Monday, April 30, 2012

The Beat Goes On

Not too long ago, I was driving somewhere.

Don't ask me to remember where, because I don't recall the route or what Point A or B might have been. All I know is that at the time, it was a bright sunshiny day and I had an urge to hear some Tom Petty.

Fortunately, I'm a Petty fan and have several CDs with me in my vehicle. So I put one in the player to crank up.

Clip Art Source.
Sadly, the CD player at that moment decided to eat my music and wouldn't play. And I couldn't switch to other Petty CDs, or even eject them to try again. Pretty much, I was SOL.

That door to listening to Tom Petty at that moment in my drive appeared to be closed.

I wasn't happy.

Then, something profound happened. Well, maybe it wasn't that profound... but it certainly felt that way at the time, and given all the other stuff happening in my life.

Switching to FM and a classic rock station, I came across the introductory notes of the very song I had been hoping to hear first - Free Fallin' by Tom Petty.

This made me smile, but it also made my mind do some cartwheels and a couple prayers of gratitude escaped my lips.

When one door closes, another opens.

And at this point in my life when there's so much change happening, that message - even brought to me in the form of Tom Petty's tunes - made all the difference.

Once again, I found myself driving out Into the Great Wide Open and just Learning To Fly on this crazy road of life.

The beat goes on. Even when it doesn't seem like it will. You just have to have a little faith.

Wednesday, April 25, 2012

Necessary Coverage

Insurance coverage is always an "interesting" topic for those of us living with diabetes.

Or more to the point: the struggle to get what appears like logical coverage is always a tug of war that too often seems to leave one side face down in the mud pit.

We have to fight the fight, pretty much every time we need some of the necessary medical supplies and life-sustaining medications in our D-Lives. So, just thinking about using a new D-device, especially one that's just recently-approved by the FDA and hot of the presses, can be a tad bit daunting and stress-inducing.

That's what came to my mind when the recent topic of the mySentry came up at the Medtronic Diabetes Advocates Forum and everyone was talking about how insurers might want or not want to cover this new device given FDA-approval in January. Especially since it might not necessarily be seen as "medically necessary" at this early stage.

In many situations, it seems as though people might simply choose not to pursue these D-devices or supplies simply because of the expected resistance in trying to get coverage (assuming we have it). So with this new device, people might just choose to wait or not even ask for coverage.

But an interesting aspect of this discussion opened my eyes about the path to insurance coverage for these new devices. We heard how simple requests for coverage, even if we're denied, go a long way and set the stage for how insurance companies view the need to provide coverage for these devices and supplies. Insurers don't see much credibility in the Pharma or medical device companies telling them that their products should be covered. The response is basically, "Well, of course you want YOUR products covered!"

But when it comes from us, on the patient-end, the insurers see that need demonstrated in actual numbers that show there is a need for coverage. The more we ask, the more they'll see "hard data."

This is similar to the CGM Anti-Denial Campaign that Gina Capone created and led, and the Medtronic executives watching this issue on mySentry believe coverage will gradually expand in much the same way. At least two insurers are already covering (Ohio State Health Plan and AvMed Health Plan in Florida), and there's scattered reports on Children With Diabetes forums and in other places online that show other companies are at least offering some coverage.

The bottom line is that even if there's a basic desire to get coverage for one of these devices or supplies, we should go for it. Even getting "denied" by insurers means that we're putting a piece of the puzzle in place and showing the need for coverage.

Disclosure: As detailed in this recent post, I've been given the chance to trial test the mySentry and I'm going to embrace that offer and write about my experiences, whatever they may be. But whatever is decided and however this test-run plays out, it doesn't change the fact that we need to advocate for coverage. This goes beyond any one individual person or small group of people; it's about the larger D-Community and insurance coverage for not only for this device but for all devices and supplies that so many of us need.

So, let's get to it. Time to advocate for what we need.

Monday, April 23, 2012

Rage-Bolusing Cause & Effect

Diabetes can be annoying.

This past weekend was a great example of the said annoyance.

My meter greeted me with a "Hi" reading on Sunday evening, following a full day where I'd been higher and unable to go below 250 mg/dL or so. That "Hi" message came up, and I felt like it was greeting me with a mocking, taunt-tainted laugh. I glared at my meter, wanting to throw it. But didn't, because really I knew my carb count slacking and pump set fussiness that day were the likely culprits that I could've taken care of much earlier.

Oh, well.

A post-dinner hour correction of 16 units followed that High, but it only brought me down to about 488 mg/dL a few hours later. A new pump set was in order not long after midnight. A little rage-bolusing was also on tap, and of course I decided to stay up late thanks to the higher BG symptoms and restless that comes along with them for me. Some late-night TV watching, water drinking and d-blog writing helped pass the time.

By 3 a.m., I was only down to 380 mg/dL.

I stayed up, still unable to sleep. So I tuned in to a SyFy showing of the 2009 remake My Bloody Valentine and drank some more water plus a cup of English breakfast tea. A showing of Saw followed that. And also some more D-blog reading to pass the time. The Riley Dog and I also played some rope tug.

By 4 a.m., it was at 313.

A 7-unit correction (rage bolus x 2) tempted me, and I gave in. JUST. WANTED. TO. GET BACK. TO. THE. 100s. N-O-W.

You know where this story is going, don't you...?! I'm sure you do.

Getting to 6 a.m., I dropped Low - something I knew would likely happen, thanks to the earlier rage-boluses that my pump told me to indulge in and I didn't resist. Because I just wanted those "good numbers" again.


Breakfast time had arrived, and so it was the perfect time for some apple juice and Greek yogurt.

And all was well.

Just another day of Living With Diabetes, riding the glucoaster of Highs and Lows and everything in between.

Friday, April 20, 2012

Expo Awesomeness

Attending my first-ever American Diabetes Association Expo in Chicago recently was a great experience, not only for the event itself but because of the great opportunity it presented for a D-Meetup with friends from the online community and others in the D-world for the first time.

We traveled from Indianapolis to Chicago by bus, the 30 of us ranging from ADA volunteers, to parents of children with diabetes and adults living with all types.

From the online community: Aside from myself, there Mike Durbin and his girlfriend who are from northern Indiana, and Jeff Neitzel from Central Indiana.

Once in Chicago, we had the privilege of meeting up for the first time with Marie and Missy who live in that area. A couple others who live in the area were unfortunately unable to make it, but we carried their spirit with us. Plus we met an array of new friends in the Diabetes Community, from parents to people living with all types of diabetes and other chronic conditions.

Being my first time at one of these expos, I was mildly impressed. There were cooking demos with "healthy" food, exercise routines, medical screenings and every possible type of information about diabetes you could ever care to find. Plus dozens of vendor booths, offering free products and masses of propaganda brochures and pamphlets about their newest wonders in diabetes-friendly products. I was intrigued to get the low-down on a cool new OneTouch lancet device that I didn't know existed, and also got to actually hold the new Tandem t:slim insulin pump in my hands and learn a little about it firsthand. And I came home with a bag full of materials and items.

Overall, a fine experience: but it was really the people that made it what it was, not necessarily the information or items at the Expo. These events are largely focused on type 2, just because of the simple nutrition label displays and "what is diabetes?" information and screening that gobbles up the most space and attention. The Diabetes 101 nature of these events can be boring... sometimes, I actually prefer the medical conferences where it's more "insider-baseball" that gets at a different intellectual or experience level.

But, being around these friends and professionals and some of the cool experiences of meeting new people made it completely and awesome day. Plus, it was cool meeting a new D-mom from Central Indiana who have a 14-year old son diagnosed at age 5. We talked quite a bit on the bus and especially about the Diabetes Youth Foundation of Indiana D-Camp, and I enjoyed those conversations and being able to make a new connection.

So, final verdict: the people made the day worthwhile. And here's the photo evidence:

(Oh, and check out the BLUE and a certain blue circle pin being worn in this photo!!!)

April, Me, Marie, Mike Durbin, Jeff

Thursday, April 19, 2012

Reaching the Unreachable

A theme discussed for the past couple years in the Diabetes Online Community has been how to take the "online" aspect of this offline, into our real life communities where we can reach those who aren't connected.

But even more than that, it's about reaching those who aren't connected by things many of us take for granted: Internet access, health insurance, organizational and individual support, or medicine and health care accessibility that many of us take for granted. Many efforts have been happening on that front over time, yet it continues to be an area we must continue working on because so many people out there need to find what they don't have.

We must do better, individually and collectively.

At the recent Medtronic Diabetes Advocates Forum, this was a topic that came up a handful of times. One conversation focused on how the Diabetes Online Community, can reach out and connect with those people who don't have access to these support resources. Ideas: get into nursing homes, doctors offices, church communities where so many patients aren't getting training or support and where we can help them find those fellow PWDs. In large part, many endos and CDEs - and even patients themselves - don't realize there's a need because they've never been told or thought much about the health impact these interactions and relationships can have.

Just knowing someone "like them" and being able to share their own stories, experiences, successes and failures and frustrations.

That aspect of going offline to bring more online or just reach them in general is an important topic, one that makes me smile because many of people in our community are already working hard on improving this and making sure it happens more often.

Then, there's the global aspect of reaching the unreachable, beyond even our own borders in the U.S. and more developed countries. In those places, people don't don't have access to these life-sustaining supplies and medicines, or D-Camps or medical professionals who can help them live happy, successful lives with diabetes.

Dr. Kaufman speaks as D-Advocate Cherise Shockley listens intently.
Dr. Francine Kaufman was one of the speakers at the conference recently. She's Medtronic's chief medical officer and a renowned diabetes researcher and doctor who's taken an inspiring leadership role in global diabetes advocacy. She talked about starting camps in places like Ecuador where kids are getting their first diabetes educations. Going to South Africa where orphanages are the only places care is available and that's where these kids are sent. In India, where girls aren't even considered worth saving so they end up dying once they're diagnosed with diabetes.

Then, Dr. Kaufman talked about her own experiences in Haiti, where there's an astonishing 85% mortality rate in the first year of type 1 diagnosis. After the 2010 earthquake, a million people are still homeless and the situation remains difficult, dire and heartbreaking. She reminded us about a story I recall seeing on the news after the earthquake and have heard a little about since then, but had mostly forgotten about and hadn't really made a D-connection to until Dr. Kaufman made it for me.

She mentioned how Academy Award winning actor Sean Penn bought a nine hole golf course in Port-au-Prince and turned it into a camp, where about 50,000 homeless people are living on it in makeshift tents and makeshift housing structures that she described as made out of plywood and looking like floorless doghouses. He created a charitable organization known as the J/P Haitian Relief Organization, which manages the camp and helps with food, sanitation and health care. He's receiving the 2012 Peace Summit Award this month during the Nobel Peace Prize laureates' annual meeting as a result of his continuing work there.

Dr. Kaufman talked about going from clinic to clinic and working to develop standards of care for people living with diabetes. In her first year there, they didn't have any meters in the hospitals at all. Only urine strips were used, even for those who are in comas. Now there are some meters provided, but strips are too tough to get so there's limited use and access. Same with medical equipment - she said you can open up a closet and all kinds of equipment falls out, unused because they're missing batteries and supplies have run out. She taught a medical school, where the students basically know very little to nothing about diabetes and they have no textbooks - only what there shown on slides and taught by the instructors like Dr. Kaufman.

This same lack of education and care exists not only in Haiti, but in Indonesia and other places in Africa and Asia. They're teaching them these care aspects.

But then Dr. Kaufman shared a story about a mom she met in Haiti, who was thankful for the D-Care education and support but said she must return home and simply can't afford to practically bring any of that knowledge to her daughter with diabetes because she doesn't have a job. There's an 80% unemployment rate there, and that prevents many parents provide the needed D-care their kids need to be healthy or even survive.

A concept underway involves an idea about how WE can help. The moms do incredible craft work with  beads there, and they might be able to make crafty beaded bags of diabetes "stuff" that could then be sold to us (in the U.S. or first world countries) as a revenue-maker for them to provide diabetes care for their kids. Details on that are still in the works, but those of us who attended the conference will be watching for updates to let everyone know.

This all just blows my mind, and really provides perspective for those of us who so often find ourselves griping about our latest A1c, insurance company or Flex Account frustrations and higher prescription prices. At least we have access and can basically afford these things. I know that friend and fellow D-blogger Sara Nicastro has an incredibly inspiring passion for helping those with diabetes in Haiti where she's traveled and third world places, but this is an area so often I find myself not focusing enough attention on. I want that to be different.

One key program doing wonders to help in these situations abroad - including Haiti - is the Life for a Child program through the International Diabetes Federation (the org responsible for World Diabetes Day on Nov. 14). The importance of this program and what's being done throughout the world can't be emphasized enough, and I hope that those individuals with the means can find the ability to help out in some way.

This whole notion of reaching the unreachable has global implications, from our own backyards to far away places we may only have heard about on the news. We are all connected, and it personally does my heart well knowing we have people like Dr. Kaufman doing what she can to help make a difference.

Taking advocacy that might be in a university lab or company corporate office, or even in online blogs or Twitter chats, to those offline who need it most.

Wednesday, April 18, 2012

Lows In Public

No Low is fun, any time or place.

A low blood sugar at home can be scary and embarrassing enough.

But being out in public, around other people who may or may not have any experience with diabetes or hypoglycemia is a completely different experience.

I absolutely hate having Lows in public more than anything. To me, there's nothing much worse about an average D-Life than losing your ability to think, function and even take care of yourself when you are out among other people.

If I'm going to be away from home for any period, I do my best to prepare ahead of time and make sure I know where my BGs are at. Being on an insulin pump gives me that control, to some extent. But regular BG testing and mindfulness - and consideration for other people - goes along away.

If I go Low to a point where I am not lucid and able to self-treat, that puts at least one other person in the uncomfortable situation of having to navigate my health and Low BG. That person may not have any personal experience on that front, and it's really not fair to put someone in that situation.

For example, if I'm going to be walking around all day at an event, then I might choose to run a bit higher - even in the 200s - just to make sure I don't get too Low. More testing might be in order. A temporary basal on my pump could be a solution. But having quick-acting sugar - juice, glucose tabs, candy, or whatever - is necessary. That way, if I feel a Low coming on or see one's on the way, I can take immediate action to prevent it.

I've gone Low at work more than once. In the past, those situations were so serious that I'd passed out and the paramedics were summoned. This is just embarrassing, and aside from everything mentioned above, it's tough to get over the feelings after these Lows that people are looking at you a little differently. That maybe your reputation, or ability to self-manage and be "normal," is compromised. I hate that. Really. Really. Really. Despise. That. Feeling.

Everyone's Lows May Vary, but for me my reactions out in the world have ranged from the inability to read and talk normally, emotional fits, even unconsciousness. One time a few years ago, there was a Low that came at me at the end of the workday when I was about to go home. I found my way to the parking garage and spent 30 minutes riding the elevator up and down and wandering the garage levels searching for my car. Even tripped and ripped my pants and got a bloody knee. Luckily, my Loving and Supporting Spouse was trying to reach me by phone and eventually did and talked me to getting to my vehicle, not starting it and eating glucose tabs to bring myself up.

So, thanks to my own diligence and with the help of a Continuous Glucose Monitor (CGM), I am able to catch and prevent these Lows most of the time.

Back in the day, before starting on an insulin pump, these had the chance of happening more often because of the higher uncertainty of insulin injection treatment. Research and history shows that our old friend NPH (which is still out there and being used by some) has an higher track record of being crazily unpredictable and leading to dramatic dips and spikes in BGs. When I first started on a pump, I had some severe Lows in public because of my tighter management and unfamiliarity with it all. Luckily, it didn't take long to learn how my body responded to a pump and these types of regular Lows were short-lived.

Obviously, you can't always prevent Lows. Even when you do everything right, these situations happen. That's just a part of diabetes, at this point in time. And just because I've found an insulin pump to work the best for me in "managing" these public reactions, that doesn't mean that others using Multiple Daily Injections or other insulin injection regimes aren't able to manage just as well, if not better. I know many who do.

Whatever treatment method works for someone, I urge them to use it. But overall, I'm thankful we have the ability to mostly control these situations and make sure we're not confronted with them out in public.

Tuesday, April 17, 2012

MySpouse and mySentry

Without warning, the surprise came as the recent Medtronic Diabetes Advocates Forum was coming to a close. Our group of about 30 advocates was sitting in the conference room listening to Nancy Katz, VP of consumer marketing, give closing remarks when she made an announcement that caught us completely off guard.

The news: We were being given the chance to use the newly-approved mySentry system and related products on a trial run for three months.

We didn't ask for and honestly didn't expect this.... Incredible offer that would be open to us, if we choose to accept it. I'm pretty sure I heard a roomful of gasps and someone may have proclaimed "Holy shit" when hearing this. It might have been me.

News about the FDA's approval of this gadget came in early January after something like four years of talk and waiting by many in the D-community, mostly parents. This is essentially like a CGM-connected alarm clock, which has a monitor that can sit on a nightstand or desktop and display real-time CGM sensor data worn by an Adult or Child With Diabetes. Through an outpost that can be placed up to 50 feet away. Shows predictive alarms at both BG ends and is marketed as being "just a glance away" to provide some peace for nighttime sleeping without worry of dangerous Lows.

But the device is mind-boggling expensive and hot off the shelves, meaning insurance might be more reluctant to cover it without first seeing the need and value of those patient end-users (Med-T let us know within a week of the DAF is that both Ohio State Health Plan and AvMed Health Plan in Florida have already established coverage).

This mySentry offer came on Friday, March 30. And I spent about three weeks pondering the possibility and whether it was something I wanted, needed, or even had the stomach to accept. This has been something I've struggled with and have not been sure if I'd participate in, even though I'm a loyal Medtronic pump user myself (a Dex CGM wearer, though!).

I'm close to a decision, but haven't officially decided yet. I let the Medtronic folk know about my possible interest last week, and they've sent me prescription forms that need my Endo's signature before anything more can happen. And so that's where we are at this point.

On one hand, the issue of fairness was on my mind. Is it fair that I am offered this opportunity when so many others in the Diabetes Community aren't? Why should I have this chance when others probably need it just as much, if not more? Especially those who might view it as an incredibly important new device that they really want, but just can't access at this time?

And it's not even just the mySentry device, which costs a mind-blowing $3,000 (WTF, Medtronic?!?!? Are you freakn' serious?). No, we're also talking extra stuff, too. I currently use the 722 Paradigm pump that does not have predictive alerts; so that means I'd need a 723 Paradigm Revel, which would cost me roughly about $399 after a trade-in rebate for my previous generation pump. Tack pump supplies and CGM sensors, and we're easily into the hundreds of dollars that I would probably have to hand over after my insurance coverage. So in total, I'm guessing that post-insurance (assuming there's even coverage for the MySentry at this point) we're talking a few thousand dollars.

Then, I questioned my own ethics and objectivity. More so, how this might look to skeptical eyes and critics: Medtronic not only flew me to California and put me up for a couple nights in March, but now they're basically buying my publicity by waving free devices and supplies at me for 90 days. Not to mention the tab for airfare, transportation and lodging that Medtronic paid to get me to the forum. How can I possibly even consider this as "objective" coverage that can be defended, especially through my lens as a newspaper reporter who knows better than these types of things?!

My heart and mind wrestled with this, leaning against this generous offer by Medtronic.

But two things made me look at this differently.

First, I realized something: the importance of evaluating this very newly-approved device outweighs the concerns because of a very simple truth: I tell it like it is.

Don't expect sugar-coating (is that a diabetes joke there?), or a glossing over of critical components to make this out to be good when it's really not. And if it's good, I'm not going to be critical or negative about it. (Seriously - what D-device has ever been 100% good and not worthy of some criticism? None, as far as I've experienced.) My integrity, honesty and transparency stands on its own. And if critics or skeptics don't like it, they are free to not read my posts or my blog at all.

I'm a patient, and this is a seriously-interesting (but overly-expensive) new gadget. If it's being marketed as something it's not, that is important to talk about and tell people who might be considering using it in the future. BEFORE they put the time and money into getting it for themselves.

There's something else, though. In the end, the decision was one that both Suzi and I reached together - based on our differing views.

See, I believe in the potential benefit of this device and think it will help provide what the marketing people have said is that needed night-time relief. Not only for myself, but for my wife. That it might actually help wake me up and prevent some of those night-time lows when they come at me unexpectedly. Plus, it can be taken when traveling and that's particularly appealing for me - as I'm prone to going Low when I am by myself and that's even more scary when Suzi isn't there with me.

I saw a demo (link goes to Sara's fantastic recording of the presentation from the front row) at the Medtronic DAF and heard the alarm(s) in person, and really think it's something that would draw me out of deep sleep and motivate me to test, treat or take care of whatever needs to be taken care of in the middle of the night.

My Loving and Supporting Spouse disagrees, and doesn't see the need. She leans toward thinking this is a glorified "alarm clock" version of the CGM that I already have and use. Although it may make a noise that's louder and more noticeable than the little oval-shaped Dexcom or even the Medtronic CGM-pump Paradigm combo that I had used before, she thinks it's too easy to silence and ultimately won't stop me from hitting "snooze" and ignoring it.

Yes, my wife sees the benefit for a parent in another room who might not have to wake up in the middle of the night and go check a child's pump or CGM. Or even those sleeping alone, who might be more prone to sleeping through the less-audible sound or burying the device under a pillow. But for us, who sleep in the same bed (when I don't fall asleep on the couch) and basically have each other as a layer of security in case of sneaky Lows, she's not convinced.

And so, that's what has guided our decision up to this point.

With this trial, we may see that one of us is correct and the other's wrong. Or we may see that we're both right or wrong to some extent. Either way, that's something we can share, together. So that the story is told based on our observations. No, it's not fair that everyone can't go through a trial like this. But it's a start, I suppose, in getting the message out about this gadget and what it does or doesn't mean to those of us in the Diabetes Community.

But before a final decision is made, I want to hear from YOU. What do you think, based on all of this? I've read some other blogs and commenters voicing concern about this arrangement, and know some of my fellow D-advocates have also been wrestling with the issue. Just some of those I've seen write about this include - KellyK, Kim, Sara, Sarah (Sugabetic), Scottie J, Amy and Bennet to name just a few of those I've seen so far.

I'm happy to talk more on this whole topic, and of course will be sharing as the trial period moves forward. So stay tuned for that and please don't hesitate to reach out and ask questions, offer comments or criticism, or whatever may be on the mind. Feel free to comment here on this post, send an email, use Twitter, or just give me a call if you feel the need. Eager to hear your thoughts on what direction to go here. Thanks!

Monday, April 16, 2012

Eye on the Water Glass

Late last week, I met with Mind Ninja for our first session in almost a month.

We had a lot to talk about, especially given my recent visit to California as part of the annual Medtronic Diabetes Advocates Forum. Overall, we caught up and talked about the positives and negatives of life I've been experiencing lately. We discussed the theme of one door closing and another opening.

After our gap in visits, one of the things I wanted to talk about with her was my experience of just interacting with people, with friends, and how my mind and self-consciousness can sometimes get in the way of that.

A story I told her was that in past years, despite my recognition that I was among great people and friends and that I was representing many others in the D-Community who couldn't attend, my head was telling me that I wasn't up to the task and should just withdraw. That led to my dwelling on this amazingly anti-social behavior, something almost foreign to me because that's NOT how I have historically been. Somehow it's what has evolved as I've dealt unsuccessfully with depression and developed what seems like a paralysis when it comes to simple interactions or public speaking engagements. That still seems very weird to me, but it is what it is.

So going to California recently, I had in my head these past failures but was also armed with new ammunition to fight these past feelings. Medication, positive thinking, and just overall lifestyle changes meant to eliminate some of the stresses that had plagued me and brought me down. And although I felt unsuccessful in many ways, there were successes.

Among them: While I was still "the quiet guy" who didn't talk much in the larger group sessions, I was able to talk more openly in smaller groups and one-on-one conversations. Instead of withdrawing and staying by myself, I made conscious decisions to go out and be around people, to soak up their energies and interact in those smaller situations to build up my interaction experience.

That is what Mind Ninja and I discussed recently, and explored those small successes - rather than dwelling on whatever failings may have happened.

She shared one of the well-known, almost cliche examples of optimism v. pessimism: a half-glass of water. Some see it half empty, others half-full. Two guys in a desert, seeing mirage and having an insatiable thirst and coming up upon a glass with water in it. One sees it as not enough, the other sees it as a blessing just to have any. What do you see, she asked me?

In my head, I was thinking:  "Well, it really depends on my blood sugar. If I'm sky High, then that water takes on a whole new meaning for me and I can't get enough of it..."

Being a Type 2, she probably would have appreciated this joke to some degree.

But D-joking aside, I got the point and we talked about that. Historically. I've been a "glass half empty" type and have evolved in the past decade to seeing the other more optimistic side of the water glass. Lately, though, it's as if I have been saying I'm seeing it half full when in reality I'm "wearing a mask" and actually believing the glass is half empty.

It was a good, productive discussion that I benefited from. And was able to apply to an example from earlier that day, in fact.

I'd gone to the eye clinic for my annual exam. A month later than last year's visit, although I had been there late last summer for a quick follow-up. This is always a stressful experience, because I dread the moment when I'll hear if any diabetic retinopathy has surfaced. I first got that news several years ago, but it has always been mild enough where nothing more has been necessary - just tighter D-management. And whatever retinopathy symptoms I had, they've dissipated once my BGs improved.

This latest visit to my optometrist Dr. Funky Eye brought the news that more "severe" signs of retinopathy had surfaced again. He talked, and there seemed to be way too much scientific terminology and mumbo jumbo. But basically, what I heard is that white blood cells had clustered in my right eye near the retina, something that could result in blood leaking and vision loss.

Science Talk: Thanks to Google, this is what the Internet medical lingo tells me: My blood vessel tissues have become slightly deprived of oxygen and these white blood cells - known as leucocytes - stick to the capillary blood vessel walls and block them, cutting off even more oxygen in the tissue. This is background or mild non-proliferative retinopathy. If not treated or slowed down with better BG management (assuming that's possible), the retina would next respond by increasing blood flow through the larger blood vessels, causing the cells in the capillary walls to thicken. That leads to a leakage of fluid known as macula oedema. Eventually, this would all continue and new but fragile blood vessels would grow and possibly start bleeding very easily - leading to the most advanced stage of retinopathy known as proliferative retinopathy. Laser treatments come into play to prevent the blood vessel growth and bleeding. /End Science Talk.

Again, all I heard was that my retinopathy was worse and that I might need laser treatment. My mind was clouded with fear. I wanted to cry.

I go back in two weeks to see the Advanced Eye Doc (an ophthalmologist who's co-founder and medical director of the eye clinic I go to), so that he can perform a more detailed examination of my right eye to determination how far along my retinopathy is and whether any treatment - injection or laser - is needed. So, I'm a little anxious.

Immediately after this appointment, I was depressed. And scared out of my mind. And really wanted to dwell, just go crawl under my covers at home and hide.

But I went to see Mind Ninja a couple hours later, and gained some mental insight into how I was feeling. With the Water Glass example came the realization that nothing is certain at this time and there was no need to overly stress myself out about this, since there may not be true concern and even more because there's nothing I can do about it now. All I can do is work toward being better from this moment on. Not perfect, just better. Even if eye treatment is needed, enough people I know have experienced this and survived just fine with their vision. There's nothing to really worry about, once I dwell on the positives rather than the negatives.

With that, I'm going to look at the metaphoric water glass in that optimistic light as much as possible. I will take the view that my BG is at 100 mg/dL and I'm not desert-mirage-thirsty, so that water glass is half full and is more than enough to quench my thirst.

And even when I drink all that water up, there's a faucet in just the other room to get more if I need it. There's a combination of optimism, reality and practicality that I'm embracing and will be working to keep in my mind when these situations surface.

Life is good and will go on. The water glass is half full.

Friday, April 13, 2012

Inside the Hive

One of my key takeaways from the Medtronic Diabetes Advocates Forum 2012 was how this company is focused on patients and actually wants to know what we think about the products and bigger diabetes picture overall.

Set at the company's California HQ in Northridge (outside LA), this forum and particularly a tour of where the CGM sensors are made was something I was really looking forward to. In large part, because I've been using Medtronic Minimed for most of the past decade as my one and only insulin pump and have used the company's Continuous Glucose Monitor (CGM), before switching over to Dexcom. So, to see the place where these sensors and D-supplies are made was personally very exciting for me. But it's also a privilege being able to be a part of a broader discussion with fellow advocates, diabetes colleagues and industry folks about where we are and how can get to the next level.

For disclosure purposes: I'm sure most readers know that Med-T paid for airfare, transportation, two nights of hotel stay, and food. Plus, we got some "freebies" and "perks" that are being written about in other posts. But all that aside, these are my thoughts based on what I saw and experienced.

There's a lot to write about, and so this post specifically deals with one part of the overall experience.

The Tour
Photo taken, submitted by Medtronic
A unique aspect of this was a tour of the CGM sensor facility. Nine of us went on the tour, while the rest of the Diabetes Online Community members (many of whom went on the tour in 2011) took part in a Q&A with company executives.

Of course, on the tour we couldn't take pictures (read: "trade secrets"). And we had to deck ourselves out in cool hazmat gear, from hairnets to shoe covers to goggles and gloves. We had some fun with that, including some fun photos.

There's a handful of phases to making these sensors, but overall it takes a bit more than 4 hours to make a single sensor from start to finish. In the actual "hands on" assembly phase, it's only about four minutes from one end of the room to the other. Lots of microscopes, chemical processes, hand assembly and reviews as they work their way from one end of the manufacturing facility to the other.

Before seeing this up close and personal, I really thought that the process would have been more automated. Like with robots and moving parts more integrated, rather than human hands doing most of the work. But it was interesting to see the people doing the work, and seeing firsthand how the quality-control is built in to the system at each stage.

At various points, if a piece of the product doesn't meet a certain criteria and isn't 100%, then that item is discarded. Even the ones that our tour guide displayed and showed to us, and we got to hold, they were immediately disposed. As a user of these products for more than a decade, that makes me feel very good about the company I'm paying for these supplies.

The tour was very eye-opening to me, and I think it was a perfect compliment to the presentations we saw before and after that throughout the day.

Before the tour started, one of the Med-T execs was talking about the company's interest in strengthening its focus on "consumer-friendly" aspects of its products. He mentioned that pump skins (such as my patriotic American flag design or the bacon wrap skin) was one of the first of these heightened consumer-friendly moves. Another example that came up during the day, demonstrating that Med-T has end-users in mind: Color screen pump is coming to Europe in the next year.

Sure, these examples are aesthetically focused and may not seem important in the grand scheme. Critics may brush the pump skins or color screens off as something designed as "feel good" moves designed to just squeeze more money out of us. Those may not be "important" in the upgrades or improvements, some might say. I'm naturally cynical, but now after being there and getting this "inside view" I disagree with that sentiment. In my opinion, I think what the DOC saw through this forum demonstrates that the company execs and product-designers have us in mind, not just their bottom lines. They're putting real people preferences into the equation when brainstorming and designing the next generations of D-devices, giving us options - should we choose to use them - to personalize these devices that we're connected to most of the time.

Plus, everyone's preferences differ - "one person's trash is another person's treasures." Why I use one pump or blood meter may very well be why you don't. Your Diabetes May Vary.

In a side conversation with Jeff Hubauer, general manager of the Insulin Delivery Business division, I mentioned how important my local rep's customer service has been. I shared why I have chosen the Medtronic pump through the years, how convenience through the holster is a big thing for me, and why I didn't like the CGM. It all came down to being consumer-friendly, he reiterated.

That takes me back to the tour, where I mentioned something that is one of two key reasons why I don't like Medtronic's CGM and choose the Dex. First, it's basic economics of only being able to get 6 days (or FDA-approved 3 days) from the MM sensor versus at least two times that (FDA-approved for 7 days) from the Dex sensors. Secondly, it comes down to my perception that it's an intimidating sensor that I dread using.

I've written about this before: "Doesn't this (sensor) really sorta look like a BEE WITH A STINGER???? One that plunges into your body, sinks below the skin, settles in underneath that subcutaneous layer, and then lounges there for as long as possible."

That description may seem odd to some. But as someone who's really not a fan of bees or wasps or anything that stings, I get a little bothered by the black stripes that are on the CGM sensors. Our tour guide joked at one point that they could be painted yellow, which made me shudder. Overall, they got the point. At least one of the Med-T execs said they've heard this before from parents, and I know personally that some Parents of Children With Diabetes have made this same observation online and to me. So, it makes me feel good that these aesthetic "concerns" were addressed and seemed to fall on listening ears.

Another aspect of this consumer-friendly discussion delved into how we as People With Diabetes download (or fail to download) our data. The consensus from most in the room was that we don't do it enough, and there was talk about figuring out a way to help on that front - maybe through text alerts or more convenience in not having to connect to a cable? (not everyone was on board with this concept, since it would probably become too intrusive and Big Brother like).

Someone mentioned that there's a difference between uploading/downloading data and interpreting that information displayed on often-confusing charts and formats. We need a more concise way of viewing data. Manny asked about the leap from uploading CGM data to an online cloud - something that would be not just for our own care, but also could be used for other platforms such as D-communities and research.

This all led to the group talking about the interesting issue of why we're so willing to share our diabetes data online (via Twitter and blogs) but why we don't track it for our own health benefits. Again, the point about our lack of logging came up and how so many of us go to our docs without a clear picture of what the numbers actually mean when they ask, "So, why were you High or Low here?" George offered a gem of an idea: Tie #bgnow or that type of concept of online health info through Twitter to uploading data, allowing us to extract what we may have done that day and at that time to provide a better picture of what may have led to our results.

Lane Desborough, product strategist who's a D-Dad himself, responded that getting that D-data into more hands is a key priority for Med-T. A slide later in the day went to the point that Medtronic is aiming to become the iTunes for the Diabetes Community, where everything will be basically connected to some degree and easily accessible to PWDs.

All of that seems well and good, and so I guess we'll see where that takes us... and how the future consumer friendly changes are unveiled.

What else?

During the course of the day we learned the company is working on a patch pump, although no dates are certain and we couldn't get any more detail out of them on this. Med-T is also already developing the Enlite Sensor 2, which is both exciting and depressing since we've yet to get the first generation here in the United States. We heard the good news that Med-T is preparing an application to the FDA for Enlite sensor approval here in the U.S., so hopefully the data from overseas will help speed that process along! Same goes for the Medtronic Veo pump, which is currently available in many countries but not the U.S. Greg Meehan said in response to questions about this FDA-reliant timing of the Low Glucose Suspend device getting through regulatory hurdles here, "We don't know, but we're optimistic that we'll see it in the near future."

Update: MedT actually hadn't even submitted to the FDA its application for review of the Enlite sensor or the Veo (or 530G), at the time of this summit. That submission didn't occur until June 2012. So, it's not fair to blame the FDA for any delays on this before that time (if even then) -- that falls solely on Medtronic in preparing and submitting this for regulatory review.

Of course, there was talk about accuracy and CGM lag times that are simply fundamental realities at where we're currently at in these early generations of technology and devices. I was really pleased to hear that in the past two years, Med-T has opened up it tech & algorithms for "open-sourcing" rather than maintaining the proprietary control it's been notorious for historically. Lots of progress happening, the company execs noted. So that's encouraging progress, in my eyes. 

In the end, what I saw from this tour and discussion demonstrates that Med-T has quality and safety in mind at every level. That Med-T is listening to what we, the patients or end-users, need and want.

Sure, some may not care for Medtronic products or supplies. Some might not like the fact that basically all the pumps have looked the same for the most part for a decade. Customer service and cost considerations and so many other aspects may differ for people. But I think the message portrayed at this event goes beyond Med-T and its products:

"Good is not going to good enough" as we move forward, and really we're all in this together.

From what I observed, these people care and are doing what I think is important for not just those who use these products, but to touch the lives of so many others. To make a difference in the bigger picture. We have a long ways to go in many areas, and neither this company - nor any other - is perfect. But neither are we as PWDs. And they're doing some really importing things in the name of progress, and taking our voice into consideration.

And that makes me proud to have been a part of this, getting that perspective that I didn't really have before. Even if it meant traveling inside the bee hive.

Wednesday, April 11, 2012

On Parole

Without actually participating in the Health Activist Writer’s Month Challenge, I saw the Day 10 prompt "Dear 16-year-old Me" and decided to offer some thoughts on that topic. Not exactly in letter format, but close enough.
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In a particularly powerful role, you may remember Morgan Freeman's passionate monologue in Shawshank Redemption about how he wished for the chance to travel back and talk some sense into his younger self.

"Am I sorry for what I did? There's not a day goes by that I don't feel regret... I look back on the way I was then, a young stupid kid... I want to talk to him. Try to talk some sense into him. Tell him the way things are. But I can't. That kid's long gone, and this 'old man' is all that's left. I gotta live with that."

For this type 1 diabetic of 28 years, I regret my actions in one formative phase of life just like Red did in Shawshank. If only I could do travel back to the 90s, confront my Rebellious Teen Diabetic Self and tell that stupid kid firsthand how important D-Management is. How you aren't invincible and won't live forever. What an opportunity that would be.

But, this isn't Back to the Future. I'm not Marty McFly, and there is no Flux Capacitor or 1.21 Jiggawatts. (What the hell's a jiggawatt, anyhow?) There's no going back.

Awhile back, Renata over at The Diabetic Duo wrote about a parent's perspective about teenage rebellion and the impacts that can have on someone with diabetes. This is my version, as someone who was one of those "teen rebels" who someone miraculously lived through those Years of Rebellion. With that, for any children, teens, or families reading this: Please do as I say, NOT as I've done.

My Type 1 diagnosis at the young age of 5 means that Life Before Diabetes doesn't stand out in my mind. This lifestyle of balancing insulin, exercise, blood tests, and meal planning is really the only lifestyle I've ever remembered. In a way, I am thankful for that because I didn't have to "retrain" my brain as those diagnosed later in life - even as adults with Type 2 - must do. I was also incredibly fortunate to be the only son of a Type 1 D-Mom, who was diagnosed herself at the same young age. She has lived through this now for more than five decades, watching incredible changes that have materialized and not materialized since the late 50s.

But despite this early adaption and parental wisdom, my D-Care hasn't always been adequate. Nope. Far From It.

My A1C numbers reached into outer space. Like how the Willy Wonka Chocolate Factory Elevator crashed through the glass rooftop and soured above the city. Numbers hovered in those teen years at 13% for too long, at one point hitting as high as 21. Only by A Higher Grace did I manage to get where I am now, without feeling significant repercussions from those days. One day in my later teens, I recall my Endo At The Time brandishing a disappointed look as he glared point blank at me and said: "If you keep doing this, you're going to be dead by the time you're 21."

Finally, it sunk in. I listened. For a while. The College Years and My 20s saw many of the same cycle. Swings where I'd push for tight control, but then periods where I'd slack off completely. Meeting the woman who'd become my wife changed things for the better, and over time with her help I've gotten to a point where D-Care is a priority in my life.

At age 33 now, I regret those past decisions every single day. Magically and miraculously, I have not experienced any significant complications and my life isn't impacted by them. Maybe I'm proof that you can slack off in your teens and 20s and somehow avoid complications... I don't think of it that way. I think of it as pure luck, with uncertain results as I continue traveling down this path. In the end, I don't know what real impact that rebellion and D-Denial has had on my body and if it's cut anything off the end.

That is certainly possible, but it SO could have prevented.

If I could ever write a letter to a 16-year old version of myself, and deliver it to that younger ME, the writing would essentially reflect what I've mentioned here in this post. But I can't, so all I can do is live for the future, starting right now.

Am I rehabilitated? Like Red says in that same monologue,  I think that's a bullshit word. I'm just doing my best. Not fail completely but learn from my failings to do better in the future. I won't repeat the mistakes of the past, and I'm not going to be trapped behind the bars of regret. No, I'm on parole. Hopefully that will mean I won't be sent back to any kind of metaphoric diabetes prison later on in life.

Reflecting on these D-Regrets brings to mind a particular pertinent quotes from poet and philosopher Henry David Thoreau that have been with me since my college American literature days.

"One can't too soon forget his errors & misdemeanors. To dwell long upon them is to add to the offense."


"Make the most of your regrets. . . To regret deeply is to live afresh."

 Both are particularly relevant here. Or, as we'd hear in Shawshank:

"It comes down to a simple choice: Get Busy Living, or Get Busy Dying."

Tuesday, April 10, 2012

Any Bit Better

We're all trying to be better, whether we're talking about our own human or spiritual lives or the health components that come with Living With Diabetes.

Insulin pump manufacturer Medtronic hosted its second Diabetes Advocates Forum March 29-30 at their headquarters in Northridge, California. While I wasn't at the inaugural event in 2011, I was honored to be invited to this sequel that brought about 30 diabetes advocates from the online community together to discuss how we can all work together in reaching people who need it.

One of the topics on the agenda was hearing from a fellow Person With Diabetes, Chuck Eichten, who's been living with type 1 for many years. He led a discussion about the idea of Doing Better, and as we entered the meeting room that Friday morning we all were able to see a copy of his latest book, The Book Of Better, sitting at each of our seats.

I'd read his smaller bite-sized version, Better Is Better, a while back after it was published in 2005, but had not had a chance to see this full version of the book until now. The group took a tour at one point and I ended up walking beside Chuck, talking with him for about 10 minutes about our own D-lives and writing passions. And then getting back to hear him speak was simply a great experience.

The conference was busy enough and I didn't have a chance to read more than a few page flips until my trip back to Indiana (which was great, as I'd given my other book away to a Type Awesome on the flight out).

But getting through the entire book on the nearly-six hours of flying, I was thoroughly impressed not only with the content but the presentation that has marketing genius written all over it. This isn't a typical how to guide full of medical terms and dry language. No, it's a combination of both creative words and colorful, masterfully-laid out designs and artwork that make you want to keep reading.

I love this book. And no, it's not just because I got it for free (thank you, Medtronic).

On one hand, it's almost common sense to say that there's an understanding that "you can't be perfect." But so often, we PWDs feel like we need to be perfect in order to achieve those "good" or "bad" numbers, those acceptable A1cs that our medical professionals and normal medical textbooks dictate to us. If we don't hit those targets, it's so very easy to feel as if we're failing.

With those feelings of failure in mind, that's why I am so impressed by Chuck's message to just achieve to do a bit better. We got to talk some more after leaving the conference and heading back to the hotel and then to dinner, and Chuck is just a great funny guy who is very inspiring to be around.

That message he radiates personally and in his book is particularly important to me these days.

I've been dealing with my own mental demons lately, questioning my self-worth and feeling inadequate in so many ways. But instead of constantly feeling as though I am not doing good enough, I have found strength by focusing on the baby steps forward that I can make. Basically, looking at the glass half full rather than half empty.

It's easier said than done. But we have a choice: To just look for a little optimism that's just a few feet ahead than seeing all the negatives on the road to perfection. I prefer that first option.

Personally, one of the slides Chuck showed from a pair of quotes in his book (taken from a saying that Michael Jordan had) is a motto that I'm adopting in my life, diabetes management and otherwise:

"I CAN accept failing. I CAN'T accept not trying."


Meeting Chuck and getting a copy of his book was awesome, and I'm looking forward to the May 25 when he'll be a guest for a videochat discussion over at TuDiabetes. Hopefully many people in the Diabetes Community can tune in and hear some of the great message about just being a bit better.

Monday, April 9, 2012

Skittles On a Plane

Somebody once made a movie about Snakes On a Plane.

Nobody has decided that Diabetes on a Plane is script-worthy, but I'd like to put that invitation out there to any budding screenwriters who'd care to toss their ideas into the hat. It may not be the most suspenseful and dramatic movie, but I'm sure it would be appealing to some of us who are always finding something of an adventure when it comes to Traveling With Diabetes On a Plane.

In my case, I'd offer a D-version of a substitute for those snakes: Skittles.

On my recent travels to the Medtronic Diabetes Advocates Forum in Los Angeles, the travels to the D-conference started out early - to the tune of making a 6 a.m. flight out of Indy. Getting to the airport without any coffee in my veins because of the early hour, it's nothing short of a miracle that the TSA didn't give me any hassle. Decided to not bother with declaring my medical devices, so just took them off and stuffed them in my carry-on laptop bag and went on through without any fuss. (Note: This later came up at the Forum, and I was told you're apparently not supposed to send pump or CGM through X-ray... so don't do as I do without consulting your device manufacturer info first.)

Indy to Chicago was nothing worth writing home about (or blogging to the world). Except that I finally got my first cup of coffee. Same uneventfulness on the flights back, going through Dallas/Ft. Worth to get back to Indy. Uneventful and hassle-free.

But the four hour flight to LA was the interesting, on the diabetes front.

I had an aisle seat, thanks to some advanced planning to avoid getting a dreaded middle seat.

Of course, my pre-planning turned out to not be very effective - actually it was counter-productive - thanks to my being on the aisle where my left arm was adjacent to the aisle, giving fellow passengers walking by and the beverage cart perfect access to my CGM arm site. That arm must have been hit a dozen times, and at least a couple by the beverage cart, yet someone the arm site managed to stay attached. (Not that it mattered, though, as you'll soon see...)

As one might expect, as soon as we got into the air my BGs dropped and caused my Dex to start freaking out. The sensor failed, and despite trying to reconnect it wouldn't re-connect. And then, that much-fun message ERR 1 flashed on the screen, all as I wasn't feeling exactly "in range." A pair of tests confirmed I was batting about 54 mg/dL - and probably still dropping.

So, a few handfuls of the Skittles from my laptop bag came to the rescue.

That needed sugar-boost brought my senses back and put me back in the mood to carry on a conversation with the woman next to me, who had been quietly watching some of my BG testing, insulin pump/CGM button-pushing, and candy-inhaling. Plus my eating a few crackers I had in my bag.

Middle Seat Lady: "Do you have diabetes?"

Me: "I do. Type 1."

Lady: "Oh, my father-in-law is diabetic. I'm not really sure what type. And my husband, he's a... a... 'pre-diabetic' in denial."

"Seems like we all have a connection to some degree," I offered. "Does your father-in-law take insulin shots or some other type of medication?"

Lady: "He takes pills every day. Or at least he's supposed to."

"I know how that goes. I take insulin through a pump, but there's a lot I should do that I don't."

That led to a chat about the different types of diabetes and D-Living in general. We also fell into a fascinating conversation about what was taking us all to LA - she visiting an older sister with her other sis, my going to a D-conference. We talked about her job in the recycling business, which was pretty enlightening and informative as she told me about the industry's evolution in the past 20 years.

After we talked for a while and the conversation drifted off, I decided it might be time to check my blood sugar again - since we were a couple hours into the flight and I was starting to feel low again. I tested and was back into the 60s, and decided it would be good to get some substance in me. Traveled back to the stewardess sitting area and snagged a sandwich, then made my way back to the aisle seat. Before digging into that, I opted to inhale a few Skittles just to boost me up a bit. I'm a fan of the colorful candy, and probably would have been passed out from a Low without having these on hand.

So, it was my pleasure to be able to grab the last handful from the bag to do the job. And mid-chew of those half dozen Skittles, that's when I felt it - a CRUNCH. The sound and feeling you experience of a breaking tooth.

Son of a...

A filling had broken off. So, I then found myself navigating four days of careful eating before being able to getting back to my dentist at home. Navigating the plane ride while low, without wanting to eat more Skittles or the thick sandwich, gave me a fun balance between not wanting to keep dropping lower and not eat anything that might further damage the tooth.

Suspended the pump, then set a temp basal and got an orange juice from the beverage cart (which again came by about an hour before we landed and tried to take out my still-failed CGM sensor). That kept me in the 110-125 range, a victory in my world.

As we ventured the landing into LAX, the Middle Seat Lady and I started saying goodbye. She mentioned again that maybe her father-in-law would start taking better care of himself, if even just testing his blood sugar more often to know where he's at. But he, just like her husband, weren't very happy about having to live with diabetes and seemed to be resisting.

Earlier in the flight, I'd been flipping through a book that friend, fellow advocate and diabetes journalist Riva Greenberg had sent me not long ago. I was navigating a rough patch and she sent her book, The ABCs of Loving Yourself With Diabetes. I had a few books to read on my smartphone, such as Beyond Fingersticks by Wil Dubois and A Lovely, Indecent Departure by D-Dad Steven Lee Gilbert. But having a hard-copy of a book to read is something I always prefer to have, too. So it was Riva's book that was with me on this trip out. Loving the book and knowing how much it can help, I grabbed it from my bag and offered it to the woman as something to share with her father-in-law and husband.

"I think they need this more than I do, and besides - we're all in this together. Give my best to them both, and let them know they can do it."

She was very thankful and seemed like she wanted to flip through it right there on the spot.

We shared for a few more minutes as we landed and sat through the waiting as the rest of the plane's rows de-boarded, before it was finally our turn. And with that, we made our way into LAX and the rest of the trip ahead.

(Disclosure: Medtronic paid my way and put a roof over my head. But all advocacy on this plane ride was my own. And I purchased my own Skittles and $10 cobb salad sandwich on the flight. Just so you know.)

Diabetes Advocacy on a plane. And Skittles. Better than snakes, any day.

Tuesday, April 3, 2012

Forum Photo Recap

We're just back from the 2nd annual Medtronic Diabetes Advocates Forum out in Los Angeles, and there's a lot to recap. But first, I need to process everything. And sleep. Not to mention maneuver my day job. So before getting to the actual accounts of the full schedule, here's a photo recap until I can find the time.

Of course, there was plenty of coffee & Diet Coke.

One of the first slides, about MedT's Enduring Mission.

MedT's CGM unit has 400+ people working on tech for us.
Cherise listens intently to Dr. Francine Kaufman talking about taking D-Advocacy in Haiti.

Me and Lenny!!! Photo taken by Sarah (Sugabetic).
Some of the DOC, wearing blue inside MedT. Photo courtesy of Cherise.

The Cool DSMA Live Crew - Scott J, George, Cherise.

Charlie's D-Angels - Sarah (Sugabetic), Kelly Kunik, Cherise Shockley.

David Edelman, Kelly Close, Manny Hernandez working hard post-dinner.

Still half-asleep, we gathered for breakfast Saturday. Photo courtesy of Bennet.

Wait, they have Type 1 medical elevators now? 

Some of us traveled to Santa Monica Pier on Saturday to stand in the sand.

For Simon...

And of course, there were cupcakes!! And we traveled to the infamous Sprinkles Cupcake ATM. Even though it was closed down for restocking, we were able to get some snapshots of Kelly Kunik posing near the ATM as we waited in line to go inside for cupcakes.

Thank you, Medtronic, for the very great forum. Disclosure: MedT paid our way, put us up in hotels and offered food and transportation for most of the stay. They didn't ask me to write, but likely assumed the attendees would - as that's how we roll.

More to come on the discussions and conversations, piece by piece as time allows. Stay tuned!