  Another neat tech that's totally TBD.

* Freedom Meditech, Inc. is working on a non-invasive ocular glucose measurement technology that's being touted as a "potential breakthrough."  Their “consumer ready” product is anticipated to be the size of a small pair of binoculars, they say. Hmmm, nevermind that Oculir went under because they just couldn't make the optic technology work.  "The optics needed to shine on the eye and collect the light was a lot bigger challenge than we anticipated.  This turned into more of a research project versus a development project, and the investors weren't willing to support that," Oculir's former CEO told me.  Let's hope Freedom Meditech has something new and amazing up their sleeve.

* In Switzerland, a company called Solianis is testing a "multi-sensor" CGM system.  From the company's website: "Solianis’ non-invasive continuous glucose monitor employs Impedance Spectroscopy to track changes in the glucose levels. The IS technology uses frequencies between 100kHz and 8 GHz to measure the effect of changing glucose levels in blood, cells and interstitial fluid and the resulting changes in the ac and dc conductivity in both hyper- and hypoglycaemic events."  Anybody know what those frequencies might mean, in terms of making this product more effective than previous attempts at transdermal monitoring?

* Who saw who saw these cool non-invasive D-gadget designs from Sascha Morawetz?  One is a digital diary, to be used for record-keeping and "optimizing therapy" and the other is an "insulin aerosol inhaler, replacing the common insulin pen."  Right. If only the contents were actually safe and effective. 

Maybe someday.  Meanwhile, the designs are REALLY nice.

* Speaking of non-invasive drug delivery, there's some progress in "intradermal" systems -- using microneedle technology that painlessly permeates the skin -- from the Georgia Tech Research Corporation (GTRC).  This group has created a patented PyraDerm delivery system, and is planning to start clinical trials in the second quarter of 2008.  That would be very soon.

* Meanwhile, Oramed Pharmaceuticals in Jerusalem has successfully completed Phase 1B clinical trials of its oral insulin capsule. This trial utilized healthy volunteers (ie non-diabetic), and was focused on finding the optimal dosage for the formulation of the company's product.  It's now gearing up for Phase 2B trials, using volunteers with Type 2 diabetes.  The company was just named one of the 60 top “enterprises of tomorrow” representing the future face of Israel -- an event held to mark the country’s sixtieth birthday.

All these companies are putting an awful lot of effort and money into new non-invasive treatments, so I believe that it's not all fairy tales and pixey dust.  I'm crossing my (poor bruised) fingers that at least one of these comes to market sooner rather than later -- and is actually affordable and works.

Suddenly Celiac

Back in 2003, when I was diagnosed, nobody seemed to know anything much about the connection between Type 1 diabetes and celiac disease.  Or at least it wasn't mainstream, certainly not for my doctors at the time.  Celiac is of course and intolerance to gluten, a composite of proteins contained in wheat, rye and barley.  Having it therefore means eating no foods that contain those grains.  Picture that!

But my point was that suddenly, I seem to see the topic of diabetes & celiac popping up all over.  I was amazed to find an article in this month's edition of Diabetes Forecast, called "A Tricky Diagnosis: Why You Should Learn About Celiac Disease" that explains the classic and atypical versions of this disorder:

* Classic = nasty gastrointestinal (GI) problems when you eat gluten

* Atypical = mild or no GI symptoms, but a skin rash (dermatitis herpatiformis - yikes) that can appear on your face, elbows, knees or tush

The article notes that the latter may in fact be the more common presentation. And they cleverly note: "Because grains find their way into all kinds of products, always read labels on foods, over-the-counter medicines, and supplements. Ask your doctor about the ingredients in prescribed medicines."

Well yes, I had to learn all of this the hard way.  Like when we stopped at the drug store for some allergy pills, and later my lip swelled up like a ubangi.  That was a nice look at Disneyland, I'll tell you.

If you are in this boat, see this nice new Boston Globe piece about how to find gluten-free products. If you're in Europe, it might cheer you to know that a new 2,230-meter factory has just been opened in Wales to pump out gluten-free goods.  In Seattle, "Gluten-Free Girl" Shauna James is doing great things with rice and corn pastas. Personally, I prefer Quinoa. It's not so heavy and dry.  But if you happen to have diabetes as well as celiac, you will REALLY want to watch the pasta, anyway; it's carb-noxious.

Here's a list of research on the connection between celiac and diabetes, including one study indicating that the disorder was discovered in 12.3% of children with Type 1 diabetes.  New research on "the double life of proteins" may help scientists understand this all better.

Meanwhile, you are not alone.  Mark your calendar for May 28, when DiabetesTalkFest will be hosting a chat with Catherine Oddenino, editor of "A Gluten-Free Guide."  This woman knows what she's talking about, because she's not only an expert in gluten-free gourmet, but she also manages her Type 1 diabetes with an insulin pump.

Wisdom of the Winners, and More

Harking back to the last contest hosted here, Seven Words of Wisdom for Living with Diabetes, today a nice photo montage of our wise and wonderful winners -- and their coveted prizes.

-- Terry Keelan sporting attitude, and his new DBMine shirt

(Pay attention. Lick your fingers. Move forward.)

-- Brian Boone's wrist looking cool with his new leather med-ID from StickyJewelry

(Check your glucose. Check again. Check again.)

-- A very happy Karen Doering, with her niece.

(Every day is different, not exact science.)

And Karen's prized prizes: a colorful new "Spring Squared" diabetes carry bag from StickMeDesigns (I have this one, too!) and lovely beaded med-ID bracelet from StickyJewelry.

-- Karin Bowman, with her bag and bracelet in use. Note how she's got her OmniPod PDM neatly in the bag. Hooray for a good fit!

(Be diligent. Be educated. You're not alone.)

Thank you to everyone for playing!

btw, another cool contest along these lines has come and gone recently at the NY Times: What Kids Need to Know, which asked for great examples parental advice, either dispensed or received -- i.e. what was the best practical advice your parents gave you?  Actually, the call for submissions included this wording: "If you were diagnosed with a terminal illness, what wisdom would you want to leave with your kids?"  Yikes... but I just had to share some of my fave entries:

Do not let your bottom grow into the shape of your chair.

Always go outside when the sun is out.

Respect the nap.

Your parents are actually pretty cool people, no matter how many times you’re embarrassed by them.

Do not sell any of your old rock concert T-shirts on eBay until you are over 40.

And many, many more.  Enjoy.

Speaking of contests, please tell at least two friends about the DiabetesMine™ Design Challenge, open for YouTube entries till the end of the month.  We've got at least one cool video and a handful of new group members over there already.  I have just learned today that DexCom Inc. is kicking in another $200 in prize money, so get designing, People!

Tarpal Cunnel Syndrome - Ouch

No, that's not my cat walking on the keyboard again, typing crazy things (although she does that often).  It's me.  My carpal tunnel syndrome is acting up again, and I'm hating it.  Who would have thought a little cramping in your forearms could be so bad?

Even though I've spent most of my adult life typing like a maniac, I didn't actually get carpal tunnel until my 3rd pregnancy (when everything just seemed to fall apart).  In fact, I found out I was pregnant after going to the doctor complaining of severe pain and cramping in my wrists and hands.  I'd wake up over and over in the night with my hands so numb that I thought they were going paralyzed.  Once, we called my physician father-in-law in Germany at 2am California time to ask for help.  He thought it might have to do with funky way I was propping myself up on pillows at night (?), or maybe it was hormonal.  Bingo! No. 2 turned out to be the trick.

It's pretty common knowledge now that carpal tunnel is associated with pregnancy.  I was given lots of handouts on the topic.  But here's the bummer: after baby came, my carpal tunnel didn't go away.  It got so bad, in fact, that for a while I was wearing splints on both hands and taking 800mg tablets of Ibuprofen several times a day.  I was so desperate, I dragged all three of my kids along to the orthopedist for help. 

"Did anything change recently, other than having the baby?" he asked. 

"Well I was diagnosed with Type 1 diabetes a few months ago, but it can't be related to that, can it?"

"Everything's related to the diabetes," he replied. 

Aaargh!

Sure enough: "Most studies now strongly suggest that carpal tunnel syndrome is primarily associated with medical or physical conditions, such as diabetes, osteoarthritis, hypothyroidism, and rheumatoid arthritis."

And it's a bitch (if you'll excuse the expression).  I never imagined how painful or disabilitating it can be. At its worst, I could literally not make toast for my kids in the morning, let alone help them button their sweaters. I could barely hold my blow drier up straight, and was wiped out from being up all night with the pain.

I happen to know that the editor of Diabetes Health magazine, Scott King, suffers from a severe case of carpal tunnel himself.  He was diagnosed 10 years ago, and just underwent arthroscopic surgery in both hands on February 5th. (Those are his hands in the photo above.)  I know many people are leery of "going under the knife," because these procedures aren't always successful.  But it seems Scott's was a great success. He writes to me, in shorthand:

"I have only one little hole in both wrists, almost healed now
but scars are still sensitive
and i can TYPE gain with no pain!

that was the worst part

after the surgery

hands hurt horrible for the 1st 2 days

(they should have given me better pain drugs, as I was in so much pain, i had to chew up 3 vicadins just to get some relief)

but by 1 week i was flying out on a business trip, everything was great!

I DO WISH I had the surgery earlier

as i still have tingling in my left hand, damage to the nerve"

In case you're hit with this malady as well, Scott shares a few related articles from his publication to check out:

"Diabetes Masks Signs of Carpal Tunnel Syndrome", July 2002.

"The Canary In My Coal Mine", February 1996.

"Carpal Tunnel: Readers Respond In Droves", January 1996.

"It All Started With Tingling Fingers", November 1995.

Anybody else out there suffering with carpal tunnel?  What have you done about it, if anything?  Sure makes it hard to test your glucose, no?

NEWS FLASH: Top Orgs Band Together for New "National Diabetes Goal"

At a briefing in Washington DC today, the American Diabetes Association announced a highly ambitious (or crazy?) new National Diabetes Goal: "By 2015, 45% of Americans who are at risk of getting diabetes will know their blood glucose level and know actions to take."  If you do the math, that translates to getting about 59 million people screened and educated. By comparison, the data says that currently, only about 17% of Americans at risk -- about 22 million people -- know their blood glucose levels and what to do about diabetes.  Wow, they've got a lot of work to do. 

At least there's power in numbers, it seems: on board supporting the campaign is a virtual Who's-Who List of nearly every significant diabetes group in the country, including more than 20 diabetes health, non-profit and business advocacy organizations.

The campaign was initiated by the National Changing Diabetes Program (NCDP), a program of Novo Nordisk, which recently commissioned a landmark Gallup study surveying public knowledge and perceptions on diabetes. 

What's interesting about this Gallup study is how comprehensive it is.  The results gathered now constitute the "Societal Barometer" portion of an ongoing three-part "Triple Barometer" study:

* The Societal Barometer is based on a national public opinion survey of 2,015 adults conducted by Gallup^® for NCDP. Results showed that "almost all Americans (94%) consider diabetes a serious health issue, and half say they feel personally affected by diabetes. Yet awareness is not translating into action to prevent diabetes."   

* The second portion, an Economic Barometer, will explore how the cost burden of diabetes is distributed in the US across health care providers, public and private insurers, and individuals. The research will take place in two parts: first, they will conduct analyses of the cost differences between Type 1 and Type 2 diabetes, of diagnosed diabetes and undiagnosed diabetes, and pre-diabetes and gestational diabetes; then a second portion will survey health care providers to focus on gaps in diabetes-related reimbursements and identify areas for improved reimbursement policies (!! - inserted)

* Finally, a Clinical Barometer will assess how the quality of diabetes care is measured in the US and identify any existing gaps in these efforts and recommend improvements (insert more exclamation points).

What's interesting about this emerging National Diabetes Goal campaign is this slogan: Awareness of diabetes is not the problem; it’s time to motivate action. "People are aware of the diabetes issue, and now they need behavioral change," Senior Director of the NCDP Dana Haza tells me.

Yes indeed. But how the heck do they plan on kicking 59 million butts, if you will?  The campaign materials being distributed don't indicate much detail.  All I could find was a statement calling on those at-risk for Type 2 diabetes to ask about getting their blood glucose checked at their next doctor’s visit, and a quote encouraging American families to "take small, manageable steps — rather than drastic, unsustainable changes — to ensure long-term health."   

Small, manageable steps?  Know your numbers?  We could have told you that.  Now what?

According to Haza, the strategy is to enlist organizations and "champions outside the clinical setting" to get things moving among the patient community where they live. By that she means working with the national drug store chains, school nurses, large employers, and community ethnic groups to start prodding people to get tested and make lifestyle changes for the better.

It still sounds a little vague on the details to me.  But on the other hand, just the fact that these groups are banding together this way to attack the problem is pretty huge in itself.  In the words of the campaign brochure, "What kind of progress against diabetes could we make if we unite to achieve one ambitious goal?"  Lots, presumably.  And now they've got exactly seven years to figure it out.

                            *****            *****            *****

Other stuff the NCDP has accomplished:

* Remember that big study that came out in January showing that diabetes cost the nation $174 billion a year?  The NCDP was behind that, the goal being to illustrate that just 2% of that whopping sum is spent on prevention, which urgently needs to change, Haza says.

* The NCDP is behind pending legislation pushing for the establishment of a National Diabetes Coordinator.  That would be an executive-level government position -- a Surgeon General of sorts, whose job would be to focus solely on diabetes issues.
 

Filling Your Glass

A lot of people write to me explaining how they sometimes feel so blindingly angry about having diabetes.  They're just pissed off, and I can't blame them.  Living with this thing is inconvenient and aggravating, to say the very least.

So I spent some time recently taking stock of what helps me the most when I just get down and out.  There are lots small things that help the diabetes seem less daunting, and if you add them up, the sum can be greater than the parts -- if only you're willing to take a "glass half-full" look at your life.

Check out this month's Straight Up column over at dLife for my personal list of 9 Things that Help the Most.  This includes everything from my favorite BG testing devices to carb counting aids to where to find a good laugh (required).

I noticed there's a new meme going around about "Five Things You Won't Find in a Book." I'd wager to say you won't any of my "9 favorite little diabetes helpers" in any book either (not even ours).

Really: we all know that the best D-advice we ever got wasn't from some book or institution, but mainly from each other.  So have a look my column, and take a minute to jot down a half-dozen things that help YOU when you're diabetes is really getting to you.  I'd love to see us all share some great lists.

btw, the one thing I forgot to mention was the magical power of music to energize and soothe.  Somewhere in the back annals of my iPod I just rediscovered Freddie Mercury's Miracle and These Are the Days of Our Lives, and Beth Hirsch's You Make It Easy, for example. 

Those help.  And you won't find that in a book.

More Damaging Headlines: the FDA Disses Insulin Pumps

Another diabetes media blitz you won't believe.  Check out "FDA study: Insulin pumps linked to injuries, deaths in teens," an Associated Press headline that's appearing all over God's creation today. 

And I quote:

"The federal review of use by young people over a decade found 13 deaths and more than 1,500 injuries connected with the pumps. At times, the devices malfunctioned, but other times, teens were careless or took risks, the study authors wrote."

"Some teens didn't know how to use the pumps correctly, dropped them or didn't take good care of them. There were two possible suicide attempts by teens who gave themselves too much insulin, according to the analysis."

The FDA study referred to is published in the May issue of the journal Pediatrics; it reports of "adverse events and deaths in adolescents using the pumps occurred from 1996-2005."

I've been corresponding this morning with Steve Sabicer, the spokesman for Minneapolis-based Medtronic Inc. who's quoted in the AP article, and we're both wondering:  What was the FDA thinking??

"This FDA retrospective analysis fails to include ANY data on how other patients manage their diabetes, or what a 'safe' level of adverse events might be when managing such a complicated disease as diabetes.  In fact, most studies contradict this AP story and point to how insulin pump therapy reduces the incidence of adverse events and deaths in patients.  A consensus statement on the topic was published in Diabetes Care not too long ago on this very issue."

Here is a LINK to that consensus piece, which states -- and I quote:

"Based on the available evidence and the experience of the expert panel, CSII (insulin pump) therapy may be appropriate for children and youth of all ages provided that appropriate support personnel are available. CSII use in children and adolescents may be associated with improved glycemic control and improved quality of life and poses no greater, and possibly less, risk than MDI (multiple daily injection) therapy."

It's just short-sighted and frankly silly to blame the insulin pump -- again, one of the best D-tools we've ever had available -- for volatility in some young people's diabetes care.  I cringe to think what kind of repercussions these headlines will have for insurance reimbursement, which is already so tough.  Of course, again, I can only assume it's all about the money.  But talk about risks: the only way you'd get my pump away from me (as Charlton Heston might say) is to pry it out of my cold, dead hands.

Diabetes Diagnosis: The Musical (?)

The winner of this year's Bayer Dream Fund contest certainly has something new and different in mind.  Wendy Coleman, a theater and speech professor at Albany State University in Georgia, will use her award to "compose and perform a play about managing life with diabetes," complete with song and dance numbers.   The piece is called This is Our Story: Learning, Loving and Living Well with Diabetes, scheduled for a brief tour of five southern states starting this August.   

I'm sure there are valuable lessons there, but I'm somehow having a hard time imagining lining up at the box office for a play about this @#$% disease.  So I had a chat with Wendy herself to dig a little deeper into her unique vision.  Here's my mini interview ("minterview"?) with Wendy:

So were you working on a play about diabetes before you heard of the Bayer contest?

I was thinking about how to get the message out about how important it is after diagnosis to really take it seriously and move forward and take care of yourself… and I thought, "What if we do play?"

Who are the characters? And how long is it?

It's a two-hour play with intermission, based on my life and who I am -- how I handled my diagnosis with Type 2 in 2005.  The main character goes to a new doctor, and is told she has diabetes. She goes into denial, walks out of doctor’s office and literally drops the prescription slip for her glucose meter into the trash can -- like this didn’t even really happen to her.  She's experiencing symptoms, fatigue and the rest...

Later she has a "Dickens moment" where her Aunt Bessie comes back from the past and walks her through history to help her understand that "this is not just about you; it's about the past, present, and future –- those who will come after you."

I'm still having trouble visualizing a Broadway version.  What are some other key scenes you can share?

Her "aha moment" is when she meets her great grandfather who's going to be a Baptist minister.  Then she begins to understand more about who she is.. I'm also a minister (an assistant pastor at a local church in Albany), so this ties into my life.  She  sees him struggling with some complications of diabetes.  He’s in a wheelchair, and he says "it's because I was too proud and too busy and I didn’t want to go to the doctor."  They have a real heartfelt conversation about how he comes to understand his health.

I'm trying not to make it drab and dreary.  We'll use a lot of humor. Mostly we have young actors embodying elderly people -– not as characatuers, but they bring life and enjoyment to the depiction of being older.  There's also lots of dance and singing. We're working on the lyrics with an experienced musician, and we'll will bring in a dance company to do some of the dance scenes.

So what would be your measure of success for this play?

I really want to see people encouraged to get monitoring, to learn their medical history, and their family history. And if you're diagnosed with diabetes, to know it doesn’t have to be a death sentence.  It requires some changes, which can be simple, but can make a world of difference.  I also want them to not be embarrassed and afraid and ashamed if they're diagnosed.   

For me personally, working on this has already had an impact on my diabetes care.  I'm more conscious and more responsible in taking care of myself.  I don't ever want to be a hypocrite: if I’m not doing it, then how can I tell others what's right?

I'm hoping that after our last Dream Fund performance in December, the play will catch on and we'll get other sponsors and be able to take it all over the country.

Well Wendy, I'm still having a bit of trouble picturing it.  But heck, if plays with names like Menopause the Musical and Urinetown can make it big, I'm sure there's a chance for one about an ailment effecting as many millions as diabetes does.  Break a leg!

"Mystery Carbs" Question of the Day

We like to think we've got a handle on this carb-counting thing.  But the truth is, most of us have very little clue -- not least because nutrition labels on packaged products are so darn confusing. One of our beta testers over at the new community recently posted this query:

When I'm counting carbs I often read the "category" of carbs that are in the food I'm eating (i.e. Dietary Fiber, Sugar, Other Carbohydrates, etc.). I have noticed that often they don't quite add up to the Total Carbohydrate amount.

Maybe this is a stupid question with an obvious answer but:

Does anyone know what these "mystery carbs" are or where they come from?

Not a stupid question at all. I couldn't answer it off-hand.  Why are we consuming more carbs than appears necessary or possible based on the corresponding food data?  For some insight, I turned to local San Francisco nutrition expert Norae Ferrara.  Of course, nothing is simple with diabetes.  The answer was much more than I bargained for. Here's what this food whiz had to say:

Label reading can be tricky because the original purpose which is to provide accurate, useful, information is also clouded by marketing strategies of most companies who may add more information than is required, or practice "rounding" of values to emphasize or de-emphasize certain components.

 

To further explain:

 

Definition of Carbohydrates

Carbohydrates are made up of: 1) Complex Carbohydrates, 2) Simple sugars (or sugar), and 3) Dietary fiber (sometimes separated into soluble and insoluble on the label)

 

Required Labeling of Carbohydrates in the US:

United States Federal Law requires that companies state on the nutrition facts label the total grams of carbohydrates, dietary fiber, and sugars. This makes listing the content of complex carbohydrates as optional, which in most cases, will make up for the difference between total carbohydrate, and the sum of dietary fiber and sugars.

 

A truly complete label for a breakfast cereal might look like this (remember, each time a component is listed as a subgroup--underneath and indented to the right--it means that it is included in the total listed above):

 

Total Carbohydrate 24g

      Dietary Fiber 3g

        Soluble Fiber 1g

        Insoluble Fiber 2g

      Sugars 10g

      Other Carbohydrate 11g

 

While the more common food label will list only what is required, for example the same product might also be listed as:

 

Total Carbohydrate 24g

      Dietary Fiber 3g

      Sugars 10g

 

Rounding:
Companies may choose to round up or down to the nearest .5g. They may choose to round .3g fiber up to .5g, or just call it "less than 1g", when it is a desired component, or they may choose to round .3g sugar to 0g, for example, when the component is not highly desirable.

 

That sounds pretty sneaky to me.  Might be OK for enticing dieters to eat their products, but a veritable nightmare for anyone attempting to dose insulin based on that information.  No wonder I manage to make frequent "mistakes" even when I'm eating neatly labeled foods.  I know what you're thinking: don't trust the packaging, learn to estimate carbs yourself -- within a fraction of .5g.  Correct.  Great strategy.  But it seems like that could take a lifetime, and a lot patience that I do not possess.   *Sigh*