A woman was wearing this shirt today in my gym class. She told me she bought it on Confidence Apparel. I wasn’t thinking particularly of diabetes when I read her T-shirt, but I was thinking we should honor the hard work we do each and every day, regardless of the outcomes we get. We live with a second job, 24/7. Few people see it, and we ourselves don’t readily admit to how much weight we carry, thinking we need to be strong and ever-resilient.

So take a few moments right now. Recognize all that you do to keep yourself as safe and healthy as you can. Recognize you are all the things listed on this T-shirt. Take it in and treat yourself with the kindness and love you extend to others.

Perhaps I’m particularly feeling this way today because my blood sugar was up and down all day long to extremes that left me exhausted. It isn’t an often occurrence, but it happens. It’s part of this condition we live with. And when it happens we deserve to move gently and allow ourselves to just fold into it. After all, tomorrow is another day.

“Why Doctors and Pharmacists Are in Revolt” appeared in yesterday’s New York Times written by Noam Scheiber. If you subscribe to the Times, read it. If not, I’ve pulled out a few highlights below, but I cannot do it justice because the piece is long and multi-layered.

The overall message, as you can imagine, is due to recent mergers of chain drugstores and clinics, the exodus of health professionals during and post covid, the focus of profit over care, managers who are business executives, not medical professionals, care is becoming ever more bled out of the system and the system is ever more standardized.

Health professionals are increasingly overworked and have less access to resources and staff. Those at the top are seen, and treated, as efficiency managers. Those under them, cogs in a wheel. As a result, patients get less time with their docs and pharmacists, less personal attention, health providers who are exhausted, and increasingly are recipients of policies that are profit, rather than care, based.

I know this is not a new story. If you follow our industrialized medical system and the plight of health professionals, as I do, you’ve been reading about this over the past several years. Somehow, however, this article really struck a nerve. Perhaps it’s the fact that health professionals now feel the need to unionize – no longer given the respect of their years of education and training, they are seen as ‘Human Resources.’ That title invented by management in business years ago. The irony of people being resources, while you’re trying to say that you respect people, is thick.

Dr. John Wust, an obstetrician-gynecologist featured in the article talks of how little input doctors are given regarding the practices designed for and around them by health corporations. Once he could have never dreamed of being in a union but now he feels it’s his only recourse.

Both CVS and Walgreens say they have made significant investments in their workers’ staffing needs. But as Scheiber writes, “A longer-term consolidation of health care companies has left workers feeling powerless in big bureaucracies. They say the trend has left them with little room to exercise their professional judgment.” Professionals feel micromanaged and everything has become about the metrics.

Pharmacists described being held to measures as to how quickly they answer the phone and how many scripts they fill for 90 over 30 and 60 day prescriptions as the 90 day fills mean more profit. One cited pharmacist gave up his position as district manager to become a frontline pharmacist again. He couldn’t inflict on others what he saw as unconscionable, including weekly calls when a budget for tech hours exceeded by 10, nothing much, but a warning call its required.

I will close with this quote, “Corporate tells you how to manage your patient,” said Dr. Frances Quee, president of the Doctors Council, which represents about 3,000 doctors, most of them at public hospitals. “You know that’s not how you’re supposed to manage your patient, but you can’t say anything because you’re scared you’re going to be fired.”

What world have we created? Why is money almost always more important than how we treat each other, the planet, the other species that live here?

I have no answers. I just wish more people were asking and asking more fervently. I think at some point this movement by health professionals will cause a change I hope so because it frankly scares me to see so blatantly, so openly and so glaringly the profitization of healthcare, the thing we will all be relying on more and more as we age.

I think it’s lovely that diabetes like heart disease, HIV and probably Siberian huskies with pink paws gets its own special day of recognition. If you are doing something to bring greater awareness to what it’s like to live with diabetes, I applaud you. Keep going.

I recently was part of the #dedoc Voices, an incredibly vibrant group of people living with diabetes who gathered from around the world for the recent EASD conference in Hamburg and ISPAD conference in Rotterdam. Respectively that’s Germany and the Netherlands.

I made this mini shout out to how many years I’ve been living with type 1, 51. Not riveting, tis true and no cliffhanger, but hey. And now you know the photo above is the Joslin medal for 50 courageous years.

I will continue to give a shout out to those of us who live with this condition. To help educate, help people get access to vital medicine and help encourage health professionals to treat us like people, not machines.

I do this every day just by living with my condition, I don’t have to be on a stage. Because while it’s nice for diabetes to have its own day once a year, we still have it the other 364, and now that I’m of a certain age that’s over 20,000.

The husband passed this article below on to me . He is a devoted Apple watch wearer and has been for years. The last thing I want on my wrist is a mini computer, and I don’t even wear a watch anymore. But this was a remarkable feat from a very smart watch. At the end you learn about its superpower, Fall Detection.

Apple Watch Ultra fall detection dials 911 after man with diabetes fell unconscious

by Wesley Hilliard

A Las Vegas man with type 1 diabetes fell unconscious from low blood sugar but was saved thanks to his Apple Watch Ultra dialing emergency services when Fall Detection kicked in.

World Diabetes Day is on November 14, and even though Apple Watch can’t directly track blood sugar just yet, it can help save people in deadly situations. We’ve already covered a story where AFib notifications led to a diabetes diagnosis, but this event relied on another health feature.

According to a report from KSNV shared by 9to5Mac, a 40-year old Las Vegas resident named Josh Furman fell unconscious due to low blood sugar, but his Apple Watch Ultra dialed 911. His Dexcom G6 alerts him of low blood sugar due to his type 1 diabetes, but the levels were so low that he fell hard to the floor.

Fall Detection was triggered, and 911 was dialed. It also sent messages to his emergency contacts, allowing Furman’s mother to relay his medical condition to emergency services.

“I don’t know how long I was out for, but when I woke up, the Apple Watch had basically called 911, the paramedics,” Furman said. “But I could not talk. I sounded like I had a mouth full of marbles. 911 could not understand me, but they had the GPS from the watch, so they knew where I was.”

Furman was lucky, as he had the Fall Detection feature set to always on, which is not the default for users under 55. Typically, Fall Detection is only on during workouts.

“I don’t think people know enough about their Apple Watch to realize what it can actually do with the Fall Detection (feature),” he said. “People that are elderly probably don’t know about the Fall Detection (feature). You actually have to turn it on on your iPhone.”

Fall Detection is available on Apple Watch SE, Apple Watch Series 4 and later, or Apple Watch Ultra.

Those who want to turn on Fall Detection or check if it is enabled need only go to the Apple Watch app. Tap “Emergency SOS,” then select the toggle for Fall Detection and tap “Always on” if desired.

Note: Reprinted from Apple Insider

It’s not the low so much as the high. The 220 mg/dl at 4 am. I don’t eat much pasta and when I do I usually eat half a portion to keep my carbs lower. But someone else picked the restaurant and I feared as soon as I heard the name, “The Spaghetti House.” Sure enough, the menu consisted only of 7 different spaghetti and ravioli dishes.

Did he know I have diabetes? Yes. So does his sister. But we can say his knowledge only goes so far. There were no other restaurants open to change venue, so I decided to take a ‘diabetes vacation.’ I ate with abandon, almost the entire plate of spaghetti and mussels and one bruschetta.

As you can also see around midnight my blood sugar was bottoming out. So I ate a bit of fruit to raise it. Oh, Lordie. I can only guess the pasta, doused by me in olive oil was giving me a slower than slow rise due to the fat.

The moral of the story: it’s always a new day. Some days you clinch it, some you don’t. But let’s all take a breath, admit to the complexity of having to be a nuerobiologist, dietitian, mathematician, sociologist and archeologist to manage this condition. In my book, that’s flowing with the numbers, as they rise and fall, doing the best I can to keep guiding them back into range.

This also comes with the caveat that there’s no self-blame. I’m responsible for being familiar with my patterns and how various foods and activities influence my blood sugar. But that’s it, I make my best effort, most of the time, and adjust given the outcome. And the occasional diabetes vacation deserves to be on the playlist given all we handle.

I was reminded of this while recently at the EASD. Medtronic has been running this campaign for a few years now. It’s called the Big Blue Challenge. Post a video of yourself on social media balancing a blue balloon, while doing an everyday activity, and Medtronic will donate $5 to Life for a Child. Life for a Child is often the only organization that gets much needed insulin and supplies to children in need around the world.

The Big, Blue Challenge has raised $200,000 since 2020 which has been donated to Life for a Child.

All the instructions you need, like how to upload your video, how to let Medtronic know you’ve done it, are here. Medtronic will even send you a balloon.

The main goal of the #BlueBalloonChallenge, is to change people’s perception about diabetes by creating a recognizable metaphor:

“Living with diabetes is like doing everything you do in your daily life while keeping a balloon in the air. It’s a constant balancing act”

I can certainly attest to that, as can we all. Take a look: what can you lose, while you benefit those less well off?

Bastian Hauck above, founder of #dedoc who sponsored my trip to EASD last week.

While at the EASD conference (European Association for the study of diabetes) last week in Hamburg, Germany, diabetes stigma was a large topic of conversation. Not in the scientific programs, of course, but for those of us there as #dedoc voices and several health professional who also realize the damaging consequences of stigma: shame, burden, burnout, guilt, giving up one’s self-management.

Chantel Mathieu, President of EASD, whom I didn’t know before but now so admire, also gave a committed passionate talk why this has to end.

If you would like to contribute to the effort to end diabetes stigma, you can read more about it and sign the petition here. This is a well thought out movement, not just an idea. I was proud to add my name to the list.

Almost weekly my cousin, a psychiatric nurse, sends me another spoof of United Healthcare by Dr. Glaucomflecken on Youtube. While I watch healthcare disintegrate into for profit, assembly line, tests-are-more-important than looking at patients, ophthalmologist and comedian William Flanary, the man behind the Glaucomflecken mask, gives me something worth watching.