Author Thinks Like a (Rather Opinionated) Pancreas

Gary Scheiner is an outspoken CDE (Certified Diabetes Educator).  That’s probably because he’s lived with Type 1 diabetes himself for over 20 years.  Best known for his insulin-pumping guidebook, Think Like a Pancreas, he’s become something of a guru on the best techniques for achieving optimal diabetes control.

Gary_book_photo Trained at Joslin, he’s done extensive volunteer work for the ADA, JDRF, and DESA (Diabetes Exercise & Sports Association).  He’s authored dozens of articles, and speaks at local and national meetings on diabetes, fitness and motivation. Plus he’s received numerous awards for his work, including the 2003 Novo Nordisk Research Grant Award for the study of basal insulin profiles in insulin pump users. In short, Gary’s a kind of D-Superman, now running his own private practice near Philadelphia, PA, called Integrated Diabetes Services.   

This week, he was kind enough to answer a few penetrating questions for our community here at DiabetesMine.com:

DM) In your view, what was the most important advancement in diabetes care made in 2006?

GS) Definitely NOT inhaled insulin!  Talk about good research gone to waste.  Hundreds of millions spent on that stuff, and it will barely scratch the surface when it comes to treating diabetes properly.  For Type 2s, Byetta made some strong headway — finally, a medication that improves BG control without “burning out the pancreas”, and helps with weight loss.  For Type 1s, my vote is for the strong growth of real-time continuous glucose monitoring.  There are still improvements to be made, but the technology came a long way last year.

DM) What’s the single most important thing a Type 1 diabetic can do to achieve optimal glucose control?

GS) Hate to quote my book title, but the bottom line is, you’ve got to Think Like A Pancreas.  Regardless of your lifestyle, likes and dislikes, you have to match your insulin to your ever-changing needs.  It takes a sound program design, flexibility, and the willingness to experiment and learn from your mistakes.

DM) And a Type 2 diabetic?

GS) Become obsessive about healthy habits, and stop thinking that medication can take the place of a healthy lifestyle.  Even if medications manage to get blood sugars down towards normal, you’re still at risk for serious health problems unless you take your health and fitness seriously.

DM) How soon do you think continuous glucose monitoring will become “mainstream”?

They are already becoming mainstream… for the rich & famous!  Once insurance plans begin to cover the supplies, we’ll see many more people using them.  Right now, the cost prohibits the average person from being able to afford them.  It might take a year or two before the big private insurers start to cover them.  Medicare will probably take much longer.

DM) And how will patients and doctors share and utilize all the CGM data?

They probably won’t, to be honest.  This is the kind of thing that patients need to learn how to use and interpret on their own.  It’s a very individualized art form, and it can be quite time consuming.  If there is one thing we know about medical care in this managed care era is that physicians don’t have time to get very analytical or creative when they’re forced to see 10 patients an hour.  It’s going to be up to people with diabetes to come to their own intelligent conclusions.  That’s going to take some training by CDEs and representatives from the CGM manufacturers.

DM) What’s the most exciting thing happening in insulin pumping right now?  Powerful new “smart pump” features? Wireless models like the OmniPod? Something else?

GS) It may seem minor, but the “active insulin” or “insulin-on-board” feature has made a big difference in pump therapy.  Bolus calculations could be hazardous to one’s health if pumps did not have the ability to estimate the amount of insulin still circulating from an earlier bolus, and deduct it accordingly.  Unfortunately, every pump on the market handles residual insulin differently, so there is no real consensus as to how to use the data. I also find that downloadable (or is it uploadable? I get confused) pumps allow clinicians like me and patients (like me also) to see a nice graph or summary of blood sugars, insulin doses and carb intake.  Since I routinely work with patients from all over the country, pump data downloads make it easy to assess where a client’s control is strongest and weakest.

DM) What do you think the world of insulin pumping (continuous insulin delivery) will look like in 5 years?  In 10 years?

GS) Everyone is hoping for a continuous glucose monitor that is small and minimally invasive, and accurate enough to rely on, linked to a pump that has the intelligence to deliver insulin automatically without the user having to be involved.  While this seems like a dream come true, it may be a long, long, loooooong way off.  The insulin delivered into subcutaneous tissue by the pump tends to be too slow to cover most foods, and it takes too long to finish.  The same can be said for subcutaneous sensors; their accuracy is limited by their measurement of interstitital fluid rather than blood.  What I’d REALLY like to see is a wand that you can wave over any food item and have it tell you the exact carb count!  There’s this Chinese dish at the place next door to my office that gives me fits…


Thanks so much, Gary!  Are you sure you don’t want to move to San Francisco and become MY diabetes educator?  We do great Chinese food here…

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15 Responses

  1. Bonny C Damocles
    Bonny C Damocles January 29, 2007 at 8:14 am | | Reply

    Gary Scheiner, I highly respect and like you for saying that type 2 diabetics should become obsessive about healthy habits, and stop thinking that medication can take the place of a healthy lifestyle.

    Since my diagnosis in July 1991, I have been learning that there’s no similarity between types 1 and 2. By not being awed by the excellent success rate that most type 1s get, I am able to focus better on the most effective way of controlling my disease – by using exercise as my only diabetes medication.

    Amy, thank you very much for asking Gary the right question and for your informative and useful blog.

  2. Carey
    Carey January 29, 2007 at 8:15 am | | Reply

    We recently bought ‘Think Like a Pancreas’ and learned that he’s just a short drive away from us. Thinking it would behoove us to try to get him to see our son. Thanks for posting the interview.

  3. Scott K. Johnson
    Scott K. Johnson January 29, 2007 at 8:49 am | | Reply

    Great interview Amy & Gary!

    I’m a big fan of Gary’s work and highly recommend reading “Think Like a Pancreas” if you have not already.

  4. Scott
    Scott January 29, 2007 at 9:01 am | | Reply

    I think Gary is terrific.

    But I have to say that I think the title of his book “Think Like a Pancreas” is really a misnomer. First, you need to think like beta cells which constitute a mere 1% of the pancreas mass — not think like a pancreas which continues to manage the role of secreting digestive enzymes even in patients with type 1 diabetes just fine.

    Also, on a more serious note, the neither the beta cells nor the pancreas do any thinking, they simply respond physiologically to changes in blood glucose, and until the medical profession acknowledges that we are not being treated in a physiological manner, we’re really not being properly treated!

  5. Alison
    Alison January 29, 2007 at 10:33 am | | Reply

    Great interview! “Think Like a Pancreas” was one of the first books I got after being diagnosed with T1 two years ago and it’s still one of the most helpful books I’ve read. :)

  6. Bernard Farrell
    Bernard Farrell January 29, 2007 at 5:03 pm | | Reply

    Amy

    Thanks for an informative interview. I guess I’ll have to read Gary’s book.

    I completely agree with Gary regarding the CGM data. Endos and health care providers just don’t have the time to review and interpret the numbers we have today. The increase in data will swamp them. I’m hoping that CGM providers will recognize this and make it easier for us all to get our data out and derive information from it.

  7. Rachel
    Rachel January 29, 2007 at 5:26 pm | | Reply

    thank you for asking the type 2 question. Just another kick in the butt for me to keep exercising and eating well. ;)

  8. Allison
    Allison January 29, 2007 at 11:10 pm | | Reply

    As a patient going on 2 years (and I’ve actually known Gary since I was 17), he is pretty awesome. But don’t tell him I said that. ;-)

    And Amy, he does to remote consulting for people who live elsewhere. I’m 3,000 miles away and my A1C is the lowest it’s been ever.

    Things to think about…

  9. Steve
    Steve January 30, 2007 at 5:52 am | | Reply

    Every time I read the kind of thing he says about type 2′s, I cringe! I hear you, but I don’t do it. Argh!

  10. kendra
    kendra January 30, 2007 at 10:49 am | | Reply

    I love me some Gary Scheiner! Thanks for coordinating this interview; great post, Amy. Can you believe I had never heard of a basal test before I read Think Like a Pancreas? Yeeeeikes.

  11. Johnny C
    Johnny C January 30, 2007 at 2:24 pm | | Reply

    As one of Gary’s patients since his earlier days as a CDE to the present time. The most valuable piece of advice I could give to another person with diabetes would be to see Gary. I am fortunate to live close enough to Integrated Diabetes Services so Gary can print up page after page of my Guardian CGM data and carefully analyze it on the spot. If this wasn’t the case I would use his remote counseling. His help and expertise in the managment of diabetes is second to none IMO.His book is superb.God only knows what my numbers would be like without him. Pure Genius. Thanks Gary You Rock!

  12. lenlutz
    lenlutz January 31, 2007 at 12:07 pm | | Reply

    “Thanks so much, Gary! Are you sure you don’t want to move to San Francisco and become MY diabetes educator? We do great Chinese food here ?”

    NO…. he wants (i hope) to stay in the Philadelphia area, and keep up the wonderful work he has done for those of us in the area.

    BTW…. though i have tried many many times…. IMNSHO, chinese food and DM is not a great mix….. (does anyone ever know whats really in it)

  13. Pablito DELAROSA
    Pablito DELAROSA June 28, 2008 at 11:13 pm | | Reply

    Why is there a warning label on my metformin that says: TAKE THIS MEDICATION WITH FOOD OR MILK ?

    What’s the reasoning behind it?

    Thank you,
    Pablito

  14. Amy
    Amy April 6, 2011 at 10:17 am | | Reply

    I just discovered this article, because I recently discovered his book. It has been life changing. I know a lot more about diabetes than I ever thought I could humanly grasp. He makes it easier to understand and implement. My husband has gotten crazy advice over the years. One instructor told him to just eat the same things every day. Boring and unrealistic! So thankful I found his book at Borders!

  15. Bionische pancreas | diabetesforum.be
    Bionische pancreas | diabetesforum.be April 11, 2013 at 11:30 pm |

    [...] boek aan het lezen van Gary Scheiner : "think like a pancreas". Hier een quote uit een interview met hem "Everyone is hoping for a continuous glucose monitor that is small and minimally [...]

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