Last week I needed a blood draw and an IV infusion for a lab test. I was greeted by a friendly, masked lab technician to draw my blood and insert the needle to set up the IV. As soon as I sat down I told him, “Use my left arm, they always have trouble getting blood out of my right arm.” Then he proceeded to stick the needle in my right arm. I looked at him quizzically while he poked around. Three times before mumbling something which I assume was that he couldn’t find a good vein. Duh.
Same thing then happened as he twice tried sticking a needle in my left arm. Finally, he left the room and brought in the nurse who immediately got the needle in. The photo above shows the bruise from one of the lab technician’s attempt. What strikes me beyond the tech’s incompetence and unwillingness to ask for help sooner, is my own lack of insistence that he try my left arm first and that he get someone else after his first failed attempt. I know I have small or recessed veins and this is often difficult.
Of course there’s the assumption that he’s the expert. That I want to be kind and rally him on thinking, ‘go ahead, stick me again, you’ll get it.” Meanwhile I’m scanning my head on alert for fainting, which I have done before going through this process. The only good news I can take away is I will not let this happen again. Advocating for one’s self isn’t just contained to making sure you get a necessary procedure. Is stating what you know about your own body with as much confidence as we give others to poke and prod it. I encourage you to do the same.
Abbott, maker of Freestyle Libre, is notifying people who use the Libre 3 that three lots of sensors may be giving false high blood sugar readings. Of course we all know the danger of thinking you’re high when you’re not, injecting insulin and finding you’ve just induced a bad hypo.
The three lot numbers are:
You can find the lot number on the bottom of your sensor box as pictured above. It’s written in white on black background. If you no longer have the box you can find the lot number in the Freestyle Libre app.
Abbott says the issue affects only a small amount of sensors but if your sensor is in one of these three lot numbers visit the site and select “CONFIRM SENSOR SERIAL NUMBER.”
I don’t know why it’s so rarely mentioned but everyone who uses a CGM should know about compression lows. It’s a false low that occurs when you are leaning on your CGM sensor. It happens most frequently overnight, if you wear it on the back of your arm as instructed. You turn in your sleep and bam, the weight of your body is pressing on the sensor on your arm. The picture above is a clear demonstration how I must have rolled onto my CGM last night while sleeping.
I wrote about this previously as well, but thought it worth repeating.
It’s a funny thing writing a blog for this long. If you’ve been with me for a while you’ve noticed I post less frequently and the pieces are shorter. When I come across something I feel is worth sharing, something newsworthy or just an insight, I’ll post it. The remainder of the time, I’m just out here living my life. That said there are some classic articles the seven years I wrote on the Huffington Post if you want to see.
The living took me to London the past two weeks. It was actually a wedding that prompted the trip, but while there I got to meet a gentleman, Alan Sinclair, who’s dedicated much of his medical and academic career to advancing care for type 1s as they age and become elderly and frail. I’m currently on a committee under his stewardship. The main committee of medical professionals and researchers is establishing guidelines for health professionals who care for elderly/frail T1Ds who use CGMs in setting such as hospitals and nursing homes. Alan and his wife kindly and generously had me and the husband to his home for a beautiful lunch, and pronounced immediately that I was the star, since I’m the one who lives with this condition. I didn’t argue as I sipped my rose in his garden.
You realize how 20 years ago such a committee wouldn’t exist. We didn’t have CGMs and people with type 1 diabetes didn’t live as long. Just like the Joslin Institute now gives medals to those who’ve lived 80 years with type 1, things are getting better, even if it feels at times like it’s happening at a snail’s pace. Were I still in London, I’d say, “Brilliant, let’s keep cracking on!”
If you don’t have access to the Times, here’s the gist of the article. Dr. Ofri’s daughter needed a quick x-ray after a bike injury to see if she’d broken a bone. They were away from home and so went into a local urgent care. When Ofri got the bill for the ankle and wrist x-rays it was $1,168. Ofri noticed the bill didn’t come from the urgent care but a hospital, and they were billed at the cost of hospital x-rays. Ofri was told the urgent care was affiliated with the hospital and as such is allowed to charge hospital prices.
“It’s difficult to quantify how many patients find themselves unknowingly getting higher-price care at HOPDs as we did…There are also stories on Reddit and other platforms about new — and steep — facility fees at doctors’ offices appearing on medical bills and often not covered by insurance. One patient’s bill went up 10-fold for the same procedure after her doctor’s practice changed its classification of her appointment to a hospital-based designation.”
Be aware next time you need an urgent care facility. The good news is after six months of fighting the charge, the hospital canceled Ofri’s bill. Be aware too, appealing a bill is almost expected these days before insurance will cover it or sneaky hospital systems will drop it.
I just got the announcement in my email this morning although it was announced on June 4th. The long-standing, original, research and advocacy organization, Juvenile Diabetes (Research) Foundation, has renamed and rebranded itself into Breakthrough T1D. The organization originally began as ‘Juvenile Diabetes Foundation,’ then moved to ‘Juvenile Diabetes Research Foundation’ to highlight its research activities, and then ‘JDRF,’ to recognize that not everyone who has, or gets, T1D is a child.
Medscape has some interesting statistics about people living with type 1 diabetes, for instance the median age worldwide is 37 years old.
This year’s rebranding is to bring more attention to the fact that the organization works on behalf of all people with T1D, regardless of age, and that their broader portfolio of work includes trials and projects that are under the radar like funding devices and biological cures, including stem cell trials and research.
It’s worth a look around their new website to see they hope to accomplish for the future, and where they’ve traveled from to get here. That’s just what I intend to do later today.
Above Yahya Ur Rehman, final year MBBS student at Liaquat Universityof Medical and Health Sciencesin Pakistan
Yahya wrote to me to share his story and I want to share it with you, below. It’s unique in that this young man, at only twelve years old, not only saw his future, but saw how lacking diabetes treatment is in education and connection.
“In 2013, at age of 12, my life took an unexpected turn. I was diagnosed with type 1 diabetes. The news was overwhelming, but my frequent visits to the diabetologist soon became a part of my routine. It was during one of these visits that I witnessed something that would forever change the course of my life.
A young boy, no older than five, sat in the waiting room with his father. The father was a farmer, appearing bewildered as the doctor explained his son’s condition. The doctor prescribed insulin, but it was clear that the father had no understanding of what diabetes entailed or how to manage it. There was no mention of the importance of carrying sweet products to counteract hypoglycemia or the dangers of hyperglycemia. It struck me that counseling was just as crucial as the prescription itself.
Watching this interaction, I realized the significant gap in healthcare education for people from underprivileged backgrounds. At that moment, I decided that I wanted to make a difference. I resolved to pursue a career in the medical field, driven by a desire to bridge this gap and provide comprehensive care and education to patients.
Determined and focused, I poured my heart into my studies. Six years of relentless hard work paid off when I was accepted into the MBBS program at
Liaquat University of Medical and Health Sciences on merit in 2019. It was a proud moment, but I knew the journey ahead would not be easy.
One day, during my clinical rotations, I encountered a patient who reminded me of the young boy I had seen years ago. This patient, too, was from a rural area and had little understanding of his condition. I took the time to explain everything in detail, ensuring he understood how to manage his diabetes. The gratitude in his eyes was a profound moment of human connection that reaffirmed my purpose.
As I progressed through my medical education, I became increasingly involved in patient counseling during my clinical rotations. I found immense satisfaction in taking the time to educate patients about their conditions, management strategies, and the importance of lifestyle modifications. This hands-on experience deepened my understanding of the challenges faced by individuals with diabetes, especially those from underserved communities.
Throughout my journey, I learned invaluable lessons on the frontlines of healthcare. I discovered the importance of empathy, patience, and the power of education. I also witnessed the transformative potential of innovative treatments and breakthroughs in diabetes management. For instance, I learned about continuous glucose monitors and insulins, which have revolutionized diabetes care and improved the quality of life for many patients.
These experiences reinforced my aspiration to become a diabetologist. I wanted to dedicate my career to helping people manage their diabetes through both medical treatment and comprehensive counseling. I believed that empowering patients with knowledge about their condition was crucial for effective management and better outcomes.
Today, as a final-year MBBS student, I am more committed than ever to this goal. I actively participate in counseling sessions during my clinical rotations, focusing on educating patients about diabetes management, dietary habits, and the importance of regular exercise. I emphasize the significance of understanding the symptoms of hypo- and hyperglycemia and the steps to take in each scenario. Additionally, I encourage patients to maintain open communication with their healthcare providers and to never hesitate to ask questions or seek clarification.
My journey has not been without challenges. Balancing the demands of medical school with my commitment to patient counseling has required meticulous time management and unwavering dedication. However, the rewards have been immeasurable. Every person I help, every life I touch, reinforces my belief in the path I have chosen.
Looking back, my own diagnosis of type 1 diabetes was a life-changing encounter that set me on a path to help others navigate their own health challenges with knowledge and confidence. It has been a journey of personal growth, professional development, and profound human connections. I am grateful for the opportunity to make a difference in the lives of others and to contribute to the field of diabetes care.
As I prepare to complete my medical education and embark on my career as a diabetologist, I remain committed to my mission. I strive to provide not only medical treatment but also the necessary welfare and counseling to my patients. My goal is to ensure that no one leaves my office feeling as lost and confused as that farmer did years ago. I am dedicated to bridging the gap in healthcare education and empowering my patients to take control of their health.
In the years to come, I hope to continue learning and growing as a healthcare professional. I aim to stay abreast of the latest advancements in diabetes care and to integrate innovative treatments into my practice. Most importantly, I aspire to be a source of support, guidance, and inspiration for my patients, helping them lead healthier, more fulfilling lives.”
Just returned from a day at Camp Nejeda in New Jersey presenting ways to better handle our diabetes ‘demons’. This one was captured by my old friend, and amazing advocate, Ginger Vieira, pictured above.
Camp Nejeda runs two weekends a year for adults with type 1. I’ll be back in September with the husband as we talk together about spousal diabetes and all that comes with it. Meet us there if you can and bring your partner.
Today the New York Times wrote an article and posted a video about the making of Smarties. In the early days, before glucose tablets, I relied on Sweet Tarts, but I know tons of people were gobbling Smarties. So thought you might enjoy.
So what the heck is that above? At 4 am I appear to be 170 mg/dl. I was 173 mg/dl when I checked upon waking and 166 mg/dl when I checked on my meter. I checked because this is unusual for me and I just put this sensor on yesterday, and we know they can go wacky in the first 24 hours. Yet, that it was not.
Since I typically need 2 units when I wake up a little high, let’s say 130 mg/dl – one for the Dawn Effect and 1 for my coffee. – my fingers skipped my rationale calculating mind and pushed the plunger down on 3 units. After all, I was 170!
An hour later I paid for my impulsivity. 55 mg/dl (also confirmed on my meter) was the bottom only because I finally ate a teaspoon of honey and 1 jelly bean. FYI I hate to eat for no other reason than I have to, so I usually wait it out like a Tiger Mom watching how far and fast my numbers go up and down.
I think unfortunately the rage bolus is here to stay. It’s just the expression of human emotion. We want to rectify a troubling situation FAST. Even I, who generally follows Dr. Richard Bernstein’s “law of small numbers” (google it for the short explanation) gets sucked in when my emotions override my better thinking; but of course I can blame it on neurobiology saying my perhaps to say it’s really not my fault at all as it’s my amygdala gets hijacked and I just go along.
Then, the only thing you can do, the only route back to sanity is self-forgiveness. Luckily today I had the fortitude to bestow that gift upon myself. I wish you the same.
Diabetes Stories 