I’ve mentioned my “catch-all” Google Reader query for “diabetes” before, right? Right. As you can guess, most of the stories over the past couple of weeks have dealth with the FDA and Avandia. There’s been a lot of talk about the FDA’s ruling, and subsequent actions, but that’s not what this is about. Although, it does involve the FDA.

Today’s Google Reader overload included some mentions of a little company called “Abbott Diabetes Care.” Check this out (and I quote):

“This inspection revealed that these devices are adulterated within the meaning of section 501(h) of the Act, 21 U.S.C. 351(h), in that the methods used in, or the facilities or controls used for, their manufacture, packing, storage, or installation are not in conformity with the Current Good Manufacturing Practice (CGMP) requirements of the Quality System (QS) regulation found at 21 CFR Part 820. We received your response dated March 26, 2010, in addition to responses dated April 23, 2010 and May 25, 2010 from Mary C. Getz, Division Vice President Quality Assurance and Compliance, concerning our investigator’s observations noted on the Form FDA 483, List of Inspectional Observations that was issued to you. We address your March 26, 2010 response below, in relation to each of the noted violations. These violations include, but are not limited to, the following:”

Key words to focus on are “not in conformity” and “violations”. In a nutshell, the FDA isn’t too pleased with how Abbott is manufacturing its glucose meters. Aside from the part where I have a FreeStyle Flash (Bart Allen), my concern is that the average, unassuming person with Diabetes may never hear about this. The full text of the letter can be found at FDA.gov, but I can’t imagine this is something Abbott would actively promote. Hey everyone! Look what we got in the mail today! For the less informed, they will never hear about this, they will never know this ever happened and they could carry on, using a potentially faulty device that is supposed to be the primary technology responsible for their Diabetes management.

Here’s another nugget: “Please notify this office in writing within 15 working days from the date you receive this letter of the specific steps you have taken to correct the noted violations, which may include notification of your current and past customers. Your response should also include an explanation of how you plan to prevent these violations, or similar violations, from occurring again.  Include documentation of the corrective action you have taken.  If your planned corrections will occur over time, please include a timetable for implementation of those corrections.  If corrective action cannot be completed within 15 working days, state the reason for the delay and the time within which the corrections will be completed.”

I don’t ever recall registering my meter with Abbott or any other entity. How can they possibly reach every customer of their devices? I fear for those who lack the resources or ability to stay informed. I fear for those who are just trying to get through the day without a hassle, and don’t have the time to look up and assess a situation. I’m talking about this on a blog that will be read by people who have just as much if not more access to this kind of information than I do, what about everyone else?

Also, on a lighter note, I fear that if I have to replace Bart Allen for a new meter I wont be able to think of a clever name to keep with my super hero theme. It really is perfect: FreeStyle Flash…The Flash…Bart Allen. I’m telling you, it was fate.

Also. Ludacris….Diabetes Advocate? That’s ludicrous!

I have been using 10 units on both sides as a baseline dose to see where things need to change. Of course, I kinda fell into a rut and accepted that 10 was the perfect number for a few weeks, but lately I’ve been noticing that I need a little more. Now the challenge is to figure out how much is just right. Since I know that Lantus is not a 24-hour insulin as advertised, I feel like a little bit of overlap would be ideal. Inject the next round of awesome while the current dose is tailing off. Or something like that.

My hope is that I can figure out where the right level of Lantus is and in turn, reduce the amount of Humalog I take during a typical day. I know corrections happen and some days are straight up insulin resistant, but that’s natural when it comes to living with diabetes, right? If I can figure this out, I feel like I will be adding some stability to my diabetes management. Until now, I haven’t really felt too confident in Lantus’ ability to do whatever it is that it’s supposed to do, but maybe that’s because I haven’t tried to work with it.

You’ll have to forgive my slow-to-act nature with this, changing my insulin needs on my own is still kind of new to me. For so long my insulin regimen was set in stone, or at least that’s how I saw it. Now that I’m becoming more flexible (read “realistic”) with what I need to properly manage this disease, I am hopeful that Lantus will be able to play a significant and meaningful role in keeping me healthy.

Is it wrong that it feels like I’ve been doing all of this without reading the instruction manual? Without really thinking about what I’m putting into my body? Until recently, without questioning what I am doing and why? Slow and steady, I’m starting to figure out this balancing act. Let’s just hope I don’t do a face-plant any time soon. That would suck on so many levels.

I understand that relying on this technology has the potential to be my metaphorical downfall but Diabetes management is only as good as the tools used to assist in that management. My blood glucose meter determines how much insulin I need to take at a given moment, factored in with any food I’m eating, if the number I start my mental-math with is inaccurate then the rest of my calculations are flawed. And while the Dexcom is no substitute for my blood glucose meter, the additional information it provides is valuable. Trends help anticipate lows and highs. Seeing a straight line over a 3 or 6 hour period can generate an instant smile. Of course, things are never that simple.

Multiple times over the weekend I saw straight lines that were wrong. Way wrong. An hour hovering around 80 turned out to be 150. Waking up with a steady climb to, and above 200..after correcting…twice…was really 95. I don’t worry that I have a bad sensor or that this technology is unreliable, using this device is a constant game of adjustment and readjustment. My fear is that even if all things Dexcom are working properly, it could still be misinterpreting its readings. I don’t drive my car if I’m below 80, but if Hal Jordan doesn’t show any signs of concern and I put too much trust in it’s abilities, what happens if it and I am wrong? There aren’t too many options for treating a low when you are sitting in bumper-to-bumper awesomeness on the Beltway.

I’m not really sure where all of this text is supposed to go. I apologize for my ramblings today. I guess I just get frustrated when I try to put a little faith in this technology and it doesn’t return the favor as often as I would like. I’ve become so obsessed with ‘the line’ that I can’t really stop or slow down my desire to keep a constant watch on things. Dexcom is an addiction to data unlike any other. I just hope that this addiction doesn’t end with me in rehab. Is something like that even possible?

PS. If you haven’t yet, go see Inception. It’s fantastic.

If you’re on twitter, give her a follow. If you’re reading this blog, chances are you like reading blogs about Diabetes so you should check out her blog too. Finally, I’m hoping you’ll consider supporting “The D Team”. All of the information you need can be found at this handy-dandy landing page.

I’m not trying to pressure you into doing anything you don’t want to, but we speak so strongly about the bond between members of the Diabetes Online Community, this feels like the perfect opportunity to show what we are capable of.

Get Some!

Have a nice day.

As is the case all too frequently, Lantus and Humalog do a number on my blood glucose and I receive a friendly “DO SOMETHING” alarm in the middle of the night. At this point, I think Lantus and a single unit of Humalog are overkill. It’s a shame that simply looking at my insulin pens don’t have some kind of magical blood glucose lowering ability. How sweet would that be?

At the first sign of an alarm, I see Hal Jordan has a course South East. I munch on a York Peppermint Pattie and try to get back to sleep. What feels like seconds later I get an another alarm, only this time, Dexcom’s playing for keeps. A quick test reveals my blood glucose is at 59, Dexcom reports South East (still) so another Peppermint Pattie it is.

Side Note: These are the moments when I would typically start eating food until I saw an upward trend on my Dexcom receiver. These are the moments when I’m at my weakest. Last night I managed to eat that second Peppermint Pattie and nothing else. Words cannot properly articulate how difficult it was to only eat that. 15 for 15, right?

The next alarm I receive is about a half hour before my traditional alarm for the work day sounds off. Prognosis? I’ve climbed to 201 mg/dL.

So let me get this straight: I have the patience of the Dali Lama with my Diabetes as I wait for my blood glucose to rise, I don’t over eat, I don’t overindulge, aside from the part where I dropped to 59 I do everything by “the book”. And THIS is how I wake up…to another high alarm.

Even when I play by all the rules, Diabetes refuses to. I know this is a by-product of striving for tight control, but it feels like the rewards are so far and few between the missteps. When the most noteworthy measure of success only shows up every three months compared to little reminders of not-as-successfulness every few hours, it’s hard to stay motivated. But that’s the struggle I we go through every day.

This slice of the Internet started as a venting mechanism. There were no expectations from potential readership. There were no expectations for feedback or interaction from followers on Twitter. I was frustrated and chose a blog as my escape. Clearly it became more than that, but at its core this blog has always been about me. I know that might sound selfish, but the day I start blogging/writing/podcasting/whatevering to meet someone else’s expectations is the day I need to reevaluate my priorities.

I know that coming out of the fun in Florida, everyone would be talking about the same handful of topics for the next week or so, that’s fine. But I can’t help but wonder what my impressions would have been having participated. When got the initial invitation to attend I questioned the logic behind my invitation. I don’t think that this blog speaks to a greater cause among persons with Diabetes and even though an issue like meter accuracy is vital to how I and you all handle your business, I’ve never stood up and tried to make a difference. Does that make me a bad blogger? Am I a horrible advocate? Am I an advocate at all? Am I abandoning my connection with the Diabetes Online Community because I don’t write about things like that?

Of course I’m concerned that the tools I use to keep myself alive and healthy aren’t perfect (or anything close to that). But if I don’t use what little attention I get on this blog to promote the greater good, am I worth that attention?

It’s difficult to discuss this without sounding like a pity party or like I’m begging for attention. It’s none of that. But as my presence and participation within the Diabetes Online Community has increased, I wonder what my contribution is. If Twitter were turned off tomorrow, how would @iam_spartacus be remembered? There are millions of people out there living with this disease, and plenty more that don’t even know it yet. Am I wasting my voice if I don’t use it to support those without one?

I still worry about going to sleep and waking up uber-low, or worse, not waking up at all. Teaming up with Hal Jordan has had a lot of great results. High blood glucoses (can you pluralize that?) do not loiter as long as they used to and when they do pop up I have been much more accurate with my corrections so ensure that I return to a happier range without overshooting my target. But I still don’t trust myself or this technology enough when it comes to sleeping.

I rarely feel comfortable or safe going to sleep with a #bgbed between 100-120. As my Lantus works to balance out my Dawn Phenomenon I fear that it will kick into overdrive – so I eat. Technically it’s just a small something before I go to bed, I’m not having Ben & Jerry’s or anything, but it’s something substantial enough to raise my blood glucose. And this throws the rest of the night off. I’ll get an alarm at 5am and see a slow creeping line approaching 200. I’ll correct and have to suffer through another hour or more of alarms as my blood glucose peaks and slowly rides back down.

Up, Up, Up and awaaaaaaay

This happens a bit too frequently for my liking. But I can’t get past the snack before bed until I get past the fear of sleep. And something tells me that will be an epic struggle.

Diabetes = Fear of Sleep. That makes total sense…ugh.

Then again, every time I sing high praises, Diabetes feels the need to knock me down a peg or five. It is with that loosely thought out context that I get to blog about seeing three separate, distinct and uber-frustrating “LOW” readings over the course of a 24-hour period. Seriously Diabetes – not cool.

Now, I’m going to use the word blame in the next few sentences, but believe me, I know that’s not how this works. Blame is not the kind of mentality I need to bring into this lifestyle. Diabetes is relentless. It doesn’t care how awesome your last A1c was. It doesn’t care that it was the 4th of July. It doesn’t care what kind of pants you wear. Wait, that’s Fight Club. But I digress.

There’s plenty of blame to go around, mostly at myself. Over-correcting for highs that aren’t that high. Injecting before a meal but mismanaging the preparation time. Over-correcting for highs that were that high. It all comes back to me and my ability to manage this disease. No one else is dialing up another dose of the good stuff. I’m the one responsible for this, and when I experience a multi-low day like I had this weekend, it weighs down on me. Big time.

By the end of the night, I felt exhausted. I had gone through too many caprisuns. I munched on too many glucose tablets. There was just too much. At one point, I simply put down my spoon of ice cream at felt like giving up. I don’t wanna eat anymore. This is the kind of mental struggle that Diabetes can put me through. This is the stuff they don’t teach you when you’re sitting in that hospital bed and you found out a few hours ago that you have Diabetes. This is the kind of emotional breakdown that, no matter how many times you read about it on this or any other blog – SUCKS.

I hate what this disease can do to me. But I am stronger than this. So I’ll pick myself up, recalibrate Hal Jordan, and get back to browsing my Netflix Instant Watch queue. Tomorrow is another day.

It’s a shame I can’t keep that attitude for the rest of the run up to my next blood draw and endocrinologist appointment. Not that none of this matters, because testing before each meal is crucial to managing all of this. Not that I shouldn’t be concerned with how many carbs are in whatever I’m about to eat, because those numbers do matter. It’s just that when I’m in “game time mode”, I think I care a bit too much at times. I’ll overreact to a #bgnow that isn’t really that bad, but because I have high expectations for my management, temper tantrums are bound to happen. I wonder if it’s better to care too much than to not care enough. Is there a happy balance in the middle where someone can stay on top of their blood glucose without getting too upset? I’d like to find that place and live there for a while. Or forever.

With this latest A1c (6.5) I feel like this is a good opportunity to reengage some other important aspects of my management that I admittedly let slip as I took a few big leaps into the next chapter of my life. The first is exercise. It seems my enthusiasm for weight lifting comes in waves and right now it’s a low tide. But with my recent participation in the local Tour de Cure event, and lengthy bike path mere steps from my home, cycling is the natural next step (pedal? gear shift?) for me. I’m not sure if talking about riding a bike on a blog is terribly interesting, but I’m sure I’ll think of something.

The other aspect that needs an upgrade is my diet. Basically, I lack variety. I know it. You know it. The American people know it. I’m slowly working in a new food here and there, but I need to be more determined to try new foods. In talking about this with a friend, I came to realize that trying new food isn’t that difficult, besides “I don’t have to like it.” It’s taking me a long time come to that realization, and even then I still have a lot of apprehensions about simply sampling a new dish. It’s a real flaw of mine that I really want to remove. This change in particular won’t happen overnight. It probably won’t happen over the next few months. But I know that the only way to eat healthier (not going to say healthy, but healthier than I my current diet) is to start trying new foods. Foods with, you know, nutrients in them. I’m not talking about a food revolution, but having a vegetable or two with dinner shouldn’t be the end of the world. Easier typed than swallowed, I know. I’ll get there.

So as I continue to ponder over what to do about some aspects of my management, I have a decent plan on paper (or at least a post-it) for improving other parts. If I can keep this A1c thing steady while improving other improvable parts of my health, then that’s a plus. Right? Right!

Just a reminder, I’m not a medical professional and my words are not to be taken as any kind of sound, intelligent, or reasonable medical advise. I’m just thinking out loud in this one. This is more of a trip into the Mind of Chris….You’ve been warned.

Don’t get me wrong, 6.5 is fantastic. I’ve been working my butt off for this. Obviously a great deal of credit for this one goes to Hal Jordan. I knew that my control had improved after adding the Dexcom to my arsenal. Highs were treated sooner and more aggressively. I’ve had fewer overcorrecting-low incidents, although there are still too many for my liking. And each day I’m getting better at having a sexy, straight line for 3-6 hour intervals on my receiver’s display. This thing works, I’m living proof. Joining the revolution was one of the best things I could have done for my health. Luckily I had you all, my eager-readers, specifically the Diabetes Online Community to get my back.

But that’s the problem. The DOC was my initial exposure to this technology. I know the Internet is much faster and more accessible than my doctor, but I doubt he would have ever suggested this or any other method to improve my control if I hadn’t said anything. I know that I have to be active and engaging when it comes to my own health care, and I value each and every one of your input when I need it, but you all should not replace my endo or a CDE or any other kind of training. And right now that’s what it feels like. I wonder why I pay a guy to say “keep up the good work” when he has had so little input and impact on my health. Right, appointments are (supposed to be) every three months and if necessary I could always call, but I don’t want to feel like I’m a burden just because I’m the one not satisfied with my control.

This is a tough mental state because I know I’m doing a great job, even with my somewhat analog technology. Daily shots and a Dexcom got me to 6.5%, sweet. But what about all the bumps along the path to getting here? Who was it that suggested switching the timing of my Lantus? Who was it that suggested splitting the Lantus, and to that point, who worked with me to figure out how much to take and when? I’m not trying to dismiss the value of an endocrinologist, but I didn’t expect things roles to feel so out of place. There’s no right way to say this, but it feels like the more hands-on and go-get-em I have become, the less I seem to need a medical professional.

I know that’s not how it really is and I should appreciate that things are going well right now. With something like Diabetes, the only thing I can be certain about is the uncertainty of this disease. No matter how hard I try, no matter how hard I focus on doing what I need to do to be healthy, there’s always the risk of something coming around and screwing life up. I’m doing what I can do minimize that potential and with that I have some decisions to make.

I don’t know what to do about Not House. I have done a lot of this on my own, and as it stands, with my analog scheme of MDI, there isn’t too much tweaking that an Endo could really do. A lot of this is more or less “guess and check”. Does 10 units of Lantus work during the day? No? Try 11 (or 9 depending on the need). Even if splitting the dose was his recommendation, I would still have a lot of work to do on my own. I can’t necessarily blame him for the amount of effort that I’m putting in to this because this is MY Diabetes, not his.

The worst part is that I’m not exactly sure what it is I want out of my Endocrinologist. I’m almost 26, I don’t need a firm pat on the back when I get things right. I’ve shown that I am capable of fairly awesome control without too much external motivation. Surely that’s the kind of patient a doctor would love to have, right? At this point I know I’m rambling so I should probably wrap this up. I’ll figure out what I need to do and execute my plan when the time is right. Maybe that time will be tomorrow, maybe in a month, maybe a year. One thing I do know – it could be worse. Anywho.

6.5%. MDI. Dexcom. I am Spartacus.