Monday, July 30, 2012

Here's to ushering in the era of the "Smart Meter." In the last few years, the market for sleeker, fancier meters and spiffy smart phone apps has moved faster than Willie Nelson running from the IRS, all with the purported aim of...
What, exactly?

I don't know. I mean, theoretically, it should be to create meaningful data patterns so that we can use the information to make changes in diabetes management. That's why the Verio IQ seems like such a great idea. Lifescan’s new meter is touted as the "first ever that automatically alerts you to patterns you might not even know were there.”  Essentially, it alerts the user to repeated patterns of high or low blood sugar.

Great idea! But the execution? Ummm...well....

Let me begin by saying that I landed the meter for free, which is cool. I like free stuff, generally. And the meter is slick. The screen lights up nicely, and I appreciate any meter that illuminates the spot for the test strip. (Why this is not a standard feature in all blood glucose monitoring devices actually kind of baffles me. A midnight hypo is so much more fun when I get berated by my spouse for turning on every light in the bedroom trying to check the BGs, right?) Much appreciated.

But the hallmark of this device is that "pattern alert technology," and the idea that the user can make adjustments based on quality data. That "quality" piece is critical. Meters are FDA approved with the idea that they can have a margin of error up to 20%. I'd heard from others that the Verio IQ seems to read on the high side, which can cause one to over-correct a perceived low blood sugar. I had no such issues. The meter was accurate to both my Accu-Check and Freestyle meters. The problem, then, was not with the readings, but with the data collection. Allow me to explain...

The pattern alert technology is predicated on time, clumping numerical data in a two hour window. If you are typically high in the window between 6am and 8am, you'll get a fancy message letting you know that this is, well, typical. Nice. Except, that's useless. I mean, not totally useless. My diabetic mother did pretty much the same thing every day of her life. Me, though? Not so much. I got up this morning at five, for example, and went for a run. Tomorrow, I will get in some intervals on the bike after work. Wednesday, I have a group ride scheduled with my friends starting around noon...
Do you see where this is going?

The data would be most useful if it were based on the tags and not on day part, with custom tags like, "Before Run" and "After Run," or even generic tags like "Post Exercise." That kind of dynamic data collection could be really insightful. I could see, based on the averages of the tags, what my blood sugar was doing pre and post workout or, more specifically, running versus cycling. Or when I race. Or during illness. But the Verio IQ allows for only two tagging options: "Before Meal" and "After Meal" which are really for your own reference only. Everything is averaged based on time of day, and the "Before Meal" or "After Meal" tag is just used by the Verio to populate the initial data. That makes the "pattern alerts" kind of irrelevant. Knowing I'm often low at 2:00 might be attributable to something...or it could be a function of coincidence. Numbers, taken in isolation and paired with time of day are, well, just numbers...generated not unlike every other meter on the market. Sure, sure, those others meters are lackluster in their marketing and don't look nearly so fancy, but in terms of function, they are pretty much the same. Unless, of course, you are my mother.

If you really want to take those numbers and make them contextual, you will still have to have the fancy app on your phone, or go old-school and keep a log. I suck at tracking, so I do neither. I just test often, correct as needed, and hope for the best. It's worked pretty well so far.

All that aside, The Verio test strips are formulary with my insurance, and I prefer the size of the meter to my current insurance approved option. I also liked the display. I may switch. After you get over the hype of the "smart meter" and the "pattern alert" business, it is kind of cool and feels nice in the hand, and is easy to read and tote from place to place. Good enough. 

Thursday, July 19, 2012

Diabetes camp pretty much rocks.

Sure, sure...I got sent to camp as a kid, but my folks trotted me off to Bible Camp, which is a whole other deal, and is probably why I am now a Buddhist. That, however, is a blog post for another time...or, better still, a few hours spent on the sofa with a qualified mental health professional.

About Diabetes Camp...

I was slated to travel to Spokane, WA so as to speak with the children at Camp STIX about diabetes management and, of course, cycling. On Tuesday morning, my cell phone rang with a phone call from Janet, the Sanofi rep covering Eastern Washington state. She was calling to let me know she was waiting for me outside my hotel room...which was funny, because I was sitting in my office located a thousand miles away in Erie, Colorado. Whoops. A little miscommunication between TT1, Sanofi and the camp had me speaking at 10:00 on Tuesday morning, despite having made travel plans for a speaking engagement on Wednesday.

Luckily, Janet is good natured and camp is a flexible place, so things were changed and schedules adjusted accordingly, and all in good humor.

With that in mind, I had planned to work a bit, and then go for a nice, long training ride before getting on my plane. T'was not meant to be. On the heels of a bike wreck last week, my husband had been experiencing some rather annoying symptoms, like an inability  turn his neck, occasional double vision, lost sensation in both arms, pain when running or talking or breathing, and he can only sleep upright with his feet propped facing North and while moaning about Mitt Romney (I blame that last part on pain meds).
So, with that list of antagonisms, his doctor demanded I take him in for an emergency MRI. I obliged...but not without making fun of his condition and periodically screaming, "Oh my God! Look at that!" to see if he was faking the whole head-turning business.

From there, I had an hour drive home to get my stuff, and then another hour to make it to the airport...and my flight was due to depart in two hours and forty minutes. Not a lot of time for the Beckster...and I had not eaten dinner, either, which was doing nothing for my mood.

I was even less jovial when I landed at a dead stop in the middle of the highway after an exit ramp collapsed along my route.  It took me well over an hour to drive six miles, with me freaking out the whole way, gesturing like a psycho in the middle of Interstate 25. Of course, I missed my plane. The benevolent Gods of all things aviation, however, managed to pull through and I got booked on a flight taking off 45 minutes later. All good. Except that I had to eat about 1000 calories of Mike & Ike's on the plane so as not to die because I hadn't any dinner, and had not adjusted the basal settings on my insulin pump. The guy next to me said, "You really have a sweet tooth." I shot him a look that quietly conveyed, "I can tear off your face with my bare hands, thank you very much" as I shoved the remainder of the package down my gullet.

I landed in Washington shortly after midnight, and called the hotel to send a Towncar. In mere moments, said chariot appeared, driven by a guy named Dana, who was slightly weird. He greeted me, told me we were waiting for two other parties, and then said, "I really hate my job." I nodded. From there, he told me about how he used to teach high school but working with kids gave him a generalized anxiety disorder, and he was in the process of having his meds adjusted and felt like he might be going nuts.

"You probably killed a few people too, right?" I was trying to lighten the mood. He looked at me like I was insane, so I decided to pretend to make a call...

Crazy Dana aside, the hotel was beautiful! It was located in downtown Spokane, and was one of the oldest hotels in the area. I was now regretting having missed the early flight...

Janet met me in the rotunda the next morning at 7:00 so we could drive to the camp. She and I chatted at length, and I was glad I liked her since we would be spending the next several hours with one another. Also a mom and an athlete, a vegetarian and home cook, we had much in common.

We arrived at Camp STIX just as the campers were finishing breakfast. The cabins were located alongside a river, and surrounded by evergreen trees. It looked remarkably like Colorado, actually. Janet and I watched as an Eagle landed in the marshy area alongside the water.

The camp had all kinds of amenities, not the least of which was a giant floating trampoline. Awesome. They had huge water slides and canoes and swimming pool, basketball courts and ring in which they were playing an Israeli Dodge Ball game. We were given a tour of the MASH areas, too, where they are collecting data for TrialNet, and we were shown the "low kits" issued each cabin after dinner for nighttime crashes (complete, I should add, with Mike & Ike's).

The camp had a 1:1 camper-to-staff ratio, and the kids tested six times a day. Very cool.

I gave a quick talk about my diagnosis...what it is like to manage my blood sugar on the I do what I do and how living with diabetes has impacted me and the way I manage my health. The kids followed with tons of questions - good, thoughtful ones, too. They asked the usual things: What kind of bike do you ride? How fast can you go? Have you crashed? Do you know anyone in the Tour de France? Do you ever win?

But they also asked the things that matter most: What do people say to you about diabetes? Do you feel different when you are with other athletes? How do you keep from going low? What do you eat? How much do you eat? How much do you test?

Those are the things that matter to kids who live with this disease.

One young boy raised his hand and asked me to divulge my A1c. I smiled, "5.4%" There was an audible gasp. I laughed. "Yes, my A1c is better than a lot of people who don't have diabetes because they don't pay attention. I have to think about what I eat before a race. I know what my 'ideal' starting blood sugar is going to be. My husband? Who also races? He has no idea. That's why diabetes isn't always a disadvantage. I know things about my body and my response to food and exercise that people without diabetes can't know. Maybe it makes me better on a bike...maybe it doesn't. But it definitely puts me in the position of controlling this disease."

Afterward, a young girl came up to me and told Janet and I about how she had been terrified to ride a bike after watching a guy have a seizure while riding due to low blood sugar. I nodded. "That is scary...but it's scary because he wasn't in control. If you are checking your blood sugar and eating what you need, that won't happen. Cycling is a dangerous sport...but it's no more dangerous for me than for someone without diabetes. In fact, it might be safer, because when I ride, I have more information about my body than others."

I spent the next half hour chatting with individual kids who talked about their sports and camp and how long they had diabetes, and how they were doing managing the disease. A kid came running up to me and handed me a sugar-free popsicle. Snack time. Right on. (I never get popsicles. Don't tell my kids.)

Moments later, a rep from Novo Nordisk walked toward me and introduced himself. Their athlete, Indy car driver Charlie Kimball, was slated to speak that afternoon.
Charlie was diagnosed about five years ago, at age 22. We swapped stories, and talked about glucose control while doing our respective sports. Not surprisingly, we found we had very similar regimens. In fact, there were a lot of corollaries between bike racing and racing a car...though Charlie's crash stories involve a lot of fire and explosions. Much cooler.

He was great with the kids, too, and had such a wonderful message. He asked me if I thought I would have become a cyclist if I had been diagnosed as a kid instead of as an adult. I told him I didn't know. He said, "I think I would have been scared to race if I was diabetic before I took up the sport. That's why I'm here: So these kids don't have to be limited like that." Nice.

We were quickly roped into a game of "Message to Garcia," in which one team tries to deliver top secret messages and another team tries to intercept them. After a good deal of smack talk between Mr. Kimball and I, we took our places on opposing sides. Mr. Super Fast Car Racer got his ass handed to him, too...though not without an allegation of cheating on my part. Apparently, one cannot pick up a child and hold them over their head and race across the finish line. "Hey, Schleck. Isn't there enough cheating in cycling?" Oh, snap. Charlie is a funny man.

Seriously, we had a blast.

I then went to test with the kids, and stayed for lunch. I got to hear the first few minutes of Charlie's presentation, but Janet and I had to cut out so I could make my flight home. In all, though, it was an amazing opportunity to meet some really great kids and, I hope, deliver a message that diabetes doesn't have to put you on the sidelines.

Monday, July 16, 2012

I'm overdue about eight race reports...but suffice it to say that if anything truly amazing had occurred, I would have updated my blog far sooner. Really, there are only a handful of things worth note:

1. Drove to Lawrence, Kansas to race with teammate Cait Silovsky, shown below. I was having a pretty solid race, too, until I laid down the bike around a corner with two laps to go and decided to walk before getting pulled. Bummer.

2. Raced a few smaller, local crits where I sucked hard. It’s easy to look at all the super fast girls at races - with their ridiculous abs and envious race finish times - and aspire to be like them. That's the time to nut up, quit sulking, and remember why I got into this sport to begin with: to challenge myself, control my blood sugar, and to have fun. Of course, suckage is not always a good time, so I'm working on that.

3. Had a pretty fair race at the State Championships a few blocks from my house (so I didn't even have to wake up early), and my legs felt remarkably good the next day. So much so, that I managed a six mile run before seven o'clock in the morning. I believe this to be a function of the Lefthand Brewery Recovery Beverages provided at the event, living up to their billing as "recovery aids."

4. "Man Down! Man Down!" Same race, TT1 Elite cyclist Dan Schneider took a nasty spill on the third lap. My four year old got to see Dan before and after, and was totally impressed by the carnage and asked if she could take him for sharing.

5. Kept swearing that "this will be my last race of the season," only to get sucked in to doing "one more."

Dennis and I spent the July 4th weekend trying to get in some much needed training rides, only to find ourselves cycling amid a sea of bikes in downtown Boulder, where there are more obstacles on the streets than in a game of Mario Kart. I had to dodge opening car doors, gushing fire hydrants, texting pedestrians and bikers going the wrong way on one-way streets like vehicular spawning salmon. All thanks to warm weather and a ban on fireworks.

For his part, Dennis managed a nice crash last week then ended with him in a ditch, being awaken by an oncoming motorist. No broken bones. No concussion. But he did manage to aggravate a pre-existing injury which is now costing about $900 in physical therapy.

I'm racing at least one more crit before August. I should be able to finish with a respectable time unless my leg falls off or I get abducted.