Tuesday, October 4, 2016

Playing Darts

For the past five months, I've been unconnected to my insulin pump and have been doing daily injections and inhaled insulin to keep my blood sugars in check.

All is well on that front, and at this point I have no plans to go back to insulin pumping in the near future.

As some may remember, I've been on a pump break since mid-May -- mostly because of my need to mix it up in my diabetes management, to motivate myself to get back in gear. But also, because of my frustration and disappointment in Medtronic Diabetes and their business decision-making that I, personally, do not feel best represents the D-Community.

Anyhow, with that being said... I'm still perfectly happy "playing darts."

This is a phrase my Loving and Supporting D-Spouse uses to describe my insulin injections. Whenever I ask for her help in doing a shot in the arm, she jokes that it's time to "play darts."

No, she doesn't actually toss the needle at me.

It's just a fun term of endearment we both use, to keep the daily D-tasks more light-hearted and fun in some small way.

This isn't the first time for me "playing darts," so to speak. The first 17 years of my T1 involved daily injections, and once I began pumping in 2001 there were many times I took a short pump break for various reasons. So, this time isn't new, but it may turn into a permanent break... that's still TBD, and I'm taking it a day at a time.

At the three-month mark of "playing darts" in August, my A1C was just about the same (even though I am suspicious that A1C result and think it wasn't showing the full story).

Since then, I've been bouncing around more often on the BG front and have seen some higher BGs over the past couple months due to my own slacking. But I am happy to be experiencing less unexplained hypos, so that's one for the win box.
I am hoping that my next visit in November reflects more of my efforts in getting my A1C down to 7%. To me, the treatment choices I've made over the past several months are the best way to get to that goal.

My Personal Afrezza Effect 


Afrezza is inhaled, but I've found over the course of a few months that it's barely effective in the evening hours for me. As a result, I turn to NovoLog fast-acting after dinner-time until the early morning hours, when I am happy to start my inhaled Afrezza as needed.

Over time, I've determined that one 4-unit cartridge is more like 2 or 3 units. But even that's not an accurate comparison, because this inhaled form doesn't work the same way as traditional insulin and it's a complete paradigm shift in getting used to its effects.

One thing I have noticed is that since mid-July (or roughly the three-month mark of starting Afrezza), it seems to be taking me more of this inhaled insulin to achieve the same fast-acting response as it did during the first three months.

I have tested this out in several ways -- with no food on board, very low carb and protein, higher "simple" carb meals, little stress and normal temps without any illnesses messing with me. Even have tried paying more attention to my inhalation technique, focusing on that "deep lung penetration" aspect to ensure I'm getting of the powder into my system properly. All of them have shown the same result: a single cartridge of Afrezza just isn't working as effectively as it once did.

 Usually, within 30 minutes I can start seeing the Afrezza Effect on my CGM. At times, it may take up to an hour to reflect any meaningful change, while at other times it's noticeable within 15-20 minutes. All just depends on the day, time and most likely whether a dog wagged its tail overseas...

That doesn't phase me from using Afrezza most of the time, it's just one more piece of information that I use in determining what's needed to keep my D in check. If that means an 8 instead of a 4 unit, or a couple of them instead of one, so be it.

I'm happy this is part of my toolbox to manage diabetes. It's also nice that my insurance company has gotten over its hesitancy in covering this and my local pharmacy seems to have overcome its ineptitude in access Afrezza. For now, at least.

Trying a New Basal Insulin

For basal insulin, I've been using Lantus twice a day.

A new basal insulin that I have just started this week may help on that front. On Tuesday morning, I began using the extra long-acting Tresiba that's supposed to last for 42 hours. This is something my doctor and I decided would be best, since I sometimes tend to miss a basal dose in the morning or evening, and because with Lantus my BGs spike on the tail-end.

So hopefully, Tresiba works better for me combined with Novolog and Afrezza.

At some point, it may be worth investigating new and exciting options in the smart insulin pen world, but that's something to explore down the road once we get into a new year... we shall see.

Appeal of Latest Diabetes Tech?


Whether I ever return to my Medtronic insulin pump is TBD, and despite the very exciting recent news of the first-ever Hybrid Closed Loop being approved, I do not have an interest in what the company offers at this time. Specifically for me, data-sharing is a deal-breaker and when MedT tells me that I have to use the 3+ YEAR OLD model and not the newly-designed 630G or hybrid closed loop... um, no. You lose.

More exciting is the Tandem t:slim X2 pump platform that is now available, and while I have no interest in returning to a pump right now, this is the one that temps me the most -- especially since it works with the Dexcom CGM sensor, one that I trust a lot more than the promises of any MedT tech that are still questionable to me.

With those D-tech points aside...

In the meantime, I'm happy using the darts I have and trying to hit as close to the bullseye as possible when it comes to BGs and staying in range.

Saturday, September 24, 2016

Our Wedding Engagement Newspaper

Happy Wedding Anniversary, Suzi!

As I do every year, I sit back on this special day and re-read the newspaper I created to propose back in March 2003. This full eight-page broadsheet is the one I spent about three months creating many months in advance.

It was quite the task, writing my own stories, editing and designing, selling ads to pay for the whole thing, and recruiting a roll of writers made up of family and friends. All of them keeping the upcoming marriage proposal a secret, of course!

I still remember staying out late at night, telling you they were late nights in my real paycheck-providing newsroom job when in fact they were spent at my old college newspaper stomping grounds putting this paper together.

It was tough, but it all paid off.

This is really a place to post the full newspaper, to keep it alive in digital form online. Sure, I have a couple dozen copies left over from the 1,000 created for that night and beyond. And every one of those eight pages has been framed to display in our home, to display for us to reflect on and for all those who might want to look at them.

Our newspaper hits the 21st century blogosphere, for the entire online universe to see as it may want to (likely clicking on the images themselves, to make them show up in readable sizes...)

The Daily News, Engagement Edition. Created for the proposal event on March 15, 2003.

Front Page

Page 2

Link to Front Page Proposal story. And the Page 2 jump.
Link to Speech story. And Page 2 jump.
How'd we catch each others' eye? Here's a Christmas 2002 account of those initial impressions...
Link to the Page 2 story on Sustaining Surprise.

Page 3

Inside Spread, Pages 4-5

Written by one of Mike's good friends from high school. (Click for bigger image)

Page 6
 Link to In the Beginning, a story of Us on Page 6.
Link to Page 6 story 9/11 emails between Mike and Suzi

Page 7
Back Page (The Ad Page)

Happy Anniversary, my love.

Our story continues, and I'm honored to have the chance to live it with you.

Tuesday, September 20, 2016

An Aching Tooth and Diabetes Stigma

I sat silent there in the dental chair, listening to the new dentist ask an array of basic questions about dental history and overall health.

Of course, diabetes came up.

Earlier, in the waiting room, there were the new patient forms to fill out everything about me. All the health and medication issues, and that typical checkbox for "diabetes."

I checked that box, but wrote in "type 1" on the line almost by instinct. I questioned that even while writing it, because I wondered if it somehow implied I was saying, "Not Type 2, or that kind of diabetes..."

Was I fueling misconception? Was I feeding into the daunting cloud of diabetes stigma that exists in the world?

Deciding it was over-thinking, I ignored my concern and wrote it on the form. And then went about completing the rest of the paperwork before seeing this new dentist for the first time.

Nice enough lady, and I was eager to get to the meat and potatoes of why I was there in the dentist chair: Discomfort in a tooth that concerned me.

As the routine goes, she went through the paperwork quickly and read off some of the health and medical related points I'd filled out. That's where she came to my checked box about diabetes.

"Oh, and diabetes... type 1, so that means you've had it since you were a child and it's OK?"

Red flags went up in my brain, but I hesitated.

"Yes, I was diagnosed at age 5, but you can be diagnosed with type 1 at any age!"

"Type 2s are being diagnosed as children more commonly, too!"

"Why the hell would it be OK at any age?!?!"

"It's not really referred to as juvenile diabetes anymore, because most of us with T1D are adults and more are being diagnosed as adults."

"What are you implying about those diagnosed as adults, or those with type 2 or gestational... no one chooses diabetes!"

But, I didn't say any of that.

I recalled writing "Type 1 diabetes" on the form in the first place, and how I'd ignored my gut instincts to just leave it as "diabetes" because distinguishing the types didn't matter at this moment.

Yep, I had pretty much brought this on.

Then I also remembered: My tooth hurt.

And that's why I was there.

So, I politely agreed with her, confirming that I was diagnosed as a young kid at age 5.

And I didn't say anything. I chose not to advocate, for whatever it might be worth.

Now a week later, I feel guilty for not raising my voice and advocating to that Healthcare Provider when I had the chance. I may not see this dentist again for a variety of reasons, but that just means I lost the chance to clarify something about diabetes that she may not have understood.

Especially in light of the latest research from the big EASD conference in Germany, in which a study showed that half of those with T1D are older than 30 years old. It's not just a kid disease, and the use of the word "juvenile" is outdated and inaccurate in many cases.

All of that makes me feel more at fault for not raising my voice to educate this dentist, especially when these folks are on the front lines in healthcare and can actually diagnose diabetes and help keep an eye (or tooth?) on D-management.

By not speaking up, I am a part of the problem in maintaining the status quo that's so saturated with stigma and misconception.

The Diabetes Community has an aching tooth in how it self-identifies and responds to the public, and that stigma is not far off from being that painful tooth that's in need of a root canal.

In retrospect, my silence feels like I just flooded the tooth with ice cold water and am now feeling the painful sensation that comes from allowing someone to continue not knowing about diabetes.

No, I don't always have to advocate in these types of situations. But then, I can't be surprised when someone doesn't know how things really are about diabetes.

And my tooth still hurts.

Thursday, September 15, 2016

Which Don To Respect?

Remember how I used to occasionally reference the "Don of Rage Bolusing?"

You know, that was mostly a term of endearment for my insulin pump. Even though sometimes, I used it to describe myself from time to time. In those times when I saw stubborn High blood sugars that wouldn't budget with normal correction doses, via my insulin pump.

So, I would click a couple pump buttons and dose a wave of insulin... a rage bolus, as it were (hat tip to Kerri). Since I liked to be silly and named my insulin pump "The Don," thanks to my love for the Godfather movies and TV Show NCIS where Mark Harmon plays the character Gibbs.

Yeah, it was all in good fun. A way keep my sanity while keeping up with this wondrously exciting life with diabetes jam-packed with device juggling, management tasks and mental gymnastics.

Well buh-bye, Don of Rage Bolusing.

I've been on a #PumpHiatus for the past four months. There was never a certain date, and as of now I'm not 100% sure if and when I might go back to my insulin pump. This Multiple Daily Injections (MDI) system using Novolog pens, Afrezza inhaled insulin, and a twice-a-day dose of long-acting basal is working fine for me.

With that, I've hung up my hat (at least temporarily) as the "Don of Rage Bolusing"...

Instead, it's now: 

"The Don of Rage Dosing" 

or maybe, too:

"The Don of Rage Inhaling"

(Hat Tip for my Type Awesome Spouse for noting this distinction.)

We'll see what happens next, and which Don ultimately wins out.

Either way, there must be respect.

In the meantime, I'm kissing the ring and trying to control the rage as much as possible. While respecting that fact that it's my diabetes calling the shots and "settling all family business" relating to my blood sugars, more than anything...

Thursday, August 25, 2016

Driving A Car on Dangerous, Worn Tires

Hello again. Blue Care Network.

It's me again. The guy you've added to "The List" on potential rabble-rousers, those you sound warning bells on whenever their name pops up in the call que or a written communication comes in. Yep, that guy.

We've done this dance before, you and I. Remember?

Letter to My Insurance Company: I'd Rather Not Die Today

If My Diabetes Devices Were Parts of a Car...

My inhaled insulin Rx request that you initially denied, and then changed your mind on. The other battles that I didn't care to continue, because even though it was a question of improving my health, it wasn't worth my sanity.

Yet amazingly, you don't seem to learn the lesson. Even though it's clear you have a pattern of "deny first" and thoughtfully-consider the request later on appeal, the cycle continues.

Alert your supervisors, because you're all in for another round.

A few weeks ago, my doctor's office called in a prescription for a new type of basal insulin. We had met earlier that day in his office, discussed my diabetes data and all of the medications I've been using. He and I both agreed, after analyzing my data and determining that my current and past insulins were not working effectively to achieve the desired outcomes that a change was in order.

We decided that Tresiba was unique, doing something that other insulins did not. It had good customer feedback from those who've used it, and the science shows it lasts 42 hours instead of how long the competing Lantus and Levemir last (sometimes not even the full 24 hours they are labeled for). Because of my specific situation, my doctor agreed this would have a better chance of lowering my glucose variability, stopping those dangerous Lows that I have been experiencing, and even improving my A1C more than we've been able to accomplish to date.

I was excited to find a medication that might actually help keep me healthier and limit some of the scary hypoglycemia and hyperglycemia I have been seeing.

Unfortunately, Blue Care Netowrk denied that prescription claim.

In your denial letter, you specifically stated:
"Coverage is provided in situations where the member has failed to achieve adequate blood glucose control with use of both Lantus AND Levemir for at least three months each. Coverage cannot be authorized at this time. The member must still try and fail Levemir for at least three months to meet coverage criteria."
Holy, hell. Did you seriously tell me to "try and fail" for an effective 6 months before starting a medication that my physician and I both agree has the likelihood to improve my health????


That is very concerning language, on so many fronts. It's like you telling me to continue drinking toxic water before you'll give me access to bottled water. "Hey, data shows your current water is not good for you, but we want you to use that for three months. AND THEN, go next door to the house that data shows also has less-than-ideal water, and use that for three months. ONLY THEN, will we make sure you have access to clean bottled water that's shipped in from outside the city."

Seriously, Blue Care Network. That is what your official denial letter says to me.

Here, let me put this in terms you may be able to better understand. Maybe a car analogy will help you better grasp the foolishness of your decision-making here:

If My Diabetes Management Was a Car... 

I currently own a car, and you've paid for the wheels and gas and some of the engine work that's been done on this during the past 8 months.

However, when I drive this car on the local side-streets or expressways, it's a bumpy ride. My car shudders, sometimes resulting in my loss of control of steering and acceleration.

In consulting with my expert mechanic, who examined the body of my car and spent time looking under the hood, he advised that I needed 4 new tires.

Realizing that this is a serious problem that endangers not only myself but other people on the road, I've decided to address this issue and buy new tires. That is what I've asked for you to help on, since you're in the business of helping your insured customers achieve better outcomes.

Instead, you questioned my mechanic's orders. You relied on the textbook answer that was written years before my current car was even manufactured on the line, and was written based on outdated auto mechanics.

Your logic: I should continue driving on what I have now, for at least three months. And if that doesn't work, I should not listen to my mechanic and I should rotate the tires in hopes they'll magically heal themselves and allow for a smoother ride. By your reasoning, that tire rotation is a "clinically equivalent" option to buying new tires.

"Try and fail," is the language you used in a denial letter. You also talked about cost management and how this is a basis for your decision-making.

In the meantime, I wonder what happens if my car stutters and stops on a busy interstate? If I am seriously injured in an auto accident as a result of my car not functioning properly? If I am unable to work and be a productive member of society, as a result of my car malfunctioning because you denied to fix it based on the expertise of a mechanical expert who has actually looked at my car and warned of these potential issues?

I doubt you'd be quick to cover those above scenarios, probably because of the same "cost containment" rationale. And I wouldn't be surprised if you offered up language in denying those expensive claims, along the lines of "You should've fixed this before it became dangerous."

No, Blue Care Network. You are the one making dangerous decisions here.

You are forcing me to drive down the road on dangerous, worn tires. I'm riding on danger, because you won't do what you're supposed to in helping me afford the best treatment that will keep me safe.

My physician has offered medical advice based on my patient data, and we have determined the best course of action. We understand that you're concerned about containing costs, as we all are. But we also know that this particular Tresiba Rx is the best option, and it's different than anything else out there. That's why we have asked you to cover this medication, something that isn't "clinical equivalent" to anything else but has the potential to keep me safe and healthy.

We have already started the appeals process for this particular prescription, and I trust based on past experiences with BCN that this will be overturned and approved sooner, rather than later. For example:
  • The nurse who who told me that (after I had complained about my Dexcom CGM sensors being denied and gotten Huffington Post coverage on that), she was instructed to take a second look at my Dexcom CGM supplies, which had been denied. And learned upon re-examination that "Oh, you were already using this device, so that's now been approved."
  • That you approved my Dexcom CGM sensors in February, but in May you denied the Receiver and Transmitter that is needed to operate this CGM system. As I wrote before: If My Diabetes Devices Were Car Parts, it was like you OK'd the 4 wheels and steering wheel, but not the body of the car needed to use those other parts.
  • Within an hour of appealing a denial related to my Lantus insulin (you know, the one you're now insisting I "try and fail," my Rx was approved. 
  • You had denied my Humalog originally because I needed to first try the competing fast-acting insulin Novolog. As I'd never used Novolog before, I opted to not fight on this and to try that insulin. Yet, amazingly, I learned that after I'd called my local pharmacy to fill the Novolog, you went ahead and approved the Humalog insulin anyhow -- despite how I had not met the "clinical criteria" you had told me to follow.
  • In one of those above situations where I was fighting BCN and appealing a denial, two of the BCN representatives I spoke with on the phone specifically told me that they weren't permitted to give me information about my own medical care or the decision-making on my claims, because I was not the prescribing doctor.... One of those reps had the mind to throw HIPAA privacy at me as a reason behind this BCN policy... (Yes, really!) A few more phone calls up the chain of command resolved this, with apologies from a supervisor.
All of this proves to me that your decision-making process is, by design, aimed at denials and making it more difficult for patients and providers to obtain coverage.

No, I don't think insurance companies should be in the practice of blindly approving anything and everything we ask for. Yes, there does need to be some oversight and cost-analysis weaved into this review process. However, even when physicians follow your clinical criteria to the letter, and submit documentation showing so, you have a policy to deny first.

My hope is to highlight the arbitrary nature of your policies and decision-making, to help you understand that they simply don't make sense and go against both common sense and medical standards.

To be clear, I'm not worried about myself, and obtaining this particular medication. My concern is more about the pattern of denial your insurance company seems to have. I'm troubled by that trend, and worried about other patients. Those who don't know that they don't have to take No for an answer, but they have options to appeal.

My own doctor has told me of situations where he has Rx'd particular items, only to find out at a patient's next visit that they ended up not ever using it because of an insurance denial. They either decided they weren't able to get coverage for that medication, or they weren't interested in appealing for what they needed. I can't even imagine how many doctors out there have a blanket policy within their practices of not appealing, simply because they don't have the time or resources to devote to that process.

That's wrong, in my opinion. And I believe it goes against the very definition of what you profess to be all about, in your mission statement on healthcare coverage for people who need it.

With that, I leave you my ask:

Please, listen to the doctors who are writing these prescriptions. They know what they're talking about, as physicians, and we trust their medical advice.

Tuesday, June 14, 2016

Thoughts on #DiabetesAccessMatters From the Airport

Here I sit, in the New Orleans airport waiting for my flight back home following the ADA’s biggest diabetes meeting of the year.

I've got some personal thoughts to share.

This isn't a professional recap of anything, just a line to what's going through my head and heart here at the moment. More professional, balanced writing and analysis will occur elsewhere, in due time. 

My mind is swimming with so much information and there's so much to process on so many fronts. While this ADA event leaves me hopeful and inspired in so many ways about the state of things, it also leaves me a bit unsettled and sad.

In many ways, I feel powerless to move the needle on change when it comes to making sure people have access to the tech and treatments and tools they want to use.

#DiabetesAccessMatters was a big topic on everyone’s mind at ADA.

No doubt, the United Healthcare and Medtronic partnership in early May was a hot-button issue that got attention and drew broad discussion going beyond just those two companies.  It came up so many times, officially and unofficially. Key leaders and groups are working on this, having discussions with MedT and other industry players. They’re talking with insurance companies. They’re looking at how the D-Community can coordinate and do more to persuade payers not to limit our choice and access.

Many of us who were there sounded like a broken record, expressing our frustration and disappointment – talking to tech company folk and doctors and regulators and so on to make sure they know how we feel.

They do.

I’m happy about that.

Everyone's trying to figure out "What's Next?" and what we do, but there's nothing black and white about any of this. It's all so damn complicated and has a lot of moving parts. So much is dictated by unintended consequenes of federal and state laws, how businesses are responding to the whole healthcare game, how digital health data can be used most effectively to guide decision-making and help get people heather. It’s not easy to figure out this stuff.

What gives me hope is that some of the brightest minds that I've ever seen in diabetes, healthcare, policy-change and frankly the world are on this.

And then I go online and see people in this Diabetes Community saying “Oh, advocates aren’t advocating on #DiabetesAccessMatters. It must not matter to them.”

Since it's now been just over a single month since the UHC-MedT partnership came to light (thanks to a smaller competing company's red-flagging), the fact that no concrete answers have been publicly outlined and nothing's "fixed" must mean this just got swept under the rug. 


Since I am at the airport right now, I kind of want to go put all my Internet-connected onto a runway and just have them run over, to get away from that crap. Seriously? How goddamn naïve. 

Don't misunderstand: I'm not mad about people being mad about things not moving faster. I wish they did. Of course. I am not mad about people voicing their opinions. That's what #1 is all about. What gets under my skin is those who decide to start questioning advocacy, saying nothing is happening or it's just forgotten about because it hasn't been shared on social media or anywhere else for that matter. 

Shit is happening, and it’s happening by those who ALSO don’t know what the fuck to do about this or how to change it. But they’re asking questions, working to coordinate effectively, and make a lasting change in this area that goes beyond diabetes.

And with that, it’s where my heart shifts a bit…

Because despite all that’s happening behind the scenes, I feel so helpless. That with all this talk of coordination and change, we’re not able to make anything happen. It’s not us calling the shots, it’s the payers. Everything in diabetes tech and treatment these days is about making sure PWDs can use these tools correctly and effectively, achieving better outcomes and getting to a good healthy quality of life.

I've seen some friends express similar feelings (as I'm sure others have), and I have to echo that I'm feeling a lot of the same helplessness about this -- even though it's only been a month or so and despite all the conversation that is happening.

That desire for data-driven outcomes is what’s pushing these UHC-MedT style decisions forward, and those are going to continue because that’s the reality of the world now (at least the first world, where people can afford this shit).

Many globally can’t and that’s a whole other – somewhat related? – topic on access in itself, and it all makes my mind just start drowning again.

Insulin costs way too fucking much.

Devices do, too.

People at insurance companies who aren’t on my medical care team are second/third/quadruple guessing my doctor-ordered treatments. They’re saying I only have access to what they think will do better for me, based on dollar signs instead of my own health and choice and medical guidance.

They want my A1C lower, but want to limit the amount of test strips I use each day – thereby screwing with my chances of lowering A1C .

Assuming I live long enough to get to Medicare, my access and choice is limited even more just like all those who can’t get certain pumps, CGMs, best medicines or enough supplies now. But hey, that’s OK… they’re hedging bets that we’ll just die soon anyhow, so WTF does it even matter?

Anyhow… ranting aside.

I will continue to do what I can from my little corner booth.

If that means not being a customer of these companies that are pulling strings and not standing up for full choice and access across the board, so be it. If they don’t get that they play in a sandbox and must nurture the ecosystem in order to best make people healthy, then they don’t get my business. And they get my condemnation.

I will tell anyone I know about how I feel about this. That includes diabetes advocacy orgs that are collecting our stories, my elected leaders, insurance policy-makers, and my medical care team. I’ll encourage the company I work for, as well as others that are and will continue to be in the insurance-shopping business, not to choose UHC or other insurers who blatantly adopt these money-driven policies.

It may not be much and it may not change the game, but it makes me feel like I’ve accomplished something. And maybe that’s all I’ll be able to do for now, before the eventual day when I won’t have a choice about making a choice and will have to go silently along with whatever’s forced upon me.

And now, I have 10 minutes to board the plane. Maybe the sky-high view between Louisiana and Michigan will bring a little wisdom, or something (probably not, as I'm flying Spirit that makes me pay more for everything)...

Son of a bitch.

Clouds may be all to see, anyhow.

Wednesday, June 8, 2016

First Month of My Insulin Pump Break

A month ago, I decided to step away from my Medtronic insulin pump.

This was long overdue, a needed change that I needed to revisit in order to get my diabetes back in line. Yet, I had been putting this off and it wasn't until Medtronic's business decision to screw with patient choice and access that I made the final personal decision to disconnect from my pump and go back on injections like I've done a few times in the past. My first pump vacation lasted for about five months in 2010, and led to a 1.1% drop in my A1C. The later vacations also saw smaller drops, but still they helped me re-focus on D-management.

And so, that's what I set out to achieve in the here and now. 

After my first month of this #PumpHiatus, my BGs have been phenomenal compared to how they were before.

Glucose variability is hella better, and my A1C dropped from 8.4% in February to 7.6% in early June! This was also down from my A1C last Fall where it rang in at 9.1 -- so progress continues, and I'm very happy.

My endo is happy, too.

Here's what my D-data shows:

(Enter first air-pumping here!)

A few specific reasons are behind the improvements, I believe.

  1. Discipline: Whenever I mix up my management routine, I tend to do better. So going back on MDI has motivated me to pay closer attention to all aspects of my D-care, from insulin dosing and carb counting to exercise effect and so on. Whenever it comes down to eating something, I must weigh whether I want to dose insulin for it -- and that more often than not has made me second-guess the desire to eat at that time. 
  2. Low(er) Carb Eating: Yes, I have been watching the carbs and taking in fewer of them. Instead of a sandwich for lunch, an avocado with chicken or tuna salad. More veggies instead of rice or pasta. More fish and meat, and even less beer (WTF?!) that's sweeter and more carb-heavy. This has meant less glucose variability, a pretty certain consequence of carbs for me. As a result
  3. Afrezza: Yep, I'm back on inhaled insulin. For close to a month,  I've been using Afrezza and am LOVING the blood sugar effect it's helped me achieve so far. I'd tried it out last Fall for a few weeks, but decided that it wasn't something I wanted to continue using because of long-term concerns about potential lung effects. But none of that's known for sure, and so I was willing to try Afrezza again once going on my pump break.
    I've been using it for higher carb meals and larger corrections, keeping Novolog pens as my "base fast-acting insulin" used for smaller doses and meals that are more predictable. This works the best for me, instead of using Afrezza 100% of the time. I still have some reservations (possibly paranoia??) about long-term effects, and so I am not going full force with Afrezza. For me, I'm also pretty confident in my ability to improve even more and get to a better place as having Afrezza in my D-toolbox along with other insulins, my CGM and everything else.

    For the first few weeks, I was actually fortunate to snag some samples to use and didn't have to buy it myself in the beginning. Now, those samples are gone and I'm going through the process of getting insurance approval for Afrezza ASAP, so I can weave this into my routine again.
Overall, I've not calculated how much less insulin I am taking but that's a work in progress and I'll start doing that D-match for summary sake before long.

I've just recently started using my Dexcom more fully, taking advantage of the "Events" feature that allows me to chronicle insulin doses, carbs, exercise, Lows, Highs, Alcohol, and Stress.

And no app is needed for insulin dosing, for me. I just do the math -- that's easier for me. If I am 200 and need to correct to get back to my preferred 100 level, it's a simple equation using my correction factor of 25 points per unit of insulin:

200-100 = 100....

/ 25 = = 4 units.

Typically, my insulin's still kicking for about three hours so any additional correction doses during that time would be scaled back significantly, depending on the exact timing.

So, things are going well.

My next A1C is slated for mid-August -- a time my endo and I chose specifically because it will be a good follow-up to see how my A1C fairs for a full three-months of this #PumpHiatus.

As of now, taking a step away from my pump was the best decision I could've made for my D-management at this point. I'm eager to see what the next couple months bring.

Thursday, May 26, 2016

If My Diabetes Devices Were Parts of a Car...

I can't even write this post without shaking my head in disbelief, wondering how such stupidity exists in this world.

That first sentence should tell you immediately that this is an insurance company related post.

Back in March, I wrote about my challenges in getting my Dexcom CGM sensors approved by Blue Care Network of Michigan. Despite my using these sensors for a few years (but never before dealing with this particular Michigan-based HMO), the insurer declined them as not medically necessary. I wrote a Letter to my Insurance Company and that was shared widely, including on the Huffington Post.

Despite telling me that an appeal would be necessary to demonstrate that I met the required criteria, BCN soon changed its mind. A BCN rep actually told me that she received a call from her higher-ups, to "look at my case" again. She did. She saw that I'd been using these Dexcom sensors already thanks to other insurance companies' approvals, and she marked it approved.

Hey, great. Only problem: I didn't actually need the sensors at that time, and my now-required medical supplier had decided to just pull the trigger on ordering these CGM sensors without my consent. So even though I now had the green light from insurance, I declined these sensors and yelled at my supplier for starting this whole process unnecessarily.

Fast forward to now. We've reached the sequel in this story.

Since that time in mid-March, my 1-year warranty has expired on my Dexcom G4 with Share receiver and I am also in need of a new six-month warranty G4 transmitter. So, in early May, I began that process to get a replacement for each of these key components. It's particularly important because I don't have any backups, and in just the past couple weeks I've noticed my receiver seems to be on the fritz.

I'm losing signals more often, the battery is losing its charge frequently, my data seems to be more inaccurate, and sometimes it won't even start charging when I plug it in.

I've been relying on Dexcom for years now, in large part due to my hypo unawareness. And with my recent push to get into better control and keep my blood sugars lower, I'm even more nervous without my Dexcom on board. So, timing is critical here.

As always, the doctor-supplier-insurer process is slow. But now I found myself facing resistance from my insurance company to approve my Dexcom Receiver and Transmitter.

At first, they denied both. Then after another call from my doctor's office during the "peer to peer" process, they signed off on the Receiver but not the Transmitter.


So, BCN, let me get this straight:

You approved the Dexcom sensors in March even though I didn't need them.

Eventually, you decided I could get a new Receiver.

But now, when I need the actual Dexcom Transmitter that make the sensors actually usable so I can see data on the Receiver, you won't approve those????

OK, BCN, let me make this simple for you to understand. If my diabetes devices were like car parts, this is basically what you're saying:

Yes, this is like giving me new tires to drive on when I already had good road-worthy tires, but not approving the car that I need to actually use those tires? Or, keeping with the car analogy -- you've approved a steering wheel for me, but won't allow me to get a car that I need to use that steering wheel.

I'm sure the same could be said about an engine, that I've got all the other needed parts but in the end I can't actually make the car go anywhere.

Essentially BCN, you're saying "GO DRIVE!" but you're only allowing me access to this:

Doesn't make sense, does it?

I phoned BCN to ask for more detail. First, they rattled off reasons why it was "still pending," including the tidbit that they needed more info from my doctor's office despite his prior authorization for the Dexcom sensors in March and the insurance company's approval to pay for that. One woman said the prior Dexcom sensor OK wasn't good enough.

My mind is just exploding with how moronic this rationale is.

I asked for more specifics, but the customer service department couldn't explain any more. That would have to be explained by another department, the Care Management team. I was sent there, but a woman there told me that they could only talk to providers, not me THE PATIENT. She actually said that HIPAA prevented her from disclosing any more to me, because I wasn't the doctor.

Of course, I objected. And argued with her.

That's a violation of my federal rights, I told her. And then I launched into a rant about using her name as the basis for my soon-to-be-filed Administrative Complaint with BCN. She consulted leadership for about 10 minutes and caved on that point. Eventually, I whined loud enough that a supervisor decided to walk my case over to a department nurse to review and make a determination on it.

By day's end, my Dexcom receiver and transmitter were both approved.

Still, no one could answer my simple question about what had taken so long and why this was still pending.

I doubt they even understand why, because it's all so arbitrary. Insurance companies are designed to deny first, and apply logic later. Clearly, these people don't even understand the devices they're making important decisions about, and they're screwing with patients' health and lives in the process.

Maybe people who work at these insurance companies have a different sense of cars and transportation than I do, and that's why it seems so off the wall. Maybe they do build their own cars using the tires and steering wheel they buy separately, before they even have a car to put them on. That's the only way this makes any logical sense.

Unless, of course, you just admit the truth that the system is broken and insurance companies don't know what they're doing, and are only putting profit about patient health.

That's the only sad way this makes any sense at all.

Monday, May 16, 2016

Ron Swanson's Message For Diabetes Blog Week

This is Diabetes Blog Week, Year 7.

The Prompt: Message Monday. Share your message, all about why you blog. Yep, share that story.

Everyone's got one. All the many diabetes blogs are sharing their messages, which are pretty consistent on why they got to blogging and what's important to them.

Yeah, that's all great.

But I'm not currently in the mood to advocate or press my brain into thinking about diabetes more than I have to. Seriously, I do that enough in my day job.

On the personal front these days, my message is simple: Fuck you, diabetes.

Seriously. These 200+ blood sugars in the past week are kicking my ass, and while I am taking a needed pump break and don't feel discouraged about that, it's getting to me that I'm higher than normal and am just tired of this.

I"m somewhat burnt out and not all too keen on going deep. So, for the moment, that's all I want to say.

I'll let the dozens of other bloggers go into whatever serious point they feel the need to.

I may not write every 5 days, because I don't have to. It's about writing on my own terms, as I need and want to. I hope that's why everyone blogs, so it's from the heart and serves whatever purpose they need it to in their world.

Really, I don't give a shit. And I'm perfectly cool with that right now.

For me, I'm going to just keep navigating blood sugars as needed. And now, it's time to catch up on Game of Thrones before relaxing with a little Ron Swanson and Leslie Knope.

Monday, May 9, 2016

Goodbye, Medtronic (From A Once-Loyal Pump Customer)

I am mad, sad, confused, conflicted, and utterly disappointed.

All because of the recent UHC policy change about making Medtronic it's preferred, exclusive in-warranty pump supplier.  My head has been spinning and my emotions have run the gamut, wondering what I truly think and how this actually affects me. No, I don't have UHC at the moment and I have found the MedT pump the best choice for me.

However, I can no longer personally support you as a customer, Medtronic.

Photo from A Sweet Life.
This is tough for me, both as a patient who likes your pump, but also given the professional hat I wear as a diabetes advocate and journalist covering this industry and topic specifically. Make no mistake, I'm trying to draw a line here between the personal and professional as much as possible. I know both professionally and personally there are good people at Medtronic trying to do good in this world, and I hope this doesn't diminish that.

But in the end, I am a patient and diabetes device customer first and this is where my decision is based. This is completely a personal decision, and my POV there is what I'm writing here.

This may not be a big day to anyone other than me, as I'm only one of millions of patients and you have a whole array of products and people beyond just me and my insulin pump. Yet, I think it's important enough to tell you what led me to this decision. And I want others to know, too. So, I will not go gently into the night.

For the past 15 years, I've been insulin pumping and it's been a great piece of technology for me. As a young man in my final year of college, I finally agreed to consider an insulin pump instead of multiple injections per day. At that time, two pump choices existed -- Disetronic (now Roche) and Minimed (now MedT).

I clearly remember my endo at the time telling me the best insulin pump out there was Minimed, and I should make the move to start on that pump. Knowing I had an option, I examined both devices. I also remember my MM trainer at the time, telling me that pump was the best but that clearly I had a choice between the two on the market then.

My preference was MM 508 at the time, which coincidentally was 15 years ago this month. (So, hey, happy Pump Anniversary to me!)

We've been together in various pump generations for the most part since then, even when Minimed got bought by Medtronic and a lot changed in the company culture. Still, we've endured for most of those years... Only once, I deviated for about a year to another pump that's no longer on the market, but that change didn't make me happy and I saw myself not using the pump in the most effective way. My A1C rose in what I believe was a direct result of that and I remember being so frustrated with that other non-MedT pump that I wasn't using it for all of its effectiveness.

Before long, I fled back to my trusted Medtronic Minimed pump.

I was glad to have the choice. Through the years, many more pumps have become available and I've been lucky enough to try them out to see if they were any better for me. None of them were as good as my MedT pump and the company behind this device, I determined.

Now, it's not so clear based on your company business decisions more than anything.

After struggling with the news of this UHC-MedT partnership, and searching my soul, I can no longer continue as a Medtronic customer -- no matter what I feel about the insulin pump.
Medtronic, I just don't trust you any longer. I do not feel you represent me in allowing my doctor and I to choose the device that best works for me

Rather than relying on patient choice and winning a fair fight, you are forcing hands and using the insurance coverage game as a way to hook more people. Yes, people still can choose a non-MedT route per se. But I ask you to consider this:
  • How many will just give up and not fight when they're told by insurers that "We only cover Medtronic pumps in network."
  • How many doctors won't have the time to wage the battle to demonstrate "medical necessity" for this insulin pump, and instead will just encourage patients to choose MedT because it's the market leader and a good piece of tech that's been around for decades?
  • How many patients will hear "more expensive cost for out of network insulin pumps," and see the higher dollar figure and opt for what's technically more affordable?
  • What about all those insurance plans that are, more frequently these days, totally wiping out any "Out of Network" coverage and requiring you to pay the full price out of pocket unless you go with an in-network brand? (My current Michigan-based HMO currently does this, in saying I have no coverage for anything out of network. Luckily, my insurer doesn't at the moment have an exclusive agreement with any insulin pump or CGM company, so I'm OK there for now... Yet, things change and my insurer will probably change next year. So, yikes.)
In essence, you are eliminating choice and access.

I have now seen how you're willing to ignore what patients actually want and do not respect that it's our choice to make.

I'm afraid that before long, this same rationale will be carried over to my beloved Dexcom CGM and I'll be forced to pay a higher cost simply because it's not Medtronic. I will be penalized for choosing what I believe is a better technology, and I just hope I'll be lucky enough to fight the fight and argue for my preferred technology and then I'll be able to afford the higher price-point.

Based on current tech, I will not use the Medtronic CGM.  I'd rather not use a CGM, which I understand and fully grasp would likely have a negative effect on my health, keep me less in range, and ultiately lead to higher A1Cs and potential life-threatening situations. But I see the Medtronic product is inferior, and I exercise my ability to choose my preferred brand -- or to not use one entirely if my choice is limited.

Eventually, I feel this lack of choice could also happen with closed loop tech. Medtronic will likely make it to market first, but I worry that this "we are the preferred choice" mentality will carry over to those competing systems in a way where other APs won't be able to fight a fair fight, and that could even cause them to go under. That's not cool in my mind.

So much is being written about this within the Diabetes Online Community and beyond, and it's a lot to soak up. Particularly, a few D-peeps have written posts that resonate the most with me and had me nodding my head:

This one by Ally at Very Light No Sugar, where she shares this point:
As we over-emphasize cost-cutting, we must be careful not to also snip choice and patient autonomy. Reducing costs sounds great in the short-term, but we cannot disregard the long-term. If patients’ health is compromised by inadequate access to resources, all the costs that insurance companies may have saved upfront will later be seen in hospital bills and subsequent treatment.
Scott at Rollin in the D also writes a Chain of Thoughts where this point stood out to me:
What is the underlying premise that makes UHCs and MDTs actions so wrong?  This is not about choice. This is not about diabetes. This is about insurers playing doctor, and choosing the best treatments based on financial, rather than medical knowledge. The problem extends well beyond insulin pumps and well beyond diabetes. The argument that needs to be made is this: insurers should not be allowed to dictate treatment. The argument needs to be made at a regulatory, governmental level.
Scott also speculates on some points in trying to connect dots and the bigger picture, and while neither of us know whether any of that is actually true, it makes a lot of sense to me and really scares the fuck out of me about Big Brother going all SkyNet in the healthcare arena and sharing info with my insurers without my express consent. It freaks me out that I may be slowly being turned into a guinea pig. Honestly, it any of that is true, then I kind of want to distance myself from this now as much as possible before it gets crazy and there's no way back.

Something else comes to my mind in all of this...  I've also heard talk that MedT recently pulled sponsorship from a beloved organization and summer conference, one that helps people in a way that can't even be put to words. If you check out the event sponsorship page, there's clearly no mention of MedT -- that's striking as the company has been a sponsor of this particular conference for more than a decade.

Whatever Medtronic says officially about this, I'm also smart enough to realize the timing, that just very recently the organizer of this non-profit hosting the conference was publicly heralded for being a part of a new startup developing a cool closed loop system -- one that will, eventually, be a competitor to MedT.

Again, it's all speculation on my part, but I see no coincidence here. And it speaks volumes, if true, in a way that shows MedT cannot draw a line between psycho-social support in our D-Community and its own bottom line. Especially when every other company in the diabetes industry apparently has this ability and continues sponsoring the conference.

This has all been weighing on me, and I've decided to start exploring my options on insulin pumps. I even took the weekend to ponder whether this is really what's best for me personally, and if I feel this strongly about making a change. The answer: YES.

A few days after this whole controversy erupted and the JDRF responded with its stance on supporting choice and patient access, I wondered when my current MedT pump warranty expires. I couldn't find this information in my own documentation at first, and so I called your company to ask that simple question.

Like a smack in the face, I heard an automated message on the call where you tout this new UHC partnership. WTF, seriously?!??

You'd think that with all the fuss over this right now, you'd take a step back and ponder the potential PR disaster you're currently maneuvering. And just maybe, you'd think twice about flaunting this in our faces at least for the moment, while emotions are so high and some of us are on the fence about how we truly feel.

That sealed it for me, and you lost me as a customer, Medtronic.

Of course, I still need to figure out what device I'm going to turn to and when exactly that will happen.

But I cannot remain a customer of a business I so deeply despise for its business practices. Whether it's a smart biz move or not, I don't care. You are pulling the strings to screw with choice, effectively making it more difficult for people with diabetes to obtain the device they really want and will really help them more than yours. It's one thing to win by having the best tech, by providing the most innovative tools. That's what the free market is all about.

Sure, I get that you're not the first to make this move. Others have done it for years in healthcare and diabetes specifically -- insulin, medications, test strips, and so on. To me, this is different because it's caught so much attention and highlighted the bigger problem of access, and because you're the big player on the market doing this now, it's serving as a potential catalyst for change. And this isn't the only issue factoring into my decision; if it was, I might not be ready to say goodbye right now.

I am only one guy, one insulin pumper who's business you have lost. Am I being too emotional and knee-jerk on this? No doubt, I am probably being naive in thinking that a company will do the right thing over its bottom line, thus "shooting itself in the foot" to some extent by helping competitors. It's all complicated and I don't fully know what the answers are and maybe I am being overly-dramatic in making this choice.

But again, it's my choice. And it's one I can currently afford to make, whereas in the future I might not have that chance.

Just like if I walk into a big chain store, and that everything I need and want is in the aisles, but I see every other customer being treated like shit. Even if I'm being treated like royalty, I can see what's happening and know it's only a matter of time before I am treated like shit, too. And so, I choose to go shop somewhere else.

Rest assured, Medtronic: This is not because I don't like your insulin pump, and don't trust you're making better next-gen pumps and CGMs. This is all about your business attitude, and so I say goodbye.

Instead, I will move toward another company that cares more about this community and seeing choice exist for those who want and need it. Those that recognize they are one option, but believe they're the best and are willing to let customers make that case for them instead of cutting our legs out from under us.

Even if that device doesn't have all the best features in my eyes, at least I can look myself in the mirror and know that I am not supporting with my dollars a company that doesn't truly care about me and others in this D-Community.

Be clear, too, Medtronic: I don't want you going away as a choice for people, even if you want all the other choices taken away from us. #DiabetesAccessMatters.

Right now, I am taking an insulin pump break. I've done this before and I've been talking about doing this for the past few months, and right now I need a pump hiatus regardless of all this other business-related stuff going on. This all just motivates me to actually unhook my pump and go back on Lantus pens and Humalog for awhile. In the past, that's helped me get back on track with diabetes management so I'm hoping for that again over the next few months.

So here I am, with my Medtronic pump in the draw for the near future. I am sad, mad, confused, conflicted, and disappointed. But ready to move forward with what's best for me. Most importantly, it's on my own terms.

Thursday, March 10, 2016

Happiness and 32 Years With Type 1 Diabetes

You know, I am very happy with my life.

We can complain all day long about This or That, but when the rubber meets the road, the undeniable fact is that I'm doing OK. I've got more to smile about than not.

Especially when it comes to diabetes.

I am 37 years old and today marks my 32nd year of living with type 1 diabetes. At least, according to my self-proclaimed diabetes anniversary day.

Oh, and it just so happens that today's also the birthday of Mr. Chuck Norris -- so that's even more awesome.

We can find so many things in life to gripe and cry about. I do quite a bit -- from insurance coverage woes, to carb counting and meter accuracy to complications and everyday stress that throws my blood sugars into a tizzy.

Yep, I'm rolling with some mild complications (retinopathy and neuropathy, among them) after my three decades of T1D. Nothing too serious, just hovering there in my world like a dark cloud that sometimes appears in the sky but most of the time isn't visible.

And I have a pretty serious post today over at DiabetesMine, about an insurance hassle that's come up relating to my CGM sensors. It has me a bit worked up, but I'm confident all will be OK. Shit happens, and when it comes to D, I am ready for that.

But on a diaversary day like today, it seems a good time to reflect on how good I've got it. Too often,  I don't spend enough time appreciating all I have. The simple moments that make me smile.

Right now, I'm focused on the little things in life that seem to almost be trivial enough to not register -- but they are, in fact, the most important aspects of what my world is at this moment in time.

It's trash day and I did my duty and collected the garbage cans around the house and compiled everything in the big can that goes out onto the carb, along with the blue recycling bin. But then I overslept, and so my wonderful wife finished the job and dragged everything out to the curb.

Yep, she's awesome.

Most of the dishes are washed, but not all of them -- because, I'm not that motivated.

Some of the laundry is clean, yet it still sits in the clean laundry basket waiting to be folded -- and it's been a few days, so it very well may end up with the unclean laundry baskets and just get tossed in the washer again.

These are the simple life truths, and last night sitting around after the Midnight Hour, I found myself appreciating them even more.

Today, this will be a normal deadline-driven workday. I'll be working at a remote office and facing a daily commute, something that I'm not accustomed to. After work hours, my wife and I will go out to a dinner together -- nothing fancy, but just enough to be special. Because, we are together. And I know 100%, that without her I would not be here to mark this 32nd diaversary.

Sitting here (last night), I think of her. I'm watching West Wing on Netflix -- because it is Election Season, and we're all wanting a president like Jeb Bartlett. But that aside, it's my appreciation and love for life and my wife that shines through. Those eyes make my heart leap with joy, and I can hear that hallmark laugh of hers and it brings a smile to my face.

Life with diabetes can be tough. But I know, all will be fine.

Tonight, there will be a toast at dinner marking this Year 32. It will likely be a Michigan microbrew or a fine Bourbon to mark the occasion, and I'm pretty sure we'll throw a dessert (maybe even a cupcake!) into the mix from there.

And while there may not be a Beta Cell Bash to mark the occasion as in years past, and I'm bummed to not be heading to this year's Diabetes UnConference in Vegas like I did last year, I know this one is just as special as all the rest. Here's to being alive -- thanks to insulin, inspiration, love, support, and the latest and greatest technology.

Can't wait to see what's next, as I move toward future diaversaries.

Monday, February 29, 2016

Hello From The Other Eye Docs

Hello, it's me.

After all these years, we're fully established back in Michigan after more than a decade in Indiana. And with that, comes finding the new doctors -- including my trusty diabetes-focused endo Dr. G, and that ever-important eye specialist who's going to see me (!) through whatever vision and retina woes may come my way.

Making a new appointment at the start of the year and going through all the insurance referral hassle thanks to the new HMO, that appointment finally came at the end of February.

No, it's not with Adele. So sorry for that opening -- couldn't resist.

I've never been to this eye clinic before, but this doctor's name was on a list of about a dozen others given by Dr. G. Along with his eye credentials as an expert in this field, I put some faith in that. The whole appointment took about 2 hours to go through the new patient process and enter in all the info that apparently didn't transfer over from the electronic forms I'd filled out ahead of time.

And apparently, this office didn't have my files from Dr. Funky Eye back in Indiana and so they didn't have my basic eye and health history. Even though I'd made sure to fill out the required authorization forms and confirm all this had been done back in January... (sigh).

After everything, I met with Dr. Eye Glass who was able to get a look at my eye strength and figure out what I needed as far as contact lenses and new glasses. It's been about 5 years since my current pair of glasses, and she noted how it was time for a slightly stronger Rx. I also mentioned that I'd started experiencing that "Bifocal Effect" during the past couple years, and had trouble reading with my glasses or contacts without using a cheap pair of reading glasses.

She suggested I try a new high-tech lens, Sync 8. Apparently, it's aimed at younger generations or those who find themselves starting at computer screens, smartphones, TVs and all the other near and far distance things in life. They're supposed to basically be like bifocals without the traditional lines or tiered design. Dr. Eye Glass also pointed to another high-tech feature dubbed ReCharge, which reduces by 10% blue light that comes from smartphone and computer tech.

Both sounded fine by me, so that's the plan in the coming weeks - to pick out a new pair of frames and get them ordered up.

I was happy after seeing Dr. Eye Glass, and sat back in the waiting room with my eyes dilating as I waited for my new ophthalmologist. I didn't wait long.

After some initial intros, he and I delved into my record -- which didn't have much. Even though my eyes were dilated, I swear he rolled his eyes at me a few times when after my responses to questions about basic eye and health history, relating to diabetes and the diabetes retinopathy I was first diagnosed with retinopathy in 2007.

Sure, the retinopathy had never really gotten worse over the years and was always confined to the levels of "keep your blood sugars under control." Even in 2011, when it did get a bit worse than it had been before. So, I was sure that it had gotten even worse since the last time I saw Dr. Funky Eye in Fall 2014.

He shined the blue and very bright white lights into my eyes to get a peek behind the retinas, and after a minute or two, he wheeled his stool over to the desk to jot some notes into his file. Holding my breath, I could hear my heart pound as I waited to hear how much worse my retinopathy had gotten.

"Your eyes look wonderful!" he said.

And then he said nothing else. There was no "But" coming after that, it seemed...

My heart did a little dance, but I was also a bit unsure.

"You mean, it's still in check and the retinopathy isn't any worse?" I asked.

No. Actually, he didn't see any signs of retinopathy.

Hmm. OK, but how is that possible when I haven't really been doing any better D-management wise in the past year or two....

He didn't answer. There was probably an eye roll going on there, that I couldn't see. So, I decided then that his pseudo-name would be DR. EYE ROLL.

Also, he did another look into my eyeballs and Pffted -- YES, he actually Pffffftd! --- when I mentioned the optic nerve hypoplasia that Dr. Funky Eye had previously diagnosed me with back in 2009. This was when we noticed I couldn't see the lower half of anything out of my right eye, thanks to my optic nerve not being fully formed there.

There was also no sign of that, Dr. Eye Roll told me.

Double Hmmm.

We chatted, he seemed a bit rushed, but happy that my eyes were fine -- especially for someone with type 1 for 32 years. He suggested a field vision test next time, in a year from now. Even though I'm pretty confident the whole array of tests in that first 90 minutes of my appointment included those very same type of vision field tests.

At that point, my confidence in Dr. Eye Roll completely faded and I decided we may not be seeing each other again (seriously, no pun intended).

Sure, I am happy to hear no retinopathy. But I think a second opinion is warranted.

Still, I do like Dr. Eye Glass and plan to return to this clinic's optical shop to snag my new lenses. Just, I don't think Dr. Eye Roll is going to be my new Eye Guy going forward.

We'll see...

Monday, February 8, 2016

Hello Again, Mr. Mumbles

Several years had gone by since the last time Mr. Mumbles visited our house, and quite a bit has changed. But one thing that hasn't is the fact that once again, Mr. Mumbles met Mr. Diabetes in way that wasn't too much fun.

One day after my 37th birthday, I found myself in the dental surgeon's chair getting two teeth removed.

A bridge had come loose just before Christmas, and a subsequent dentist appointment in January after the bridge was removed discovered the teeth underneath weren't salvageable. So, setting the appointment as early as possible without interfering with my actual birthday, I scheduled the extractions.

The experience itself wasn't all too bad, as I specifically asked to be put under. We got to play a fun round of "Find A Vein" until they punctured both elbow joints and my left hand, before settling on a particular visible vein on the top of my right hand. Under pretty quickly, and the teeth were extracted.

Then, the true adventure began.

That first day after is when the pain set in, and aside from looking like a pitiful chipmunk, that old chum Mr. Mumbles came to visit. Last time Mr. Mumbles came to visit was 2012 for a root canal, and before that was 2008 after a tricky root surgery under my gum.

All of this, is part diabetes and part oral hygiene over the years. I've been told my teeth and gums are particularly susceptible to decay and dental horrror, for whatever reason the Diabetes Gods saw fit for me.

Once I got home, we were already well-stocked on pudding, applesauce, yogert, Poweraid, and gel packs for hot and cold compressions. Not to mention pain pills and my 7 days of antibiotic.

Since I wasn't eating much, my sugars tended to run lower -- except that first couple days, when I was fighting off the pain and immediate surgery aftermath when I stayed in the 200s most of the time. But I made sure to keep up my food intake and dose accordingly, and when my CGM wasn't connected I tested frequently to make sure all was OK on the blood sugar front.

I had assumed by the weekend, I'd be all set and back to my regular self. But Mr. Mumbles remained for a few more days, preventing me from going to a much-anticipated Michigan DiaBuddies meetup and also a Superbowl gathering with friends. I later learned on Facebook about 30 people showed up to the D-Meetup, and there were even Blue Circle Cupcakes! Bummed totally, I am.

Next step in a couple months: getting an implant or two. The whole process is supposed to take about six months or so, and I am hoping by Fall we can get all of this finished up.

I don't like Mr. Mumbles all too much, so the fewer times we can visit is preferred.

Saturday, January 16, 2016

Mountains + Valleys + Mittelgebirge of Diabetes

A new day begins.

All is smooth, as I coast along the waters and taking in as much of my surroundings as possible as I go about my daily business.

My waters get rocky and I make a dash to the coastline, journeying onto land and venturing toward a spot that's somewhere between a short hill and high mountain. Was that water the Atlantic Ocean or the Great Lakes, and are those Mittelgebirge of Central Europe or am I still in my beloved Midwest, seeing a small jump thanks to an afternoon energy-boosting snack of Michigan-made almonds and cheese-stuffed mushroom.

Not sure, but wherever I am and wherever I'm heading, I am ready.

Dinner takes me to China. Spicy Kung Pao beef with fried rice, an egg roll with sweet & sour sauce, and Wonton soup. Pre-bolus, with 40% now and 60% stretched out over three hours.

Enter the Chinese mountain climb, but one that only takes an hour before I start descending.... down, down, back toward sea level until I plummet too far into the Chinese Valleys below my hypo threshold.

Correct, correct, climb back up. Ever so slowly and cautiously, taking it easy and not overloading because I'm not ready for another climb.

My journey continues, as I creep upward. But all I want now: Sleep. That will go over well, after this somewhat tame Glucoaster of a day. This one was a success, part of my new D-management strategy for 2016 to hone my climbing skills up and down the slippery slopes.

Today's journey was OK.

Where will I end up tomorrow?