Just when I thought I’d experienced every indignity and inconvenience this disease could dish up, along comes basal testing.

I’ve had the Big D for almost seven years now, and I’ve always been told never to skip meals (a good thing too, because I need my meals!). At the same time, I know you’re supposed to test your basal rates periodically to make sure your background insulin is doing what it’s supposed to. Admittedly, I haven’t ever done that pesky basal testing stuff… until now.

A few weeks ago, I was privileged to start working with well-known certified diabetes educator Gary Scheiner, who is one of our Design Challenge judges this year. Gary offered me his CDE services on a trial basis, as his company is developing some new techniques and wanted a Guinea pig to test them out.

Lucky piggie that I am, my first challenge working with Gary was to start basal testing, “since you can’t start fiddling with bolus adjustments until you’re sure that basals are set right,” as Gary says. Gotcha.

First off was the through-the-night testing segment. I was to eat dinner and dose by 7pm, and then test at 11pm, 2am, 5am and 7am — which wouldn’t have seemed so daunting if my husband didn’t abhor my alarm clock so. It’s a Japanese LCD model I bought off Overstock.com, and the alarm tone is, well… obnoxious. But I like it because of the big, clear, backlit screen and easy-off buttons. You should’ve heard the groans that first night! (not from me)

And too bad for me again because I blew it in Round 1: I was running high all night, and kept administering correction doses, not realizing that that automatically ends the basal test right there.  Engaging in Round 2 the very next night took me back to the Infant Days: bleary eyes from being rudely awakened every few hours all night long — ugh! Luckily it went much better, at least on the diabetes side (I was forced to renounce my Japanese alarm clock).

Next, I was supposed to start skipping meals, one by one, for further evaluation of basal rates.  Skipping breakfast. Now does that sound simple to you?

It’s sort of equivalent to, I don’t know, say… the end of the world, for me. When Gary asked me not to eat until 1pm, I just about had a conniption fit. I emailed to explain: I’m one of those people who MUST eat right away when I get up in the am … When I have to do fasting lab tests, my hubby practically has to carry me into the building. Not good.

“Be brave,” Gary replied.

Wha? Next email:

Gary, I don’t think you fully understand. This has nothing to do with being ‘brave.’  I talked it over with my husband, and he’s not keen on me doing it — but if so, then we need to plan carefully for a day when he can fully take over feeding the family in the morning and I don’t need to go anywhere.  It may take a little time before the ’stars align’ for this.

Guess what? We moved on, to the skipping-dinner-segment.

That went pretty well, since I distracted myself by planning it on a night when hubby and I were invited to a cocktail party. I drank Diet Coke only, and steered far, far away from the food tables. I tested dutifully at 5pm, 7pm, 9pm, and 10pm. After that I was allowed to eat. Tuna salad never tasted so good.

My BG levels dropped off a little too sharply at the end, so we reduced my basal from 9-10pm. That’s some serious fine-tuning there, Gary.

Next up, skipping lunch. I am not looking forward to this one, either, in which I’m not to eat or drink anything with calories between 8am and 4pm — with testing at noon, 2pm, and 4pm. I’m hoping for a day with a really good distraction. Any suggestions, my D-Friends?

Whine, whine, whine, I know. I am well aware that most people living with chronic illnesses have bigger problems than being asked to skip a meal now and then. I just find it unusually unpleasant. And it’s the additive effect that gets to me: the constant testing and dosing and correcting, carrying all the backups, the midnight lows with the sweating and the unwanted eating, and the bouncing back up way too high — not to mention the fact that other people can eat and do as they like without all this crap (just ask Kris Freeman).  Grrrrr.

Do not. Like. Basal testing.

Hate. Diabetes.

OK, I’m done for today.

As you all hopefully know, the 2010 DiabetesMine Design Challenge is ON. We opened for entries last Monday.

I’m excited about community voting this year (y’all get to choose the competition finalists). I’m equally delighted to have such a wonderful panel of expert judges whose role will be to determine the winners from your list of Top 10 finalists.

A new face on our Judges’ Panel this year — but a familiar one around here — is the famous certified diabetes educator (CDE) Gary Scheiner, author of Think Like a Pancreas. (I also just began working with him as a patient myself – so cool! More on that tomorrow.)  Today, Gary kicks off our series of brief chats with each of the Design Challenge judges:

DBMine) As a CDE,  do you find that diabetes patients really care about the design of medical devices?

GS) I’m lucky to work with patients who really do care about device design.  They’re the type of cutting-edge people who realize that diabetes needs to integrate into their lives, and not the other way around.

Gary, you live with type 1 diabetes yourself, and are constantly hooked up to a pump and CGM system.  How could better-designed gadgets and programs potentially improve your own life?

I think some of it is psychological.  Doing the same thing with the same tools day in and day out becomes monotonous, and we tend to become lackadaisical about our care.  Keeping things fresh helps to maintain our interest, which allows us to keep our focus.

What advice would you give to an amateur out there who has a great idea for a diabetes tool?

Get seed money.  Lots and lots of seed money.  Bringing a product to market is an expensive process.  You can start out by entering and winning the Design Contest at DiabetesMine!

We’re thrilled to have you as a judge this year.  Again as both healthcare professional and patient yourself, what would you most like to see materialize out of this contest?

I would like to see something with real practical value, not just something that looks/sounds cool.  I still remember the “Lasette” device that would prick your finger with a laser beam rather than a metal lancet.  Sounded great, worked terrible.  It was huge, hurt like heck and left the smell of burnt flesh in the air.  We don’t need contraptions like that.  We need things that solve real problems.

Thank you, Gary. Practical is definitely top of mind.

Following my series of interviews with Kris Freeman, I got a note from competitive cyclist Phil Southerland, founder of Team Type 1.  He wanted to let me know how well his group of athletes with type 1 diabetes have been performing so far this year.

Phil was concerned that the mainstream media coverage of Freeman’s challenges may have stirred up “a lot of negativity about diabetes.”  So he asked me if he could submit a piece here to show that being prepared, and working hard at it, diabetic athletes can not only compete, but also WIN endurance sports. “I want to bring some positivity back to diabetes, and thought you could help us do it,” he writes.  All I can say is, MY PLEASURE. Please enjoy Phil’s treatise today:

A Guest Post by Phil Southerland, founder and CEO of Team Type 1

The 2010 bike racing season started off with a bang for Team Type 1. Matijn Verschoor won the first race in the 2010 Greenville Training Series closely followed by Justin Morris in 5th place, Olaf Kerkof in 9th, Joe Eldridge in 11th and Stradford Helms in 12th.  While this would be a great result for any team this early in the season — it is even more exciting to see these athletes with diabetes perform so well in competition.

Winning with diabetes is arguably harder than winning without diabetes. Fueling for peak performance is one of the keys. It requires a plan to fuel before during and after a race that is part practice, part science, and part personal preference.  I’ve seen some strange diets in the peloton.  For all the gels and bars, there’s always a PB & J in the mix for someone.

I think that it’s a good time to have diabetes. The medical technology available to athletes with diabetes is the same for local amateurs to world-class performers in sports from baseball to bike racing. It can enable athletes with diabetes to stand on the podium.  And we do.

Continuous Glucose Monitoring devices take the guesswork out of fueling for and during an event. My team is sponsored in part by the FreeStyle Navigator brand.  Information from the device helps athletes make the right choice at the right time for what to eat to keep the pace up and stay strong. I encourage athletes that I meet to work with their medical care provider to discuss options specific to their unique needs and management plans that to help them achieve outstanding results.

The key to our athletes success is being prepared.  Our guys know what to do if their blood sugar rises, but more importantly they ALWAYS have food on hand should they see a “projected low” glucose.  Starting  a race without spare food is like skydiving without a backup chute.   That’s why our athletes always go into races with plenty of Dex4 glucose (also a sponsor) — the quickest way to prevent and/or fix a low.

Team Type 1 has expanded to nearly 80 athletes across 6 teams in the past five years.  We’ve had great results are raising awareness of what athletes with diabetes can accomplish. I’m excited to start 2010 on such a high note and continue to strive to put a rider with diabetes into the Tour de France.

That’s a pretty lofty goal, Phil. If anyone can do it, you can!

Disclosure: I do not know for sure whether this company intends to enter this year’s DiabetesMine Design Challenge competition (although I hope so!); I’ve simply been corresponding with the co-founder for several weeks and find the product interesting — and hopefully inspirational for all fans of diabetes innovation.

A small company in Finland called Mendor has caught the diabetes-consumer-design bug.  The glucose meter they’re developing by the same name bears a striking resemblance to a cellphone, with the lancing device and test strips built right in, making it extremely portable and easy to use. God knows I’m a big fan of all-in-one D-products that reduce our hassles.

I like the look and feel of this meter, and the ease of use.

And yes, it’s a lot like the OnQ All-inOne meter from Intuity Medical, which has $64 million backing its push for FDA clearance at this time.

Competitor from Intuity Medical

Like the OnQ, the Mendor all-in-one meter is convenient and discreet. It requires no carry case or any other extra components (separate lancing device or strip vial).  It fits easily into a pocket or purse and it can be used for days and weeks without no need to frequently reload strips (depending on how many strips you use per day).

The Mendor device is also fully mechanically operated, so there is no noisy electric motor or beeps.

The “magic” of Mendor is apparently the unique web-based data logging software that comes with the meter. According to the company, it “is not like all the log books out there, but rather helps diabetics at home and professionals at practices to determine the current state of patients treatment with a couple of easy steps.” Since it’s not out yet, the real benefits of their program remain to be seen. But I like their thinking, anyway.

So it gets high marks on form factor and user-friendliness, but there are limits to the innovation here; no wireless technology is employed yet, and no — the meter does not interact with any pumps or CGM systems, even via cable at this time.

And now to real-world adoption issues: the biggest open question is pricing for patients — make-or-break in my book. According to the company, exact test strip pricing is not set yet. Assuming strips are loaded on a cartridge, how many will each cartridge contain and what is the cost??

The Mendor meter and software will be launched in Finland and EU markets during 2010. USA launch is planned to take place during 2011, so let’s keep our eyes peeled: how will they fare vs. Intuity’s device? Or something else, even cooler, that might come out of this year’s Design Challenge?

Admittedly, I’m a bit tardy here in publishing the final installment of my Winter Olympics conversations with cross-country skier Kris Freeman.  He has type 1 diabetes and was America’s best hope for a medal in his sport in Vancouver this year — but alas, things did not go well for Kris this time around.  He suffered a BG low in the 15k, his best event; fell far behind in the 30k; and ended up dropping out of the 50k last Sunday, as the Olympics came to a close.

I spoke to him on the phone that day, as his driver tried to navigate his way to the airport through throngs of reveling Olympians.

DM) Kris, if there were ever a time when you felt cursed by diabetes, I guess it would be now….?

KF) My whole thing is that you can do anything with diabetes, but sometimes it is harder.

This week one of my races was affected by diabetes, but it’s hard to say how much the others affected by it. I have very little answers about what went wrong right now. I was sitting with my coach for last couple of hours talking it over…

Having diabetes definitely throws another variable in there, but it’s a challenge I’m going to continue to tackle.

It must be really difficult to tell where diabetes issues leave off and other barriers to optimal performance kick in?

Well, (on Sunday) I didn’t have any diabetes issues at all. I just felt like I was running on empty.

I don’t have any regrets about finishing the (15k) race after that low, but I haven’t been feeling the same since.

I’ve been ski racing with diabetes for the last 10 years, and I’ve had the most media attention ever in the last two weeks.  And it was the worst time of my career. That’s unfortunate, because that’s not the message I want to send out there — that diabetes makes it impossible.

I messed up my blood glucose once and other than that, I was just flat and bad.

You’ve said you didn’t want a “DNF” (did not finish) in the Olympics, but you didn’t complete the final 50k race on Sunday.  What happened?

The reason I stopped that race was not that I couldn’t continue. It was just clear at the halfway point that the chances of scoring a medal were gone, and competing for nothing just made no sense. I felt out of shape — and I was emotionally and physically drained.

What’s next for you then?

My coach and I decided it’s best if I go home now, rather than going on to the World Cup event in Finland. This week has been exhausting. The last three races were so far off the mark for me, we don’t see any point in my continuing right now.

I will go to US Nationals in Maine at the end of March; I believe I can turn the corner and get back into shape by then.

I got a cold after the last race. I feel I’m susceptible to illness at the moment. And I’m not in the best frame of mind right now.  Just going home and getting back in shape is best — sleeping in my own bed.

Still, it must have been the experience of a lifetime. What was it like just being in the Olympics?

The organization was great. The Olympic Village was great. It’s always amazing to be around the top athletes from around the world — always a good atmosphere. I just wish I could have added a little more to it.

But Gary Hall Jr. (Olympic swimmer with type 1 diabetes) says the food choices there are especially challenging for diabetics…?

This time around the food was quite good. Anyway I’m used to having to make careful choices with my food. But that was definitely an issue for me in Torino.

It’s always a little frustrating because I’m around hundreds of athletes who’re hungry and don’t have to think a thing of it.  They can down a quart of Gatorade all at once and not think twice.

What are some of the particular challenges of being diabetic and training with other athletes who are not?

It is a much different deal. Sometimes I do look over at my teammates with envy when we finish a workout and they whip out a Power Bar and a quart of Gatorade and down that in about three minutes. That’s about 115 carbs right there, and I just can’t do it that way.

What’s really hard is when we’re on the road. The hardest thing is balancing food and insulin needs between racing as hard as I can for 2 days then sitting on airplane going to our next event. The levels of activity are so different and my insulin needs change so rapidly.

Will you be employing some new D-tools when you get racing again later this month?

I realized that most of my training and most of my data is built around the 15k race – which was by far the most disappointing I had here. We’re gonna work up some new tests, and I’ll get my hands on a CGM as soon as possible and use that as best as possible.

What about connecting with other diabetic athletes — like competitive cyclists and triathletes — to share CGM strategies?

I’m open to anything at this point. It really depends on the level at which they’re competing; it’s not just about finishing a race. I want to lead and win races.

So was switching to the OmniPod pump a good choice for you?

Pumping is definitely an easier way of controlling your glucose levels, just because of being able to change the basal rates at any time.

I definitely feel like at this point that I haven’t learned how to use it properly in the 30k and 50k events.

If I made a mistake it was that once I had the 15k figured out, I thought it would just be a variation of that. But twice the distance really changes your insulin needs.

And the Pod stays on without any trouble?

Yes. I always shave the area that I put it on to maximize adhesion.  I also always thoroughly alcohol the area to remove any body oils.

I wear it on my chest sometimes, on my upper pecks. I haven’t noticed any differences in absorption between my arms and chest.

You should know that you’re still an inspiration to all of us with diabetes! You should feel good about your efforts…

I do feel good about it, but I try never to think about myself as a ‘diabetic’ person. I don’t ever like to think, ‘I’m doing OK for a diabetic.’

Diabetes is part of who I am, but it’s not the way I identify myself.  I have very little doubt that I’ll be back at the Olympics in four years, and I’ll have that much more information next time around.

Will you continue to act as a Goodwill Ambassador for Eli Lilly?

I’d very much like to continue the relationship with Lilly. I love that they send me to diabetes summer camps. They put me in a position to make a difference.

And you use their products?

I’ve been using Humalog insulin for 10 years and I have no plans to change at this point.

I know this is a tough moment for you.  Do you have anything special to say to the diabetes community?

I just want to reiterate that having a top result in cross-country skiing involves so many variables, and diabetes is just one of them. I’m not blaming that at all. Other things went awry. Sometimes you do your best and it still just doesn’t happen — and that’s what happened this week.


Thank you again being so candid, Kris. We hope you do know that you truly are an inspiration to PWDs all over this country, and beyond.