#DTM2018: The Diabetes EcoSystem

A few weeks ago I attended the Diabetes Technology Society's 18th annual Diabetes Technology Meeting  (#DTM2018 on the twitter,) in Bethesda, Maryland on November, 8th, 9th, and 10th. 

It was an excellent opportunity to listen to lectures from diabetes tech-heads, FDA, researchers, scientists, healthcare professionals, and to learn more about the latest diabetes and dtech advances for people with diabetes. 

A tremendous amount of information was discussed at a rapid fire pace - as in it made my head spin - but in a great way. 

I’m glad I was able to experience it. 

Full Disclosure: I was able to attend thanks to Ascensia Diabetes Care, who sent me there to cover the event as their Guest Reporter. Ascensia covered all my expenses, (travel, lodging, meals,) and provided me with an honorarium for my time and my talent. 

As always - All thoughts are mine and mine alone. 

My first of two #DTM2018 articles is up on Ascensia's website, mapping out the topography of the Diabetes Ecosystem, its parts and booming expansion - and how “people with diabetes are more than the twin of their diabetes data. We represent what the data cannot articulate - the living, breathing, real life component of diabetes. Our voices need to be included on panels and discussions when it comes to diabetes tech.”

Click HERE and give it a read! 

This Weekend, Don't Forget To Get Your Cher On And 'Turn Back Time.'

This Cher meme has been all over Facebook the past few days & it makes me laugh whenever I see it!
 I tried researching the image and found a link on a Reddit feed from last year.
Not sure if that's where it originated, but here's the link, just in case. 

Daylight Savings Time officially begins on Sunday, November 1, at 2 a.m.

Do yourself a favor and get your Cher on by turning back the time one hour on your diabetes related devices. Items including but not limited to, insulin pumps; cgms, glucose meters, pebbles, apple watches, regular watches, household & car clocks - before you go to bed on Halloween~ 

Diabetes Bonding At The Spa & Over Medicare & CGM Coverage

So every fall I treat myself to a really good facial, because after a summer of outdoor fun in the sun (complete with lots of salt water, massive doses of sunscreen, and big straw hat,) my skin always needs a little extra attention. 

And when one of my favorite spas has a special on facials, you know I’m all over it! 

I could write about how I gave myself a correction bolus after I parked my car (and before I ventured into the spa,) because of a 240 blood sugar from a miscalculation of carbs at lunch. 

I could discuss checking into the spa early because I wanted to to take a steam and sauna, and needed to detach from my pump for over an hour in order to do both. 

Or how after reattaching my pump an hour and 10 minutes later, my blood sugar was137, with 1.9 units of insulin on board, requiring me to dial back my temporary bolus to 30%, down a few ounces of fresh guava juice and throw back some almond honey treats before I went in for my actual facial - but I digress. 

It’s what happened in the room where I got my facial that really hit me in my heart.

After introductions with my most excellent esthetician Danni, I quickly explained that I had t1, wore an insulin pump, and showed Danni my micro wristlet with my meter, strips,  glucose tabs inside and a glass of guava juice.... just in case.

Danni: Oh, I totally get it - my dad has type 1.

Me: Really?? How’s he doing? 

Danni: He’s doing great!
Me: Is he on the pump? 

Danni: No, he’s on shots - it works for him.

Me: That’s all that’s important.

Danni: Actually, his Doctor wrote him an RX for something... I forget what it’s called. 

It’s not an insulin pump, but he would have to wear it all the time and it has something to do with his blood sugars. God, I can’t remember what it’s called.

Me: OH, OK , a CGM - A continuous glucose monitor.

Danni: YES. But medicare wouldn’t cover it - he’s over 65. It’s a shame because he was really excited to get one.  

Me: THAT SUCKS. You know, there are some bills re: diabetes and cgm coverage for medicare coming up in the House. Tell your dad to call his local JDRF chapter to discuss CGM coverage for medicare and help him tack action.  He can also go to JDRF.org and click on the advocacy link - it will take him to a link regarding CGM Medicare Coverage.

Danni: Can I do that, too? 

Me: Of course you can - the more Advocates the better!

Danni: I’m going to check out the website for my dad - and we're going to call! 

THANK YOU.

Me: Great! Also, you need to checkout diabetespac.org - the site will really help you guys navigate through the diabetes legislation - and they make contacting our Reps in DC re: said legislation incredibly easy. 

Danni: I’m all over it!

We talked a little more about diabetes - and then we got down to business regarding the facial. And when we were done, she handed me two pieces of paper. 

The first had the names of the facial products she used on my skin, the second was a blank sheet of paper for me to write down the JDRF and diabetespac info.

I left the spa with my skin glowing, a blood sugar of 147 and feeling relaxed. 

But as I drove home, my thoughts wondered back to Danni and her dad, who like so many of my friends with diabetes who are over the age of 65, was being denied crucial and life saving  diabetes technology.

Nobody should be forced to age out of lifesaving diabetes technology  - NOBODY.

And I thought of how quickly my almost 38 years of living with diabetes had gone by, and how no matter what amazing diabetes technology is on the market or down the pike, if you don’t have the means (insurance,)to pay for the technology, or if you age out of coverage for said diabetes technologies - you can’t get that technology - and that's not right or fair.

And it made me mad... and it made me fear for my diabetes and financial future.  

The laws MUST change and it’s up to to us to spearhead those changes. 

And don't think that because you or your loved one with diabetes aren't seniors, this issue doesn't concern you, because it absolutely does. 
This isn’t a senior issue - It’s an issue that touches every single person living with diabetes, regardless of age, and  for several reasons. 

1. We are in this together  

2. Seniors aren't the only people with diabetes on Medicare

3. Time is a thief and it goes by like that! 

So please guys, click on the following links and let your diabetes voices be heard - your voice is incredibly important - as is your current and future access to diabetes technologies~

http://jdrf.org/take-action/advocacy/cgm-medicare-coverage/

diabetespac.org

Tonight: Set The Clocks Back On All Your Diabetes Hardware ~

On this first day of National Diabetes Awareness Month in the United States and International Diabetes Month on a global level & I'm keeping today's post simple. 
Daylight Savings officially begins at 2:00 a.m., EST on Sunday November 2nd. 
So before you go to bed tonight, make sure you set the clocks on your insulin pump, CGM & glucose meters and every other clock in your universe, back an hour before you go to be. 
Also, make sure you change your lancet!! And change the batteries in all your smoke alarms! 

Turn your Cogsworths back an hour.
Cogsworth image courtesy of disneyclips.com

In Life With Diabetes, Small Medical Advances Aren't Small At All - Nor Are They Gadgets~

Gadget: A mechanical contrivance or device; any ingenious article

1. A small mechanical  device or appliance 

2. Any object that is interesting for its ingenuity or novelty rather than for its practical use.

Synonyms: Contraption, whatsis, dohickey, thingamajig dictionary.com

Insulin pump: A pump for delivering insulin in order to achieve tight blood sugar control and lifestyle flexibility while minimizing the effects of low blood sugar (hypoglycemia). The pump is composed of a pump reservoir similar to that of an insulin cartridge, a battery-operated pump, and a computer chip that allows the user to control the exact amount of insulin being delivered. The pump is attached to a thin plastic tube (an infusion set) that has a soft cannula (or needle) at the end through which insulin passes. This cannula is inserted under the skin, usually on the abdomen. The cannula is changed every 2 days. The tubing can be disconnected from the pump while showering or swimming. The pump is used for continuous insulin delivery, 24 hours a day. The amount of insulin is programmed and is administered at a constant rate (basal rate). Often, the amount of insulin needed over the course of 24 hours varies depending on factors like exercise, activity level, and sleep. The insulin pump allows for the user to program many different basal rates to allow for this variation in lifestyle. In addition, the user can program the pump to deliver a "bolus" during meals to cover the excess demands of carbohydrate ingestion. The pump is currently the closest device on the market to an artificial pancreas.”  medterms.com

YEP, nothing novel about an insulin pump - especially if you're the person who's attached to it. And the same can be said for Continuous Glucose Monitors and the accuracy of glucose meters and test strips. 

######

Dear Elisabeth - 

I read your article in the New York Times, "Even Small Medical Advances Can Mean A Big Jump In Bills.  I’ve marinated on it for a few days and honestly, I’ve struggled with my response.  

I agree that the cost of diabetes and diabetes technologies is high (and has always been in the 36 years that I've lived with t1 diabetes,) and I'm well aware that diabetes is BIG BUSINESS. 

I find the cost of diabetes to be incredibly expensive - even with insurance - And I worry about my financial future. 
I worry about everyone living with diabetes having to deal with the same issues and concerns that I do. The financials keep me up at night. And I believe that things need to change regarding the cost of living with diabetes. 
I hesitate to start the paperwork on a new pump or CGM (Continuous Glucose Monitoring system) with my insurance company because of all the work it requires - And I'm worried about the out of pocket expense.  

BUT, as someone who hasn’t had a day off from her type 1 diabetes in 13,230 days and who knew many of the casualties of the Diabetes Dark Ages by name and personally, I'm here to tell you that my quality of my health and the quality of my life has improved greatly over the years since the advent of diabetes technology. 

And I know that my future good health depends on diabetes technology, highly engineered insulin and anything else that:

1. Keeps me alive
2. Reduces the risk or helps to limit future diabetes complications
3. Gives me a better quality of life with diabetes.

In your article you stated: That captive audience of Type 1 diabetics has spawned lines of high-priced gadgets and disposable accouterments, borrowing business models from technology companies like Apple: Each pump and monitor requires the separate purchase of an array of items that are often brand and model specific. 

I found that statement to be callous and sensationalized and a huge over simplification of the many benefits of diabetes technology - Actually, you glossed over the benefits, BIG TIME.  
But I did and do relate to the frustrations re: to the integration and purchase of diabetes weapons. 

Still, make no mistake - Glucose meters, test-strips, Insulin Pumps, CGMs, fast acting insulin, etc., are weapons when it comes to living with diabetes - crucial ones that help us navigate the ever changing terrain of the diabetes battlefield. Without them, we'd lose the D war. 

Elisabeth - Your article made it seem as if people with diabetes didn't need or benefit from D technology  - And that's not true. 

Here’s the thing: Unlike many chronic illnesses, a large portion (8,757 hours  a year - give or take a few hours) of my type 1 diabetes care is in MY HANDS. 

So yes Elisabeth, people with diabetes absolutely need all the help we can get! 

And people with diabetes need glucose meters that provide us with graphs that chat with both our insulin pumps and our CGMs - Glucose meters and test strips that are accurate in order to properly calculate insulin via pumps, shots or CGMs and we and require fast acting insulin that quickly correct elevated blood sugar and allow us to eat when a meal is ready, instead of 20 to 30 minutes after taking it. 
And those people with vision issues because of diabetes need and require glucose meters with an audible voice. 

Personally, I would NEVER entrust my life, my health or my future health to mere gadgets Sidebar: Please refer to opening paragraph for the definition of the word gadget. 

Life and life with diabetes is far to complicated for novel gadgetry. 
Nobody living with diabetes and regardless of the type would rely on simple gadgets - But it would be great if we could. 
For those of us who remember The Diabetes Dark Ages, the time before insulin pumps; CGMs and glucose meters, life with diabetes had less precision, less flexibility and was more complicated - And led to more diabetes complications. 
We tested urine instead of blood,(disgusting and far from accurate,) had only a few types of insulin to choose from. And as far as the diabetes diet back then, it was anything but flexible. 
God, we would have given anything to have diabetes technology and fast acting insulin available to us! 
Technology like insulin pumps that allow for the customization of insulin delivery and more glucose meters/test strips and Continuous Glucose Monitoring systems and the advent of  analogue insulin .
The creation and availability of analogue insulin changed our lives for the better and allowed better glucose control, i.e.,blood sugars and meal time flexibility. 
All, key weapons for those of us doing battle with diabetes on a daily; yearly, weekly and decades, basis.

In the 1980’s, when my family and I received our first glucose meter - which cost hundreds of dollars; wasn't covered by insurance and was shared by the whole family shared, my parents, (my dad had t1) sister, (also a t1) and I had to meet with our pharmacist to learn how to operate the meter. 
The meter was the size of a VHS tape, took 3 minutes to calibrate and had a 44 page instruction book. There was nothing portable or convenient about it - And it was far from accurate - But it was more accurate than urine testing - And we were grateful for it.
A few years after we purchased our first meter, I lost 2 of my aunts to type 1 diabetes- they were in their early 50's. 

And I believe that if my older sister Debbie had diabetes technology available to her when she was diagnosed as a child( in the late 60’s,) or even as a teen, she wouldn’t have died from diabetes complications. Complications including; heart attacks, gastroparisis, multiple strokes and kidney failure, 22 years ago at the age of 34. 

I miss my big sister and I think about her every day - And I wish that she would have had the diabetes technology that I have available at my finger tips today - And clipped to my hip since 2002. 
And I will continue to advocate for people living with diabetes - And I'll fight tooth and nail to make sure that we've left the Diabetes Dark Ages forever. 
Sincerely, 
Kelly Kunik
t1 Person with diabetes for 36 years.
Diabetesaliciousness.blogspot.com
@diabetesalish