SOMETIMES THE "OLD" IS BETTER THAN THE "NEW"

The Lancets used for the necessary testing of Blood Glucose are getting better and better. There now exists on the Market a Lancet that is 33Guage (very sharp and thin). This is all very good if you are newly diagnosed with Diabetes, a young child/infant/baby or someone who still has "Virgin Skin". If on the otherhand, you have had Diabetes for a long time (I have had Diabetes since I was 6), do a great number of "Finger Sticks" and have developed scar tissue, then the "New & Great 33 Guage Lancet" is not for you. The first time I had tried one, it did not even penetrate and was not even felt. There is logic within Diabetes. The more frequently that you use sites(no matter how much rotation you do) you will inevitably develop underlying scar tissue at the point of impact, preventing very thin lancets from drawing blood. One way around this is to have a Lancing Device that has greater depth and a higher degree of force. Sounds like a Bow and Arrow to me.
So I am very happy to be able to use the 31 Guage Lancet which is able to penetrate through the tissue with just enough force.

JUST BACK FROM THE E.R.

I just got back from the E.R. after yesterday's battle with HYPOGLYCEMIA. After my neighbor called 911 at 2:00AM because I yelled at her to do that, since I was on the floor of my apartment thrashing about with the Forces of Life and Death. The Paramedics arrived and asked if I wanted to go to the hospital. Since I had drunk a good quantity of Maple Syrup and my Blood Sugar was now 65mg/dl where previously it was 40mg/dl. I decided against going to the hospital. They would have given me Glucose I.V. and taken my blood. These things I was doing myself minus the Glucose I.V.
What happened was when my BloodSugar was 40mg/dl, I decided to make Crepes with Maple Syrup to raise it up. However, Time was not on my side. Yes, I began eating the Crepes w/Maple Syrup, but next found myself on the Kitchen Floor with my plate smashed doing battle with the Forces of Life & Death from the Hypoglycemia. It must have gone down to about 20mg/dl. Since I now have Hypoglycemia Unawareness, the Falling of my BS is very quick,
Before the Paramedics left, I tested my Glucose and it was now 86mg/dl. We all felt assured that things were OK. However, an hour later my L Hand began to swell. I immediately put ice compresses on it and knew that it was related to the Fall. Since the EMT people had already left, I decided to go to the E.R. in the morning after sleep.
While waiting in the E.R. Waiting Room I heard someone coughing and sneezing. I turned in the direction and again saw that the simple implement of a tissue or handkerchief was not used to cover the nose and mouth. The person looked like a Fellow American. So it shows, that All People,including Americans (based on my comments of yesterday in the TUBERCULOSIS article) can display low class, base behavior, not caring about others or themselves.
Back to the E.R. The results of the Xray revealed a fracture of the Radius on my L Hand. So I have to wear a Soft Cast for about 6 weeks. The irony about all this as I told my Physician and Nurse is that all the long years I spent in Martial Arts, I never incured a Fracture, However my Battles with staying Alive from Hypoglycemia related to Diabetes caused more Pain (Emotional & Physical) as well as Fractures in comparison.
Eventhough I ended up staying 8 hours in the E.R. from 4:00PM to 12:00AM, Dr. Kaplan who was the E.R. Attending and Dr. Gulotta , the Orthopedic Resident were great as were Thomas and Mei my E.R. Nurses.

TUBERCULOSIS

Today in New York City, the temperature was around 50℉ so I decided as usual to go to Farmers' Market for more great Food for the week. The best way of getting there for me other than biking is the Subway. I boarded the train which was fairly empty (it was around 1:00PM). At the next stop however, a woman wearing a face mask gets on and sits close to me. I immediately moved to the other end of the car. It was not long before another woman who was already seated began expectorating her phlegm into her used coffee cup. Having had worked at Columbia University School For Public Health at one time and having a healthcare background before I entered the Food Industry, I again moved my seat to a Safer part of the subwaycar.
I do know that there was a time when anyone who had a communicable disease or a respiratory infection and was coming into this country would be quarantined for the good and safety of all.
Is it no wonder that there has been an increase in Tuberculosis in New York City. There exist now entities that look like human beings who when the need arises to sneeze or/and cough it is done openly without using a handkerchief (foreign substance to many) or tissue to cover the nose or mouth. This is so that their germs and poor habits can be openly shared with others in close proximity. I once saw someone who resembled a human being (outer form only) expectorate on the floor in the Lobby of Bellvue Hospital. I am sure that this "wholesome activity" is going on in other cities as well. Afterall, isn't it more important to show "Foreigners" how accepting we Americans are of all who come to our Shores, despite being "Blown-Up" as we were on 9/11/2001?

DON'T YOU DESERVE THIS LEVEL OF CARE?

When I was on the Insulin Pump some time ago, I still would have severe hypoglycemic reactions. All the more so, since I now had what is called "Hypoglycemia Unawareness". A condition due to lack of sufficient norepinepherine levels that act as an early warning system for low blood sugars.
There is a hospital in New York City that every once in a while will advertise on radio as to 'how great they are' by saying in a very Pompous Uptight/Upper Eastside/Snobby Woman's Voice, "Dont you deserve this level of care"?
Well since I was affiliated as a patient with this hospital, I decided to go to their Emergency Room. The day before I had dropped to the floor along with my floor lamp and awoke about two hours later because of the "Hypoglycemia Unawareness". Not only did this result in a loss of consciousness, a loss of my floor lamp, but heavy contusions on both legs which caused "open cuts" resulting in skin infection. Since Medically this is considered an Emergency, I naturally went to the ER of this supposedly great hospital. It was about 5:00PM when I was admitted into the ER where still wearing my Pump and after having seen the On-Call physician in the ER who suggested an alteration in my insulin settings and a dressing for my wounds. Since I was still laying on the Stretcher-Bed waiting for the Dressing to be applied by Whoever, I decided as I often do, to check my Blood Sugar. It was 40mg/dl....I was going into another Hypoglycemic Event and those Idiots who supposedly know all about Emergency Care, did not seem to know that a person who has Diabetes and is wearing an Insulin pump, is in need of FOOD!!!! Especially since it was now 7:00PM and I had been in the ER since 5:00 PM without any food.
I then got up off the Stretcher-Bed, approached the ER Physician who had seen me and said in a very loud voice so others would hear me as well, that I was Hypoglycemic and needed food. I also showed him the reading on my meter to confirm what I had said. I am glad I embarrassed him. I did get my food and later thought to myself as I left the ER as to why there is much Litigation within the Medical Profession. Could it be that the thousands of unnecessary deaths in hospitals due to negligence and stupidity is the reason?
Don't You Deserve this Level Of Care?

ONE OF THE MANY WORSE SCENARIOS FOR THOSE WITH TYPE 1 DIABETES

This goes wothout saying fellow persons with T1DM......do everything you can to try to stay out of hospitals as an in-patient.
A number of years ago, I had to undergo an operative procedure. As many of you know, all patients who are admitted for any surgical procedure must have an IV placed. This allows for easy access to administer medications quickly via a vein. It is especially useful if a person is not allowed "anything by mouth" and again it is a very quick/reliable way to adminster medications.
So, when I was admitted, the IV nurse places a solution of D&W in my vein in order to "keep it opened" in case different medications are required. Being proactive and never giving up self-autonomy, being able to think for myself, I said "I think you should use NaCl instead. Otherwise the D&W (Dextrose & Water) will cause my glucose to become very elevated. This is in spite of the medical personnel knowing in advance that I have T1DM (Type 1 Diabetes Mellitus). Afterall, an intake form is always required for all patients where their allergies and illnesses are listed. After consulting with the Resident and Attending, the IV solution was quickly changed to NaCL (Sodium Chloride). It is blunders like this which account for many many mistakes which affect the patient and his outcome. Another reason why litigation is so prevelant in healthcare.
Another time and in a different hospital, I required surgery on my eye. The RN assigned to me after the surgery was told to put "Liquid Tears" in the eye that did not have the surgery. The eye that did have the surgery, had sutures around it so I was not able to open it until removed.
So what do you think happens? She enters my room with the "Liquid Tears" and proceeded to apply it to the eye that had the surgery and which I could not open anyway due to the sutures. In my post anesthetic state I still was able to tell her WRONG EYE!!!
The lessons to be learned from all of this (I have more stories to tell), is NEVER NEVER GIVE YOURSELF UP TO DUMMYS AND INCOMPETENCE. It is you who are in charge of your body and no one else. Afterall no one is going to feel your pain if a mistake is made. Even those who wear WHITE make mistakes. Ask any Attorney who practices Malpractice. Don't ever "sell yourself short"!! Intelligence and good judgement are not exclusively given to those who wear white. I am wearing a teashirt(white) right now as I am writing, but I still know more about T1DM than many Fellows in Endocrinology.

WHAT IS STARBUCKS GOOD FOR?

Many of you would automatically think of coffee. Since Starbucks does have great name recognition, there would be no other reason to associate the company with anything else. But wait, Starbucks has other things that are even better than coffee. Besides, their coffee is not a good as it use to be. Some of the reasons for this are that the volume of stores cannot and does not (in my opinion) keep the same quality control when it comes to the roasting of their beans. The Barristers and "others" who work for the company are not as good as once were. They seem to be people who are there to fill vacancies and nothing more. The emphasis appears to be on marketing and real estate purchasing compared with good quality and knowledgeable service. In the beginning when Starbucks "came on the scene" here in New York City, the coffee was great as compared to the cheap quality coffee that was coming in from Columbia at that time. Starbucks, since it was the "new guy on the block", had to prove itself and establish a following willing to pay more than .50¢ for a cup of coffee. They did this by having well-trained Barristers and great Roasters to handle designated areas within the city.The small number of Starbuck stores established in the city at that time enabled the fresh roasting of coffee beans to be available to each store with care and quality control. Not the case now.....there are too many stores and not enough qualified people involved with the company as once was. Basically, Starbucks has grown too big and in the process has lost quality of coffee and service."Too big to be managed effectively". OK now that I have said my little critique on Starbucks, I will answer the question posed.
Taking many insulin injections throughout the day has some risks. Since I always carry my Flash glucose meter with me in a pouch that I clip to my belt, I can always monitor my blood sugars. When I am outside (the street), I need to be able to access a place where I can either give myself a bolus if my bs is too high or take someting sweet if the opposite is true. Since I am no longer on the "Pump", I carry my insulin pen with me all the time as well. Behold Starbucks!!
How great is it to be able to sit at one of the tables and do a 5 sec. check of my blood sugar?
If my reading shows "Hyperglycemia", then all I have to do, is to walk about 15ft. to the bathroom in Starbucks and take my fast acting insulin there.
If the contrary holds where I am feeling irritable, irrational, disoriented (normal states in New York City by all) and my glucose meter shows a "Low Number", then all I have to do is again walk about 15ft. to the sugar counter and open a few sugar packets to swallow. Nothing could be easier and I did not even have to drink their horrible coffee. And if you are feeling romantic, you could always sit next to someone who you feel attracted to. All this without spending a dime. Oh, one more thing.....If you are "out and about town" and in need of going to the bathroom, there is always a Starbucks to be found (these days) on every corner. Starbucks has become a stationary ambulance for those with Diabetes that also sells coffee. Thank you Starbucks for assisting all those with Diabetes.

THE TRUTH BEHIND HbA1C

Most of us with Type 1 Diabetes are familiar with HbA1C. This test shows a 6-12 week pattern of blood sugars and is widely use as a predictor and evaluation of "how well the patient is doing" by the Medical Profession. Basically, Glucose binds with the protein Hemoglobin to give us glycosilated hemoglobin. It is now generally felt that those with Diabetes should have a HbA1c of 7% or lower, but not higher since that would mean poor control with "high blood sugars".
The thing that is wrong with this type of test to be used as a Predictor of Control is that the person could have very high blood sugars (300mg/dl and above) for 2 weeks and then have very low blood sugars 50 and below( as in the case of Hypoglycemia) for the remaining balance of the month or two.
Since HbA1C shows a median or average of the numbers.....the percentage might appear as a HbA1C of 7% and the Healthcare Providers are saying "how great and what a good job you are doing" to the patient. In reality however, the person's blood sugars are fluctuating between extremes and while the HbA1C shows "good numbers", the reality is not very good. Again keep in mind that the only thing that is measured, is the average of all the numbers and not the fluctuations that can and does occur on a daily basis.

INHALED INSULIN......BIG DEAL/SO WHAT?

The approval for Inhaled Insulin by the FDA is now going to get the "Madison Avenue Marketeers" going full steam probably with the support of some Diabetes organizations and hospitals/clinics. In reality, Inhaled Insulin is geared for those (Type 2 Diabetes) who have fears and hesitancy in taking insulin(injecting) for good Diabetes control. Dollars & Cents, it is a huge market, with about 90% of people with DiabetesType 2 as potential buyers. It will by all accounts be more expensive than vial insulin already available . In addition, it is not recommended for those who have asthma and other respiratory problems such as bronchitis. It is also not recommended or children.
This Fairy Tale, is but yet another method for taking insulin, nothing more and nothing less. Where are all the new products/inventions for Type 1 Diabetes? I'll answer that, "they are on the back burner, because Type 1 Diabetes is not as profitable as Type 2 and there is a greater monetary market potential and volume for healthcare as regards Type 2 Diabetes". This is another reason why we (Type 1 Diabetes) must be our "own Doctors" and never give up on ourselves. I have no fear injecting insulin. My big fear however is meeting up with mediocre healthcare personnel who know nothing about Type 1 Diabetes.

INHALED INSULIN

Let us celebrate!! Another star for progress in the management of Diabetes. No cures, no cures.....but lots of glucose meters,lots of insulin pumps, lots of various insulins, lots of sharp needles (31G) and lots of congraulations to be had. This all points out to where on the "Time Continuum Line" you are on. As all of you know, 100 years ago, short acting insulins, let alone disposible syringes and meters were totally unheard of and unavailable. The way people with Diabetes managed their disease was with food and starvation. I am in no way implying that all these "devices" do not make the management and life easier as far as having Diabetes is concerned, but I also know, that sometime later/later☞☞ because of the "Time Continuum", the word Cure will have a greater meaning for those with Diabetes.

WHAT SEAT ARE YOU IN?

In Type 1 Diabetes, it is most important to instill in the patient(person) the foundation for education, care and responsibility for good management. This can be made possible by having good Endocrinologists available who are more interested in Type 1 Diabetes than Thyroid Disease or Type 2 Diabetes(Insulin Resistant Disease), as well as having the opportunity to avail themselves of Certified Diabetes Educators and other Healthcare providers.
From the age of 6, I was fortunate enough to meet Physicians who stressed and encouraged my "taking care of myself and in learning as much as possible about the illness so as to become responsible for day to day living with Diabetes". This responsibility is a necessary part for the patient who is the one managing his/her illness 24/7.
I use the analogy of the Driver's Seat. You and your Physician as well as other Diabetes related Healthcare providers should both be sitting in the front seat of the car with the Physician at the wheel. Never sit in the "Passenger's Seat". You have the responsibility and duty to make decisions regarding your care along with your Physician and others.
When you choose to seat in the "Passenger's Seat" you have given up your autonomy. Not very good for ideal Diabetes Management.

HOW TO PREVENT/REDUCE CLASS 5's

Class 5's is not going back to the Fifth grade, it is however how to reduce the number of dental caries that may result in sugar intake to correct hypoglycemia.
As most of us know, that the fastest way out of low blood sugars(hypoglycemia) is to ingest something very sweet. This could take the form of any liquid such as colas, honey, maple syrup and many others. Unfortunately when we are in the middle or beginning of a hypoglycemic reaction we are not thinking about our teeth or even about what to wear the next day. Our attention is (and should be) very focused on attending to our problem and how to resolve it. If we take a beverage or any other liquid, it will not only restore our blood sugar levels to where we can function again, but a "sticky" residue from the liquid will be left on our teeth. This residue usually adheres itself to the anterior(front) layers of the enamel between the gum and tooth at the margin. If allowed to remain....it can and often does create a dental condition called, "Class 5 Caries".It is the concentrated sugar that creates this condition, and the baseline of the gum is an attractive place for caries to feed on if anything sweet is found there. I found for myself, the best way to prevent this or/and reduce the number of caries is to rinse vigorously after you are feeling better or wisely, brushing your teeth. Afterall, who wants to return to the 5th Grade?

COCONUT CAKE w/A CHOCOLATE GANACHE COVERING

On the weekends, I like to go to Farmers' Market here in NYC. I usually pick up what is in season and today was no exception. I always however pick up fresh chicken and eggs (for my baking and breakfast) so that I would have them on hand for the week. My "Poultry & Egg Vendor", is a great person and will always go out of his way to make sure that eggs and chicken are put aside for me. In turn, I will bake various desserts and cakes for him and his family. I decided to bake a coconut cake with a ganache spread to it. The combination of chocolate and coconut is great.
So I got on the subway with the cake and my large LL Bean canvas boat bag that I usually fill up from the market. When I arrived about 1 hour later, I saw an empty space where his stand usually sits. I asked the Vendor next to him as to what happened? She replied, "his truck broke down on the way to the market". Feeling a little disappointed and still carrying a great coconut cake with a ganache cover, I looked around to see if I could give the cake to anyone else in the market. I decided that I would not. So, I bought some apples and potatoes before I took the subway back home. On the subway, I started to feel a little lightheaded. Since I always carry my meter with me (Freestyle Flash) in a pouch clipped to my belt, I tested my glucose as the train headed north. Sure enough, my blood sugar was 36mg/dl. I looked in my jacket for any "sweet" things and found 3 packets of sugar (coffee packets) and immediately swallowed them. A half hour later, I checked my bs again, and it was still low at 40mg/dl. I looked in my canvas boat bag and saw the box which contained the great cake that I was unable to give as a present to my Vendor and decided that, "this would be a great way to get out of my hypoglycemia". In New York City, people as a rule do not look at others too much, since so many things and behaviors are always seen and nothing is "new". I opened the box and proceeded to cut the cake. The chocolate ganache gave way as butter would, and since the cake was so fresh it cut straight through with one slice. The best part was putting it into my mouth and eating it as I rode home. I did feel better after eating a slice of the cake and I was happy at the same time. Ode to Coconut Cake with Chocolate Ganache!!

LIFESTYLE CHANGES
It is amazing that so many people would rather continue with negative Lifestyle habits than change them for a much better quality of Life. Take the case of the French woman with the facial implant. She is now back to her previous habit of smoking cigarettes. This behavior can lead and often does to poor healing by "upsetting" the blood flow to her face as well as "interfering" with foreign tissue acceptance. It is the same with Diabetes.....It is not only in taking the correct amount of insulin on a daily basis, but it is also eating healthy, exercising and allowing "positive energy" into your life. This positive energy can be in the type of friends you associate with, the type of job you do, how much sleep you get, what kind of food you are putting into your body, how you deal with stress, doing things that "really" bring pleasure and not becoming obsessed with Diabetes by identifying with the illness(Diabetic).

THE FIVE ELEMENTS

Last night I dreamt of my "departed" Sifu(Teacher) who taught me Kung Fu.
I was in the class practicing and doing the 5 Element Form in his presence. The Five Elements are the basis for Traditional Medicine and Martial Arts within China. A fusion of Body & Mind. It is the Foundation of what the Universe is composed of and everything inclusive as well.
When I awoke, my bs was 72mg/dl......Even in sleep, the body/mind is filled with Life.

HOW TO (easily)UNDERSTAND THE STOCK MARKET
The Stock Market is like making love....It goes Up & Down. When It goes up, everyone is happy and when it goes down, people are besides themselves, befuddled and betwixted. But like all in Life, "what goes up, must come down" or priapism develops.

WAKING UP
My cats get up at day rise, which here in NYC is about 6:00AM these days. When I am still asleep they become concerned as to my safety. They have on many occasions been able to detect low blood sugar levels within me and have all "rescued " me by various means to enable me to "wake up". This morning was no exception. My Alpha male cat, Willie hopped onto the bed and used his head to nudge my arm to move as well as using his head to push my face. In addition, he knocked down my alarm clock......All these actions as well as Sammy's loud verbalizations and Sara's licking of my nose succeeded in waking me up. My blood sugar was 72mg/dl..........Time for a great breakfast of noodles, eggs and fresh coffee made the best way☞French Press.

THE AGONY & THE ECSTASY

This morning I awoke screaming in pain. I do not know if any of you have ever experienced this problem, but my calf muscle cramped up on me. The tightness (constriction) produced such pain as to warrant the scream. Since I live in an apartment in New York City where the walls are very thin, my neighbor must have thought that I was experiencing profound and intense orgasm. Both verbal expressions are very similar. I take this phenomenon to be a calling from G-D, since upon waking up and checking my blood sugar(bs) I found it to be 40mg/dl.
G-D always has a way of making his presence known so we may do the correct thing. The correct thing was to intervene so that my life would be saved.

TYPE 1 DIABETES

I first want to make it abundantly clear that this site is devoted to people with Type 1 Diabetes. There is a huge difference between Type 1 Diabetes and (the other illness, which should be called and is called in some small Medical circles, Insulin Resistance Disease). As "We" all know, Type 1 Diabetes has a different etiology, different prognosis, different complications although the "other illness" does share in some of the same complications, different methods of treatment. In this too, the only similarity is the taking of insulin. There are many other "Differences", such as motivation and identity with the illness. People with Type 1 Diabetes are usually more motivated and more fine tuned in identifying the illness as an addition to many other things that make up "who they are". This is not political correctness, but common sense. It is unfortunate that the vast amount of people within the Medical Community have not yet made that distinction. Go to any hospital in any city and you will hear people with Diabetes referred to as "The Diabetic". Not only are they in error in doing this(people are more than their illness), but they are usually referring to the other illness (Insulin Resistance Disease aka Type 2 Diabetes). To respect ourselves, NEVER refer to who we are by our Illness(Diabetic), Whenever anyone in the Healthcare community calls us "Diabetic", we should correct them by saying, "I HAVE DIABETES, I AM NOT A DIABETIC", If they do not understand this, it is time to look for a new Healthcare Provider. Remember, that you are your own best Doctor when it comes to taking care of your Diabetes. Who knows your Body/Mind better than you?