Trust Yourself

I saw my endocrinologist just three days before the beginning of the new year.

In the hustle and bustle of the last few weeks of my first semester, I may have let my diabetes care slide a little bit (read: like WHOA). Something about the stress of finals and staying up all night leads to intermittent to non-existent finger sticks along with copious amounts of diet coke and nothing but take out dinners. There were definitely days when I only checked what my blood sugar twice and saw numbers floating in the 200s and 300s (if ever you were curious, stress does make your blood sugar rise). I leaned heavily on my Egg-shaped friend and took somewhat random correction boluses. This routine disturbingly echoes my diabetes managements techniques as an undergraduate, except I didn't have a continuous monitor to keep an eye on my waxing and waning sugar levels.

Between celebrating that school was over, driving up and down the northeast, and trying to unwind, I completely forgot about my appointment. Somewhere in the back of my head, I knew there was some reason I hadn't made any plans for travelling or adventuring with friends for that Thursday. When the receptionist called, I mumbled my affirmation that I would be there. A mental image of a mostly empty spreadsheet appeared in my mind instantaneously. I didn't even pause before thinking my HbA1c would be somewhere between 7 and 9. The worry and fret weren't far behind.

I always want to be doing my best. If I can walk into my doctor's office knowing I've been trying, I don't have anything to fear. I can hold my head up high and answer any doc's questions. But this appointment was different. All I had to show were a bunch of excuses. Life gets in the way sometimes, but my good health gives me the ability to do more.

All bundled up, I walked into the office and handed the receptionist my dismal looking log. After a few minutes of waiting and watching dLife clips (love seeing people I "know" and know of on television), the nurse called me in. We went through the weight and blood pressure routine while exchanging niceties. She laughed when I told her I was a professional pin-cushion as she checked my blood sugar and loaded the on-site HbA1c tester. My doctor walked in a little hurried looking while the tester was still counting down. We chatted a bit and then she said something about not wanting to make any changes to my basal rates since she trusted my abilities to do so, she didn't have a log to look at, and my HbA1c hadn't changed much. I was so taken aback that I didn't notice or correct her about the log. In the 4 months at school and the crazy stress of finals, my HbA1c had only risen 0.2 points, which is well within the error range of those machines. She wished me well after my brief verbal and physical examination and was on her way out after before the full realization of that sunk in.

I don't usually make New Year's resolutions, because they are very rarely kept. This year, however, I'm very determined to make and keep a very different resolution. Do I want to lose weight? Yea, but that can be tackled later. Right now, all I want to do is trust myself more. I want to trust my behavior. I want to trust that I'm doing my best. I want to trust and have faith for better results than the rational side of me would expect. Because stressing and worrying about what's coming isn't healthy for anyone. My resolution for 2012 is to believe in me, to believe in good things, and to believe in optimistic outcomes.

Monkey Wrenches

Life has a funny way of putting obstacles in front of you in order to see how high you can jump. This week is not particularly pleasant for me because of a Cell Biology exam I have on Thursday followed by a poster presentation with a fellow graduate student on Friday. This is kind of the norm of graduate school so I can't say that I'm terribly surprised, but I am a little disappointed to not be more out and about advocating for the American Diabetes Month. I've had to give up my facebook and Twitter feeds for a few days and it's kinda killing me (Yes, I'm one of those poorpeople who's addicted to social media...). I still read a few here and there but doing my best to stay focus is sooo difficult even when I'm in the "zone".

In the moments in between studying and programming and sleeping and sometimes eating, I've managed to at least participate and get the word out about a few really awesome Diabetes Awareness activities everyone with diabetes (and without) should know about. For instance...

• The BIG blue Test! or the big BLUE test! or the big blue TEST! (see what I did there?)
  I was in NYC helping out while they were shooting this awesome chick. (yea I'm hiding somewhere in those group shots). You don't have to have diabetes to participate. You just have to move. What's the reward? IMPROVING YOUR HEALTH! and SAVING LIVES! In the good old US of A and across the globe. All you have to do is exercise for 15 minutes. No silly signing up either! Check it out at www.bigbluetest.org
• Blue Fridays! With awesome giveaways! Even doable on rainy days! Bonus points if you wear blue everyday?! (okay, no more rhyming. I promise)
  Every Friday in November, wear a little or a lot of blue to raise awareness! In your hair, on your nails, with your friends...T-shirts, socks, and bathrobes will do too! Check out the Facebook page here! and follow #bluefriday on Twitter!
• Team Type 1's Run Across America
  If there were ever a group of people I'd follow off a cliff, it would probably these 10 (or 11) guys. Phil Southerland (the CEO) is a great guy, and he's a constant reminder that diabetes doesn't hold any of us down from surpassing our dreams. This group of diabetic athletes is running from coast to coast, and they are estimated to land in NYC on November 14th!
• Blood Sugar Testing Flash Mob in Times Square
  I'm gonna try my darnedest to make it out to Times Square for a Blood Sugar Testing Flash Mob in Times Square on noon on Sunday, Novemeber 13th in front of the Kodak screen. If you can't make it, help out this fantastic young man by sending a picture of you and your friend Diabetes to kodak@aerva.com to be there in spirit!
• World Diabetes Day Postcard Exchange
  Art is always therapeutic, but in this case, it's doubly so because I get to reach out to someone. I was assigned an awesome PWD (or their family, friends, and awesome associates). I get make some art for them. And then I'll get one. Let's hope it's something that doesn't turn out like those finger paints when I was three...
• World Diabetes Day
  Blue Monuments. Diabetes Awareness Events. Reach Out and Hug A Diabetic Events... I may be trapped in class all day, but I'll do something awesome for it all on my own if I have to!

Alright. I have another story to share but it's going to have to wait. Wish me luck on my test.

Technology: Benifits and Drawbacks

So I'm a biomedical engineer (BME). When I started college, I really wanted to be playing with stem cells, but I picked the school who's BME program was all biomechanics, aka movement analysis and prosthetics, because they gave me lots of money to go there. As I took more and more classes, I realized I really enjoyed bioinstrumentation, aka fancy medical devices, because on any given day, I can be found carrying at least three of them on my person.

I was psyched when I saw that the DSMA (Diabetes Social Media Advocacy) was hosting a discussion week about medical devices. Unfortunately, because my social life is sideways and upside down in the summer, I haven't been able to join in to any of the convos. but I read the transcripts and try and listen in on at least some of the radiotalk on Thursdays. Then, I found out that it was this month's blog carnival, and I've been scheming about what to write about since I saw it. **I go back and forth with a lot of these issues because while I understand why they exist, I still think it sucks**

Because I'm on the up and up (I think) on how device development works, I know that bringing serious innovation forward to existing devices is hard. Partly because of how the FDA approves changes and partly because of how big business works. After that comes all the cool stuff I'd like to see happen with our current D technology.

Regulation of medical technology is hard. Period. It's a little backward in the US but it's not always better in other countries either. EACH country has different approval mechanisms. Some are easier and believe it or not some are harder to gain regulatory approval. So yes, while I'm jealous about the Animas Vibe coming out in the UK, I understand why they started there.

Regulatory approval is like those car seatbelt alarms. While they annoy the daylights out of you and they're pesky, the ONLY reason they're there is to help keep you alive. They're not really trying to hold back innovation and cool new technologies. They exist to keep us safe from medical fiascoes like the Pinto (read car that burst into flames) for the car industry. Also keep in mind, while some of what they do and their procedures make no sense, NOTHING in the medical or political world is close to perfect.

So the big bad world of big business makes it really hard for a basement tinkerer to come up with something really cool in terms of D-technology. They have lots of money and lots of resources. When larger companies absorb smaller companies, sometimes awesome things happen and sometimes awful things do. This goes back to the previous point but it's really tough and expensive to win regulatory approval as a small firm between the amount of money for the trials and the amount of paperwork to ensure you actually thought the idea through. A lot of times people have to sell their ideas to bigger companies so that they make it to the hands of everyday people like us. I was a little sad when I read the Deltec Cozmo pump (pump with meter attached) was going out of business because I was so psyched at how different it was from the other major pumps in the market. While I don't know their reasons, I do understand the pressures from a very competitive market.

As far as my hopes for D-technology, I'll break it up in 2 ways: Near Future and WAYYY out there. Everyone thinks that smaller is better when it comes to technology (see anything about cell phones and mp3 players). While smaller is cooler in some cases, bigger is also better too (especially for the older peeps with D). There are some populations of people with D that don't get as much attention as they nearly need. The two in my mind are the uber-technophiles like me and those kids who are diagnosed early on (because if I see a commercial selling my diabetes supplies with medicare once more, I may scream at the TV about how I'm not old enough for that by decades).

As far as technophiles, there's tons that we wish we could do with our D-technology. 1 integrated device to carry around instead of 3 or 4 would be awesome (are there security concerns? sure, but can't we decide our data risks personally?). Looking at our data in different forms and playing with it find trends that important to us. Customizing our devices sometimes plays a big role (see bg meter via iphone). I think someone brought up the incredible point of putting a light where the strip goes and the blood gets sucked in so we can test in the dark (think movie theaters, bedrooms, camping trips). Even some fluorescent or glow in the dark action on strips (I know you're supposed to keep them in a cool dark place but still) would be cool. It amazes me that not all pumps come with remote controls and there aren't smartphone widgets for inputting d-numbers to track. I HATE that I have to put carbs and bgs into my pump and then my dexcom. If tracking is SO important, why do they make it so impossible? I want more options. Can't we decide how complicated or simple we want our medical devices to be? I can get a less powerful version of an iphone for less money than the brand new one, but I can't do that with my medical devices? Can't I upgrade the processor or order more software to tinker with it myself at MY OWN RISK? (Although to be honest, I think that's more the FDA then the companies)

For kids? It's been a while and I was diagnosed close enough to puberty that I've always been pretty much the same size. But I met a d-dad at an interview who was telling me about how disappointed he was that his son couldn't live with an insulin pump because it's too big for him. With all of these miniaturization and customization skills that companies have, they haven't figured out how to make pumps and devices sized for kids. Ones that have smaller reservoirs and fewer options than the regular-sized adult ones would make their lives that much easier. They've started coming out with cellphones for kids that can gradually be transitioned to real phones. Why don't they have grow with you insulin pumps targeted to the ages of 0-12 years?

There are also things that most diabetics are disappointed and confused by. Like the accuracy of our testing devices. Why can two identical meters be so far off? (Variables. Temperature. Test strips. Tolerances in device specs. Testing locations. Blah blah blah. Seriously?) If we can send people to space, why can't I test my blood sugar when I'm snowboarding because my meter is too cold or at the beach because its too hot?

As far as the future, I'm right there with everyone for a cure or at least an implantable pump. I understand the difficulties with reservoirs and batteries as well as scar tissue and glucose monitoring physiology. I just would love something that would make me worry less 24/7. I'd be happy to forget that I have diabetes for more than an hour (most days, not even that).

I know that technology isn't instant like microwave noodles. It takes time and money and a lot of innovative minds. But I can't lie and say that I don't want more. More accuracy. More options. More simplicity. More sizes. I want more, and I want it soon.

This post is my July entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2011/july-dsma-blog-carnival/