So how did you hold up during Thanksgiving dinner?  Darn it, I’m a bit late posting this, but in case you’re still up against some very large meals this weekend, have look at John Crowley’s useful Tips for Getting Through Thanksgiving with Diabetes. I especially like the notes on What to Do If You Blow It: “Don’t let one mistake at Thanksgiving spiral into five weeks of high blood sugar… from Thanksgiving all the way to New Year’s Day.” Right.

In any case, this week we’ve turned our attention to what to do about other people who get meddlesome while you’re trying to enjoy your food:

THE REMINDERS

Please add your submissions to the comments section in the original Week 2 post (or here if you must).

This week there will once again be 9 winners! Every week, one lucky reader will win one of the following six cool prizes (click on the images for product info):

And for this week alone, three additional contributors will win one of these fine items:

* An “Essential Bedtime Foot Treatment Kit” from Gilden Tree Creams, retail value $24.99

* An attractive and very practical aDorn diabetic messenger bag, retail value $89.95

* A copy of the newly revised “The Diabetic Athlete’s Handbook“ by Sheri Colberg-Ochs, retail value $19.95

** This week’s round will be closed for submissions at midnight Pacific time on Sunday Nov. 30.**

So think hard about how you handle them diabetes-police-types and let us know!  Cheers.

I woke up with a sore throat today, but still, I have MUCH to be thankful for.

- 3 healthy children and a partner I adore

- extended family

- good friends

- a pretty comfortable life

- a job that I love (!)

- relative good health, even with a chronic illness

- and a whole lot of wonderful people online to share it with

In case you have any doubt that you too are blessed, have a look at this article today about the Engage with Grace initiative.  A great reminder to live your life to the fullest, right now, while you’re here.

Happy Thanksgiving, All!

In honor of THANKSGIVING this year, a special message about life and death from Alexandra Drane and the Engage With Grace team.  This initiative was born from the story of a young woman, a mom just 32 years old, who was dying of glioblastoma and desperately wanted to do so at home, with grace, rather than in the hospital.  Have you and your family considered how you might handle end-of-life choices when the day comes?  Please read:

“We make choices throughout our lives — where we want to live, what
types of activities will fill our days, with whom we spend our time.
These choices are often a balance between our desires and our means, but
at the end of the day, they are decisions made with intent. But when it
comes to how we want to be treated at the end our lives, often we don’t
express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at
home, but up to 50% die in hospital. More than 80% of Californians say
their loved ones “know exactly” or have a “good idea” of what their
wishes would be if they were in a persistent coma, but only 50% say
they’ve talked to them about their preferences.  But our end of life
experiences are about a lot more than statistics. They’re about all of
us.

So the first thing we need to do is start talking. Engage With
Grace: The One Slide Project was designed with one simple goal:
to help get the conversation about end of life experience started. The
idea is simple: Create a tool to help get people talking. One Slide, with just
five questions on it. Five questions designed to help get us talking
with each other, with our loved ones, about our preferences.

And we’re asking people to share this One Slide - wherever and
whenever they can.at a presentation, at dinner, at their book club. Just
One Slide, just five questions. Lets start a global discussion that,
until now, most of us haven’t had.Here is what we are asking you:
download The One Slide and share it at any opportunity - with colleagues, family,
friends. Think of the slide as currency and donate just two minutes
whenever you can. Commit to being able to answer these five questions
about end of life experience for yourself, and for your loved ones. Then
commit to helping others do the same. Get this conversation started.

(Editor’s note: I hope you can read it here. Otherwise go check out the original in PDF format)

Let’s start a viral movement driven by the change we as individuals
can effect… and the incredibly positive impact we could have
collectively. Help ensure that all of us — and the people we care for —
can end our lives in the same purposeful way we live them. Just One
Slide, just one goal. Think of the enormous difference we can make
together.

(To learn more please click here.)”

* Special thanks also to Paul Levy of Running a Hospital and Matthew Holt of The Health Care Blog for starting the blog-based EwG movement.  The hard truth is, we all need to think in advance about these issues ahead of time, for ourselves and for our loved ones. And give thanks for the lives we enjoy now!

What a fruitful week we have had strategizing in advance over how not to “lose it” with your diabetes control during holiday parties this season.  DiabetesMine received nearly 100 entries for the first week’s question!!  Thanks to everyone for your insights (and your sarcasm in spots ).

Now, I’d like to announce our first round of winners, nine of you!  And don’t forget to read on to the end of this post for the Week 2 Survival Sweepstakes question, your chance to add to our community’s collective knowledge and also collect a prize or two in case you haven’t won this week.

For their valuable replies to the question, “What’s your killer strategy for managing your BG while at parties?” the following readers are WINNERS / Week 1:

* Suzanne, who always has a PLAN, and remembers to take frequent “diabetes focus moments” in which she excuses herself to check and bolus. “It can be each hour, 1.5 hrs, 2 hrs or whatever fits your needs.”

Suzanne’s the proud Winner of: A case of 48 tubes of Cooper Labs’ pampering P.O.L. skin cream, retail value of $19.99 per tube (!)

* Carrie J, who remembers to eat before parties, bring a green salad, and “I’ll know that a bite can be just as yummy as a slice, one glass is enough and that perfection is overrated.”

She’s the Winner of: this week’s ExtendBar snacks “Holiday Survival Kit” including a sampling of all the company’s products:

•    5 ExtendBars (one of each flavor)
•    a 5 bag variety box of ExtendCrisps
•    a 5 pouch variety pack of new ExtendShakes powdered shake mix
•    a great Blender Bottle for mixing up your shakes
Total retail value $32.98

* Glenda Steffee, for her idea to “work the party” by volunteering to help serve punch or take photos, because “being busy sure beats standing in the corner drooling over what you shouldn’t eat!”

She’s the Winner of: A beautiful Deluxe Diabetic Carry Case in your choice of pattern from StickMeDesigns, retail value ca. $40.00

* Karen, who stays away from high sugar mixed drinks, but DOES enjoy a nice glass of wine, and who can say “no thanks” to sweets, but still might have “one small bite of my husband’s dessert.”

She wins: Blue Bunny low-carb ice cream! You’ll receive book of coupons, redeemable for 12 free cartons of ice cream. Retail value ca. $70.

* Tarra (with two Rs), for her 10-step strategy for tackling parties, starting with “I do not allow myself to pick at foods,” and ending with “Just enjoy the holidays!”

She’s the Winner of: A WellCharm cell phone sticker with 18 months free Platinum WELLness Service — a medical emergency service, worth a total retail value of $96.00

* Michele (with one L), who has a snack prior to the party and then goes armed with a pack of sugar free gum in a strong flavor like cinnamon or peppermint. “It keeps me from nibbling duing the appetizers plus - makes for fresh breath just in case”

She’s the Winner of: A free copy of the book, “50 Secrets of the Longest Living People with Diabetes” by Sheri Colberg-Ochs and Steven Edelman, MD, retail value $15.95

* Debi Martin, for her tip on the 125%  temp basal for the first hour or two of the party (We never thought of that!)

Deb’s the Winner of: this week’s HealthSimple Starter Kit containing everything you need for comprehensive carb counting and logging:

* FLASHCARBS® Card Deck and Magnet Set;

* A Care Plan Worksheet pad and Carb Count Sticker pad

* A DATAWISE® Logbook and CARBWISE CHEAT SHEETS™ Carb Counting & Insulin Dosing Worksheets

Total Retail value $64.00

* June S, who focuses on exercising before any party, and then uses the square wave bolus on her pump to deliver the insulin over 30 minutes’ time — and seltzer water, too!

June’s the Winner of: a shiny new stainless steel medical ID style 1 from HAH Originals designer medical jewelry, including custom engraving, retail value $19.95

and last not at all least…

* Kelly Kunik, for her idea of loading up on veggies and dip, and also “my most important strategy … I enjoy the moment of celebrating with my friends and family and make the focus on them - not the food. Life gets so hectic and our time together is short - I want savor every moment I have with them!”

She’s the Winner of: this week’s Verē Goods’ “diabetic-friendly” gift pack, including 5 bars of luscious dark chocolate in a variety of flavors (pure dark, mint, vanilla bean, spicy, and citrus), retail value $30.00

* PLEASE REFER TO LAST WEEK’S POST to view photos of the fabulous prizes, and read the winning entries in full.

**WINNERS: Please email a valid postal mailing address (snail mail) and telephone number to me here in order for your prizes to be shipped out to you.  All of you will also be entered into our GRAND PRIZE drawing at the end of December!

Overall, I’d say last week’s party advice could be summed up this way:

“Eat before you go, stay busy (don’t stand still by the food), ration your goodies, keep your hands/mouth full of water or a non-alcoholic drink, test often, and use your pump’s temp basal programs.”

And now for the DiabetesMine Holiday Survival Sweepstakes Question #2, hand-selected for THANKSGIVING week:

How do you “beat them off” without “beating them down” and turning yourself into Cranky Diabetic Man/Lady?  We’re looking forward to your informative, courteous, and snappy comebacks below.

I’ve been confused for a while about the controversy over “evidence-based medicine.”  Some doctors think it is correct; others don’t.  We patients take it for granted that there is solid scientific evidence behind the drugs and treatments our doctors prescribe.  So have we been misled there?

The Center for Evidence-Based Medicine (yes, there is one!) describes it as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”  Well yes, isn’t that how most academics approach their science?

But a light went on the other day while I was reviewing one of the entries for the current MedGadget SciFi Writing Contest.  In a deliciously creepy story on what happens to medicine by the year 2050, the author threw in this dig at current practices: “… surely so meticulous a scholar need not be reminded that the plural of ‘anecdote’ is not ‘evidence.‘”  Correct.

So how DO doctors decide what treatments to prescribe, anyway?

According to this enlightening look at EBM (as it is affectionately nicknamed) from a fellow “e-Patient” (cancer survivor) named Dave, there’s been a lot of “medical superstition” at work: doctors tending to overprescribe certain treatments for no reason other than the individual doctor’s preferences or prejudices.  It appears that EBM is an effort to correct this, by calling for (according to Wikipedia) “the systematic review of evidence for particular treatments, mainly randomized controlled trials.”

Again, kind of shocking that this isn’t what medical decision-makers have been doing all along.

But here’s the rub: We in diabetes know all too well that clinical trials can provide all sorts of contradictory “evidence.”  One week we read that dairy products are good for diabetes, the next week, dairy is taboo.  We read a bunch about how cinnamon lowers blood sugars, and then we learn that it may not. Etc, etc. You know the drill.

To make matters worse, Big Pharma is known for manipulating clinical studies so that they’ll be sure to produce desired results supporting their drug offerings.

So how can your doctor be expected to make any more of sense of all this than we can?  Maybe this is why many choose to rely on their own instincts and experiences within their own clinic.

Also, as Dave points out, the forced reliance on clinical trial evidence can create a bottleneck for new treatments that patients are need of now. The evidence being gathered may simply not be published yet.  You know I am thinking of Continuous Glucose Monitoring (CGM) here: the insurers wouldn’t even look at it without a mound of clinical trial data, which has thankfully been championed by the JDRF.

(Dave suggests we have a look at “the lethal lag time” section in Chapter 5 of the e-Patients White Paper recently published by the Robert Wood Johnson Foundation.)

I read somewhere recently that the US is the only western industrialized country that doesn’t have an independent body of medical experts tasked with evaluating collective study data and setting national standards of medical care — although there’s been a lot of work in this direction for diabetes in particular.  Still, these standards are presented as “goals” and “recommendations,” and I don’t believe the ADA or anyone else has the authority to enforce them.

So it’s all kind of a mess, I guess.  As a nurse-CDE told me while I was researching a story on diabetes education last year: “Some hospitals prefer to put all new type 1 patients on injections of NPH and Regular insulin. Other hospitals start all new patients on insulin pumps right away. It really depends on how advanced the program is. You could get completely different knowledge even in two hospitals across town from each other.”

And now you know why: it depends where doctors get their “evidence.”

I know I shouldn’t do this to you, but we’re adding some chocolate to the menu! When Kathy Moskal of Verē Goods (pronounced “very”) came forward with the offer to donate some heavenly dark chocolate as additional prizes for the DiabetesMine™ Holiday Survival Sweepstakes I just couldn’t resist. Hey, I’ve tried this stuff and it is off the charts.  So now it’s your turn. In addition to nearly 50 other amazing prizes, we’ll be giving away eight fabulous chocolate gift packs from Verē: 5 “diabetic-friendly”* gift packs, including 5 bars each in a variety of flavors (pure dark, mint, vanilla bean, spicy, and citrus), retail value $30.00 per set 3 “luscious + diabetic friendly” packs, including the 5 bars mentioned above, plus one box each of walnut clusters and chocolate walnut brownies, retail value $50.00 per set Yum! *Of course we need to clarify “diabetic-friendly”: the bars are all low-sugar and gluten-free, and contain per bar approx: 13 grams carb, of which 5g is sugar, and 4 grams of fiber. (Nutrition info is posted in graphic form on the company’s site)  Those numbers ain’t too bad for goodies. Plus it’s DARK chocolate, the kind with those great health benefits. Now that I’ve got you all distracted with the chocolate, would this be a good time to remind you that this contest is not just about the goodies? As Allison so eloquently puts it: “For those of us with diabetes, the holidays are a non-stop carb fest from the fourth week of November until well after the New Year’s (What? You think the candy and cookies just poof into thin air on January 1?). Blood sugars bounce off the walls with the constant influx of chocolates, cookies, carb-filled mashed potatoes, stuffing and my personal favorite: candied yams and marshmallows. Control? What control? But the diabetes community is coming to the rescue!…” This is a chance to swap our in-the-trenches experiences and help each other along through the holiday minefield.  I’m looking forward to compiling all these “best practices” into a little volume we can all share! So, onward to REMINDERS: Contest topic this week: Handling Those Pesky Holiday Parties! How do you keep from “losing it” with the buffet table calling your name and the drinks flowing?  Please add your submissions to the comments section in the original post (or here if you must). We have more than 60 great responses so far. This week there will be no less than 9 winners! And in the next weeks, even more. ** This week’s round will be closed for submissions at midnight Pacific time on Sunday Nov. 23.** So get your PWD party hat on and let us know how you do it!  Cheers.

So my “mole” who attended the Diabetes Technology Society meeting in Maryland last week got back to me, and the news was kind of disappointing.  On the whole, it doesn’t sound like there’s anything particularly new under the sun for us PWDs at the moment; it’s all about more baby steps in research and development.

But Aaron Kowalski, Research Director of the JDRF, might disagree with me there. He delivered a keynote address entitled “Accelerating the Availability of an Artificial Pancreas.” (He even offered me a peek at this slideset, although he asked me not to publish them here because he’s working on a paper about this topic right now.)

The upshot of his talk is summarized in a JDRF press release HERE.

He’s essentially explaining that the Artificial Pancreas Project is proceeding on three different tracks:

1) The extensive JDRF Continuous Glucose Monitoring clinical trials, which are providing the necessary scientific evidence that CGM does in fact significantly improve diabetes control.  (Trial participants who used the devices regularly — six days per week or more — saw a reduction in A1c levels, without an increase in hypoglycemia.)

2) JDRF’s Artificial Pancreas Consortium, which is working to bring together scientists from multiple disciplines “to safely and effectively link blood sugar sensors with insulin delivery systems, using a sophisticated algorithm to ensure the device accurately mimics how a human pancreas does.”  That means the device should be able to sense glucose and deliver just the right amount of insulin, taking into account all the relevant variables including insulin sensitivity, exercise, stress levels, meal types and others.

3) JDRF’s campaign to create partnerships with industry companies “to build artificial pancreas technologies and create a robust, competitive marketplace for them.”

OK, No. 1 is great news.  No. 2 sounds like a gargantuan challenge. And No. 3 — well, that’ll be a slow incremental process that will depend a lot on further development in Numbers 1 and 2.

I know that we have come a long way in the last 10 years or so with diabetes technology, but people have been forecasting the closed-loop system for too long and there are too many obstacles to get too excited about “acceleration” just now, if you ask me.

Meanwhile, my mole tells me that there was a great deal of detailed discussion at the conference about the possibility of including glucagon in the closed-loop / artificial pancreas system: i.e. how to overcome the complexity of delivery?  (Ooh, this is going to take a while.)

But what was new this year, my mole says, was the apparent consensus that “CGM technology is here to stay” — which was apparently not a foregone conclusion last year’s event. Hmmm…

I also learned that Dr. David Klonoff, who heads the Diabetes Technology Society, gave another talk calling into question the value of self-monitoring of blood glucose (SMBG) for Type 2 diabetics.  His take was apparently a little different, however. He states that the “human factors” of self-testing haven’t been studied enough to give us a good overview of what’s happening out there. There should be more focus on the behavior of both patients and caregivers, he claims.  That I would have to agree with! The “behavior” side of things (otherwise known as “real life with diabetes”) has been summarily ignored by conventional medicine for far too long.

So are we on the fast track to major changes in the way most people’s diabetes is treated in this country?  Probably not.  But again, all progress is good, so stay tuned.

I can’t quite remember who asked me, but in front of San Francisco City Hall last Friday evening, during our World Diabetes Day celebrations, somebody pointed to my pin and asked, “Why the blue circle, anyway? What does that mean?”

They also wanted to know why the logo didn’t have the world “diabetes” stamped across it: “Who’s going to recognize that this stands for diabetes?!”

For goodness’ sake, it’s supposed to be like the ubiquitous pink ribbon for breast cancer, red ribbon for AIDS, or yellow ribbon for bring-home-the-troops.  Setting the issue of why it’s blue and a circle aside for a moment, can’t we all agree that a symbol that speaks for itself is better than having to pin the word “DIABETES” on your lapel?

I was especially surprised to discover that folks from the local chapter of the ADA (American Diabetes Association) weren’t at all familiar with the blue circle campaign.  I sort of forgave them for it last year, since it was still very new then, but now I’m thinking that that group — and this country at large, which doesn’t play up World Diabetes Day a fraction as much as the rest of the world — may be suffering from some classic “not invented here syndrome.”  When you go to the ADA’s website right now, for example, you see “American Diabetes Month,” but nada on WDD.

I hereby proclaim this Call to Action for next year’s WDD: Let’s do it up, right, America! And that means you, ADA!  And that means you, Mainstream Media!  This awareness campaign is gaining traction, with the likes of T1 rockstar Nick Jonas on board, but it seems like we have a long way to go to catch up with the Brits, the Germans, or the Australians, for example.

And now for the Why Blue? And Why a Circle?

I know from my previous research that this symbol was the brainchild of Kari Rosenfeld of the International Diabetes Foundation (IDF) and her daughter Clare back in 2006, when the IDF was campaigning for United Nations Resolution on diabetes (which they got, btw.) The blue color is meant to evoke the color of the sky, and the circle is a symbol of unity.

You can now read the official explanation of the international “Unite for Diabetes” symbol here.

“The colour blue reflects the sky
that unites all nations and is the colour of the United Nations flag.
The blue circle signifies the unity of the global diabetes community in
response to the diabetes pandemic.”

And also, from “What’s with the blue circle?”:

“A simple blue circle because of the circle’s frequent occurrence in nature and because myriad cultures over time have used the circle to symbolize life, mother earth and health.  The unbreakable unity it represents mirrors the global diabetes community …”

How beautiful. Let’s get even more unbreakable next year, K?

Listen up, everybody, because there’s lots of booty involved!

Today, I’m just giddy to be able to announce a contest in which everybody wins:
The DiabetesMine™ Holiday Survival Sweepstakes.

The whole idea is to share some of our best tips about surviving the holiday season with diabetes, have some fun, and share the freebie love! (I’m fortunate to receive lots of complementary D-products to review, so why shouldn’t you all benefit as well?)  We have nearly 50 fabulous prizes to give away between now and Dec. 29, so read on to learn more.

Here’s How It Works (and check out all the cool prizes below!):

1)    All you have to do is check in here regularly for the next 5 weeks. Each Tuesday we will pose a question to the community. You submit your answer (ie. contest entry) simply by posting your response in the comments section of the appropriate post.  Each week, you’ll have until midnight of the following Sunday to submit your entries.

2)    Every week, 7-8 lucky winners* will be selected by an esteemed panel of three D-bloggers: myself, Allison Blass of Lemonade Life, and Scott Johnson of Scott’s Diabetes Journal. {One prize per person per week; prize choices will be divvied up at random.  A valid postal address is required to receive prizes.}

3)    The weekly winners will then be entered into a drawing for three fantastic GRAND PRIZES:

• Two Fit4D.com Starter Memberships consisting of a full two months of complimentary personalized diabetes coaching customized to your goals and lifestyle — valued at $295 each. A bit about Fit4D™:

Fit4D provides personalized nutrition, fitness and wellness guidance to people with diabetes.  Coaches integrate motivational support within programming delivered in both group and one-on-one individualized formats.  The Fit4D coaching team, comprised of dieticians, exercise physiologists, nurses who are also certified diabetes educators (CDEs), focuses on empowering people with diabetes to live rich and fulfilling lives.

• And one WellAlarm™ Gold Vermeil Circle of Health Charm with Two Free years of Platinum emergency medical notification service. Total retail value, $228.

Grand Prize winners will be announced on  Dec. 29, 2008.

*What Else You Can Win:

Besides the three Grand Prizes, we’ll be giving away dozens of other goodies, including low-carb treats, medical ID jewelry, and diabetes-related paraphernalia and books.  Here’s the list of confirmed prizes so far —

2 sets of WellCharms cell phone stickers with free 18 months’ worth of their Platinum WELLness Service. Total retail value $96.00

5 items from HAH Originals designer medical jewelry –

•    one dog tag medical ID, retail value $35.00

•    one stainless steel medical ID style 1, including custom engraving, retail value $19.95

•    and three stainless steel medical ID bracelets style 2, including custom engraving, retail value $19.95

5 ExtendBar snacks “Holiday Survival Kits” including a sampling of all the company’s products:

•    5 ExtendBars (one of each flavor)
•    a 5 bag variety box of ExtendCrisps (introduced in Jan ’08)
•    a 5 pouch variety pack of new ExtendShakes (a powdered shake mix introduced Sept ’08)
•    a great Blender Bottle for mixing up your shakes
Total retail value $32.98

5 coupon books for a year’s worth of free Blue Bunny low-carb ice cream (!)
Each book has 12 coupons, each redeemable for a free carton of ice cream. Retail value per book, $60-70.

5 HealthSimple Starter Kits containing everything you need for comprehensive carb counting and logging, retail value $64 per kit

2 cases (48 tubes each) of Copper Labs’ P.O.L. skin cream, retail value of $19.99 per tube

2 attractive and practical aDorn diabetic carry bags:
one messenger bag, retail value $89.95

and
one handbag, retail value $69.95

3 Deluxe diabetic carry cases from StickMeDesigns, retail value ca. $40.00 each

2 “Essential Bedtime Foot Treatment Kits” from Gilden Tree Creams, retail value $24.99 each

5 copies of “50 Secrets of the Longest Living People with Diabetes“ by Sheri Colberg-Ochs and Steven Edelman, MD, retail value $15.95 per book

2 copies of the newly revised “The Diabetic Athlete’s Handbook“ by Sheri Colberg-Ochs, retail value $$19.95 per book

2 DiabetesMine Care Packs: each containing one copy of our Know Your Numbers book, a DiabetesMine.com notebook and refrigerator magnets (retail value: indescribable - whoohoo!)

Making the Fun Last

Since we’re hoping to gather some great diabetes “wisdom of the crowds,” we want to capture your tips for lasting value. Allison therefore came up with the clever idea to compile all of the best tips from this contest and publish them in an e-book format. For that venture, we’d love some photo submissions to illustrate the e-book. Ideas and suggestions welcome!  Just email me here.

And now to finally get down to business: this week’s competition.  The question is…

Post your replies below, and you can win, win, win! Winners will be required to send their full mailing address and contact information so that vendors can ship prizes to them directly.

btw, multiple entries per question are OK, but each individual can only win for one entry per week.  Please don’t be shy as we have loads of prizes to give out.

We’re very excited to hear YOUR DIABETES-HOLIDAY SURVIVAL TIPS.

Happy Sharing — and winning!

Been workin’ hard on this all week.  Tune in tomorrow for the launch — we have nearly 50 great prizes to give away!

(Special thanks to Gina Capone for designing this killer-pie logo!)

See you in the AM.