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.

I wanted to bring a couple of survey opportunities to your attention. These both relate directly to fine tuning a new model of care for people with diabetes so your vote counts! One is about how long have you worn your continuous monitoring system at CGMSCENTRAL.COM and the other relates to getting at the true cost of caring for one’s health located at MYGLUCO.COM

These polls are still open so please click and vote soon. Thanks for your time.

To sum it up from my perspective, we saw an increase in the importance of accuracy and automation in the tools we use to manage this disease albeit only a few thousand people have experienced these advances so far:

• we saw several new meters come to market that build calibration codes into the test strips themselves to ensure that the meter is adjusting its interpretation of the glucose levels appropriately.
• we launched HomeCheck-A1c; the world’s most accurate A1c test and the only one that checks the sample to make sure it’s clear of interference before we determine the A1c level.
• continuous glucose monitoring systems came of age this past year as thousands of people are now using either the Medtronic or DexCom sensors. Accuracy for these new systems is relative since it’s based on calibration to a loosely calibrated glucose meter. Error on error begets error. However, managing in real-time in line with current trends is a huge change in managing blood sugar. Healthcare providers will struggle to keep up with their patients who elect to use this new tool.
• results from clinical trials using our GlucoMON® including real-time alerts from our automated diabetes management system (ADMS™) were presented at this Summer’s ADA Scientific Sessions. We demonstrated that diabetes education can be effectively delivered as part of an automated cycle of care as an adjunct to training provided by skilled diabetes personnel. A1c levels were reduced by more than 1 full point overall as well as significant reductions in the incidence of hypoglycemia and extended excursions of hyperglycemia.
• at this year’s Diabetes Technology Society’s annual meeting in San Francisco, our clinical trial partners at Texas Children’s Hospital showed that providers can deliver care more efficiently with significantly improved outcomes when they work with patients using our ADMS vs patients in the control group via conventional care.
• cgmscentral.com went live on the Web as the only site dedicated to helping people secure reimbursement for their continuous glucose monitoring systems.
• remote patient care including quarterly visits with the endocrinologist can be effectively delivered via residential quality broadband video conferencing plus our HomeCheck programs for reliable and accurate diagnostic testing, data collection, analysis and feedback. Steve Ponder (endo and CDE) accomplished this feat in November. I’m not sure who was more excited - Steve or his patient family who is used to traveling over 200 miles one way but now only once a year instead of 4 times.
• my daughter got her pink pump! Based on her enthusiasm, I guess custom colors are a good thing, too.
• we successfully concluded Beta testing of our GSM/GPRS portable wireless appliance version of the GlucoMON in preparation for general availability of our GlucoMON-RT program in January ‘08. Including certification of the device, we also upgraded our operational infrastructure in advance of supporting several thousand subscribers in 2008.

What does 2008 hold for us?

My crystal ball has never worked on time and seems to be off by varying degrees depending on the relative humidity at the time of the prediction. So, I’ll just say that I think 2008 is a year of coming together. Too much of diabetes care lives in silos; be it the way that providers deliver care or the various tools that we use. This coming year we’ll make great progress simplifying ‘day in the life of’ scenarios and expanding the numbers of people experiencing this new found simplicity. What’s not to like about that? Let’s hope we see continued progress toward a cure as well.

In 2008, Challenge Diabetes is adding several more authors as a reflection of our focus on the need for integrated diabetes care. Let me know if there are other topics that you would like to see addressed here.

All my best.