Webinar Tonight! - see below to get more info on how to attend.

Like it or not, diabetes care involves numbers. Some might say too many numbers. But one number that anyone with diabetes should know is their own hemoglobin A1C number, plus what it means.

I continue to meet patients from other practices that don’t know their last A1C value. It might be because the doctor draws the test after the visit and doesn’t get back to the patient about results. It could be that the doctor doesn’t order the test at all. That still happens. Worse yet, the doctor may draw the test and have the value at hand, yet not know how or when to act on the results.

A hemoglobin A1C test looks back several months and is an indicator of the average level of blood sugar control. It is expressed as a percentage. Recently, there has been an emphasis on converting the value to a number the patient can better relate to: the average blood sugar level in mg/dl, which are the units displayed on glucose meters in the US.

The A1C can be measured with a simple finger poke, or may be drawn from the arm. Some devices can report the result in minutes; others are handled like any other laboratory study and take a day or two to result. The ADA recommends that A1C values be targeted for 7% or lower. Anything higher should be evaluated for possible changes in management or discussion of existing diabetes self care practices with the patient. Other organizations suggest A1C be under 6.5%. There is already a major report that suggests the A1C test be formally accepted as one way to diagnose diabetes. The results are working their way through the diabetes medical establishment for final adoption.

Therefore, today’s Diabetes Challenge Question of the Day is about the A1C: YOURS: how often each year do you get your hemoglobin A1C measured; and if so do you know the most recent result? What kind of advice do you get from your diabetes doctor about your A1C levels? Is it supportive, critical or dismissive? Is your most recent value 9% or higher? If so, do you have a plan for getting it lower? And when do you get your next A1c to see how you’re making progress?

Webinar Tonight

I will not be posting an informational blog today due to the scheduled Diabetes Webinar tonight. The Webinar is scheduled to start at 8 PM CST and end at 9PM (Central Time). Updated links are posted to the site http://lionscamp.com/webinar.htm. Attendees from last Wednesday night are invited to rejoin the webinar next week if you had to leave early. During the day, join me at my twitter site for more one liners and candid photos of your kids being kids at http://twitter.com/Dr_Steve_Ponder . If you have any questions or comments about camp, please let me know anytime at Stephen.Ponder@dchstx.org.

Photo Gallery - check back later in the day and I’ll have a few posted.

Link to the story to see a video of a day in Daisy's and her family's lives

Unless We Make Some Changes…

Read this story from the BBC for yourself. We’ve seen this dramatic increase in type 1 already starting about a year ago in the diabetes centers that we work with in the USA. Basically, the new cases of kids with type 1 diabetes have doubled!

Historically, the statistics on type 1 in kids is roughly 1 in 400 or 1 in 600 depending on the source. So let’s say 1 in 500. With doubling, that number will soon begin to approach 1 in 250 over time. In the USA, there are approximately 200,000 school age kids with type 1. Another source I read in the past states that there are approximately 30,000 new cases of type 1 each year in the USA and that approximately half of those are school aged kids. Based on this story and recent discussion, it’s safe to say that there are 30,000 new onset cases of type 1 in school aged kids. It used to be that a typical age for new onset (the mode) was around 8 to 11 years. Based on discussions with endocrinologists and educators along with the information in the story, the age of new onset is clearly moving to younger and younger kids. That means more diabetes supplies over more years and more risk of trips to the Emergency Department not to mention more time at risk for complications like cardiovascular disease in the teen years.

My experience has shown me that each endocrinologist working with diabetic patients handles approximately 200 to 400 patients. There are only 200 pediatric endocrinologists in the US and very few docs coming out of med school are attracted to the relatively low pay (vs other specialist alternatives), unbilled hours for telephone consults and logbook review, and lack of control (behavior change is the required skillset vs. diagnosing to prescribe pills/dose change to fix the condition).

While there are something like 14,000 diabetes educators in the US, most of them are trained and experienced on how to work with adults with type 2 diabetes - a very different scenario than working with a kid with type 1 who may also come from a broken home or other family issues.

If each patient requires 6 hours per year (30 minutes per office visit 4 times per year plus 20 minutes per month on average for another hour over the course of a year) and there are 700 trained providers, then there are a total of 1,380,000 hours of skilled care required at a minimum since this assumes no complications. If each provider is available for 30 hours per week of patient facing time, then the current skilled pediatric labor pool is able to provide 1,050,000 hours of patient directed care. Not enough providers to deliver standard care especially when you factor in the doubling effect of new onset. The numbers I use here are only rough assumptions to illustrate the gap in the current health care delivery model for type 1 diabetes. At some point there is a scary reality and a breaking point that nobody is aware of.

Sadly, until the economics are changed to incent providers to work with type 1 kids, I don’t believe we’ll get sufficient trained people to help us with this avalanche of new patients. That leaves us with having to develop new models of care that increase the efficiency, effectiveness and reach of the trained providers we already have as well as making patients better at self-care in the absence of their diabetes coaches. A little technology will go a long way if done right and adopted (embraced) by providers. I’m reminded of a slogan we adopted a year or two ago which is now posted at the top of Diabetech’s home page on the Web, “We’re dragging Diabetes Technology ‘kicking and screaming’ into the 21st Century”. With recent successes made on the payer front, we’re soon going to need to swap out the word ‘Technology’ for ‘Providers’.

My reason for making this post is to raise the awareness that the perfect storm is upon us. Who is doing the study to prove that we need to make changes now - based on irrefutable proof that maintaining the status quo is like using a syringe to bail out a sinking ship?

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.)