I was just reading up on Kerri’s recent blog entry and I’m afraid she isn’t that unusual when you look across the broad range of people with diabetes. She’s busy and diabetes tends to take a back seat until something serious comes around.

Here are a few suggestions for Kerri and the millions of people with diabetes like her:

Make sure you never go more than 3 months without getting your A1c.

With our HomeCheck kit you can get the highest quality A1c available in about 3 minutes from home. Just order online and mail it in. Voila - you now have a pretty good idea how things are going (vs last time) and can use that info to nudge yourself in the direction of your friendly neighborhood physician for your regular appointments as needed.

Bernard Farrell did a video review of our HomeCheck and posted it online at his blog here with the video shown below hosted on YouTube:

Find a way to easily track and identify blood sugar trends.

You can use a GlucoMON to automatically handle your logging and generate reports that allow for easy identification of blood glucose trends and to perform pattern analysis.  People who use the GlucoMON say that this only takes them about 1 minute a week with the GlucoMON when it used to take them 1 hour each month before.

And because it’s so easy they are actually managing this information on a weekly basis vs monthly.  Better information leads to better choices. You can read a GlucoMON product review by David Mendosa here and then subscribe or click on the link to his complete review at healthcentral.com

Leverage the power of the diabetes community as you seek reimbursement for new diabetes tools.

If you are going to pursue use of the new continuous glucose monitoring systems, you will most likely need to fight your insurance company to get reimbursed.  Fortunately there is an online resource sponsored by Diabetech called CGMSCENTRAL located at

http://cgmscentral.com  Everyone going after reimbursement one at a time is a very slow process. If there was a way to share information amongst the entire community the process of successfully securing reimbursement will go much faster. To be armed with knowledge is to be armed.

What else do you need to simplify diabetes?

If there are other areas of diabetes care that need simplification you should comment below.  After all, if you want things done you might as well tell someone (Diabetech) who has a track record of delivering a simplified version of diabetes care.

(psssst…. Kerri if you read this give me a call and I can set you up for a trial and see if we can make it easier for you to regain those good habits.)

Through my work with several diabetes centers, I know that the rates of new onset type 1 diabetes cases has skyrocketed lately. In fact at one center in Texas they have seen a consistent influx of new cases double the rate of normal starting about 9 months ago. Other centers are talking about this too although nobody seems to have a very good handle on this in the US. The new cases of diabetes aren’t normally reported (and not required by law) so there is only informal data and the centers are slow to check around and to let other centers know of their own experiences.

Now a couple of reports just came out at the ADA Scientific Sessions that nails down that there is in fact an increase on an order of magnitude. The reports come from Finland, the world’s highest rate of type 1 diabetes at 41 cases per 100,000. This is double the rate since 25 years ago.  They are projecting another doubling to a rate of 80 per 100,000 in the next two years.

The second report comes out of Canada and it backs up this notion of doubling that is slowly raising awareness:

A second report by researcher Jeffrey A. Johnson of the University of Alberta, Canada, echoed that. Dr. Johnson and colleagues found the prevalence of diabetes under age 20 increased by nearly 50% in the last decade, from about 19 per 10,000 in 1995 to 28 per 10,000 in 2006. The rise was most dramatic in younger children, leaping 93% in the 1-4 year-old age group; 51% for 5-9 years, 42% for 10-14 years and 30% for 15-19 years during that period.  The data do not differentiate between type 1 and type 2 diabetes, he said, but “the incidence is rapidly increasing and it is likely to be due to an increased incidence of type 1 diabetes.”

So what does this have to do with Arizona traffic… or any traffic scenario in any large city? You can only send so many cars across the given traffic grid in so much time… Unless you expand the grid or somehow make the grid smarter - more efficient. In Chandler, Arizona, a suburb of Phoenix, they experienced tremendous growth and still are. The city planners should be congratulated since they approved an extensive rework of their traffic management systems and installed a series of “smart cameras” at each intersection and implemented complex analytics in a centralized management system to automatically change the timing of lights at each intersection, automatically alert the traffic manager of accidents or malfunctions, etc… in order to maximize the throughput of traffic and improve safety for the city’s drivers and pedestrians.

Of course the other or more obvious thing to do is build more roads.  That’s what the construction lobby would propose. And of course they did build roads. Only problem is that new roads don’t remove the bottlenecks (intersections). You may have actually intensified the problem though since now more cars can arrive at the same intersection at the same time.

This is exactly what is happening to people with type 1 diabetes compounded by the simultaneous rise in type 2 diabetes in kids who are seen by these same physicians and diabetes educators.

There is a shortage of qualified physicians, especially those with pediatric credentials needed to deal with the vast majority of these new onset cases.  Some people say add more pediatric endos.  Suggest that solution to a pediatric endo and you’ll either get a laugh or a smack across the chops. Let’s just say that while we do need more it’s not something that will happen soon enough at a rate to keep pace with the onset of type 1.  In other words, just “building more roads” won’t solve the problem.

I guess we had better look at information technology akin to those smart cameras to increase the efficiency and reach of the qualified people we already have then.  That includes pediatric endocrinologists, pediatricians, diabetes educators, pharmacists, social workers, family psychologists and family members to name a few. Would it be possible to borrow from the concepts deployed in Chandler’s smart traffic system? Can we increase the effectiveness and efficiencies for the rare but skilled pediatric endocrinologists and their support staff? Can we increase the flow of knowledge to the newly diagnosed so that they can be better prepared to manage their own diabetes most of the time? Would it be possible to head off a dangerous episode of DKA before it forces the patient to visit the emergency room?

Yes we can and it’s called ADMS™ - Automated Diabetes Management System. Truth is that ADMS started its deployment even before the City of Chandler had completed their traffic system. I actually met with the man leading the project back in 2003 as part of our research behind development of ADMS. Our smart cameras include the GlucoMON®, HomeCheck™ and a few other devices. The intelligent analysis is taken care of inside of GlucoDYNAMIX™. And rather than send all of the exception reports to a traffic manager, we spent additional time figuring out how to get only the useful information, at the right time to the right person - automatically - ADMS is the traffic manager.

As for our smart cameras, we use those too inside of our Diabetes Housecall program. Imagine what it must be like to leave your car in the garage, no waiting room, no waiting. Just log on with your web cam and have a 30 minute one on one 3 times per year plus at least 1 visit per year face to face (vs the typical 5 minute drive by). Your diagnostics are already in front of your endo including your blood sugar profile, your A1c and any other data needed for the visit. This program is the first of its kind and growing rapidly in Texas and Iowa and soon in a few other states as well.

So much like the people of Chandler, Arizona, people with diabetes who want a safer and more efficient system now rely on Diabetech®’s ADMS technology and programs like Diabetes HouseCall™ that wouldn’t be possible without it.

One of my favorite movies growing up (and even as an adult) was The Wizard of Oz. I learned many lessons about life from its symbolism. Without question, the most profound message I learned was that inner peace and happiness are never found “over the rainbow”, but in our own back yards (faith, family, and personal relationships). It was only at the end of her journey through Oz that Dorothy realized she always had the power within her to return home (to family and happiness). The magic of the ruby slippers in truth resided within her. But first she had to believe; not in the slippers, but in herself.

That message has resonated with me over the years regarding many other aspects of life. I see a very strong connection between this human truth and how we manage diabetes (and that of our children).

Let’s face it. Many diabetics are always looking for an “over the rainbow” solution to our blood sugar control problems; a “knight in shining armor” to come rescue us from the diabetes “dragon”. Our ruby slippers may be the latest blood sugar meter, some new diabetes care tool, a state of the art insulin pump, a new pill, or a new investigational therapy that might just “cure” our diabetes altogether.

But disappointment, rather than satisfaction, is what we often seem to find. Over my nearly half century of living with diabetes, I’ve seen countless new diabetes tools and gadgets marketed on hope and anticipation. Virtually none of these tools have removed the need for me (or my family) to take an active and responsible role in daily diabetes self care.

The hope that a diabetes “cure” is just around the corner has been dangled in front of me or my parents for over 43 years. Plus, it’s always just about “5 years away”. Don’t get me wrong. I still believe a cure will come. Maybe not in my lifetime, but I’m as hopeful as the next person. However, I’m also a realist. We make our own destiny as far as diabetes is concerned. It’s all about our choices.

But is the problem with our technology or with us? At some point we (hopefully) realize that our diabetes fate is in our hands. Oprah Winfrey has aptly coined a term for this sort of epiphany: the “ahah” moment. The point of true clarity where you see what your life challenges really are. And they’re not necessarily what you’ve been thinking about all along.

Diabetes control is not a thing, but a state of mind…a way of living. You can’t save up a “bucket” of good diabetes control to live off of during hard times. In the end, good diabetes control is the sum of your choices made each day. It starts from when you woke up this morning and exists until the minute you fall asleep. Actions you take or don’t take matter equally by my argument. First among those critical choices is finding a doctor to care for your diabetes. Next is embracing the concept of diabetes self management education. Diabetes is a condition you live with. It’s the tiger in the room you must tame; otherwise you will be consumed by it.

How each person chooses to manage their diabetes (or not) is unique. The barriers to good care are often those we place before ourselves. The greatest contributor to why we often fail is ignorance, followed by fear, and then denial. Sadly, these traits can be passed down from generation to generation. Self care behaviors (both good and bad) can perpetuate themselves within a family setting; at least until someone stands up and challenges the “status quo”. I’ve found that the traits and qualities a person uses to solve the other challenges in life often get applied to how they approach their diabetes self care.

Like Dorothy, those who succeed and conquer their diabetes are the ones who realize and accept that they have been wearing the “ruby slippers” all along. They reject diabetes as a “fate” or “destiny” and refuse to submit to it. They use the God-given powers of choice to learn more about their diabetes and continue learning. They also understand that in the end diabetes is a marathon and not a sprint. The changes they make in their lives must be long lasting, not just temporary fixes. It’s the power of choice that separates us from all other life forms in this world. We all too often abdicate that very precious power when we are confronted with a challenge like diabetes.

So next time you look in the mirror, realize that it’s you who is in charge of your diabetes. Only when this “ahah” moment occurs will you have turned a corner in your “life lived well” with diabetes.

To read yet another version of the diabetes - Dorothy analogy go here.