My regular readers might notice it’s been a little less divisive here as of late. I have no idea yet which presidential candidate will provide me a better America, and there’s only so much you can say about Mike Huckabee, “religious” political action groups, and other such nonsense. Plus Vinny over at Insignificant Thoughts has been dishing out some heavy political commentary lately, and even if I disagree on some takes I enjoy reading his stir of issues.

Last year I posted a short brief on Karla Comfort’s trek across America in her airbrushed Hummer - in support of our troops. In my post I wrote that a Hummer is a universal symbol of U.S. greed and excess, and seen as integrally tied to oil in the middle east macro view. To use it as a rolling MEMORIAL is ridiculous. What’s wrong with a Harley? On par with the rest of the U.S. populace my comments were split 50/50, half agreeing with the ridiculous irony and the other half calling me an unpatriotic jerk.

I received an email this week from Barbara, who like this commenter who mistook me for Neighborhood Flix, thought I was Karla Comfort. Karla’s presence, and her Hummer, is being requested at the Roseville California Springtime Extravaganza. With another airbrushed Hummer mom believe it or not.

Now - since this fell into my lap, I have to say I don’t feel tributes to our fallen servicemen and women have any place at county fairs - sharing space among window companies, RV and spa dealers, funnel cone stands, and radio station tents. If this was a true old timey county fair with local crafts and the 4H club selling chickens that might be different, but I don’t think those even exist anymore. At least not in central California. Now these events are simply conduits for local advertising - and I don’t find them a respectful venue for the most solemn of tributes.

I don’t feel that memorials should be relegated to city parks and Veteran’s Day parades, but they shouldn’t be an afterthought pocketed into other events. And most of all not used to bring in traffic as a promotional gimmick. My uncle, (my dad’s older brother,) died following injuries sustained in a WW2 plane crash. Portraits of him in his gunnery bubble and in his fatigues at his base hang in my living room. I’d be mortified if I ever saw his face on a Hummer, or on a balloon at a county fair.

Being a good net citizen I attempted to give the organizer Karla’s actual site and contact info, but damned if I could find it among the right-wing blogs supporting her. I did send Barbara a note saying that I wasn’t Karla, so if need be they can get in touch. If anyone is attending the Roseville Springtime Extravaganza please send me an update…

Speaking of respectfully disagreeing; last summer I wrote about why seven year Jason Rinkel should abstain from getting a medical assistance dog for his type 1 diabetes. This story was the best of local news sap, but like most local TV news stories it faded away quickly. I detailed my experiences as a type 1 diabetic, and wrote about why an assistance dog would PREVENT Jason from living a normal life, which is perfectly possible with diabetes.

Jason’s older brother Mark was nice enough to post a note thanking me for plugging his site, even if I think the idea is completely unnecessary. Turns out Jason and Mark DID raise enough money, and are getting their dog in a few weeks. I suggested to Mark that he and his brother start a blog about how their new companion works out in relation to Jason’s diabetes. I truly am interested in how well this ($25,000) dog functions with Jason’s diabetes.

Even though I still disagree with the medical necessity of using a dog for blood sugar detection I think that Jason is extremely fortunate to to have Mark as an older brother - and I wish them the best.

My original post, and Jason and Mark’s site at pawsoflife.net.

One more: Read the current Bus Radio discussion and ensuing comments, then read Katy’s comment at #14. No adult should ever dismiss the views and opinions of the younger generation, when Katy’s clear and logical points far outshine the verbal chaos and cluttered prose spewed out by the parents that also commented. The chasm of clarity is astounding.

Weekend dispatch complete. It’s a sunny 55 degrees here in Denver and I’m off to go biking.

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Happy New Year! As promised a follow up to my earlier post in which I detailed my changeover to an insulin pump with constant glucose monitoring. As described on December 12, I’ve been using the Minimed Paradigm 522 with the Guardian constant glucose sensor.

If you’re completely bored by this and follow my articles of travel, restaurants, clubs, and Denver life - you should skip this and read my story on American Airlines flight 1469. However as insurance starts to cover this equipment more type 1 diabetics will be utilizing this and similar monitors - so hopefully this will help those new to this.

In brief: Pager size insulin pumps are used by type 1 diabetics in lieu of injections. Pumps better mimic the pancreas by giving a constant dose of insulin with manual doses at meals or as needed. An ancillary gadget called a “constant glucose sensor” sends your current blood sugar reading to your pump, providing you with a constant stream of blood sugar numbers and direction of blood sugar level - rather than the lone number obtained from a finger prick.

Overall it’s an incredible life changing tool for a type 1 diabetic. Knowing the TREND of your glucose is something that was only in the realm of imagination for years. Now, to be aware and know your blood sugar minute by minute, WITHOUT the need for (as many) messy finger pricks is an enormous step forward. And to have to blood glucose number sent directly to a small screen is a wonder of med-techy synergy.

Here are the drawbacks. Well not exactly drawbacks, but things to be aware of in order to develop your own workarounds and methods to match your daily life.

Appearance: The sensor and transmitter piece aren’t quite as sexy looking as the photos. It’s necessary to cover them with a small dressing. No big deal - the starter kit includes transparent adhesives. Medtronic sells a pack of 100 at the astronomical price of $62, but you can find similar at Walgreens for under $5.
New Sensor Obligation: When starting a new sensor you need to allot yourself a seven hour block of “awareness time.” Better said: keep your meter handy.

After starting a new sensor you’re required to enter your first BG in two hours, then another in five hours. It’s not practical to start a new sensor late in the evening, as you’ll be alerted to enter a BG in the middle of the night. After the two and five hour BG calibrations you’ll be prompted for one BG entry (calibration) every 12 hours. This is pretty easy, and I’m getting used to “thinking 12 hours ahead.” For example if I do a calibration at 2pm, I have to remember to do one around 10pm or before bed so my pump doesn’t wake me up at 2AM requesting a calibration. Typically morning and early evening is best, (before meals,) as your BG needs to be relatively stable for the best calibrations. You can set your calibration reminders up to four hours before a necessary BG entry. But again think 12 hours ahead. If you’re planning to sleep in Saturday morning you don’t want your last Friday entry to be 6pm, or you’ll be harassed by your pump at 6am. This hasn’t been an issue so far as I’ve actually been taking MORE manual readings to test the accuracy.

Accuracy and Rapid Changes: During periods of rapid change the CGM definitely lags. If my BG is 200 and I lower it down to 100, my spot checks show it will be a bit slower to reach 100. BUT, I do show during normal periods of minor fluctuation it’s very accurate. Its stable periods (non-rapid change) it’s been leveling out matching my finger sticks within 20 points.

However I am bit disappointed in how it matches blood sugars that are rapidly rising. And I’ve found when my level is LOW and bring it up, the readings bottom out and take quite a while to reach up to where it should be. These “flat periods” and annoyances are similar to blogger Jay’s experience in this recent post. I see way too many of these stagnant periods when I KNOW my levels are changing, but the results are slow to follow and stagnate within 10 points.

Attempting to remedy this I’m experimenting with new sensor sites. I realized my last sensor was on a site where I’ve given myself many shots over the years. I’m on day two of a new sensor, placed on my upper leg, and am watching the results closely. Pasta dinner at Maggiano’s last night DID prove more accurate, although my manual checks showed little fluctuation anyway.

(more…)

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For about 12 years now I’ve been a type 1 diabetic, meaning insulin dependent. Type 1 diabetes requires that you to check your blood sugar throughout the day and take shots to regulate food intake (usually at meals.)

I rarely mention this in my blog because it’s been a part of my life for so long I don’t even consider it noteworthy. Unlike an ambulatory or noticeable handicap I don’t consider type 1 diabetes to be that life altering. With proper care and planning type 1 diabetes is easily manageable, so long as you are disciplined about the food you consume and daily exercise. From traveling to scuba diving to hiking, camping, and skiing - diabetes has never prevented me from doing anything I’ve wanted in life. Oh wait - I suppose it did prevent me from becoming a professional airline pilot, but in retrospect that’s probably a good thing because my alternate life might find me unemployed living out of an efficiency apartment in suburbia. And eating nothing but fast food - thus developing type 2 diabetes.

So the overall theme of diabetes is really kind of boring to me. I did write a post in which I told a diabetic kid he shouldn’t get a dog. Then I later realized no matter what the circumstances are you should never tell a kid he can’t have a dog.

As benign as it outwardly appears diabetes does constantly factor into your daily life. The most annoying part of type 1 diabetes is the need to constantly test your blood sugar, and also experiencing blood sugar swings. During a normal day, i.e. sitting at the office or puttering around the house it’s rarely an issue: I prick my finger and sample a drop of blood with a meter. Based on the result I take a shot if it’s too high, eat some food if it’s too low, or simply remain aware of my blood sugar level for future activities that day.

However there are times when it’s a pain in the ass to check your blood sugar. When out at a restaurant or bar with friends. Or when doing my favorite “INGS” like flying, hiking, skiing, biking - it requires me to stop what I’m doing and reference my small meter. Granted glucose meters now take less than 20 seconds to process, but it’s still something that requires an interruption. And of course those are the times you NEED to check your blood sugar more often.

For years type 1 diabetics have tested their blood and injected themselves throughout the day this way. However for the past few years many have been using a newer and more effective method of control: The Insulin Pump. Insulin pumps regulate the delivery of insulin more effectively by mimicking the pancreas: they administer a small and constant dosage throughout the day and night. This is far more controlled than ONE daily injection of a “24 hour” insulin, plus additional shots with meals. People who have given up multiple shots for the insulin pump have stabilized their blood sugars and have seen amazing improvements. And with constant delivery the pump is excellent at “holding” your blood sugar levels within a tighter range.

Yet I was never that keen on wearing a pump because I really don’t mind giving myself shots. It’s easy and I’m used to it. That and the co-pay for an insulin pump is north of $1,200. BUT - the advent of the constant glucose meter is something that I find absolutely incredible. When I learned that my insurance would now cover the insulin pump AND the constant glucose monitor I decided it was time to upgrade my gear. For the past month I have been equipped with the Minimed Paradigm insulin pump which operates in tandem with the “Guardian Real Time constant glucose monitoring system.”

The benefit of a constant glucose monitor is to reduce or eliminate major blood sugar swings. Even diabetics who exercise tight control are still subject to blood sugar ups and downs. If you eat without giving yourself sufficient insulin your blood sugar is high. If you’re exerting energy during activity and don’t eat enough food you’re subject to low blood sugar. As mentioned you track these by checking blood sugar, but again when these “finger pricks,” are needed it’s often at the most inopportune moments.

Also correcting high and low blood sugars often result in a “superball” or “pendulum” effect. If your blood sugar is 220, and you correct with a bit too much insulin you risk plummeting to levels too low. Then eating food bounces it back up. Once your blood sugar is “bouncing” it’s often difficult to stabilize it back to a normal range and stop the pendulum effect.

But the constant glucose monitor provides a constant update of what your blood sugar is, and WHERE it’s going. The knowledge of the TREND allows you to take action BEFORE your blood sugars reach high or low levels.

The constant glucose sensor/transmitter attaches to your body and looks like a small seashell. It transmits a signal to your insulin pump every five minutes relaying your blood sugar and rate of change. This rate of change, or “trend” is very beneficial. For example if your blood sugar is 150 and climbing you can correct with a small dose via your insulin pump, rather than a large and potential overcorrection. You are in a sense operating an “external artificial pancreas.” This isn’t automatic though. It still requires you to be aware, alert, and make decisions regarding your food and activity hour by hour. However the resource of this small device as a guide and tool is a significant change in the life of a type 1 diabetic.

Contrary to some beliefs this system doesn’t eliminate blood sugar checks. Since the little “seashell” glucose sensor draws from your interstitial fluid just below your skin while a finger prick checks actual blood (which is more accurate,) you still need to compare and calibrate at least twice daily.

In some ways this system is far more discreet than the routines of my previous 12 years. I’ve never felt embarrassed about giving myself a quick shot. But if I’m on a plane, in a movie, at a concert, in a meeting, or similar environment it’s often inconvenient to squeeze out a drop of blood onto my machine. Now I simply look at my small pager size device for information.

But in some ways it’s NOT so discreet. Although only a small device clipped inside your pocket, you do have a tiny tube connected to a your “infusion” site, which you change every few days. As cool as this gear is, you are constantly tethered to it, and even though the pump and tube can disconnect for showering, swimming, hot tubbing, high action volleyball games, and sex - you still have your small “infusion site” patch on you. Should you find yourself at a nude beach or similar situation where you don’t care to explain a cyborg-like port on your upper buttocks, thigh or abdomen, you can easily remove the infusion patch and transmitter. But the costs of these proprietary pieces means most folks leave them attached for as long as possible. After I adjusted to the fact that this little guy is going to be at my side for a long, long time I realized that everyone, (including me,) has cell phones, iPods, and other miscellaneous toys that already reside on their being all day long. Another gadget in today’s world really isn’t that odd. The only difference between carrying this and another gadget is the small tube.

After reading this a non-diabetic is probably thinking “Holy crap I’m glad I don’t have to deal with such a nightmare.” And I’d probably think the same. But to me this is absolutely the coolest piece of gadgetry I’ve ever owned. I admire the development and technology in the medical field, and I feel very fortunate that I have the resources to obtain this.

The answer to the most FAQ’d? No, it’s not painful. The required two cannulas that sit inside of you are made of extremely tiny flexible plastic. Inserting them is no different than a shot, and once they’re under your skin you don’t even feel them. Good times.

Since my blog is more than sufficiently fragmented between travel, food, Denver, and random musings I probably won’t post further on life with diabetes - but if my regular readers are interested I would be happy to post a follow up.

If you’re curious for more I recommend visiting the blog Sixuntilme.com, written by the very attractive Kerri. Kerri’s excellent writing details life with diabetes, and she also contributes to the online site dlife.com (You guessed it - diabetes life.) Kerri’s blogroll lists a host of other bloggers devoted to the highs and lows of living with diabetes. And I’ll bet now you can guess why that last sentence was a pun.

childrenwithdiabetes.com is an excellent resource for parents, with information on insulin pumps and constant glucose meters. From a design and style standpoint Amy Tenderich of diabetesmine.com suggests we recruit Steve Job’s help in developing the next generation of insulin pumps.

And if you want an example of totally playing up your diabetes for attention watch Brett Michaels “Rock of Love” on VH1.

James Van Dellen Denver

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Hi Jason- my name is James. I have a little blog here that nobody reads. OK I have a few readers. But it’s fun to write. Kind of like kicking a ball around in the backyard by yourself. I like writing about places I visit and about things I read in the news. Which brings me to you dude! I just read about you and your quest to obtain a blood sugar sniffing dog. And raising money with a lemonade stand? Genius. If a sick blond haired little boy selling lemonade while pining for a puppy doesn’t tug at the old strings nothing will. And the fireman outfit? Again, you know cute.

I’m fairly critical of the media and especially critical of the way local news edits and spins stories to create what THEY want, rather than the truth. So when I saw the story “Diabetic boy needs dog” my eyebrow raised a bit. And unlike most other stories I’m barely qualified to comment on, I’m a type 1 diabetic - just like you. That gives me a bit of credit. I also checked out your site pawsoflife.com and read more about you.

First - I’m sorry to hear that you were recently diagnosed with Type 1 Diabetes. I know exactly what transpired when the doctor sat with you and your parents in that little room and explained what diabetes was. Like most folks they probably thought only overweight people confined to motorized scooters developed diabetes. Nope - type 1 is genetic, and many healthy people just like us have it. Your mom probably cried and pontificated about how you and your family’s life will change, and lamented about how you won’t be able to live a normal life.

I know this because 20 years ago my sister was diagnosed with type 1 diabetes at your age. My mom and dad had to learn how to take care of her, how to spot and correct her blood sugar ups and downs, and how to administer injections and medicine. And blood sugar monitoring equipment was stone age compared to what we have now. And you know what else sucked? After watching my sister live with diabetes through childhood and teens I was diagnosed myself at age 20. How’s that for a kicker? It’s a rarity really, as most type 1 is early or late in life. Anyway for 12 years now I’ve checked my blood sugar, taken shots, and made it a part of my life. But you know what? It’s not that bad…

After the initial minor life modifications and learning curve I can honestly say that very little in your life will change, and again, it’s REALLY not that bad. As for finger pricks and injections? Hey, it’s a part of life now. You’ll get used to it. Having diabetes is annoying at times. It still sucks sometimes for me too. When I’m out at the bar with friends and we run off to a movie, or more often another bar, I don’t want to have to slow my friends down taking my blood sugar. And I need to ensure I carry food with me at times. Trust me, you don’t want to go hiking eight miles and not be stocked with power bars. You don’t want to keep your blood sugar too low if you’re snowboarding or exerting energy for the day. And while you don’t want your blood sugar to be low, you don’t want to remain consistently high either. I admit it IS a tricky balance.

But all that said: If I had to CHOOSE a disease or illness to have, type 1 diabetes would be my number one choice. Well maybe psoriasis, just not on my arms. Hey we aren’t in wheelchairs. We have our arms and legs, and they work. We can see, hear, smell, and do EVERYTHING anyone else can do. Diabetes is 100% completely controllable. It takes discipline, strength, and skill. But you’re young, and smart enough to run a lemonade stand. Hence I think you’re smart enough to take care of your body and learn the intricacies of it.

If you look through my site, (and excuse the profanities – I usually don’t write for nine year olds,) you’ll see pictures of me doing everything a normal person does. I bike, swim, travel, scuba dive, fly airplanes, and I do it all with type 1 diabetes. Is diabetes annoying at times? Certainly. But it’s never stopped me from doing anything I wanted in life.

Now. This dog business. I had a golden retriever growing up. He was great, and I still miss him. (Speaking of needles.) Who on earth told you that you need a dog to tell you when your blood sugar is low? I love dogs. I think dogs that find people alive in earthquake rubble or dogs that assist blind people are incredible. As are their trainers.

You really need an insulin pump combined with a constant glucose monitoring system. Your mom says on your site they aren’t completely accurate. That’s correct; however no method of measuring your daily blood sugar is completely accurate. Twenty years ago my sister had to match up a blood sugar stick to a set of colors. This cumbersome process took two minutes. Today my blood sugar meter takes about 20 seconds and gives me a specific number. You’ll rarely get a 100% accurate reading, but that’s irrelevant, because what you should be concerned about is the TREND of your blood sugar. Is if going up after a big meal? Is it descending rapidly after a long soccer game? WHERE your blood sugar is going is more important that the NUMBER it’s at. Also a dog isn’t going to bark out your blood sugar number. See what I’m getting at? It’s up to you.

If I may quote your mom from your site:

Right now we have 3 options. We can continue testing our son around the clock. Option 2 is a continuous glucose monitor which would subject Jason to technology that is not yet accurate, having another infusion site (like a small IV), and doesn’t save any finger pokes. Or the option we have pursued and been approved for - a service dog (and best friend) that can help us know when Jason is in need of medical attention.

Jason, listen to me: A dog won’t change the fact you’ll STILL need to check your blood sugar every few hours. I do it at my desk every few hours at work, in the morning before biking to work, at home in the evening, and when I’m out with friends. I could have Lassie sitting right next to me yet I’d still need to monitor my sugar levels. Also according to what I’ve read a dog will only alert you when your glucose has reached a point of too high or low. What’s the point? You should already know where it’s going. And as mentioned, a constant glucose meter will do this for you.

Plenty of kids are diagnosed each year with type 1 diabetes. The weapons to combat this disease are knowledge of your body, eating and insulin delivery to match your daily activities, and having supportive family and friends. We have technology now that can basically give you a virtual pancreas. That’s pretty darn cool. And it’s more discreet than a dog. Plus, you don’t want a dog taking care of you - YOU want to take care of yourself. Relying on a dog to observe your blood sugar swings would cause more hassle and inconvenience than just doing it yourself. You want to be like a normal kid. Carting a dog around school will not make you seen as normal. Eventually you’ll realize you KNOW your daily patterns, activity habits and eating scheduled, and you know what to expect from your body. By the way does this dog bark at ALL blood sugar extremes? If we were standing in line at Subway and my blood sugar was high would be bark at me? Just curious.

I say keep the lemonade stand going, but when you reach your goal $25,000 donate it all to the Juvenile Diabetes Research Foundation. Better yet keep hustling the media and get a company to match it. $50,000, or even a portion of that money invested in research by knowledgeable people will help many MORE children like you. You and your brother would have the satisfaction of making life better for many other children, some that don’t have the resources and availability to medicines that we’re fortunate enough to have.

I know, I know - you still want a the dog! I did too when I was your age. Why not adopt a puppy from Maxfund? Hey no kid should get to fly pass the responsibility of house training a dog. Sorry Jason - I had to, you should too. You’ll still make the news, but it’s a wiser decision that will benefit more people, including yourself.

Feel free to drop me a note. I may disagree with your family’s assessment of requiring a dog - but friends can disagree and still be pals. If you have any questions send me an e-mail. And should anyone read this and think I’m a total jerk for picking on a little kid - here’s a link to the PawsofLife site if anyone wants to donate. I might even order some chocolate chunk cookies. I love those. Almost as much as I love sun chips and a cold beer on a hot summer day.

All the best - James

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