Month: March 2009

The Apidra pen arrives this year

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UnknownApidra SoloStar® Pen

Unknown-1Lantus SoloStar® Pen

Just a bit of news: Apidra, a rapid-acting insulin used before meals like Humalog and Novolog has just won FDA approval to be packaged in a prefilled disposable pen, to be called ” SoloSTAR®.” They’ll be available in pharmacies sometime this year.

Apidra and Lantus are both Sanofi-Aventis products. If you use the Lantus pen SoloSTAR®, (Lantus being long-acting insulin most patients use once or twice a day to cover the fasting state), the two pens will come in different colors to help tell them apart. And trust me, there are endless accounts of patients mixing up their rapid and long-acting insulins because the pens or vials look so much the same. However, I’ll have to reserve judgment as what I saw didn’t look that far afield from the Lantus pen: a grey blue vs. a blue grey? What’s so hard about making it in green or orange? 

 

I’m an Apidra user after years of using Humalog. For me, Apidra works faster than Humalog which means I need to use less and its quicker action gives you the advantage of injecting during and sometimes after a meal depending on what you’re eating. This takes a lot of the guesswork out making my doses a wee bit more accurate. 

2:10 A.M. to 2: 25 A.M., just another night with a low

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I woke up last night at 2:10 AM and just felt off. My first thought of course was low blood sugar, even though my thoughts weren’t rising like scrambled eggs and my heart wasn’t beating out of my chest. I crept out of my bedroom into the kitchen, flicked the light and tested. Darn, a borderline 65 and it was only 2 A.M. I should have known when I was 123 before bed that I wouldn’t make it through the night. 

Typically, when I have some wine with dinner my blood sugar needs to be about 140 before I go to sleep since I’ll drop about 60 points overnight, and there I was 20 points shy. I wore a CGM once for 3 days to see if my blood glucose followed any trends. What was revealed to me was that indeed it did–I drop significantly overnight. When I asked my diabetes educator, “Why?” and, “What can we do about this?” the answer was “We don’t know why, it’s just how your body responds” and “Let’s move your Lantus from before bed to the morning. The drop may be less severe.” And it is. So now I follow a fairly doable system  knowing where my blood sugar needs to be before I go to sleep based on whether or not I’ve had two glasses of wine. I just have to be alert and make the effort even when it’s the last thing I’m in the mood to do at midnight.

Anyway, back to the kitchen. After discovering I was 65 I ate one glucose tablet, a few strawberries and a small bite of an Extend Bar. A few bites before bed help keep my blood sugar more level overnight. Then I tiptoed back into the bedroom. My husband who was now on the verge of wakefulness said, “Are you OK?” I said “Yes.” And I was, and I wasn’t. I don’t often have this thought but I did last night, How unfair and frustrating that this is how I have to live! How amazing that this is my life?! The thought that followed seconds later was a resigned acceptance, Well, if this is how I have to live then this is what I have to do. This is my life.

But there’s a second act to last night’s show. Now back in bed I lay there having a debate with myself whether my 1 glucose tablet, 2 strawberries and bite of Extend Bar was enough to get me through the next five hours. After a good ten minutes debate, because I really didn’t want to get up again, my sleepier side lost and I walked back into the darkened kitchen and retrieved and chomped down another glucose tablet. 

This morning I woke up at a stellar 86. Yet I’ve been mulling all morning about how hard I work at managing my diabetes and the only reward is maybe I’ll get less complications, maybe they’ll be postponed, maybe I will make it to 80 years old and won’t have more than my share of heartache. 

Of course now that the sun is making its way over to my living room window, my thoughts shift along with its brightness. Living side by side with my intermittent anguish is the hopeful expectation that within the next five to ten years there’ll be more advances in diabetes research, tools and procedures that will make managing diabetes almost effortless and ensure us much better control. 

How odd that all that we do to manage diabetes, particularly for type 1s, just becomes mundane in an egregious life, and that we exist in a constant ebb and flow from fear to faith and night to day. 

Making the most of the hand you’ve been dealt

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Screen Shot 2015-02-08 at 1.05.19 PM

I was just so moved by this article in the NY Times Sunday Styles section last week, “In a Charmed Life, a Road Less Traveled” by Layng Martine Jr. that I insisted my husband read it. “Anyone who is in love is living a charmed life,” said the author, “especially if you’ve been in love for many years, through good times and bad.” I was moved both because it resonated with how I feel about my partner and because love never left this relationship. Not after the author’s wife lost the use of her legs, as well as other bodily functions. Not after she had to give up so many things she once enjoyed, and they once did together, like hiking in the mountains, strolling on a beach, tending to their garden. 

Martine Jr. continued, “After the doctor left, tears filled her eyes. “It was all too perfect,” she said, “wasn’t it?” And it did seem that way. It always had… Not long after getting home from the hospital, when we were having dinner by candlelight at our kitchen table, she burst into tears. “I don’t know if I can do this for the rest of my life,” she said.

All I could say was, “We’ll do it together.”

And then they began to look for what could be instead of what they had lost. “We began to think of what we could do to replace playing tennis, walking on the beach, working in the garden. 

We take many more drives now, preferably in our convertible… where they bring the food to our car…We know to say “Yes” to nearly everything because there is probably a way to do it. We know there is happiness available every day… A few months after the accident, Linda started driving again. She has rolled three marathons — yes, a full 26-plus miles in a racing wheelchair.” 

And now, so long since that fateful night, looking across the dinner table at my wife, or seeing her across the room at a party, the hopeless crush I have on her is as wonderfully out of control as when I first saw her more than four decades ago.” 

Fifteen years after the accident they have found a way to still roll through Tuscany, in and out of Ireland’s pubs, and watch the sun set holding hands on a country porch.  

“We don’t know what will happen tomorrow, or who will live how long…We are two, but we are one. And I love those numbers.”

This is a story of love and support, of possibility and survivorship, of finding happiness in simple things and adapting to what life hands you. And while it’s easy to say when you’re feeling down look around at the people who have it worse than you, it can still be hard to make your unhappiness smaller. 

But the game really is to find ways to still have happiness and contentment no matter what life has handed you. And the lesson to be learned is it is possible. 

A scare, an unnecessary fright and bad behavior, all over potassium

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I had my blood drawn two weeks ago to check out my vitals and all were in target range except my potassium. Potassium?! Who even knew they tested your potassium? But I was told it was out of range, high, a “6” and needed to be retested to see whether the test result was accurate.  How important can it be that it might be a little high? [Normal range is 3.5-5.3 mEq/L.] O.K., no sweat. After all how important can potassium be? Certainly not up there with my A1c, cholesterol, triglycerides, microalbumin and thyroid activity.   

Now is when it gets interesting. First, I had to instruct my endocrinologist’s office to send the test results to my general practitioner. Isn’t that what an HMO is all about? Your GP sends you out to specialists who report back? Apparently not. When my GP got the results a day later his assistant called me to say, and I might add sounded a little worried, “Riva, do you know your potassium is high?! The doctor wants you to get it tested again.” “No problem,” I said nonchalantly. I already have an appointment next week to have it retested. I hung up the phone wondering what’s all the fuss about my potassium? 

I suppose my comfort came mostly from the fact that this very thing happened to me once before several years ago, and I’m basically healthy: I eat a Mediterranean-like diet, high in healthy fats, whole grains, low in fats and sugars, plenty of veggies, my weight is in range, I walk every day…But the idea that something might be wrong began to pray on me so I looked up on the internet foods high in potassium to see if that could have caused the spike. If so, I’ll cut down on those foods I decided. In my search naturally I started reading about potassium. The Mayo Clinic site reports, the most common cause of high potassium is impaired kidney function, such as due to acute or chronic kidney failure. High potassium is a life-threatening disorder that can cause muscle fatigue, paralysis, abnormal heart rhythms, nausea and require kidney dialysis.

Whoa, stop the train! Now I’m a little freaked out to be honest. I still believe my number must be wrong but….what if it was right? What if my potassium is now a problem and I’m headed for kidney failure or am already in the early stages? How I will fare with such a fate? Of course I also did read sometimes a report of high blood potassium isn’t accurate. It may be caused by the rupture of red blood cells in the blood sample during or shortly after drawing the sample. The ruptured cells leak their potassium into the serum. This falsely elevates the amount of potassium in the blood sample, even though the potassium level in your body is actually normal. But, achem, I wasn’t quite so confident anymore.

The conclusion to my retest is the first test result was an error and I’m in range. But here’s my real beef. I was retested on a Wednesday, first thing in the morning and called my endo Friday morning to get the results. His assistant told me he wasn’t in but would be in in the afternoon and yes she had the results. I was very clear that I wanted to know the results that day as I didn’t want to go the whole weekend fearing the worst. He didn’t call me back.

I called again Monday morning. I was told my endo was busy all day with patients and the assistant said fleetingly as a throw-away, “He doesn’t call you if your test result is O.K.” But I had no assurance of this. I repeated to her that it wasn’t O.K. before and I’d like to know for sure if that was a mistake. Please ask him to call me.” She said she would leave him the message. He didn’t call.

I called Tuesday morning and she told me, “I gave him the message yesterday. I’ll tell him that you called again.” No return phone call. I called again at 5 PM to find the office closed and so I left this message, more or less. “I can’t understand why after having an abnormal value for my potassium and getting it retested and not knowing whether or not it’s still abnormal and calling Friday, Monday and today, no one has bothered to call me back and let me know if I’m O.K!” It took five days to get me to that point. My husband was already there the first day.

My doctor called the following morning. “What can I do for you,” he said. No apology, very matter of fact, and he told me my potassium is in range. As he was about to get off the phone he said, “I don’t call patients when the results are normal.” I said, “After getting an initial result that wasn’t, it only makes sense I would want to know whether this result was also abnormal or not.” He muttered something that was hard to make out and we hung up.

I began to think about what this policy of only call a patient when there’s a problem creates. It means you don’t even hear from your doctor when there’s a resolution to a problem. Further, don’t you think if your doctor called and said when your test results were all in range, “Your labs are all good, all normal, good work! Keep it up, you’re doing something right and that’s great!” that you’d be more motivated to continue the good work? Yes, it may cost a doctor another half hour a day, or maybe he’d outsource it to his nurse. But right now, without it, it costs patients a lot of mental stress and our healthcare system big bucks. How perverse is our system that hard work and effort go unappreciated and unacknowledged and we’re only told about problems? 

O.K., I’ve ranted, it’s out of my system now, but just between you and me, I’m changing endos.

Do you wear a medic alert bracelet?

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womens-medical-id-braceletsMedical alert plaque from Sticky Jewelry

DiabetesHealth ran an article on its web site last week which got to me, “Medical ID Bracelets: The $15 Lifesavers.” Admittedly, I’ve had diabetes for 37 years, been on insulin for 32 (I was misdiagnosed early and put on oral meds the first 5 years) and have never worn a medical alert bracelet. Why? Thirty years ago when I looked at them, there were few available, they were all ugly and screamed, “I’m deathly ill.” Or so they made me feel. Then I just sort of forgot about them over the years. I learned how to recognize and treat a low, never expect to have a time I can’t, and never received any suggestion from either my general practitioner or endocrinologist that it might be a good idea to wear a medic alert bracelet. When I think about that now, that seems a stunning lack of care.

But reading the article about how such a bracelet can and does save lives, I thought how foolish am I not to wear one. I have enough lows and am alone often enough that I could end up in a situation where I pass out and such a bracelet could save my life. Each morning I walk an hour around my local park. I take my SweeTarts, some money and my keys, but nothing that would alert anyone to the fact that I have diabetes. I do carry a wallet card, but often am out and about without my wallet. Thinking back, my last two great lows both occurred in airports when I was traveling by myself. Luckily I had sugar with me and enough brain cells working to stop and treat myself, but what if I did not….?

So, over the past week I’ve conducted an exhaustive online search to see what’s available, and being the finicky Virgo that I am, have only had trouble choosing because quite a few different styles appeal to me. Although I know I’m in for a bracelet; necklaces bother me and something on your knapsack or some other hidden place defeats the purpose. Also, it’s a bit tricky to find one that both is immediately identifiable as a medic alert bracelet and yet looks attractive enough that you’d wear it. But, too fashionable, and I doubt any paramedic would bother looking to see if there’s life-saving information on your dangly, jewel-crusted bracelet. But feeling these two bracelets satisfy that debate, right now I’m  wavering between the beaded bracelet and more sleek stainless steel lynx bracelet, and then my friend who makes jewelry said, “If you buy an engraved plaque, maybe I can make a fashionable bracelet for it.” Well, now I’m just stumped altogether. But, it’s my plan to have one within a month’s time. I also checked my local drugstores and found you can buy a medic alert bracelet there for about $7.00 but don’t expect any style. 

If, like me, you haven’t thought about getting a medic alert piece of jewelry for decades or no one’s ever suggested you wear one, think again. And if you have access to the internet, expect to find enough choices, whether bracelet, necklace, charms etc, to spend a few hours finding just what you like. Well, that’s if you’re like me, I guess. 

Here’s also what I learned as far as the information to have engraved: 1) Diabetes, 2) If you’re insulin dependent which can be summed up in IDDM (Insulin dependent Diabetes Mellitus) 3) Allergies 4) Phone number to call, and what I actually realize was really important, 5) Your name. And that’s because if you do pass out, those working on you will call your name to try and revive you along with other life-saving medical measures. Since space is limited depending upon what item of jewelry you pick and from which manufacturer, choose the info that’s most important for you. Also, some bracelets will let you engrave on both front and back, others just one side. I’m going with:

Type 1 Diabetes IDDM

Riva Greenberg

Mom: Phone number

It will be interesting to see how I actually feel wearing it after being unencumbered all these years. Will it feel like I’m shackled or a “Badge of Honor.” I’m going for the latter. Will let you know.

Win big, help millions

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Got an idea for an innovative new diabetes device or web application up your sleeve?  Amy Tenderich, noted blogger of DiabetesMine, is running the DiabetesMine Design Challengewith a Grand Prize of $10,000 for ANYONE with a good idea to help manage diabetes: patients, parents, startup companies, design & medical students, developers, engineers, etc. The challenge is sponsored by theCalifornia HealthCare Foundation.

The contest runs through May 1st and winners will be announced May 18th. in addition to the Grand Prize are smaller cash prizes, consults with design experts and a mini-workshop with health and wellness experts at Ideo, the global design firm. 

Check for submission and judging criteria and contest details and then let your innovation flow.

 

A type 1 support group for women in New York City

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A support group for women ages 18 to 35

 NewImage

 The other night I met with a young woman, Katie, at a tea shop in lower Manhattan. She’s a social work student and has single-handedly put together a type 1 support group of young women, a rarity in New York City. They meet at the Friedman Diabetes Institute at Beth Israel Hospital (317 E. 17th Street) every second and fourth Tuesday of the month from 6-7:30 PM. If interested, you can contact Katie at: DiabetesNYC@gmail.com. I was meeting Katie because she was interested in my coming to speak to the group.

On the subway ride to the tea shop I thought of the several things I could talk about. I could talk about the principles in my book, The ABCs Of Loving Yourself With Diabetes. About how if we focus on the good things in life like love and friendship, think back to how we’ve overcome obstacles in the past and call upon these same strengths dealing with our diabetes, and be kinder to ourselves as we try to manage this slippery slope of blood sugar numbers, that we will be more capable to manage our diabetes.

I thought about my book that will be on bookshelves this summer, 50 Diabetes Myths That Can Ruin Your Life: And the 50 Diabetes Truths That Can Save It and that I could talk about the most common myths that even well educated patients believe, and clear up the confusion. Now that would be a lively discussion!

I arrived five minutes early to the little Greenwich Village outpost and after surveying the more than 50 varieties of tea took a seat at a small table in the front of the shop. Katie walked in right on time and fit her self-description: black coat, dark curly hair, red messenger bag. We greeted each other and after bringing back our pot of tea began to talk. When I asked Katie, “Is there anything in particular you’d like me to talk about?” She said, “Yes, could you talk about relationships?” Relationships? Me? And so I asked, “Relationships? Me?”

She said, “I read your article, Love and the Juvenile Diabetic and it really touched me, and our members being young women are really concerned about dating and boyfriends, like how do you tell someone you’re dating you have diabetes and when do you tell? Relationships is on the top of nearly everyone’s list.” Wow, I thought, being happily married for the past seven and a half years has wiped out my memory. For surely I felt that way in my 20s and 30s. I told Katie I could share my own experience, but I had no credentials to talk any more expertly about what her young women should or shouldn’t do, only common sense like, feel your way, trust your gut, tell your partner what he or she can do that would be of help to you and if they ignore your needs, run, run, run in the opposite direction.

Thinking about it on the train home I began warming to the topic more and more. When I told my husband what Katie wants me to talk about he said, “Maybe I should come too and represent the other half.” Well, we’ll see, we’re letting the women vote on that.   

So maybe now I’ll be able to add a new line to my bio: the Carrie Bradshaw of diabetes relationships. In case you’ve forgotten, Carrie Bradshaw was Sarah Jessica Parker’s lovable relationships columnist on the HBO sitcom/drama “Sex and the City.”