Doubly upset with insulin manufacturers for look-alike insulin pens


On the top Tresiba long-acting basal insulin. On the bottom FIASP ultra-rapid insulin

Please Novo Nordisk, what are you thinking? Both your Tresiba and FIASP insulin pens are nearly identical. I know already I will at least once, if not more, grab the wrong pen and take seven times my mealtime dose accidentally.

For the first time ever, after 46 years with type 1 diabetes, I’m using Novo Nordisk’s insulins for both my basal and bolus: Tresiba and FIASP.

This is the picture I took this morning of my pens just after looking down at the Tresiba pen in my thigh as I had my finger on the plunger having just pressed it, thinking, “Oh, my god, is that my Tresiba in my leg or the FIASP? SH*T!!!” All I saw was a navy blue pen.


The caps look different because the Tresiba pen (on the bottom) has a Timesulin cap on it.

I switched to Tresiba and I’m experimenting with FIASP after being a long time user of Sanofi’s Lantus and Lilly’s Humalog. I’m very happy with both insulins. Tresiba covers me a full 24 hours plus, while Lantus only stretched to about 19 hours. And FIASP, which I’ve just started to see if it actually is faster than Humalog, appears to be. No complaints about the insulins. In fact, I’d recommend them easily.

But how could those at pharma companies, whose hands these pens flow through upon creation and sale – device designers, engineers, research and development, business development, marketing and strategy professionals – not consider the risk to patients of confusing these two pens? Untold numbers of people with diabetes will use both these products – just as the company would like them to.

How could one not notice that the identical color of the pens, design and shape will cause many customers to mix them up and result in potentially life-threatening consequences?

I’ve already done it, mixed up my short acting and long acting pens once with two pens from two different companies that were not identical.

Novo Nordisk is not alone, although I find the choice of navy blue for both pens egregious. Here are Sanofi’s Lantus (basal insulin) and Apidra (bolus insulin) pens. Also, far too similar. In “real life” the color difference is not as pronounced; they both share a blue/grey hue.


Luckily, this morning the correct pen was in my leg. But trust me, in the middle of making breakfast and picking up a pen to take one of my six or so shots a day, the day will come when I take seven units of FIASP (my Tresiba dose) when I meant to take one. Am I to blame? Sure. But make it easier for us to avoid potentially life-threatening mistakes. Make insulin pens mistake-proof.

Why can we not have pens that are dramatically different colors, especially from the same company, different shapes, different texture or make a sound when you take off the cap. Users of insulin pens already take it upon themselves to distinguish their pens by putting duct tape or rubber bands around one pen, or keeping their pens in different rooms. It should not be so hard.

I’d like to see the company that embraces the hippocratic oath, “first do not harm” and reflects it in the pens they put in our hands.

You can do more, you can do better to help people with diabetes have one less thing to worry about – taking an insulin overdose – when they take their medication multiple times a day.


Grace for the new year

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Reflecting on this past year I realize how truly rich I am. How many experiences and adventures have colored my days. How many friends and colleagues have enriched my journey. And how grateful I am for family who always give me, and the husband, a safe space to land.

I hope 2019, amid the noisy, chaotic world, is a year we all find our inner stillness; that quiet, vast and unflappable place within us. And that you be touched by the grace of those who come along your path just as you have graced other’s paths.

Wishing you peace, happiness and health in the new year.

The language of diabetes and diabetes-speak

Of all that’s happened in diabetes this year, it was also the year of bringing people’s attention to the judgmental language embedded in our diabetes culture. I offer congratulations to the American Diabetes Association and the American Association of Diabetes Educators who jointly created a white paper on the topic. Among the paper’s recommendations is replacing “diabetic” with “people with diabetes.” Replacing  “test” blood sugar with “check” blood sugar. To never, ever label people with diabetes as “non-adherent” or “non-compliant” and, in general, to use language that is factually correct and judgment free.

That said, there is another language in diabetes. It’s the talk that goes on between those of us who tread water every day with this condition.

My friend just emailed me with this photo of her pump. The photo came with this message, “Just when I’m feeling like I’ve eaten too much and not been exercising…my pump responds with this.”

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You’re wondering what this means. She and I have been talking about noticing the number “111” on her pump and my CGM over the past weeks. Why? Because 111 is called an angel number, a symbol of spiritual awakening, pointing you to your purpose in life. We think it kinda fits us and we think noticing how frequently it shows up is a hoot.

So I of course wrote her back in diabetes-speak —

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Shall we just say I had to laugh when this came up for me this morning —

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Salt, Sugar, Fat: the book about creating the irresistable trifecta

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My last post was about the non-nutritious food served on airlines. If you want to learn how, as a nation, we have ended up with an overabundant supply of not food, but food-like substances, as journalist Michael Pollan, calls them, you should read, Salt, Sugar, Fat: How the Food Giants Hooked Us, by New York Times journalist Michael Moss.

The book is an eye-opening account of the food industry from when it began to employ scientists and marketers, and collude with the government and certain health organizations, to create cheaper food with few real ingredients and many chemicals. How and why the government began paying farmers to overgrow corn, wheat and soy, and how they all promote these fake foods as healthy with false nutrition claims.

There are so many devious, just-this-side-of-lying, and outright lying strategies about the nutritional value of these concoctions of chemicals, you will find the book jaw-dropping; unfortunately, in the worst way.

For example, America’s beloved Velveeta cheese, is a processed cheese-like product invented in 1918. Today, as over the years, its formula has changed, it is labeled as a “pasteurized prepared cheese product,” no longer technically cheese. Certainly it bears no resemblance to cheeses either made by artisanal makers here or in Europe, where the process is slow and personal and the prime ingredient, milk, comes from grass-fed cows.

Oscar Mayer Lunchables, which became a runaway lunch best-seller amongst kids, had not a speck of nutrition in it. It was the company’s way to reel in more money. Tang, which captured America’s heart when astronauts took it into space, has more sugar in it than soda. Cheap hamburger meat, that goes through bleaching and worse, that got termed “pink slime” finally got pulled off supermarket shelves when enough people complained. Trust me, I was raised on Carnation Instant Breakfast Drink and Pop Tarts and daily tuna fish sandwiches on Wonder bread. And an all time favorite, Chef Boy Ar Dee canned ravioli!

The history of how quick, cheap, processed foods arose is fascinating and all here. It started with a Kellogg brother, John Harvey, a doctor, nutritionist and health activist who created a sanitarium for people to regain their health in Battle Creek, Michigan. One of this main staples on the menu was whole grain cereal, no added sugar. When his brother, Will Keith Kellogg, in John’s absence on a trip to Europe, added sugar to the cereal and saw how people loved it, he split away from his brother and created the first sugar-laden breakfast cereal – Kellogg’s Frosted Flakes. Frosted with what? Sugar. American breakfast was born.

Coca Cola is given a lot of attention as a genius company for strategizing and turning the entire world onto Coke. During WWII they got Coke out to soldiers on battlefields, adding a patriotic feel to the product, and into gas station vending machines across the country.  Sad to say today as Americans recently began to drink less Coke, understanding the health risks, Coca Cola began exporting Coke overseas to hook poor people in underdeveloped nations.

You cannot read this book and not understand why we’re facing our current healthcare crisis and epidemic of chronic illness. And why what you eat is at the root of health, and disease.

Best and worst airline food

Each time I’m on an airplane I marvel again at how unhealthy the food is. Yes, if I can, I bring my own food on board, but that’s not always possible. I don’t eat the white bread roll and chemical-heavy salad dressing. I don’t eat whatever processed snack item they may serve like fake pizza. If I actually get a meal, I usually eat the protein and veg of the entree, skip the dessert, and save the cheese for a few hours later.

How interesting that someone actually rated the best and worst foods among most airlines. Turns out Alaska Airlines came in first place. Darn, not much chance I’m going to Alaska anytime soon.

Still, it’s interesting to see how our major and smaller airlines stack up – A ‘diet detective’ rates the best and worst US airline foods or health.


How many chances I have to be wrong every day

Every time I check my blood sugar I have the opportunity to be wrong – about what I thought the number would be, what range I’d be in, too high, too low. These mistakes are consequences of my every-few-hour analysis and decision-making regarding how much insulin to take for the next meal or correction.

Every single day I have multiple opportunities to be wrong about these decisions, which we know, PWD to PWD, are merely guesses.

So when I woke up this morning to a blood sugar of 126 mg/dl, I thought about this and I wondered how does being wrong several times a day, or few days, affect me and my sense of self? Here’s the 126 backstory: last night after a miscalculation of how much insulin I needed for dinner, my blood sugar dropped to 68. I ate a third of a cup of blueberries, after checking with CalorieKing how much frozen blueberries would raise me. But, obviously, I misjudged. (Or my body was doing something I had no clue about). I wanted to get myself up to 100, yet I awoke at 126.

Obviously, I didn’t need as many blueberries as I thought. Ten too many? Five too many? Obviously I should have waited longer after eating them before going to sleep to see how much they raised my blood sugar. I should I have stayed up til 1 AM rather than let my jet lag push me into bed at 10:30 PM. Obviously. Once again I made a mistake.

How does this affect us? Judging ourselves as often making mistakes when we can only guess at insulin dosing? I am fortunate that I know you cannot predict or control blood sugar. I know that even with my CGM insulin dosing is still, and always, an educated guess. I am also fortunate that I can usually move on from my self-criticism quickly and appreciate that I manage my blood sugar as well as I do.

Someone once said to me if you have type 1 diabetes, “You’re either a super-hero or a train wreck.” I have known train wrecks. They are not around anymore. Fortunately, most of the people I know today who have type 1 diabetes are super-heroes.

Yet that’s not really an apt metaphor and my super-hero friends and acquaintances would likely agree. Yes, we have a second job managing our blood sugar and diabetes. Yes, our life-saving medicine, insulin, can kill us if we guess terribly wrong. Yet there’s no way to know for sure each time we dose insulin exactly how much we need. And please don’t even get me started on riding the “roller coaster.”

If you truly understand what type 1 diabetes requires to manage it well, you could see those who do so as super-heroes. Yet I know we’re all just doing our best, day in and day out. We rely on the help and support of others when we need it and we roll with the punches knowing insulin dosing is neither science nor art. It is a calculated guess based on mystery, the mystery of what your body is doing at any given moment that is largely hidden from us.

Still, we continue, decision-guessing multiple times a day, day after day, rarely saying anything about it. I imagine, you like me, hear the voice of your self-critic when the number on your meter isn’t what you want or expect. And then you move on to make the next guess, hopefully, forgiving yourself with equal speed. Perhaps that’s really the definition of a diabetes super-hero.

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Teaching diabetes care in Copenhagen, traveling in the Netherlands

It’s been a few weeks since I posted. I’ve been in Europe both working and relaxing. I was invited to present the Flourishing Approach to practitioners at, and related to, Steno Diabetes Center in Copenhagen. Steno is a leading research institute and clinic in Denmark. The interaction was extremely successful, including a meeting with the CEO of Steno, Allan Flyvbjerg, who is looking for innovative ways to progress diabetes care and sees the value of the Flourishing Approach.

That morning I and the husband presented the Flourishing Approach to health psychology students at the University of Copenhagen. It was enormously rewarding relaying ideas of a different way of seeing and working with people who have a condition to such young, curious and fertile minds. And not one was on their iPhone during our talk! Instead they were surprised, fascinated and curious what diabetes really is and is like to live with. I am grateful to psychologist Timothy Skinner who invited us to take over his class.

It’s both fun and rewarding that Copenhagen is one of the world’s cities where the Flourishing Approach is connecting since I lived there for a semester during my junior year of college. How well I remember sleeping under the hugely warm white, white duvet and bicycling in the dark from house to train station to go into the city for classes. As I told the students, I could never have envisioned I would be back teaching at the university one day.

All to say it’s been rewarding work and a wonderful trip. Now back in the Netherlands, the husband’s home country, there’s a week left to wander down these beautiful cobblestoned streets and admire the centuries old buildings and canals.

A smattering of the trip in photos:

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Painting: The Anatomy Lesson of Dr. Nicolaes Tulp. Painted in 1632 I use this in my presentation to show how focused we are in health care on the body alone. I took this photo in the Mauritshuis museum here in Holland.

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Totally insulin-worthy Appel Cake at a bookstore in Amsterdam

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A popular bridge in the center of Copenhagen. The locks represents couple’s love.

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Lecturing health psychology students at the University of Copenhagen


Presenting at Steno Diabetes Institute in Copenhagen


A new T1D friend, Helle. We were LinkedIN until she reached out and showed us her Copenhagen. I am indebted.


Leaving Copenhagen. They don’t let you forget smoking is not good for your health.

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KLM snack on the flight back to Holland. A teaspoon of egg in a wrap. Putting profit before health. Sad to see.

See how far we’ve come in managing type 1 diabetes

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Clicking this link is almost like being swept off to a theme park. The theme: the innovations that have come through almost a century to help manage type 1 diabetes.

First, the link will ask you to enter your birthday to see what was going on when you were diagnosed. It led me to a picture I remember still of early insulin pumps that were the size of a backpack, above.

While JDRF launched this I’m sure to raise funds, I appreciate it as well to be grateful for all we have today. Glucometers, which I didn’t have the first 10 years of my diabetes life, CGMs, faster insulins, no longer having to snack for your shot and a short window before we have an automated artificial pancreas.

While I don’t expect a cure in my lifetime, I do expect more and more ease living with T1D. Maybe one day I’ll barely remember I have it. Let’s hope that’s due to innovations, not dementia.

A hospital stay with diabetes means you are at risk

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Adam Brown above

I just read Adam Brown’s unfortunate, and wonderful, review of his recent hospital stay, “My Appendix Ruptured: Scary Lessons Learned About Diabetes in the Hospital.” Adam has type 1 diabetes, is a patient-expert and works for diaTribe. In other words, he knows diabetes inside-out.

He went into the hospital with appendicitis that turned into a ruptured appendix during surgery. It also turned into a horror show of 4 days in hospital with doctors wanting to give him more than two times the amount of insulin he needed, an IV drip full with high amounts of sugar, a hospital full of nurses who’ve never heard of a continuous glucose monitor and diabetes ignorance and standards that put any patient with diabetes at risk. All this at one of the nation’s most prestigious hospitals.

You owe it to yourself to read the post. And you owe it to yourself to have an advocate should you ever be in the hospital, and to expect to continue your own care if you manage your diabetes well and know what you’re doing.

I have long told my husband if I ever go into the hospital, “You must make sure I can manage my diabetes on my own.” What a sad statement that going into the hospital with diabetes can worsen your health.