Monthly Archive for May, 2010

The Time is Now.

Published on May 28, 2010 in Community and Healthcare. 0 Comments

Wow. Friday.  FINALLY. I know this is usually a good day for most of us, but for me, this is a particularly important Friday. Today culminates two weeks of pharmaceutical sales training and testing with my company to prepare me for moving into a sales representative role here in San Diego.  And after two weeks of furiously studying the clinical trials and science behind out medications, I am more stoked than ever to hit the field and see how this knowledge plays out in a community that I’ve only ever been a patient in.

People have mixed feelings about sales reps. I wrote this post years ago in an effort to clarify the role they need to play in the medical world – to serve as a resource that complements the art of practicing medicine. Pharma reps got a bad reputation for good reason – there were years of excess, of influencing prescribers with trips to Maui and days at the driving range. But those days are long gone and we now live in a world of increasing regulatory restrictions – and quite frankly, I’m generally ok with that. Pharma reps  should be focused on offering clinical practice resources for our over-worked medical professionals. The bottom line – you shouldn’t need a huge marketing budget if your science speaks for itself.

Working for a small company, I want the chance to talk science with my customers without worrying if the rep after me is coming in with glossier materials. Many of the new regulations serve to level the playing field for sales reps, so that we can become partners in healthcare, not ATMs or walking billboards. And because I have spent so long being a patient who is ultimately on the receiving end of that information, I look forward to being part of the future of this profession and resetting expectations about what a doctor should be able to gain from his local reps.

Spending the past two weeks completely entrenched in diabetes physiology, medications, and the clinical science behind many therapeutics in the diabetes space, I’ve been pushed to reflect on my own diabetes management. I have to say, sometimes it wasn’t easy realizing that it was my very own disease state population up there on the PowerPoint, or that PWDs are often referred to as non-compliant. But what this experience has shown me is that I have a tremendous opportunity to educate about this disease in a different space.  I can’t wait to get the healthcare provider view about the challenges of diabetes management and develop what we can do together to give people with diabetes the opportunity to thrive.  Put me in coach, I’m ready to play!

Life Technology indeed.

Published on May 26, 2010 in Community, Gadgets and Going Public with Diabetes. 0 Comments

I had the privilege of speaking at the annual Biocom dinner here in San Diego on Monday night. Biocom is regional life science association focusing on initiatives that positively affect the life science community of Southern California. Their annual dinner honors local health heroes as well as creates a chance for members to come together for  networking and celebration. I was asked to share my story as a patient who works in the life science community who also happens to directly benefit from the medication of one of the member companies.

Since I take one of the diabetes drugs that my company makes, I’ve always been able to know for a fact that patients benefit daily from life tech companies and the products they develop. I have spoken many times before to various groups about what it’s like to live with diabetes – the day to day of diabetes management and how it helps to work for a company that “gets it,” but it’s mostly been from an educational or advocacy standpoint about the disease state. Monday night’s speech was different for two reasons: First, the audience members ran the gamut from CEOs of local companies to drug manufacturing engineers, all with varying levels of diabetes understanding. Second, the goal of this presentation was to show the life science community that patients benefit every day from their innovation, as opposed to my normal education spiel.

I’ll cut to the chase – the speech went great. It was well received and I even managed to eek out a few giggles from the audience in the short five minutes I had. But what I noticed and couldn’t convey in that five minutes was how the speech itself, the setting I was in, and everything going on with my diabetes management painted the picture of diabetes technology better than anything I could have said from the stage.

Diabetes technology guided my through the night – through my nerves, through the speech, through the dinner that followed, and through the night that ensued. I obsessively checked my Dexcom leading up to the speech to ensure that I wouldn’t go low during my talk. I had backed up my Dex before heading in to the reception with a finger stick test on my glucose meter, wirelessly transmitting one unit of insulin to my insulin pump, which was discreetly attached to my lower back, barely detectable under my jersey dress. Walking on stage to present, I knew from my CGM that my blood sugar was steady and wouldn’t fail me while I gave my talk. Later back at the table, I transitioned seamlessly between conversation and diabetes management throughout the entire dinner, even enjoying dessert with a quick bolus of my rapid acting insulin.

All of this technology is the reason that I get to live life to the fullest, and the reason that diabetes will never hold me back from doing anything I want to do. From the exploration of the miracle that is the human body that resulted in the discovery of insulin in 1921, all the way to the wireless technology of today that lets me manage my diabetes with the touch of a few buttons. There’s no way to convey the luxuries of diabetes technology I am so thankful for today in a five minute speech, but I am indeed so grateful for the innovation, imagination, and perseverance it has taken to get there.

The Sandman Cometh…and he brought high BGs…

Published on May 24, 2010 in CGM and hhhhmmm. 0 Comments

Wearing a DexCom or any continuous glucose monitor gives you insights to your blood sugars that you could have gone years without ever knowing. You see how certain foods, exercise, or activities like traveling really affect your blood sugar. But the most surprising insight I’ve uncovered using my CGM is what’s going on overnight.

There’s a whole eight hours of blood glucose fluctuations that I’ve been pretty blind to for years with this disease. Wearing a CGM feels like I’m putting on SCUBA gear and finally getting a glimpse at a world that was foreign to me before having this data. And I’ll tell ya – I don’t always like what’s going on in that world. Namely, I’ve got some weird high BGs that crop up late at night. The good news though is that now I’m starting to see where they’re coming from, and I can start to tackle them with a new strategy.

I do have a bit of dawn phenomenon, but that was addressed long ago when I went on a pump and created a basal pattern that bumps up my insulin from about 3am – 8am. These new highs I’m seeing are often in the midnight – 2am range, and they seem to be appearing for two reasons.

The first thing I’ve noticed is that high protein or high fat dinners are causing spikes in my BGs hours after the meal. When I put away a particularly low carbohydrate meal – for example grilled salmon and veggies – my blood sugar will stay put through the next few hours after dinner all the way until bedtime. But as the proteins and fats are digested, the numbers start to climb. To combat this, I’m going to try either an extended bolus at bedtime, or increasing my basals for a fixed number of hours. I never would have known this rise was occurring without my CGM because I was going to bed with good numbers and waking up somewhere in range (probably because my dawn phenomenon bolus was bringing it down a bit).

The second reason for my nighttime highs will be harder to treat – stress. I’m under a lot of pressure at work and home right now, and it seems to be carrying over to my subconscious. I’ve had wild dreams lately, full of vivid, stressful situations that sometimes wake me up out of a dead sleep! More than once after being awoken by these dreams, I’ve looked over and seen the glow of my DexCom, “HIGH” gleaming from the screen. (Just FYI, in CGM world, “HIGH” means you are over 180mg/dL, not so HIGH the meter can’t read it like on glucose meters. Just so you know I wasn’t in the 600s or anything to ca-razy).

On the occasions that the dreams or the CGM wakes me up, I have a chance to correct my blood sugars in the middle of the night, but the issue with this is that the BG is usually rapidly rising because the body is technically under “stress,” releasing cortical and in turn, hepatic glucose. It’s harder to shut off the liver that it is to cover carbs when it comes to exogenous insulin. Also, it’s tricky dosing for these – you want enough insulin to get a liver-induced high blood sugar down, but not so much you go low a few hours later (and have to wake up again). Either way, these are blood sugars that I would not have noticed without a CGM.

If you have never tried a CGM, I’d encourage your to wear just a test unit for a week –you’ll be shocked at how much you learn about your blood sugars so quickly. I mentioned in a post a few weeks ago that most endo offices can put you in touch with a local rep for a CGM company to get you set up with a trial unit. In fact, some offices even do group training sessions with the test units, which is pretty awesome – and free! I’ve learned a tremendous amount about my nocturnal blood sugars in the past 8 months of wearing one, which, when you think about it, adds up to about a third of my life that I didn’t previously have blood sugars for (actually, that would be true if I slept 8 hours a night…which we all know is not even close to true….but still…lots of time…). Pretty amazing what we can see with technology – I just wish there was a way to fix those night time highs without getting out of bed!