Mission Aborted

Saturday, July 22, 2006 | 1 comment(s)

Abandon ship! Abandon ship!
I just saw "Pirates of the Caribbean" last night so I'm feeling a little dramatic. My feelings on the movie (in case you were wondering), unfortunately, are a bit on the tepid side.

Well, my experience with Minimed's CGMS® System Gold™ (sic) has been cut short.

I was helping a friend move this morning, and all I can say is this: IV3000 prep tape sucks. My sweating actually repelled the tape from my skin with enough gusto to pull the glucose sensor more than half-way out.

At least I got two full days worth of data collected (hopefully). It's a bummer though that I won't get to find out what 2 slices of pizza after a couple hours of sweating and moving boxes does to my blood sugar. That was some information I was looking forward to getting out of this here little experiment.

Oh well. Guess I'll have to wait until I get hooked up with a real CGM system (which I'm sure will happen one day, though I have no idea when).


Friday, July 21, 2006 | 2 comment(s)

As in: 9.8 m/s2 of force... constantly being exerted on us... day in and and day out... even when we shower. It's kinda nice, really. It keeps our feet on the ground, makes water run downhill, ocassionally makes one fall down, but then again, it also allows one to juggle things.

This relatively weak force, however, was obviously not a design concern when manufacturing the little waterproof pouches that I'm supposed to stick my CGMS System Gold into while showering.

Here's the basic design: There's a strap at the top (although the strap must first be undone by some convoluted perferations and doesn't create a nice smooth strap in the traditional sense -- no more like a bunch of kinked strips of plastic that resembles a strap (if you use your imagination)). Attached to this make-shift strap is a plastic compartment with the opening into which you insert the CGMS monitor located (for your convenience, I'm sure) ON THE BOTTOM. I'll repeat that: the opening to the pouch is ON THE BOTTOM. I really don't know much about the history of the purse, but I'm sure it's long, varied, and probably even mildly interesting. So why on Earth would anyone mess with such a basic, well-tested design?

Not only that, the opening to the pouch (located ON THE BOTTOM) is to be sealed with an adhesive
She Said
"You can use the bag multiple times. The adhesive is strong. But we'll give you three of these little bags just in case."
, not the traditional "zip" that we've come to expect (and love) from zip-lock bags.

So I stick my monitor in this bag, and rather than hanging it around my neck (which is how the Minimed rep suggested I do it (which kind of reminded me of a stewardess showing passengers how to inflate the pfd (personal floatation device) located under their seats in case of an emergency)), I hung it on the shampoo/soap rack hanging over the shower nozzle. I was pleased that there was a little hook even conveniently located for me to hang this shower purse with the opening on the bottom.

Things were going pretty well (for a while) but then in the middle of washing my hair, the damn thing broke free from the "strong" adhesive closure AT THE BOTTOM of the bag and slammed onto the shower floor.

I am cursing.

I am getting shampoo in my eyes.

I am quickly picking up the monitor.

I am dangling it out of the shower stream.

I am trying to dangle it at an angle so I'm not running water from my hand directly over it.

I am trying to rinse the rest of the shampoo out of my hair with my other hand.

I am not pleased.

I don't know what contraption I'm going to come up with for tomorrow's shower, but it sure-as-hell isn't going to be what I was given.

A Little More Cyborg

Thursday, July 20, 2006 | 3 comment(s)

Right now, I feel like I'm a little bit closer to being a real-live cyborg.

This morning, I got set up with Minimed's CGMS® System Gold™ (sic). In addition to my insuln pump, I'll be wearing this second, larger, non-detachable machine on my opposite hip for the next 72+ hours.

First impressions: This thing is bulky. It’s probably about the size of a blackberry, but rather than the thin tubing I'm used to with the pump, the wire running from it to me is more like something you'd plug into a stereo (I'm wired for sound!). Also, since I can't disconnect from it and it’s not water proof, I have to seal it in a zip lock bag contraption while showering (I can't wait
Just So You Know
That there parenthetical tidbit was loaded with sarcasm. I wouldn't want you to actually think that I'm looking forward to this experience.
to try that out tomorrow morning).

It is purported to be measuring my blood sugar every 20 seconds, and then averaging them every 5 minutes to produce 288 data points
Show Your Work
24hrs * 60min/hr = 1440min/day
1440min/day / 5min = 288 data points per day
of blood sugar readings per day. This is an order of magnitude more than my current self monitoring.

By most standards, I'm an obsessive
My name is Kevin, I've been diabetic for 27 years now, and it’s been 36 minutes since I last tested my blood sugar.
glucose tester. I currently test approximately 12-20 times per day. I record all these readings in an Excel spreadsheet which automatically plots out a graph of my daily blood sugars (see below). Looking over some of my recent charts and thinking about the data that I'm going to be getting back from this CGMS experiment, I started to think about my A1c conundrum.
In Case You Missed This
I've been puzzled about the disconnect between my average meter readings and my most recent A1c reading(s). You can read about it here in all my yammering glory.

Okay, Okay
I'll admit it. This is a pretty atypically good day.
Also, if anyone would like a copy of the Excel file I use, I'm more than happy to share it.

So, I always thought that I was getting a picture that was pretty darn close to what I'll be getting back from the CGMS data. I mean, there isn't a whole lot of room for missed spikes in here. But while looking at this chart and thinking about my A1c conundrum, a light bulb went on over my head. The average reading coming out of my meter is biased downward because when I have a low blood sugar, I tend to test multiple times in a very short period of time.

You see, on July 18th, I tested 21 times. When I calculate the average, each reading contributes 1/21st to the overall result. In reality, however, if I were to only give each reading 15 minutes worth of weight, each would only be contributing 1/96th
Showin' My Work Again
24hrs * 60min = 1440min/day
1440min / 15min = 96 15min increments per day.
of the day. So, I'm clearly overweighting my low blood sugar readings simply because I'm testing so frequently around them. When I have low blood sugars and I test in 15 min increments, I'm pushing my average lower and lower, even though I'm not really spending a whole lot of time down in that range. This is just a hypothesis, but I think it's a pretty good one.

Hopefully the data I get back (in two weeks or something (almost useless) like that) will help me figure this out for sure. I should be able to compare the calculated average from my readings with the calculated average from the continuous readings. And since I've already had a low blood sugar while on this thing and tested within 15 mins of each other, I should be biasing my average downward and should see this when I get the data back.

(I'm really, really sorry if you've fallen asleep by now. Don't worry, I completely understand - I have this effect sometimes).

Mid-year Review

Sunday, July 16, 2006 | 4 comment(s)

Well, somehow it's the middle of July already (unbelievable).

I've never been much of one for New Year's Resolutions, but this past year, I took them a little more seriously than previous years gone by. Usually, I never made resolutions. This year I made several. I wrote them down. I've been keeping track of my progress. And now I'm taking stock. Crazy, I know. Who does this sort of thing? For most (normal) folks, these things are usually forgotten by the end of January... Valentine's day at the latest.

So, I made five (5)
So I'm curious
I see this format occasionally, and I have no idea why it's used. The whole "number (#)" format boggles my mind. Anyone know why this is used? Just to avoid confusion? Only in certain circumstances? I have no idea.
resolutions this past New Year's Eve:

  1. Be a better diabetic

  2. Start a blog

  3. Read more (hopefully: a book/month)

  4. Learn more Songs (target: similarly, a song/month)

  5. Perform at an open mic

Be a better diabetic
I realize that this is a vague statement, but I had some hard goals attached to it, for sure. Specifically, I want to get my A1c below 7.0 (and if possible, below 6.5 by the end of the year). So in December I was at 7.3 -- not too far from my goal, and I thought it totally reasonable that I could hit this. In March I bumped up a little bit to 7.4 while I was working out a lot of basal rate adjustments. And then in June I was at 7.1 (Oh so close!).

But in addition, to just the A1c, I decided I wanted to become a more active diabetic -- to participate in the community, to do some fundraising, to be more informed, and more of a diabetes research advocate. All of which I have done. I (shockingly) raised over $3,300 for the JDRF walk in May, I've attended some more Capital Chapter JDRF events and meetings, I went to the Children With Diabetes Quilt display and the ADA's Call to Congress, and I'm wearin' an "INSULIN IS NOT A CURE" advocacy bracelet (which were being given out kindly by the Children With Diabetes folks). AND, I went to the Diabetes Sports and Exercise Association (DESA) Meetings in North Carolina in June.

So, I'd say I'm doing pretty well on this resolution, but I'm still working to hit my A1c goals.

Start a blog
Done and done.
This one kinda also fits into the "becoming more of a participant in the diabetes community" bit mentioned above.

Read more
At the end of last year, it took me 3+ months to get through a fluff book ("Skinny Dip" by Carl Hiaason), which was just ridiculous. I resolved that things would be different this year. My plan was foolproof: only read thin books ("Gravity's Rainbow" and "Ulysses" will probably have to wait yet another year before I'm ready to pick 'em up). I didn't really stick to that plan, but I have read some rather not-so-difficult books lately.

So far:
  • Jan: "Blink" by Malcom Gladwell (fluffy pop-psychology that I kinda liked, but then when I stopped to think about it, there were a lot of holes in his whole premise)

  • Feb: "Think Like a Pancreas" by Gary Scheiner (a decent refresher on intensive diabetes management)

  • Feb/Mar: "The Polysyllabic Spree" by Nick Hornby (a fun collection of essays in which the author details every book he buys and every book he reads in a given month -- man, someone without a day job can really plow through a lot of books!)

  • Mar/Apr: "Freakonomics" by Steven Levitt (fun, geeky, economics/sociology)

  • (Oddly, no fiction in the first three months of the year. I'm usually more into fiction than non-fiction).

  • May: I bit off more than I could chew. My plan was to kick-up my Spanish studies at the same time as keeping up with my reading plan. I decided I would read "The Da Vinci Code" and "El Codigo Da Vinci" at the same time - first a chapter in English and then the same chapter in Spanish. I think I made it 70 pages in before I dropped it. I'm not sure I'm willing to concede that I've given up, just yet though. Perhaps I'll get a second wind in August or something crazy like that.

  • June: "Don't Make Me Think" by Steve Krug. (An easy (as it should be) book on web design and user interface, a good read).

  • June/July: I've been all over the map. I've currently got 3 or 4 books going.

    • "The Diabetic Athlete" by Sheri Colberg Phd. (I ordered this after seeing her speak at the DESA conference. Some good info in the beginning on metabolism and exercise, but then a ton of sport-specific recommendations. Seems more like a reference book, perhaps).

    • "The 7 Habits of Highly Effective People" by Stephen R. Covey (Not sure, exactly, why I'm reading this. Curiosity, I guess. What's it all about? Does it work?).

    • "Oblivion" by David Foster Wallace (collection of short stories - I just restarted one that I didn't finish some time back).

    • "Travels with Charlie" by John Steinbeck. This one's got me now. The writing is beautiful. A memoir about Steinbeck driving around the US in 1960 with his French poodle. I've got numerous pages dog-eared because of passages I want to go back and re-read already. Oh, this is good stuff (thanks, Cori).

Although I suffered a minor set-back with the Da Vinci Code (that was almost too embarrassing to even type), I think I may stay on track with the current summer reading (if I make it through even half of the 4 books I've currently got going, I should be good).

Learn more songs on guitar
Again (completely arbitrarily) the goal I set was 1 new song per month. I was playing more guitar in the beginning of the year, but mostly making up stuff for my own enjoyment. This habit significantly hinders my desire to be able to play more than a few songs from start to finish.

So far:
  • "Corcovado (Quite Nights)" by Antonio Carlos Jobim. I focused for a while at the beginning of the year and re-learned this one, but I recently tried playing it again, and I was completely rusty and forgeting parts. Oh well.

  • "Don't Be Afraid of Your Anger" by Clem Snide (easy chord progression and witty lyrics - my favorite kind of song!)

  • A while back I tried to learn "A Naive Melody (This Must Be The Place)" by the Talking Heads. The Talking Heads version is (as would be expected) very layered, complex, and funky. But Shawn Colvin has a real nice stripped down version of it that I was trying to learn (and even more stripped down since I was just playing the chords rather than learning a picking pattern for it). The chord progression is painfully simple, but my vocal delivery was never any good (I don't have a good voice to start with, and I'm not as esoteric as David Byrne nor do I have as pleasant a voice as Shawn Colvin. I was just randomly moving the capo around trying to find somewhere that worked for me but then gave up.

  • "Naked As We Came" by Iron & Wine. (I was completely transfixed by this song when I saw the movie "In Good Company." I ran out and bought the CD that week and spent many (many) hours learning the picking pattern. The lyrics are sparse and some would say depressing, but I find them to be kinda sweet. This was March when I started learning this one, and I haven't really worked on anything new since then.

Not really what I was hoping for on the new song initiative.

Perform at an Open Mic

I half-heartedly made this resolution last year (and didn't meet it). Seems I might be looking at a repeat performance, especially since I haven't been learning new songs, nor really working on the ones I know already (which is really the stuff to be working on if I want to get up and perform in front of people (which is a huge fear I will one day (hopefully) face)).

All-in-all, not bad, really. It's been a busy 6 months, and I'm sure the next 6 will be just as busy. Busy is good. I just wish there were more hours in the day.

Top Nine

Sunday, July 09, 2006 | 11 comment(s)

Top Nine
Top Nine? Yeah! Why the Hell Not!?
A "Top Ten" is so Lettermanesque and decimal centric. Nine, being a square and everything, is a much nicer number. But oh!... One of my favorite poems is about the number 10 (though that (along with the fact that I couldn't think up another complaint) isn't enough for me to go the conventional route with a Top Ten list) : "On Turning Ten" by Billy Collins. Well worth reading (even if you're "not into poetry" (which, honestly, I'm not very much, though I try sometimes)).
Reasons I need to Find a New Endocrinologist:
(In no particular order (don't let the numbers fool ya!)).

  1. I still have to go to a lab
    In Other News...
    She did just call me back (after first my making two phone calls to her office) with my most recent lab results: 7.0 at lab #2 vs. 7.1 at lab #1 two weeks prior. So, I'd say probably a statistically insignificant difference. Which, on the one hand is nice (robustness and consistency are fine characteristics for lab results), but on the other hand, I'm still puzzled about my average plasma glucose readings from my meter vs. my A1c score conundrum. Oh yeah, and the hemoglobin electrophoresis test revealed no abnormalities, so that's good too.
    for my A1c test rather than using an in-office machine (though I would still have to go to the lab occasionally for a lipid panel).

  2. When I asked her if she went to the ADA Scientific Sessions when they were in town she said "No! I never go to them. I hate the ADA Sessions."

  3. She didn’t know
    Ya know...
    It just doesn't feel right when you're educating your own doctor about the current technology out there for diabetes care. Perhaps if she'd gone to the ADA Scientific Sessions she'd be more up-to-date (just a thought).
    what the Dexcom STS was and told me that continuous glucose monitors aren’t approved for long-term use (what rock has she been living under?).

  4. When I take a log book to her, she focuses in on the worst readings and wants to know: "So why did your blood sugar go up to 285 after lunch here
    It's Kinda Like
    Sitting under a hot lamp and being asked: "Where were you on the night of April 23rd, 2006 at 8:06pm? (and what was your blood sugar reading then and why?)" Let me tell ya: feeling like you're being interrogated is NO fun.
    ?" and then shortly followed is: "Perhaps we need to change your carb ratio." Forest for the trees, ya know? Better questions, perhaps: "What's your average blood sugars look like post lunch?" Or: "How often do you have such a big spike after lunch?" But always focusing on minute details and picking out my worst moments to lecture me on really puts me off on the defensive and I end up clenching my jaw and can actually feel my blood pressure rising.

  5. She doesn’t check my feet unless I kick my shoes off and initiate the inspection (I had an endocrinologist once tell me that any endocrinologist that doesn’t check your feet at each-and-every visit should be fired on the spot).

  6. Her online faculty page lists her specialties as "Obesity, Polycystic Ovarian Syndrome and Osteoporosis."

  7. When I told her I was feeling depressed about my diabetes she laughed
    I Shit You Not
    She laughed.
    She said: "Look at you!"
    "You don't look depressed!"
    "You're not depressed."
    All with a giggle in her voice.
    at me.

  8. She didn’t know anything about whole blood and plasma differences in meters and didn’t know that the OneTouch Profile II (the meter that I was using) didn’t make the correction for plasma equivalents.

  9. She has actually discussed astrology with me.

To be fair, however, she has provided me with a few good services:

  1. At each appointment, I have her (almost
    For Some Reason
    Almost without fail, she takes a phone call in the middle of everyone of our appointments.
    ) undivided attention for at least 30 minutes. The endocrinology clinic I've been going to is at a "teaching" hospital, and so my usual experience with previous endos there entailed my answering the SAME, IDIOTIC questions by green residents who have never seen my charts before for about 15 mins. (Q: "So, you've got diabetes and you use insulin..., is that correct?" A: "URRggghhh") and then getting maybe 10 mins. with the actual doc.

  2. She has put me on lipitor and my lipid profiles are now a specimen of beauty (though they were never really bad before).

  3. She has also started me on a prophylactic dose of ACE inhibitors, which I think is probably a good thing.

But on net, I'm thinkin' I'm in the red here. I was given a few recommendations, and I tried to make an appointment with one doc, but she was booked solid for 3 or 4 months. I think I'm going to shop around some more, or try to make an appointment again with the one I tried before (even if I have to wait until December to do so).