Thursday, December 17, 2015

The Beer and Blood Sugar Effect

Yes, I have type 1 diabetes and I can drink beer.

In fact, I'm a craft beer lover who's pretty passionate about trying new brews and supporting my local beer makers (who invent awesomeness in a mug). The fact that I'm pancreatically-challenged changes nothing about that.

Over the years, I've lost count of the times I've heard folks wonder whether PWDs (people with diabetes) are able to drink anything, particularly beer. And I've been amazed to meet medical professionals who take the lazy way out and just tell patients that any drop of alcohol is off-limits. This very directive came my way early in the year, from a general practitioner who clearly didn't make the cut when I was searching for a new family physician.

Obviously, I'm not a doctor. But in my 16 years of legally drinking countless beers, I would like to think I've learned a thing or two -- particularly that YES, you can and should be able to enjoy beer with diabetes if you want to, of course doing so responsibly in the context of society and your health.

Until this past summer, I never thought too deeply about the specifics of beer influencing my diabetes management. Sure, I knew it raises my blood sugar in the short-term, and can increase my hypo risk over the ensuing hours and next day. But that's about it.

The general information available online isn't particularly helpful, either. Try searching for "beer and diabetes," or toss "blood sugar" into the Google mix, and you'll find boring, cautious bits of information that are certainly not practical. You might find general info that a light beer or "regular" 12-ounce beer has a certain number of carbs, but it's quickly followed by "don't drink more than X servings and to talk to your doctor." Of course, beer affects different people in different ways, so it's all a matter of individual trial-and-error, but isn't that true for pretty much everything in the world of diabetes?

So, I decided to investigate this on my own, much like I've done on the coffee front in the past.

Let's refer to this experiment as: The Beer and Blood Sugar Effect.

Disclaimer: By no means am I encouraging drinking of any kind. Like everyone with a working pancreas, we PWDs have to weigh the risks of alcohol consumption and take care in drinking responsibly. For us, that means knowing how much sugar is in a particular beverage and calculating that while also being aware of how alcohol in general affects our blood sugar.

Beer Base of Operations



My curiosity on beer and diabetes piqued in early August, when a conversation with a friend in the D-Community coincided with International Beer Day. That conversation evolved into talk of "best beer states," and I of course mentioned my homestate of Michigan that's ranked one of the top in the country. This friend was from a state not in those rankings.

In mid-September I began what would become a three-month, non-scientific analysis of my beer and BG effect. The home base of operations: local microbrewery Baffin Brewing Company, in my hometown of St. Clair Shores, Michigan. The brewery theme and logo are centered on a Burmese mountain dog named Baffin that the head brewer used to own, which I find awesome (those who know me and my Riley Dog can attest to my canine affection).

What's even more cool is that this brewery focuses on reuse, sustainability and being eco-friendly, and it's housed in a historic brick building that's one of the oldest in the city. The taproom walls are made from reclaimed bricks from Detroit buildings in the 1920s era and the bar itself is made from 100+ year old reclaimed lumber.

This place is way-cool as it relates to diabetes, too. Take this example from late November, when I came in wanting to try out a new microbrew pitched as a "maple syrup infused" beer:

And did I mention that they've just recently tapped a new brew, called DOC? It may be pronounced "dock," but I like to order this one by spelling out the letters, and thinking that it stands for Diabetes Online Community. Yep, this is a great place -- and it's only a half-mile from my house, so you can imagine how often I frequent Baffin. :)

Needless to say, this brewery was my home-base, so to speak, for my Fall experiment. 
Microbrews, with Diabetes On Tap

Between mid-September and mid-December, I examined four different types of beer and the effect they had on my BGs: a Belgian pale ale named Pope John Pale, an Irish red ale called The Walking Red, their dark imperial coffee stout named Bob Barley., and an IPA (whether it was the Don't Hop, Mosiac Moproblems, or Hopstepper double IPA brews).



I also sampled a few others during this whole process, from the outstanding "Holland Oats" oatmeal stout to the very sweet "Kane and Maple" holiday beer has gallons of maple syrup added, such that I could feel my BGs rising just by looking at it! But the four varieties mentioned above were my mainstay.

For each brew, I established a baseline -- no food, no Insulin On Board, no intense exercise or BG swings. I wanted to begin with as steady a flatline in the 80-160 range as possible.

Testing each beer had three parts:
  1. A single beer without any insulin dosing. Repeat a second day for confirmation to establish a baseline.
  2. One beer with insulin. Repeat, possibly adjusting dosing slightly if needed.
  3. Two or three beers with insulin, using the baseline and carb-counting info. Repeat to confirm.
Overall, this experiment meant 8 beers of each style -- a total of 32 beers consumed over the course of a few months. That's just over 10 beers a month, or 2 or 3 per week.

Needless to say, this took some time and effort.

It was interesting to see at times the additional effects of using the fast-acting inhaled insulin Afrezza, trying out two different CGMs, playing with my insulin doses and different food factors like lower-carb, higher-fat options. I realize that these variables make my experiment decidedly convoluted, but I still felt it had value for me as an "N of 1" trial-and-error effort.

There were a number of times when I got de-railed by a lack of willpower in resisting a meal or exercise a few hours post-beer and therefore forfeited those BG results. And yes, the free popcorn at Baffin certainly didn't help and was very tough to resist!




Ingredients & Resources


This whole process also made me look more closely at the beer-brewing process, trying to understanding how the making of different brews might play into their "diabetes effect."

Four key resources I found the most helpful came from the Diabetes Daily Grind, and a carb-calorie count list over at Beer100.com.
  • Podcast on Beer & Diabetes: D-peeps Ryan Fightmaster and Amber Clour over at Diabetes Daily Grind (a new site kicked off last year) recorded an outstanding podcast in April on this topic, interviewing some local Oklahoma craft brewers and talking about the nitty-gritty of brewing and how beer affects diabetes management. This was very educational and fun, and I learned specifically that the amount of sugar put into a beer during the initial brewing process isn't necessarily transformed into carbs; much of it's burned out as the substance turns to alcohol. But some does carry over, especially in higher alcohol mixes, and brewers can make a beer sweeter if they choose. I was also intrigued to hear them discuss how difficult it could actually be to require brewers to list the carb count on their wares. Fascinating stuff!
  • Online Beer Info: Despite the note above, the all-in-one brew hub Beer100.com does offer a calorie info sheet with estimated carb counts on a huge number of domestic and imported beers. I've used this list and found it pretty spot-on for me in carb-counting and insulin dosing for beer.
  • Six Beer Questions: Meanwhile, I also very much enjoyed the personal post that Ryan from DDG published in October, outlining the 6 questions he thinks about when deciding to drink beer. These echo my thoughts in many ways, and it's just a handy go-to list to keep bookmarked. I had already started this Beer and BG Effect effort by the time he wrote this, but I certainly had this checklist in mind when going about my "research."
  • DOC Gems: Of course, for personal anecdotes and stories from other PWDs, I've found myself re-reading what our friend and colleague Wil Dubois has written on this topic at Ask D'Mine over at DiabetesMine  Also read some of the testimonials shared over at the Drinking With Diabetes site.

All helpful stuff, if I do say so myself, and a lot of this factored into my experiment.

So, what did I find?

My Beer and BG Takeaways


These four types of Michigan microbrewed beer boosted my blood sugar an average of 75 to 115 points for each beer, without any insulin. You can figure out where that leaves you.


Stout raises me up the most; I can just watch my CGM line make a steep upward climb. Without insulin, my BG jumped about 100 points for just a single stout.

No matter the beer, it took about 30 minutes to start raising my blood sugar, but my levels began to smooth out within a couple of hours post-consumption. Sometimes they even started dropping.


A typical beer takes about 1.5 units of insulin for me (matched well with most carb counts of 17g or so). If I go out and have a couple beers and take 3 units stretched out over the course of an hour, I find I can stay in range, nice and steady on the CGM graph. With a 25-minute pre-bolus, too:


Overnight after drinking I do see the "alcohol liver effect," which is caused by your liver being too busy processing the residual alcohol in your system to naturally make the necessary glucose needed when your BG starts to drop. As a result, you can get hypoglycemic even though the initial beer (or cocktail) may have raised your BG level. I found that my blood sugar usually starts dropping within 6 hours after drinking two or three brews. But it's not a dramatic drop, so nothing I worry too much about personally.

But this phenom was especially interesting to watch in September, when we attended a brew festival at the Detroit Zoo and I had the chance to try about 16 small samples of various Michigan microbrews -- the equivalent of roughly 4 or 5 full-size beers. That's more than I usually have in one night (!), and I saw those higher BGs immediately post-beer, but then a drop several hours later and into the following day. I'm sure the earlier low-carb dinner, all the extra walking around the Detroit Zoo played a part in that, too.

Moral of the story: advance planning is key to being able to go out and enjoy a few brews. As a PWD, you have to think hard about the type of drink you'll be imbibing, and the food and physical activity that will likely accompany it.

So what's next for me in using this Beer and BG info?

I really did learn a lot about the actual effect my favorite types of beer can have on my D-management, and I'm excited to be sharing that with the community via the Diabetes Daily Grind podcast soon, where I'll be interviewed next week about all of this. I understand this podcast will air in January.

Please be sure to tune in to listen to our chat once that goes live (we'll probably be enjoying some beer live as well).

Now, armed with this new information, the only challenge left is to... find a microbrewery that's actually operated by a PWD. That would certainly be a taproom worth visiting!\

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This post originally appeared on DiabetesMine in December 2015, written by Michael Hoskins based on his own personal diabetes experiences and at his own personal expense.

Saturday, November 28, 2015

Sometimes I Lie

Confession time.

Sometimes, I lie about my diabetes data.

Just like I did back in my teen years, I tell fibs when it comes to my blood sugars. But unlike those days back in the 90s, this is real-time D-lying and it's mostly during the middle-of-the-night hours.

The reason: To shut my D-tech up when it's getting on my nerves.

When it's late at night, and all I want to do is sleep, my Dexcom CGM sometimes decides that the sky is falling and my blood sugar is Low. So, it decides to start vibrating incessantly and then beeping just to make sure I haven't missed the alerts.

Of course, I am connected to CGM in the Cloud and thanks to the trio of Dexcom SHARE/Nightscout/xDrip my real-time data is streamed to my wife and she's able to know where my BGs are hovering at that given time. She gets alerts on her Pebble Watch, just as I do simultaneously on my 4 CGM-connected devices (G4 receiver, regular Android phone that has Dexcom SHARE app, secondary Android phone for Nightscout/xDrip apps, and my Pebble watch).

All of those alerts bug the hell out of me, when it's the middle of the night and sleep is all that's on my mind.

Those times I'm traveling, alone in a hotel room... and the Dex goes BEEP BEEP BEEP to let me now I'm 60 and dropping. With a straight down arrow.

And knowing that I managed to forget to stop at the nearby store or front hotel food stop, to buy a snack to boost my blood sugar in the middle of the night. Maybe there's a $12 candy bar or orange juice in the mini-fridge. Or there's a vending machine right down the hall, assuming I have a couple dollar bills in my wallet.

If not, my emergency glucose tabs in my suitcase are on hand 95% of the time (when I didn't forget to pack them).

Whatever the food or drink or glucose option, my blood sugar is usually on the way upwards within 10 minutes.

That doesn't mean my Dexcom's caught up, or the data being sent to my wife many miles away (sometimes 3 time zones away) is showing this treatment.

Nope, according to Dexcom: I'm still at 55 or so.

That's when I lie.

I calibrate my Dexcom and tell it I'm actually higher than what the device thinks at that moment. Maybe it's 85, or depending how sleep-deprived and grumpy I am, I may lie and tell it I'm in the 140s just to boost it above the "Low 70" threshold.

And then, when it's comforted, I go back to sleep. Knowing my wife won't be worrying, even though I've already texted her I'm OK or we've exchanged calls saying all is good and I'm treating.

Usually within 5 hours, I am waking up and able to re-calibrate to make sure the CGM data is back on track and not way off. This hasn't been a problem, the handful of times I've "lied" to my Dexcom. Typically by lunch-time, we're back in line and spot-on as to CGM accuracy.

Sure, I get that lying to my CGM isn't how it should work.

I'm like a teenager writing in my handwritten BG log, fudging numbers before my endo visit (yes, I did this). Except now I'm using tech to do this, and be lazy.

The honest to God truth: Diabetes tech can be a bitch, even when it's saving your life. First world problems and whining D-tech trains of thought aside, it is what it is. This is just me complaining, stepping beyond all the perspective and access talk that comes with diabetes tech these days.

Most of the time, I know why I'm Low. It's not a case of my not knowing what's causing these, and prolonging the issue just because I'm lazy. No, it's simply that the low-carb meal that I dosed for but miscalculated for is hitting me now in the middle of the night. And I'm just not prepared to deal with it, thanks to sleepiness or whatever else.

No, this is a relatively small gap of time where I know I'm going to be OK, and will likely be in the high 100s or 200s before long, but I just don't want to endure the repeated alarms of my D-tech that hasn't figured out I'm actually OK yet.

Every time I've lied, it's for my own peace of mind for sleeping and my wife's that I've done this. And I am OK with that, because it doesn't happen too often and I am always OK when doing this, at very little risk of dropping Low again.

Sleep is important, and during busy travel when it's even more precious, I am OK with fudging my CGM data and data-sharing info. At least, during the overnight hours.

Lying isn't my standard protocol. But sometimes, I say, "Fuck It. Let there be sleep."

Friday, October 30, 2015

Reflecting on a Decade in the Diabetes Online Communit

Originally published on DiabetesMine in October 2015

This month is a big milestone in my world with diabetes, as it's the 10-year anniversary of when I first found the Diabetes Online Community (DOC), and my discovery of the mantra, "I am not alone."

At the time, I was in my mid 20s, newly-married, and had just started experiencing mild neuropathy in my feet. I was in desperate need of finding others who could share similar real-world experiences, rather than textbook medical advice or horror stories about how bad things can get.

Turning to the Internet (which we did even in 2005!), I found a woman on the East Coast who was about my age and telling her own diabetes story online. That was Kerri (Morone) Sparling at SixUntilMe, and for the first time when reading her personal posts, I felt a connection to someone who truly knew what I was going through -- maybe not neuropathy specifically, but just real life with diabetes. Thanks to Kerri, I soon came across another longtime type 1 named Scott Johnson in Minnesota, who was the first fellow male that I saw writing about diabetes online at Scott's Diabetes.
From there, others came onto my radar -- including George Simmons at Ninjabetic, Christel Marchand Aprigliano who hosted the Diabetic Feed podcast at the time, and of course Amy Tenderich at DiabetesMine. I actually lurked for awhile at first before commenting and it was a couple of years before I began writing about diabetes on my own personal blog, The Corner Booth. Amazing how it took me several whole years to inject diabetes (pun!) into my personal writing regularly.
A lot has changed in these past years, Including that big moment in 2012 when I had the opportunity to merge my journalism career with diabetes story-telling by joining Amy at the 'Mine. Remember my introduction post from May 2012?
On this decade DOC-aversary I decided to reach out to those first two D-bloggers I'd found back in 2005: Kerri and Scott. I'm honored to call these two friends, and still go to their blogs daily out of habit just to see what's up in their worlds.
Here's what those two dedicated bloggers have to say about the past 10 years of the DOC...
Talking with Diabetes Bloggers
DM) First, thank you both for being so authentic, and offering insights over the years that truly help people cope with diabetes. How do you respond when someone says that to you?
KS) It sounds stupid, because I give the same answer every time, but it's the truth: when someone says to me that I've brought them some sense of peace, I don't think they realize that their existence brings peace to me. That's why I started in the first place, because I didn't know anyone in my real life that had type 1 diabetes and I felt that loneliness. It's weird to feel that way -- that you're the only one. So for someone to come up and say, "I found you and it made me feel better," I have to really quash the urge to hug them. It's one cyclical thing in diabetes that's really pleasant and nice; just hearing that I'm not alone, and having that reinforced over and over is awesome.
SJ) It's a real blessing that my writing (which is a selfish, therapeutic tool for me) can also benefit others. Our mutual friend George "Ninjabetic" Simmons always talks about how important it is to know that you're not alone, and I think that sharing my struggles along with my successes does a lot to help people know that. 
Why is blogging important today as it was 10 years ago?
KS) Dude, I keep doing this for the same reason as when I started: To remove the isolation of diabetes from my life. So if I can put my story out there and find someone, that's why I continue doing it. The connections we make with one another... that's a huge bonus. For me, the page views and attention from Pharma pale in comparison to the friendships and the value of those relationships. People can stop reading and caring about the business side of this. But the fact is that as a patient, when something gets bad, you've made connections where you can call these people for help if you need to.
SJ) A big part of what makes this space so helpful to me is the sense of normalcy and knowing I'm not the only one dealing with a particular issue. And that wouldn't be possible without all of the diverse voices participating in the social media space. My challenge now is simply keeping up with all of the content being created! And think about what we have done to the search results! We are actively changing what people find when they search for diabetes information on the internet. Ten years ago it was medical information and complications. Now it is that, plus an overwhelming amount of personal, inspiring stories of people living well with diabetes! I love that!
What do you think has been the biggest change in the DOC?
KS) It's evolved. We don't just share our stories about some stupid high or low we had with diabetes. Over the past decade, we've really gotten to know people and what's going on in their lives. That's a long time to be sharing yourself online and for people to get to know you. I have good friends outside of diabetes that I've known for a long time but haven't really connected with them like I have with some of the friends I've made in the DOC. That's pretty mind-blowing, to know this level of intimacy exists in a digital medium. People used to wiggle their nose at that and think it was weird and suspect to have friends from the Internet. But no, I have friends. The Internet part has been removed from that equation.
And now there are so many of us... It's really easy to get to know 20 or 30 people, and create a level of intimacy within that small group. But now the DOC is gigantic, and it's not just "you and me," but people who are raising kids with it and married into diabetes... The community has grown so much, and it's been challenging to get to know people in that same intimate way we did in the beginning. That's been the part I have struggled with the most.
But I will not step away from long-form blogging. That's where my heart lies. Hearing someone's story, and not just some quick snippet of what's just happened, but reading the start and finish of it, that's very intimate. And that forges a connection regardless of whether you ever leave a comment or email someone. You're really getting something. I am rooted in that and love it.
SJ) The biggest change in the diabetes blogging world is the number of people and the different ways and channels to create content. I'm willing to say it's impossible to keep up with everything that's being produced right now, and what a wonderful problem to have. That means anyone can find something they like, and most can find a way to create and contribute if they want to. 
Pharma and the diabetes industry have certainly taken notice of the DOC... what do you think about that?
KS) I agree that companies have made the realization about the importance including our voices. I applaud any company that's trying to create something that serves the community. I applaud them for first trying to understand the community. That's the way to do this -- "Get to know us as people, and you will develop strategies to help treat diabetes more effectively." It has to be real.
SJ) I think it's been an interesting and mostly beneficial time for both sides (pharma industry and patients). We've become a loud voice in the space and I think that alone provides value whether companies engage or not. The relationship is stronger, and I think more learning happens on both sides when companies engage. But even when they don't engage actively, they are still listening and gathering feedback. I'd like to thank Roche specifically for taking a risk with the first Diabetes Social Media Summit. They accelerated so many of the relationships that exist today.
What else would you like to say to our readers -- who are both patients and industry folks -- about online patient connections?
KS) Notice that when people are searching and finding you, they aren't asking questions like, "How do I titrate my insulin during exercise?" No one is looking for technical stuff when they're finding people who are telling real personal stories. They're looking for diabetes in the context of a real life. That may mean wearing your insulin pump in your wedding dress, or whatever it is. But it's not sitting around all day charting your numbers and putting boundaries around your life. That's what the DOC overall has done, pulling diabetes out of the vaccuum for doctors and many others and putting it into real life where it belongs.
SJ) And I'd like to thank you, Mike, for your constant contributions and hard work over the past 10 years. Your voice and reporting skill does really great things for all of us, and I appreciate you. Here's to the next 10+ years!

Connecting the Diabetes Dots

Honestly, we can't say enough about Kerri and Scott, as well as the entire DOC. People in this community have shaped who I personally have become and helped me through some of the darkest moments in my life relating to diabetes.
To every single person reading this, I say Thank You.
We'll soon be compiling our monthly Diabetes Blog Roundup that showcases some of the favorite posts we've read over the past month. We love going through all of our longtime favorites, as well as discovering newer blogs, and seeing new ways that stories are being shared out there. Hopefully, those stories are resonating, because connecting the dots with between our collective experiences is what makes the DOC what it is.
So what do you think, Friends? How did you first find this community of pancreatically-challenged peeps, and what have you observed since discovering the online universe?

Reflecting On a Decade in the Diabetes Online Community

This month is a big milestone in my world with diabetes, as it's the 10-year anniversary of when I first found the Diabetes Online Community (DOC), and my discovery of the mantra, "I am not alone."

At the time, I was in my mid 20s, newly-married, and had just started experiencing mild neuropathy in my feet. I was in desperate need of finding others who could share similar real-world experiences, rather than textbook medical advice or horror stories about how bad things can get.

Turning to the Internet (which we did even in 2005!), I found a woman on the East Coast who was about my age and telling her own diabetes story online. That was Kerri (Morone) Sparling at SixUntilMe, and for the first time when reading her personal posts, I felt a connection to someone who truly knew what I was going through -- maybe not neuropathy specifically, but just real life with diabetes. Thanks to Kerri, I soon came across another longtime type 1 named Scott Johnson in Minnesota, who was the first fellow male that I saw writing about diabetes online at Scott's Diabetes.

From there, others came onto my radar -- including George Simmons at Ninjabetic, Christel Marchand Aprigliano who hosted the Diabetic Feed podcast at the time, and of course Amy Tenderich at DiabetesMine. I actually lurked for awhile at first before commenting and it was a couple of years before I began writing about diabetes on my own personal blog, The Corner Booth. Amazing how it took me several whole years to inject diabetes (pun!) into my personal writing regularly.

A lot has changed in these past years, Including that big moment in 2012 when I had the opportunity to merge my journalism career with diabetes story-telling by joining Amy at the 'Mine in May 2012.

On this decade DOC-aversary I decided to reach out to those first two D-bloggers I'd found back in 2005: Kerri and Scott. I'm honored to call these two friends, and still go to their blogs daily out of habit just to see what's up in their worlds.

Here's what those two dedicated bloggers have to say about the past 10 years of the DOC...


Me) First, thank you both for being so authentic, and offering insights over the years that truly help people cope with diabetes. How do you respond when someone says that to you?

KS) It sounds stupid, because I give the same answer every time, but it's the truth: when someone says to me that I've brought them some sense of peace, I don't think they realize that their existence brings peace to me. That's why I started in the first place, because I didn't know anyone in my real life that had type 1 diabetes and I felt that loneliness. It's weird to feel that way -- that you're the only one. So for someone to come up and say, "I found you and it made me feel better," I have to really quash the urge to hug them. It's one cyclical thing in diabetes that's really pleasant and nice; just hearing that I'm not alone, and having that reinforced over and over is awesome.

SJ) It's a real blessing that my writing (which is a selfish, therapeutic tool for me) can also benefit others. Our mutual friend George "Ninjabetic" Simmons always talks about how important it is to know that you're not alone, and I think that sharing my struggles along with my successes does a lot to help people know that.

Why is blogging important today as it was 10 years ago?

KS) Dude, I keep doing this for the same reason as when I started: To remove the isolation of diabetes from my life. So if I can put my story out there and find someone, that's why I continue doing it. The connections we make with one another... that's a huge bonus. For me, the page views and attention from Pharma pale in comparison to the friendships and the value of those relationships. People can stop reading and caring about the business side of this. But the fact is that as a patient, when something gets bad, you've made connections where you can call these people for help if you need to.

SJ) A big part of what makes this space so helpful to me is the sense of normalcy and knowing I'm not the only one dealing with a particular issue. And that wouldn't be possible without all of the diverse voices participating in the social media space. My challenge now is simply keeping up with all of the content being created! And think about what we have done to the search results! We are actively changing what people find when they search for diabetes information on the internet. Ten years ago it was medical information and complications. Now it is that, plus an overwhelming amount of personal, inspiring stories of people living well with diabetes! I love that!

What do you think has been the biggest change in the DOC?

KS) It's evolved. We don't just share our stories about some stupid high or low we had with diabetes. Over the past decade, we've really gotten to know people and what's going on in their lives. That's a long time to be sharing yourself online and for people to get to know you. I have good friends outside of diabetes that I've known for a long time but haven't really connected with them like I have with some of the friends I've made in the DOC. That's pretty mind-blowing, to know this level of intimacy exists in a digital medium. People used to wiggle their nose at that and think it was weird and suspect to have friends from the Internet. But no, I have friends. The Internet part has been removed from that equation.

And now there are so many of us... It's really easy to get to know 20 or 30 people, and create a level of intimacy within that small group. But now the DOC is gigantic, and it's not just "you and me," but people who are raising kids with it and married into diabetes... The community has grown so much, and it's been challenging to get to know people in that same intimate way we did in the beginning. That's been the part I have struggled with the most.

But I will not step away from long-form blogging. That's where my heart lies. Hearing someone's story, and not just some quick snippet of what's just happened, but reading the start and finish of it, that's very intimate. And that forges a connection regardless of whether you ever leave a comment or email someone. You're really getting something. I am rooted in that and love it.

SJ) The biggest change in the diabetes blogging world is the number of people and the different ways and channels to create content. I'm willing to say it's impossible to keep up with everything that's being produced right now, and what a wonderful problem to have. That means anyone can find something they like, and most can find a way to create and contribute if they want to.

Pharma and the diabetes industry have certainly taken notice of the DOC... what do you think about that?

KS) I agree that companies have made the realization about the importance including our voices. I applaud any company that's trying to create something that serves the community. I applaud them for first trying to understand the community. That's the way to do this -- "Get to know us as people, and you will develop strategies to help treat diabetes more effectively." It has to be real.

SJ) I think it's been an interesting and mostly beneficial time for both sides (pharma industry and patients). We've become a loud voice in the space and I think that alone provides value whether companies engage or not. The relationship is stronger, and I think more learning happens on both sides when companies engage. But even when they don't engage actively, they are still listening and gathering feedback. I'd like to thank Roche specifically for taking a risk with the first Diabetes Social Media Summit. They accelerated so many of the relationships that exist today.

What else would you like to say to our readers -- who are both patients and industry folks -- about online patient connections?

KS) Notice that when people are searching and finding you, they aren't asking questions like, "How do I titrate my insulin during exercise?" No one is looking for technical stuff when they're finding people who are telling real personal stories. They're looking for diabetes in the context of a real life. That may mean wearing your insulin pump in your wedding dress, or whatever it is. But it's not sitting around all day charting your numbers and putting boundaries around your life. That's what the DOC overall has done, pulling diabetes out of the vaccuum for doctors and many others and putting it into real life where it belongs.

SJ) And I'd like to thank you, Mike, for your constant contributions and hard work over the past 10 years. Your voice and reporting skill does really great things for all of us, and I appreciate you. Here's to the next 10+ years!

Connecting the Diabetes Dots

Honestly, we can't say enough about Kerri and Scott, as well as the entire DOC. People in this community have shaped who I personally have become and helped me through some of the darkest moments in my life relating to diabetes.

To every single person reading this, I say Thank You.

As always, it's about connecting dots and making sure people know they are not alone.



- - - - - - - - - - - - - - - - - - - - - - - 
This post by Mike Hoskins originally appeared on DiabetesMine in October 2015.

Tuesday, October 27, 2015

Mopping Up After a Nightcap Hypo

My watch said 10:56p, and as I walked toward the glass gas station door, the time written on the glass told me closing time was in roughly 4 minutes.

Though the glass, I could see the gas station attendant mopping up around the counter. The shiny wetness told me he'd already cleaned the floor in the two food aisles where I planned to beeline toward once going inside.

As I pulled the door open, he tossed a semi-annoyed look at me and the black dress shoes I was tracking inside.

"Did I make it?!" I asked, glancing at my watch for no reason except to show him how concerned I was with the time.

He didn't respond, but I really didn't care because this wasn't a pleasure visit to the gas station.

No, I had a mission. And the vibrating Dexcom G4 on my belt reminded me that there was a more critical point to all of this.

The 48 on my Dex receiver and CGM in the Cloud connected Pebble watch reminded me of the more critical point to all of this, the nightcap hypo that had dragged me from crawling into bed at a nearby hotel.

This wasn't the kind of night cap I'd wanted.

Here I was, on a two-day work trip, just close enough to home that I could make the 90-minute drive but far enough where it was better to just stay the night locally. I'd been walking around a college campus for a good chunk of time, and after finishing up the day's event snagged some lower-carb food and a drink at a nearby restaurant. I had just found my way to the hotel for the night and after ironing my shirt for the following morning, was ready to crash for the night.

Then, I heard the vibration and "BEEP BEEP BEEP"of Dexcom on the nightstand.

I'd been ignoring the down-trending arrow for awhile, assuming at some point my dinner would kick in and start boosting my blood sugar. But that hadn't happened, and now I was dropping dangerously low.

Two straight down arrows. Already Below 55. And then, it dropped into the 40s.

Nothing in the backpack or quickly-packed dufflebag, I discovered. An out-of-state work trip a couple days earlier meant that on my one day off, I hadn't restocked with a cracker pack or anything of substance to keep my BGs balanced.

In my Hypo Mind at that moment, I didn't realize that I did have a jar of glucose tabs but it was buried in my duffle bag.

This was a smaller hotel just outside of the college town I was in, and the vending machines in the hallways only had drinks. I bought an orange juice with the $2 in my wallet, but this wasn't going to keep my sugar steady and it would start dropping once I actually went to bed.

I needed food.

This low I could feel. It wasn't completely impacting me yet, but I knew it would be minutes before that started setting in.

So that meant going outside the hotel to the gas station a block away, on the corner. I choose to drove and not walk in order to not risk going lower thanks to the exercise. Keep in mind, I'd already gulped down half a bottle of Sunkist juice from the vending machine, so I knew it was just a matter of time before I would see the surge upward.

 Pulling up to the gas station, the pumps were already dark and I could tell it was almost closing time. But I needed food.

Once I walked inside, it was a simple task -- once I could focus enough to figure out what I needed to buy -- of grabbing a few snack items. Pop tart, a candy bar, another OJ, and a pack of Nutter Butters.

Stuff that was all in one place on a shelf corner, and had some substance in case I dropped lower overnight at any point again.

"Is that all?" the gas station attendance asked me, once he put his mop down and was behind the register.

"Yep, just these. Nothing fancy."

"Some late night snacking, I take it..." he offered, searching for more of a reason as to why I barged in disrupting his mopping routine.

"Pretty much. Stocking up."

That's all I said.

In my head, I fumbled around with thoughts of justifying my purchase. Maybe that this was pretty much for medical reasons, and how this could be a moment of diabetes advocacy. I felt guilty. Both for the thought that I was contributing to society's perception of unhealthy late-night eating, and also that I didn't "advocate" or anything.

But nothing more needed to be said in that moment. I had my food, paid and let the attendant go about his closing-time mopping.

And I went back outside, ripped open the Nutter Butters, and began mopping up my low blood sugar symptoms for the night.

Thursday, August 13, 2015

My Formative First Years of Coffee

I don't remember the first cup of coffee that ever crossed my lips.

But I do remember when coffee first became "a thing" for me, something I craved and wanted to drink up. Simply put: It was all about Coffee & Conversation, and the two went hand-in-hand.

Everything came together at a local open-all-night diner dubbed Linda's Place, in my hometown of St. Clair Shores. That was the spot that became a second home of sorts back in the mid-90s, especially during my latter years of high school. A good friend and I would make a plan to go there at all hours -- whether it was in the not-so-late evening hours, the after-midnight hours when our writing pens would magically come alive, or even during the morning or afternoon hours when we were supposed to be stationed at school.

Sure, I may have tried coffee before then and tasted it every so often, but never did I enjoy it the way that I started to in high school. Coffee was an acquired love, one more about the experience than just the java itself.

That was also about the time that my creative writing and poetry started evolving into newspapering, and so the whole "coffee and journalism" pairing couldn't have been more perfect.

Really, it was just that coffee made all the conversation better. Those were the years when we found ourselves sitting in The Corner Booth, talking about life and politics and all things possible. We wrote spontaneous poetry and prose on white napkins. We shared stories about hopes and dreams, plans and fears and all that you do when you're teenagers. We learned who we were, and the coffee just made it seem more "grown up" and real.

Coffee & Conversation is the way it's supposed to be.

You can probably tell that all means something to me, given that it's in the name of this blog and you can see that story in the "Why the Corner Booth?" tab. And hell, my image at the top has a coffee mug in it... not to mention my home office, that has a sign on the door that says "Coffee Understands" and in the corner my Riley Dog has a pillow and blanket with coffee mugs all over it.



And in the diabetes context, I've even gone about a so-called Great Coffee Experiment to explore how it impacts my blood sugar.

Yep, coffee is important to me.

Coffee & Conversation is the way it's supposed to be, and for me it all began with that corner booth in the Shores and stretching to most of the places I've worked in ever since.

Of course, I remember when we weren't in that corner booth, but settling for a cup of joe in some other location -- a home, classroom (yes, it happened), actual coffee shop, or just out on-the-go. There was even another Linda's Place on the opposite end of town that we'd gone to a number of times. In particular, that above-mentioned friend's house was one of those spots that stands out, these days specifically.

You see, her mom was one of those people you could lose yourself in conversation with. She was witty, funny, a natural smartass but someone who loved a good chat. And the coffee that went along with it.

Here's where I make an important point: She taught me it was OK to drink black coffee.

Before then, I didn't know anyone else who drank their coffee straight up. Most coffee-drinkers in my world at that point added something to their java -- cream, milk, sugar, sweetener. Even her daughter, my good friend, did this coffee pollution. And so it always amazed me to think about how great it was to see Judi taking her coffee the way it's supposed to be.

I owe a lot of that to my friend Kari and her mom, Judi. Even if I didn't know it back then.

This all comes to mind recently, as the world just lost this woman who was such a beacon of hope and goodness for so many. Seriously, coffee aside -- you want to read a good story, read up on Judi Navarra. She made a difference in lives, and was someone we should all strive to be.

All of this has made me think about my formative years of coffee, right here in my hometown of St. Clair Shores, Michigan.

That time in my life taught me to appreciate how much I love the pairing of coffee and conversation, that mixture of smooth dark roasted coffee with an aroma that could make your sleepy eyes want to be awake for some conversation. It meant sophistication, intelligence, depth and all those things you look for when you're a teenager.

Into the college and adult years, coffee became more of a way to stay awake and get a boost of energy when needed for whatever task was ahead.

I like my coffee black, and mildly hot... but not scorching hot, because I don't want to burn my tongue
and want to be able to start drinking and appreciating my coffee right away, especially when there's conversation to be had or work to be done. So, you might even see me toss an ice cube or two into it... just to get it to that perfect temp.

I'm also sure that my type 1 played into my dislike of adding any creamer or sweetener to my coffee, since from the time I was a young kid sugary or sweet-tasting drinks were never in my wheelhouse. I just liked it the way it came, and the stronger the better.

For me,  coffee is just a standard. And it's not even just about what it's in the cup, but the people you're sharing that coffee with.

So, I raise a cup of black coffee to those in my world who have come and gone, who have been a part of one conversation or another. And to all those who come to the proverbial corner booth down the road.

Here's to continuing the coffee & conversation.

#joyforjudi


Thursday, July 30, 2015

Low Blood Sugars, A No Hitter and the Michigan Move

For those who weren't aware, I just made a move from Indiana back to Southeast Michigan.

It's been an adventure packing everything up for the move, which just happened this past week. And I wrote about some of that fun over at DiabetesMine the other day.

Photo made by me, so I'm posting it here. Since it's my Moving Day, D-Stuff, and Dog.

When Moving Day arrived, I had my trusty Dexcom G4 connected along with my data-sharing CGM in the Cloud setup. You know, to keep tabs on where my blood sugars were at during this move between states.

As is typically the case, the low blood sugars came at the most inconvenient time.

The first was just as we were getting on the road for the 5+ hour drive (more like 7, thanks to the 20' moving truck slowing things down).

Everything looked fine as we were leaving the house, as my G4 happily told me that I was part of the 100 Club with a 100 mg/dL at that moment. Like, the move was meant to be!



We were all good to go, and my moving truck cab was well-stocked in case of any diabetes emergencies -- with my Dexcom at my side, Nightscout on my wrist and sharing data to my wife's watch in the car behind me, plus a cracker pack and Gluco-Lift tabs in the cleverly-marketed t:slim tin. Also, had a cooler with my insulin supply and some juice. Not to mention some other goodies, all with the vacuum and flatscreen TV occupying the passenger seat next to me.

I was ready.



Of course, within 10 minutes as we left the neighborhood, that's when I started going Low... Figures.

It was nearly dinner-time, so before hopping on the interstate, we decided to stop for some fast-food chicken and wait the Hypo and Rebound Effect out for a bit... not to mention the early rush hour traffic.

I am happy to also point out that after treating my Low before the drive, I didn't rise above 180... a small diabetes victory sprinkled throughout all of this! Woot!!

Suzi was driving in the vehicle behind my truck, with our Riley Dog. The drive was uneventful, both generally and relating to diabetes. Made a couple stops to rest, fuel up, and let the Riley Dog just get out and burn off some dog energy.



We stayed the night at the half-way mark, then finished off the move early the next morning and made it to the new house in more than enough time to start moving everything inside.

And again, Dexcom began vibrating that a Low was setting in.

This time, I swear could feel the low symptoms. But a fingerstick told me I wasn't actually Low, and I realized that I actually wasn't Low but had set my low alert to 90 for that afternoon just to make sure to catch any impending lows. It worked, and all was good!

After all the big boxes and heavy work where done for the day, I re-set my low alert back to about 70 and it made for a better BG trend for that entire day.

Our move went well, and we love the new house in Michigan!



Magically, I was impressed that the new fridge actually has TWO butter compartments -- as if, it's designed for someone with diabetes to have one compartment completely for insulin, and another actually for butter or dairy. Outstanding!!!

TWO BUTTER COMPARTMENTS!!!!

I've insisted that we need to label them, one that says "Insulin" and the other that says "Dairy." I'm told we won't be doing that, but since I work from home...

:)

That first day, after the move-in, I was pretty impressed with how I'd managed to achieve a Michigan No-Hitter (something our Detroit Tigers haven't been able to do in far too long, btw...) Looks like moving agreed with my blood sugars!



As it turned out, I had conservatively reserved a 20-foot truck and it was too small to fit everything we were moving. The movers said: "Two more feet and we could've gotten everything in there!" So, we had a small portion left in the garage to transport, and so I rented a cargo van a couple days later and made a quick trip back to Indy myself. I couldn't get the truck until Noon, and had it through the next day at that time, so half my trip was pretty much at night.

The drive was 5 hours each way, and I was at the old house for less than an hour moving in the grill, lawnmower, outdoor tools, and other items.

Blood sugars were fine, and thanks to Nightscout, I was sharing all the data with Suzi while en route.

This was a sunset captured along the interstate, on the final drive from Indy to Michigan.


At the halfway point, roughly around midnight, Dexcom started vibrating that I was going Low. And before I knew it, we entered into the below 70 threshold. And I could feel this one, making me panic in the darkened night behind the wheel of a cargo van full of stuff.

Gluco-Lift in my pocket, but I had only grabbed a two-tab pack and that certainly wasn't enough. And I had nothing else with me to treat.

An emergency stop was needed at the nearest gas station -- and I wanted a well-lit, trusty station not a mom-and-pop place out in the middle of nowhere that was probably already closed at that hour.

It took me longer than expected, but after about 10 minutes I came across a well-lit set of stations at a major exit and made my stop. Orange juice, extra coffee, Combos to snack on.

And as I sat in the gas station parking lot in the cargo van, I could sense the gas station attendant watching me, wondering why I was still sitting there after five and ten minutes of coming inside.

It made me uncomfortable, especially since it was about 12:30 a.m.

Texted with Suzi, who was turning in for the night. Reassured her that all was OK, that I was treating my low and had enough on hand to tackle any more of those, and that I was going to wait until I hit the 100+ mark to get back on the interstate.

Two hours later: I was home, and my blood sugar was in the 300s. But I didn't care, because I was physically and mentally tired from all the moving and mental somersaults and just wanted to sleep.

So, I corrected and went to bed in my new house, ready to wake up a few hours later and continue with the unpacking along with working in my new home office.


I'm excited to be back in Michigan, eleven years after we left for Indiana.

Monday, June 22, 2015

Trapped in a TV Show

A friend posted a question online the other day that got me thinking.


Certainly not a new question, as it's been going around online for years.

My answer: Well, it depends...

Mostly, on the rules.

Just how exactly am I going to be trapped in TV? Will this be like the movie Pleasantville, where I'm basically tossed into an existing story line but am really myself (except everyone seems to think I'm a particular character)? Maybe Quantum Leap, where I basically "leap" into other people's bodies and am confined to that reality and whatever limitations they may have (if they are a minority, or in a wheelchair, or a man or woman -- that's me for the time I'm in there)?

Or is it like Back to the Future, where I'm just plopped into some point and am just living my life as myself, except in the context of whatever show and time period we happen to be in.

These are important considerations in deciding on the show, I think. Because really, am I going to be a character or myself in that particular show? And if it's the latter, will I still be pancreatically-challenged and be living my TV character life with the additional adventure of managing diabetes?

Or do I suddenly just become a sugar normal?

The whole point about time is important, too.

While it may be fun to be transported into the world of the Brady Bunch for a month, I'd be putting myself into the late 60s and early 70s, a time when the "diabetes dark ages" was still playing out and there wasn't modern D-tech like blood meters, insulin pumps, and CGMs.

Sure, it'd be an adventure living in the world of Hell on Wheels, but then again that would be in the 1800s before insulin was discovered... so yeah, I probably wouldn't last a month.

Boardwalk Empire could be cool, but insulin was just making it on the scene, and so I'd probably be in the same boat because I wouldn't have access to this life-sustaining medication. Or I'd get knocked off by a gangster, since they were all over the place and I'd probably be in search of a good Prohibition-era beer to drink.

And that brings up an even more important big-picture rule question: What happens if I die before the month's up -- do I suddenly get pulled back to my own reality, or is my character just killed off and the show's cancelled?

That also helps me decide if other high-danger shows would be the best fit. Certainly, I wouldn't want to be on The Walking Dead, because I'd be the first to get zombified -- not even factoring in the "need to find insulin in an apocalyptic world" aspect. The same goes for Game of Thrones which is set in the medieval times, and with all the death and torture going on there, it'd be a bad month.

Probably best not to explore those kind of shows.

I really did love Burn Notice, but really I'd be a horrible spy and the danger factor is just too high even for that (assuming I'm either in that spy-group or just in danger by association). Smallville would also be interesting, and I'd certainly like to think I'd be safe by association to Clark Kent, but my luck I'd end up getting paired up with a meteor-freak or put in the crosshairs of some Lex Luthor scheme.

Maybe I'd be best to be in the world of How I Met Your Mother (before the ending episodes), which is basically this day and age and fun. A normal show, without much drama or danger... just good times, good friends, and so on.

Then again, thinking about all of this, I think my life is better than any TV show. I just need to learn to hit pause to cherish the episode a bit more at times, and maybe watch a few re-runs as I'm writing the screenplay for my future.

Friday, June 12, 2015

The Boston Experience

So, the big diabetes conference of the year with all kinds of science and tech talk and just "diabetes research" as a mantra has now come and gone.



I'm in Detroit following the ADA's Scientific Sessions, and have to admit my time in Boston was quite a bit of fun on top of all the interesting diabetes stuff being covered in an official ccapacity.



Here are some of the photos (I don't take many pictures in the moment, sadly), and captured some of what I experienced in Boston.

There Was Coffee (see also: Duh)



Lots of Walking (and Low Blood Sugars, Consequently)


Actually, that was a photo of the Walking Challenge app on the 2nd full day. I walked the equivalent of something like 36,000 steps or miles upon miles, and so my feet and legs are still recovering.



Yes, I wore my Dexcom G4 and had it hooked up to Nightscout for CGM in the Cloud.

But of course, my G4 sensor died and the only backup in my case got ripped off thanks to a fast-moving, unnoticed hotel wall corner that appeared out of nowhere and accosted me). But thanks so much to a good D-peep who had an extra on hand, and was willing to help me out. Thanks, Chris Angell!


Loved visiting the Joslin Diabetes Center for the first time ever.


Actually, I was in a rush to get there that day for a "Beyond Carb Counting" event, and as you might guess, I went Low and needed to inhale some fast-acting glucose tabs while listening to presentations about carb counting. Diabetes irony at its best!





Diabetes at Fenway Park (thanks to Dexcom, which held a fundraising event there)


You can't see the screen in this pic, but look below to get beyond the bright white light...

Thanks to Briley for snapping this photo!



Word is (from what I read on Kerri's blog, that there were Collector's Cards too, but I didn't know that. And I did enjoy a Fenway Frank while there. #LikeYouDo

There was other Boston fare, of course -- seafood, shrimp and New England Clam "Chowda" (see also: Mmmmm)


Yes, and Boston microbrew:




Diabetes History (the Year I was Born):



Diabetes History (Year I was Diagnosed)



The 80s were a Big Time in Diabetes:




Just a few friends from the Diabetes Online Community (DOC) I got to hang out with, although there were so many more and pictures just weren't taken of all those great times.






Thanks for a great time, #2015ADA and Boston!


Friday, June 5, 2015

Why I Fired My Endocrinologist, and What I Want in a New One

A couple of weeks ago, I laid off my endo because he wasn't willing to work with me on trying out the new inhaled insulin Afrezza.

How it all played out was unexpected and not how I would typically handle something like this, as it was a spur of the moment decision over the phone.

I had called his office first thing that day with two specific goals: to get a regular-check appointment on the calendar, and to have him consider my interest in using the new inhaled insulin product Afrezza.

In the first few months since Afrezza hit the market, I've been curious about trying it myself after hearing how it's a double thumbs-up for many patients in their D-management. I'm still skeptical and have lingering concerns about the long-term risks to the lungs, but nevertheless I want to give it a puff (ha!) for myself just to see.

Going in, I really don't plan to use it as my go-to meal-time bolus insulin. Rather, I simply want to see how it works for those stubborn sky-high blood sugars that take a really long time to knock down. And maybe to cover some high-carb meals (though I've been working to reduce those as much as possible).

In other words, right now I'm just interested in test driving Afrezza. And I think it's really important for as many patients as possible to have that opportunity, to learn about how this controversial new treatment performs in the real world.

That is what I wanted to talk about with my endo, whom I refer to online as 'Dr. Health Bug.' I really wanted to have this opportunity before heading off to the ADA Scientific Sessions this week in Boston.

But the return call I got from my endo's office that day -- quicker than most -- reported that this wasn't possible. I would not have access to Afrezza. The reason: "because it's too new."

WTF?!

My mind stumbled over this information, not knowing how to respond. "But it's FDA approved? And isn't that my choice to make, as long as I'm making an informed decision?!"

Apparently not, according to Dr. Health Bug.

What bothers me is not that this physician wouldn't just straight-up approve my prescription request without first seeing me and talking it over. No, I appreciate that he would want to be sure I understand all the pros and cons of using such a new and unique medication, one that is indeed pretty much untested in the real-world use as far as most doctors and patients are concerned. Afrezza was just approved and launched in February, so the scientific studies and scattering of patient testimony so far might not be enough to reassure the medical field at large over potential risks just yet. I understand that.

So I appreciate the caution.

But what DID bother me is that this discussion wasn't even something my endo was willing to have. Instead, I was told that there is an unwritten office policy of not yet approving Afrezza for patients because it's too new. Point blank. Across the board.

This is very troubling to me, and it was pretty much enough to push me over the line and decide to fire my endo on the spot (over the phone).


Truth be told, this was coming anyway -- and it has nothing to do with this particular doctor. In the short time I've been seeing him, I've always found him to be very friendly, responsive, and willing to work with me.

But my wife and I are on the verge of a move out of Indiana and back to Southeast Michigan later this summer, so a doctor change was coming soon anyhow. This Afrezza Rx issue just forced the issue now, rather than waiting that last month or two. I'm rather incensed about the way they're handling this.

To be honest, if we weren't moving away, I would probably hold on to Dr. Health Bug and make a concerted effort to change his opinion, but that's just not worth my time with barely two months left in the area. I did communicate my frustration to his office staff, of course, and am in the process of writing an official-sounding letter about how he -- and all endos -- need to treat patients as partners and offer them reasonable opportunities to try new therapies (!)

So here I stand, endo-less, stuck in a transitional spot that marks the reality that we'll soon be moving back to Metro Detroit after 11 years here in Indiana. We plan to be back and settled by August. It's a weird feeling, being in-between endos -- perhaps even more so than being in-between hometowns. (Odd how diabetes trumps everything!)

It wasn't all that long ago that I was in the same boat changing doctors early last year, just before I found Dr. Health Bug.

Luckily, all my prescriptions are secure for the coming months and if something does come up, I have a capable primary doc who can handle things in an emergency.

We moved to Indiana in our mid-20s and the endo I saw previously in Detroit is still practicing, but I'm not sure if we'd be a good fit these days. Fortunately, I already have two other potential endos lined up, thanks to great local connections and Southeast Michigan D-Community. So, I'm not worried like I was back in 2004 when moving to a state I'd never even visited for more than a couple days prior.

But I still find myself a bit nervous about "screening endos" and finding one with the essential qualities of:
  1. Making me feel comfortable as a person
  2. Thinking progressively enough to respect my patient POV and explore new treatment options.
Clearly, a big factor in doctor-choosing will be how receptive they are to listening and working with me; that's pretty much a deal-breaker. And hopefully, by Fall, I can get my hands on Afrezza for my own test drive and report back on how that goes.



The doctor-patient relationship is a two-way road, IMHO, and that's what I will be looking for in the coming months.

 - - - - - - - - - - - - - - - - - - - - - - -

This post was originally published on DiabetesMine in June 2015, as written by Mike Hoskins.

Monday, June 1, 2015

On The Road: Blood Sugars, Starbucks, and E-85 Fuel

These past several months have seen a lot more travel up to Michigan as we have been planning our move back to the state. Since we both have older cars, I've turned to renting some cars to save mileage.


Rental cars influence my D-travel world in small ways:
  • making sure I have the insulin pump site and CGM sensor connected in places that don't get nudged by the stranger seatbelts
  • making sure the devices themselves are accessible
  • ensuring there's a spot on the door or console to put my G4 receiver for easy-viewing-and-access; or even an extra cupholder allowing for both my coffee and D-device.
  • ID'ing an additional easy-access spot for glucose tabs and a granola bar/cracker-pack in case of Lows while driving.
My meter case is usually within reach on the passenger seat or in my nearby briefcase or bag, so there's no need to do anything different as far as my meter's concerned.

Of course, any of these drives pretty much involve some key "need to know" points for me no matter what type of vehicle I'm driving -- gas stations, coffee spots, and locales that have Wi-Fi in case I need to tune in online and get some work done while traveling.

Usually, I plot out my blood sugar checks before I leave and for these every-few hour stops. I tend to follow the same routes, and so I've come to know where the best places are to find a Starbucks that I can either drive-through or go inside, a gas station and even some free WiFi like a Panera or Hot Spot to fire up the work laptop.

My CGM is usually with me on these drives, and so I've got the continuous stream of data flowing to the receiver that is nearby and visible -- especially when I'm wearing my Pebble Watch that has CGM in the Cloud capability, and can just keep tabs by looking at my wrist on the steering wheel.



For some of these recent drives, I've managed to snag a car that needs E-85 fuel and so that's thrown a monkey wrench into my plans. These E-85 gas stations aren't all over the place, and they can be tough to find. It requires a lot more advanced planning, and I've been using an E-85 locator app or this handy site while on the road to know where the nearest fuel station is at selling this type. Unfortunately, even when I find one with that hallmark yellow pump handle, a lot of times it's out-of-order or completely empty -- have even found some of the fuel stations aren't even operating anymore.

This has made it tough to plan ahead, and as a result I've been changing up the driving routine and not stopping as consistently as I was at other locations for Starbucks, fuel, and WiFi -- meaning, it's messed with my D-management while on the road.

Thanks for the image, Google.
Seriously, if my blood sugar testing was as reliable as these E-85 locations are, I'd be screwed in knowing where my BGs are at on the road. Hell, if my insulin was dependent on the access to E-85, I'd be dead.

At least that Starbucks logo can be found on many highway signs, even they're a lot easier to find than E-85 stations that actually have fuel on tap... (although, to be honest: the Starbucks app and my Google Map sometimes lead me to non-existent coffee spots or ones that are annoyingly housed in grocery stores). But, still. Hellava lot easier to find, pretty much anywhere.

I'm just glad I don't rely on these E-85 stops to test my BGs or know where things stand. At least I'd know that if my D-management while driving was as consistent as Starbucks, I'd never stop testing because they're everywhere along the way.

OK, now that I read this whole post from the start, I realize something: There's no particular point. Except that I'm not a fan of E-85 requiring cars, and that I want to avoid renting these in the future as much as possible.

Maybe I'll just leave it with "Test, Don't Guess... Unless you're waiting for an E-85 station to fill up, and in that case you'd better Guess or just pull over to the side of the road and check, because who the hell knows when you'll have another chance."