This is a topic I’ve been thinking about for a while but haven’t come up with the right angle or the interesting thoughts beyond the obvious until now I suppose. However, you the reader can be the judge of that.

Now it’s about the Medingo pump - a so-called ‘upgrade’ to the ‘revolutionary’ Omnipod by Insulet. Revolutionary in that it eliminates the tube (while simultaneously introducing several of its own technical issues and glitches). Does it make life with diabetes easier vs a pump with tubing or does it give the user better control over their blood sugars? Not so much. At least it’s not clear to me that the pump or any device for that matter can do that by itself. What if there was an all in one blood glucose meter that doubled as a cell phone with two way text messaging (they want you to say ooh here)… So what? There are already several of these by the way, including a few different versions created by Diabetech’s engineering team. My engineers would agree that these devices by themselves are a big so what. NONE of them have data to show that they are any better at helping a person to control their diabetes nor do they make life easier for the patient. What about the new iPhone diabetes mania? Again, just a tool… so what. CGM is here. Why such a mixed review by the people who are lucky enough to have this available as a covered benefit by their insurance? What about Health2.0? Again, a collection of discreet tools that ask you to spend more time figuring out how to use it by yourself as a one-off. Where’s the focus on solutions or integrating this tool with that tool… a real recipe for success? That group told me they’re not interested in that yet but maybe some day in the future. Huh?

We’re back to the question of how does all of this technology get used by the patient which determines the result.

I’ve been in this field for 8 years now and I still don’t know of any regimented program for how one would use an insulin pump to get specific outcomes. The analogy would be Dr. Bernstein’s low carb/ no carb diet as a prescriptive guide to do this behavior and get this outcome (a non-diabetic A1c below 6 aka the Under 6 Club). Perhaps this is because of the complexity of matching insulin to carbs and the myriad choices made every hour or two by the patient that makes this unrealistic to have a militaristic prescriptive for living with a pump. But why not attempt something like a diabetes boot camp for controlling blood sugar with the emphasis on the regimen and choices vs. ‘See all these new features’ and use them however you like or don’t or skip boluses or whatever. Rightly or wrongly we’ve come up with a term describing scenarios of patients and their random approaches to how they manage as The Free-Range Patient. We chuckle about this but isn’t this really at the root of why it’s so difficult for a provider to ‘manage’ their patients? The fact is that the only person who manages the patient is the patient himself. Providers should stop using ‘managing patients’ since it is entirely incorrect and perhaps gets in the way of the proper perspective which is more of a coach. Mentor isn’t even appropriate unless of course that level of relationship has truly been established which most often times it has not since that is a rare relationship indeed.

Now here’s something that doesn’t require a new device, which can save lives and give you back more sleepful nights while also helping you to improve blood sugar control. This little trick was implemented under the close supervision of our own Stephen Ponder (pediatric endocrinologist) and a team of medical staff ‘hovering’ over their kids. This revolutionary new technique is being written up by Dr. Ponder as we speak and hopefully we can grab an excerpt of it for publication on this blog soon. This new tool is called… wait for it… extended bolus. The trick is in how this tool is applied however. Very cool and worked wonders at diabetes camp this summer. That’s about all I can say so as not to steal his thunder but stay tuned for this awesome new technique that is sure to give many a real boost to their blood sugar control.

So when the bus comes by again to pick everyone up so that they can ooh and ahh about the next magical device for people with diabetes, you won’t see me getting on. What I will do is give it the sideways look and see if it helps to solve a certain problem or remove a barrier to improved self-care as part of a prescriptive program addressing a very specific lifestyle-demographic. More simply, is it truly useful or not by itself and if not, can we make it useful as part of a prescriptive system/program?

Diabetes care has never been more overrun by new therapies and technology than today. What’s certain is that this trend will continue. I’ve lived with diabetes through many different “revolutions” in its management, starting with disposable syringes, smaller sharper needles, U-100 insulin, clinitest tablets, ketostix strips, self blood glucose monitoring, insulin pump therapy, human insulin, analog insulin, glucose sensors and everything else in-between. Many of you may not understand the initial references I just made while others may be able to add many more. Having a historical perspective on type 1 diabetes helps many of us understand how far we have come but also how much of a business that diabetes care has become. We drive an economic engine within the health care industry that is only getting larger as our ranks continue to swell.

My posts this week will be different than last week, even though we have a new group of campers. I refer any parents who want get more on my thoughts of childhood diabetes and camp to previous blog posts archived on this site which are also tagged under the category “TLC 2009″.

Quality diabetes self care is a process, not a device or new drug. This is because of the myriad of choices that go into managing constant shifts in blood sugar that occur to every mammal on this planet. In the case of young people, their team MUST include the family. To do less only harms the child or teen. Ironically, we seem to always be looking for ways to transfer many of the key day to day self care skills at younger and younger ages. As Barbara Anderson is well known to say, children and teens almost always lack the emotional muscle to match the physical muscle they use (or should use) to perform frequent daily self care tasks.

The next week will provide yet another window into how diabetes is (and isn’t) managed well in children from across the state of Texas. This camp has been the single greatest teacher in my lifelong study of diabetes in children. I return here each year to learn as well as to serve.

Today’s Diabetes Challenge question of the day asks “who is on your diabetes team?”. Are you a “Lone Ranger” or backed by the Verizon wireless guy and the “power of the network”? While we often applaud the “go it alone” approach and individual initiative in others, diabetes care is best approached as a team sport. The question is who is on your team? Who are the key players that play a pivotal role in how you live day to day with your diabetes or in the life of your child’s diabetes? Furthermore, how much of your success do you attribute to yourself and how much can you directly attribute to others on your team? How many of you wish you had a larger team? A smaller team? A more relaxed team? A more involved team? Perhaps you think that diabetes self care is just that: SELF CARE; and no one else needs to be involved. Be honest and be specific.

Stay in virtual touch with diabetes camp

I am posting daily blogs here about important diabetes issues that directly relate to the camp and posing controversial questions to you as above. I’m also tweeting very frequently from camp. Check out my twitter site: http://twitter.com/Dr_Steve_Ponder . My tweets are real time observations from camp (plus twitpics) as they happen, sent immediately from my mobile phone. I’m discussing how things are going and any special problems or situations that all parents of children with diabetes would benefit from. I’ll also answer questions posted to this blog site as quickly as I can. You can also check out the camp’s website at http://www.lionscamp.com where you can check out daily photographs from the day before. As always, we will be preparing a complementary DVD photo album for all campers to be provided at check out on Friday evening.

Parent’s Webinar on Wednesday Evening

A Parents Day Webinar will be held at 8-9PM CST on Wednesday July 29th 2009. Go to the TLC webinar site now for the details on how to participate. It’s totally free and can be accessed from the comfort of your home PC, laptop or just call in using your telephone. Even if you don’t have a webcam, you can dial in to the conference bridge. I’ll be discussing camper progress at camp to date, key observations about how campers are stacking up compared to each other, and address some major hot button issues in type 1 diabetes care of children in 2009. There are several hot topics I’ll be addressing. Join in and listen, or submit questions on line in the Q&A section of the Live Meeting toolbar during the webinar. See you in cyberspace! Also feel free to suggest topics via comments to the blog posts below. (New comments are approved so if this is your first time it may take an hour or two before you see your comment online).

Here is the background for our Diabetes Challenge Question of the Day.

We had several family members of former diabetes campers on the medical staff this week. Several were siblings of persons with type 1 diabetes. Chances are very good that a child with type 1 diabetes has a non- diabetic brother or sister (over several). I saw lots of siblings waiting around at check in. I’m sure I’ll see more today at check out.

Non-diabetic siblings often experience a wide range of feelings surrounding their diabetic brother or sister. Some may state (like my sister did at one point), that I got all the attention and special privileges she never did. Some sibs may live in fear that they might develop diabetes too. Often, the only persons explaining anything to the siblings are the parents. And if the parents don’t have the necessary training, the information that they do share may be inconsistent or sometimes simply incorrect.

Some older siblings may get placed in the position of acting as a “junior parent” to their younger diabetic sibling. This might include giving or watching insulin injections and blood sugar checks, preparing proper meals, or even making self care choices for their diabetic brother or sister.

Over time, a chronic family focus on the diabetic child may make the non-diabetic sibs angry or even resentful. Many sibs may be severely conflicted by these feelings.

So, today’s Diabetes Challenge Question is the following: How did growing up with a diabetic sibling affect you as a child and later as an adult? Did it permanently affect your adult relationship with your diabetic brother or sister? If you overcame this challenge, what do you think contributed most to your success? Feel free to be specific in your comment below.

Dance Night

The dance was a big success as always. Campers were made up and dressed up as well as one could at camp. I have several great photos below. If you are looking for the youngest campers, they were on camp out so the Rec Hall was less crowded than usual, but nonetheless just as active. Our med staff BG check table saw steady business all evening.

Last Day of Camp

Friday is the last day of camp. It’s been a privilege to have the opportunity to provide a safe and enjoyable camping experience for 215 children from across the state of Texas. My staff has also enjoyed this challenge and all are prepared to hand over campers to their parents on Friday night (or Saturday morning at 8AM for the 42 campers staying over). I will not be able to meet with the parents of campers discharged on Saturday morning since I will be occupied with orienting incoming new medical staff for Session 2, which starts at 1PM on Sunday July 26th 2009.

Free Photo/Video DVD

We shot over 2000 photos and 1 hour of video (Night Court). Mike Koch is working to create complimentary DVD’s in time for check out. These have great music tracks as well. This is Mike’s 8th year volunteering his time for the diabetic camping sessions. He was also involved with the organization of the Webinar the other evening (and this coming Wednesday evening too).

Texas Lions Camp

My medical team is very appreciative of the Lions Club and the Texas Lions Camp. The people who established this camp had their diabetes camping program vision almost 40 years ago. I’ve been lucky to be part of it each year since 1981. I encourage families to consider making donation to the camp. Every donation is appreciated and put to good use to serve the children and families of Texans with diabetes. The medical staff applauds Mr. Stephen Mabry, the camp’s CEO, for the quality team of individuals who operate every facet of the camp and effectively interface with my volunteer medical staff. The camp’s website is http://www.lionscamp.com. Photos of campers from this session can be purchased on the Lions Camp site.

Webinar

We have corrected the sound feedback problem for next week’s Parent’s Day Webinar so there will be no “echo chamber” effect. Updated links are posted to the webinar site. Attendees from last Wednesday night are invited to rejoin the webinar next week if you had to leave early. Also, the twitter site http://twitter.com/Dr_Steve_Ponder and this blog site form part of the alternative approach I’ve tried to develop to replace the former 2 hour Parents Day program in the Rec Hall we used to have. I will also have the pleasure of visiting with parents over dinner on Friday evening July 24th at 5:15 PM. If you have any questions or comments about camp, please let me know anytime by sending me an email at Stephen.Ponder@dchstx.org.

Diabetes Housecall

About 2 years ago I created a revolutionary new approach to diabetes care for children. It’s called Diabetes HouseCall. I currently have patients with diabetes in this modern version of my practice who have been seen as far away as Iowa. Texas patients as far away as 600 miles are seen just as easily as if they were in town. I encourage you to check out my practice website for HouseCall that explains how this innovative care program operates (http://www.diabeteshousecall.com ) to allow me to see you in the comfort of your own home, also while having access to all your relevant diabetes self care information. The rules of participation in this exciting program are explained on the site. I received some exciting news today that Blue Cross Blue Shield of Texas is embracing this program as a covered service starting around the end of September 2009. This would be a first for home based telemedicine care for children with diabetes in Texas. Advantages of HouseCall include 30 minutes or more of direct face to face time with the diabetes specialist. No waiting rooms, no long car rides, no time out of work or school, to see the diabetes doctor. Does this sound pretty good to you? Let me know if you need more info or would like to talk to one of the families already enrolled in my HouseCall practice. There is also an online community forming around HouseCall at glucoKIDZ.com and I know at least one of our families there would be more than happy to tell you more about their experience.

See you at Parent’s Night!!!