Medicare now covers Dexcom CGM. But also, read the fine print.

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I tweeted this two days ago when I heard yet admit I’m remiss not to have put in here. This news is important enough to stand on its own – now the Dexcom G5 continuous glucose monitor is covered under Medicare Part B.

Eligibility factors include having diabetes, current use of a home blood glucose monitor and frequent glucose testing of a minimum of four pricks daily, current treatment with multiple daily insulin injections or an insulin pump, and frequent need for self-adjustment of insulin regimen treatment based on therapeutic monitoring.  A bit more info here.

At 63 years old, this is heartening to me, only a few years away from Medicare as well as the fact that people with type 1 diabetes over 65 who have been living with it for decades are the most vulnerable population to hypoglycemia unawareness.

Let’s only hope, given the criteria for coverage, those of us who manage our diabetes well because of all the work we do, including using our devices, find we’re not eligible for a CGM because our blood sugars are so well managed!

A “hygge” weekend from presenting at ADA in Madison to entertaining in Brooklyn, NY

IMG_5837.jpgFriday I flew to Milwaukee, Wisconsin and then Ubered (I’m pretty sure it’s a verb now) to Madison. I was presenting the Flourishing Treatment Approach and conducting a workshop on two of its tools for diabetes educators at the American Diabetes Association conference.

I arrived just in time for the 5 PM reception. Well I’m no fool! Actually, it’s my way to get a feeling of the room, meet some people, ask how they’ve been enjoying the conference, find out their expectations, what they liked, what they didn’t like.

The next day as I presented I saw heads nodding throughout the large banquet hall and minds shifting to entertain this different way of working with patients. At the same time a Scandinavian invention called Hygge was happening. It continued during the bathroom break where several people reached for me and told me how inspiring I was. It was present during the workshop as participants grew closer to each other working together, as my heart space grew even wider.

In both Danish and Norwegian, hygge (pronounced hue-gə or hoo-gə) refers to “a form of everyday togetherness, a pleasant and highly valued everyday experience of safety, equality, personal wholeness and a spontaneous social flow.”

I flew home Saturday late afternoon arriving at my apartment at 11 PM. The next day I was having two friends over for brunch who hadn’t seen each other in 31 years. It promised to be exceptional in any number of ways.

The next day after 5 hours of leisurely eating, chatting, sharing confidences and laughter in my little brick-walled (no fireplace) living room I mentioned hygge. That morning the TV program CBS Sunday Morning had done a story on Denmark, the happiest country in world, giving a nod to hygge. And there we were, as the light outside my window was fading, basking in the hygge threads we had woven.

I try to make it a practice, my spiritual practice, to be kind, and now I’m adding to practice hygge. To take the time to savor the simplest moments – with friends, with family, with my extended work network and colleagues, with strangers. I’ve already been doing this for some time when I write something and reread it days later just to experience the fulfillment again of having created something I’m pleased with instead of just rushing off to produce the next thing.

You most realize the value of these simple moments when you also realize, much to your dismay, that there are more years behind you than in front of you. If you’re lucky, after the panic and anxiety sweeps over you, you also know that it is the simple moments that matter most.

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“The Book of Joy,” conversations with Dalai Lama and Desmond Tutu

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For me lying in bed and reading a good book, particularly on these cold winter days, is absolute joy. And so was reading this tome of spiritual wisdom; being reminded how we can create that soulful sort of enduring joy, not dependent on the quality of our circumstances and not  utterly battered when life turns cruel and careless.

The Book of Joy is a week-long love-fest between these two spiritual leaders as they chat, eat and turn to each other with glee conversing about how we create joy. According to these masters creating joy rests on 8 pillars: humor, humility, perspective, appreciation, gratitude, acceptance, forgiveness, and compassion.  Generosity and Community are also players to keep us steady when life’s storms come.  At the back of the book are practices to more deeply develop these qualities, mostly meditations that open our heart.

I took notes going through the book to remember its most salient points. So, here, in no particular order, are extracts from the notes I took.

“We are meant to live in Joy. This does not mean that life will be easy or painless. The question is not how do we escape life’s hardships and frustrations, but how can we use them as something positive.

Joy comes from:

  1. Ability to reframe situations more positively
  2. Ability to experience gratitude
  3. Choice to be kind and generous
  4. Maintain/meditate on love and compassion

Why be unhappy about something if it can be remedied.? And what is the use of being unhappy about something if it cannot be remedied?

Too much self-centered thinking is the source of suffering. A compassionate concern for others’ wel-being is the source of happiness.

We need goals to be inspired, to grow, develop, be enlightened, but at the same time we must not get overly fixated or attached to these aspirations. If a goal is noble, your commitment to the goal should not be contingent on your ability to attain it, and in pursuit of our goal, we must release our rigid assumptions about how we must achieve it.

Peace and equanimity come from letting go of our attachment to the goal and the method. This is the essence of acceptance.

So while we should do all we can to realize the goal we seek, whether we succeed often depends on many factors beyond our control. So our responsibility is to pursue the goal with all the dedication we can muster do the best we can but not become fixated on a preconceived notion of a result. Sometimes, actually quite often, our efforts lead to an unexpected outcome that might even be better than what we originally had in mind.

When we accept what is happening now, we can be curious about what may happen next.

It is not happiness that makes us grateful; it is gratefulness that makes us happy.”

At this age I’ve been fortunate to reach, I find when I take the time to make others feel seen and important, I get tremendous joy.

As in the book – When you wake up thank God for anther day. Hope to serve, if impossible then not to harm.

And maybe that’s really my life’s work. The littlest thing like thanking the girl who rings up my groceries, really looking in her eyes and offering a smile. A little zing happens in my heart, hers too I am sure as she smiles back. That zing is the human connection happening in real time. Something we so rarely experience these days. So take it from me – if you take the extra minute to create such interactions, you will have more joy.

Of course now I am on to my next book, This Close to Happy, Daphne Merkin’s memoir of living with depression. I expect I’ll have to practice my joy exercises every day to stay righted reading this one.

 

 

DPAC and Glu team to protect our right to healthcare. Your story needed.

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Here’s the lead – diabetes advocate Christel Aprigliano who leads DPAC, an org created and dedicated to bringing diabetes issues to Washington D.C., has teamed up with Glu and they are asking for your help. That help is to be part of the movement to get Congress to make sure if the Affordable Care Act is repealed, people with pre-existing conditions, like diabetes, will still be covered.

Go here to learn more and share a bit of your story living with diabetes. I have.

Glu, if you don’t know is a type 1 diabetes community accelerating research and shared learning in the diabetes space. As part of their mission they are working with DPAC in their joint push to keep access and affordability to healthcare for people living with Type 1 diabetes.

Thus far Glu has partnered with 72 organizations that advocate for people with life-threatening chronic illnesses to inform our current administration and Congress of the ramifications of taking our healthcare away – and to prevent it from happening. Details here, including the letter already sent to Congress.

Please share this because it’s true – we are stronger together – and no one should be without healthcare.

 

Low glycemic index treats for people with diabetes

Of late, I’ve been sent, with my permission, three different food items that claim to be low glycemic index. This is not a post to contest that. They are. I just want to share what they are so you know and can decide whether you’d like to try them yourself.

Tom & Jenny’sThey produce caramels that are frankly luscious and sugar-free. I don’t typically eat caramels, but if you do, I think you’ll be very happy.  Jenny is a dentist who wanted to bring her patients a candy that wouldn’t stick to their teeth or contain sugar. Tom left his career as a management consultant to become their Chief Candy  Officer. Screen Shot 2017-03-03 at 2.23.53 PM.png

I was sent two bags – the plain caramels and chocolate. I brought them to a luncheon of 22 people and handed them around. There was only one dissenter and most wanted more. Needless to say they’re long gone so I can’t tell you how many carbs are in each caramel, but I’m sure if you write to Tom he’ll let you know.

FiberPasta – Mary Rose, a CDE, sent me a note on Facebook asking if I’d like to try these pasta and biscotti products made in Italy and made with high protein, high fiber and low carbs. Of course I would. The pasta’s glycemic index is 29 (compared to typical 40), with 15 grams of fiber and 12 of protein. In all honesty it tasted fine, although a bit bland, so I only tried it once. I just don’t eat much pasta. But if you’re looking for low glycemic index pasta you should try it. Now, the almond biscotti (11 grams of carb in 2), I loved. Not sweet and gorgeously nutty.

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Raw Amour – These chocolate truffles (I was sent two packages – the certified low glycemic and the coffee flavor) come six in a pack. The low glycemic truffles have a glycemic index of just 6. The package was a little misleading as it says, ‘Delicious Organic Truffles for Dark Chocolate Lovers.’ That surprised not just me but also Kyle, whom I shared them with (another T1D) last night, since they taste mostly of cashew butter, which was in the center while surrounded by what looked and tasted like milk chocolate. I’ve since been told they’ll be named ‘Cashew Truffles’ which is appropriate.

The coffee flavored, which I haven’t tried yet, does contain raw agave and maple sugar, yet still has a glycemic index of 15.

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According to Raw Amour’s website, they’re the only certified organic low glycemic chocolate in the marketplace. You can also read this review on One Drop where the reviewer tested the carb impact, feeling true amour for Raw Amour.

 

What Patients Say, What Doctors Hear

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…is the perfect title for this sixth book by Dr. Danielle Ofri, internist at NYC’s Bellevue Hospital, author and regular contributor to the New York Times.

I’ve read all of Ofri’s books and enjoyed the candor, conversational tone and heart with which she writes. She is a voice and witness for both patients and providers trying to do better with this fragile union.

I wrote a full book review on the Huffington Post.

Joslin Medalists tell us how they create health

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I stole this photo from my Facebook friend, Richard Vaughn. He posted it on Facebook along with a lovely and lengthy write-up about what’s been learned by studying people who’ve successfully lived with type 1 diabetes more than 50 years.

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Richard, above, has had type 1 diabetes for 71 of his 76 years. He’s also become a wonderful advocate for the community.

If you’ve had type 1 diabetes for more than 25 years, and you notify the Joslin clinic, you will be sent a certificate. For 50 years or more you get a very special award – and the opportunity to participate in the Joslin Medal study. This is a fabulous study because it’s looking at what people do, and what their bodies do, to create health; they are researching how people with type 1 diabetes manage to live a long life to share with all of us.

I’m going to pull out from Richard’s post pretty much the answer they have thus far found to that question:

Dr. George L. King, the head of the Joslin Medalist Study in Boston, is working with more than 800 people in the Joslin Diabetes Medalist program —people who have been awarded medals for living with type 1 diabetes for 50, even 75 years —to uncover how they have managed to avoid many diabetic complications through the decades.

“They are very interesting people,” King says about his study group. “Some of them built their own glucose meters in the 1960s and 70s, before they were widely available to the public.” Aside from being avid do it yourselfers, King found other shared traits of those who have minimized the complications from diabetes, despite living with the condition for many years.

After discounting genetic factors, King’s research so far reveals that most of the Medalists exercise regularly. They are also very careful with their diets. But, more than this, King noted another shared trait that, although fairly abstract, is very important. “They are very good advocates for themselves,” King says of his subjects. “The are always on the lookout for new treatments. They are definitely a proactive group. They’re not sitting on the sidelines waiting for something to be done for them. They’ll do it for themselves first, if they have to.”

King, and other researchers, also discovered that HDL levels, the so-called “good cholesterol,” is high in Medalists without complications.” We are looking into that,” King says about the implications of the HDL levels.

By examining the Medalists King hopes to uncover the specific, if not the actual molecular ways in which they are protected from complications. Is it lifestyle? Genetics? Life choices? Or, is it something else? “The hope is we look at humans who are protected, then see why they’re protected, and come up with answers about lifestyle,” King says. “Then, by looking at their tissue and biochemistry (after death) we can perhaps develop medications to simulate the biochemistry that protected them.”

On that front, King says they have discovered a way that naturally-produced human insulin prevents arteriosclerosis. “Can we design an insulin to prevent arteriosclerosis?” King says. “I think this may be possible in the next five years.” Because up to 30 percent of people with type 2 diabetes use insulin, such a breakthrough would be good news for more than just for type 1 diabetics, he points out.

Meanwhile, as researchers like King work to understand the factors that protect some people from the complications caused by diabetes, and until the development, and testing of medications as a result of those findings come to market, there are things diabetics can do to help themselves avoid retinopathy, neuropathy, kidney disease and cardiovascular disease.

“Don’t smoke, watch your diet, and exercise,” King advises. “Also, advocate for yourself. Be proactive. That’s the main trait of the Medalists—they stick up for themselves.”

All good advice and nice to see a study looking for how people do well so we can share that with others.

Mary Tyler Moore leaves us this week

I met Mary twice. Although one time was really more of a sighting. I was walking down the street in Manhattan when all of a sudden she appeared walking past me. I remember because, after all, it was Mary Tyler Moore.

The same Mary Tyler Moore I spent my high school and college years with along with Rhoda on the groundbreaking TV sitcom, The Mary Tyler Moore show. TV Mary was loved for her come-back-up-from-being-knocked-down, can-do spirit. The real Mary showed much of the same spirit as an advocate for type 1 diabetes (T1D) for decades. At times people said, “Isn’t she too old?” But she widened the circle; she showed the world T1D wasn’t just a disease of children.

Moore got T1D in her thirties. She lived with it for almost 50 years, and had complications like vision loss. Yet, I never heard her grumble.

The first time I met Mary was at a book signing she was doing at Barnes & Noble. I went. When I reached her to sign her book, I was awful cheeky. I handed her my own book, The ABCs Of Loving Yourself With Diabetes, “Please,” I said, “allow me to share a gift with you. I hope you like it.” She was gracious. It was a moment.

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Life is moments. As you get older you realize how quickly they go. This week, after just returning from 18 days in Israel, I have a funeral to go to tomorrow after a friend just lost her mother. Last night the husband and I attended a memorial service for another friend’s mother who passed.

I heard a long time ago, “Life is not a dress rehearsal.” Israelis know this. Maybe because of the precarious place they occupy in the world, both geographic and political. Things happen quickly there. You mention something and someone gets on their cell phone immediately, a meeting is called and it takes place within days. There’s something to be learned from that. Let’s not waste these moments.

Among the many articles I’ve been reading about Moore’s death, this was an interesting tidbit. The original theme song to the Mary Tyler Moore show (Love is all around) opened with these lyrics – “How will you make it on your own?/This world is awfully big, and girl, this time you’re all alone” They were changed to enhance Mary’s and the show’s optimism – “Who can turn the world on with her smile?/Who can take a nothing day, and suddenly make it all seem worthwhile?”

Since I’m sharing ‘flourishing with diabetes’ it spoke to me. Part of what we create is based on how we see our circumstances. Mary had her demons – two alcoholic parents, alcohol abuse herself, a son die young due to either an accident or suicide when handling a gun, two failed marriages, and a series of failed TV programs after she, Rhoda, Phyllis, Lou, Ted, Murray, Georgette and Sue Ann huddled for their tearful goodbye as the lights went out at WJM Minneapolis. But she was resilient and a fighter.

With love, Mary. Thanks for making us laugh and thanks for fighting for us. You’ll be missed.

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Presenting the Flourishing Treatment Approach in Zikhron, Israel

In 2015 the International Diabetes Federation honored me with the distinguished IDF Lecture Award. That honor came with the opportunity to give a lecture on the topic of my choice. I shared the Flourishing Treatment Approach (FTA), a different way for health professionals to work with people who have diabetes (or another chronic illness). A way that helps people flourish not merely cope.

At the end of that lecture, Dr. Ilana Herman-Baham, Director of Internal Medicine and a diabetes clinic in Israel, came up to me and asked, “Would you come to Israel and share this with our diabetes nurses? They need to hear this.”

That’s exactly what I did in Zikhron three days ago at the ALUMA Israeli diabetes educators conference. It was a joy to work with them and to experience once again, as I had educators practice listening, communication, connection, strengths-discovery and inquiry skills, that the FTA works everywhere in the world regardless of culture, economics or health specialty. We are stitched together by our humanity and it is humanity that we must put back into medical training.

As much as being taught what to do, people living with a chronic illness need providers who can hear where they are and skillfully inspire them forward. I am grateful and appreciative to all who have and continue to invite me to do this work.

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