Dr. Brad Kane

2011-08-25T19:12:00.005-06:00

Overheard today -

Cadence asks "mom, how sick was I when I was a baby?" We talked about being unconscious, bags of fluid and insulin going into her body by tubes, about the drill and syringes that pumped fluid into her shin and the central line doctors put into her heart to save her life. She asks "did they take all the love out of my heart". I smiled + said, "no sweetie, they kept you alive so you could keep lots of love in your heart!!" She smiled back and said "that's good, because I love my family, so much"

Just Plain Awesome.

new discoveries

2011-08-25T07:01:00.004-06:00

I supplied the venue for an Insulin Pump information session last night at my clinic The Calgary Centre for Health. We will sometimes open up our facility to different interest groups, providing a free space to host a seminar. I had boatloads of stuff I had to get through at the office, so spending a few extra hours at the clinic last night wasn't a bad idea. There was about 20 people, there mostly parents of diabetic children. Very few people get to spend an evening with a bunch of strangers but be intimately connected through a condition. It's really kind of comforting to be in the presence of so many that know the struggle, it's an affirmation that while wandering the house at 2am looking for test strips, infusion sets, batteries, juice boxes, and hail Mary's....there's someone close by doing the same thing. The mid-day yawn and eye rub could almost be the universal handshake of diabetes.

Animas brought in Lorraine Anderson, a certified Diabetes educator and fellow pumper. The brain trust of Ward Clark, territory Manager for Alberta, the great Joe Solowiejczyk, and Teresa from the Alberta Children's Hospital were among us in attendance. The content discussed was far more in depth than just how great pumps are for managing diabetes. We chatted about matching food to insulin blousing, how to really take advantage of combination boluses, pizza bolus, super bolus, all of these great concepts that many of us have heard of but been too nervous to experiment with. Lorraine did an amazing job of empowering the group to have some "fun" with diabetes, see if you can out-think the beast. I consider myself fairly knowledgeable about insulin pumping, but found myself completely engaged and fascinated by the discussion. In fact, texting the discussion with Nicole to make sure we remembered the information. It was a really great discussion and to be honest, I found it exciting...which is so lame, but it's true! The opportunity to come at Cadence's disease from some different angles. We touched on a fair bit of topics that are frowned upon by some CDE's but in this discussion, we learned the reasons why we all do it incognito. For instance, pre-bolusing 20 minutes, overriding the pump recommendations based on instinct and experience, acceptable blood glucose departures 2 hours post meal, etc. It was great. The only issue I have this morning is that pile of stuff I had to do last night....is still sitting on my desk but i'm going to try and attack it from a couple new angles.

B.

Stats.

2011-03-23T21:55:00.005-06:00

I've been asked to give the keynote address at the Alberta Diabetes Foundation Rations for Riches event tomorrow at the Calgary tower. 10 minutes to share what diabetes is to our family. I'm going to do a blog post in the next couple days to describe the room....I'm kind of nervous, but it's an excited nervous....it's an opportunity to change perspectives.

I had to dig up some stats tonight for the keynote and even I was amazed by what I found.

- 300,000 kids with Type 1 diabetes in Canada.

- 3-5% increase in diagnosis rate per year (that's how you spell epidemic)

- 17 BILLION dollars per year towards diabetes complications yet the Alberta government doesn't cover a single dime of preventative measures. Seriously.

- in the 10 minutes it takes me to speak tomorrow morning in front of all those hungry people, 120 kids worldwide will develop diabetes...and most of them will die from it.

It has to be stopped. Get behind JDRF, ADF, CDA, educate, learn, be part of the solution.

till tomorrow!

I'm back

2011-02-17T10:13:00.008-07:00

It's been awhile since i've posted and I have finally figured out why.

There are many reasons and excuses I could throw out there, a business purchase, crumbling professional relationships, family non-D stuff...life is busy. The reason I've been delinquent about blogging is that I wasn't sure what to write. I had a comment from someone who said, is there anything that diabetes doesn't affect? I had to think about that question and for the longest time I sat looking at the cursor trying figure out what to write about that was fun, light, not related to diabetes. Well...the cursor still blinks. Don't get me wrong, there's a majority of our lives that are not related and certainly more that we don't let diabetes affect. But that's not what I write about, that stuff is awesome. LIFE IS FANTASIC IN EVERY SENSE. Diabetes is like cousin Eddy though...always there dumping his sewage tank out of his RV and spilling it onto your beautiful lawn. That's why I vent about it.

I write this blog for me. This blog is a place of emotional catharsis. It's used to be my little internet backwater that I never thought would be read, yet I get questions and emails regularly about the content. Being the parent of a diabetic is lonely place, it's a hard disease to spot. I write this blog for us I suppose and it feels good to do it. I've connected with many others that live in the same world through detailing our times of good and bad in the last 3 years of the D. I trended away from the purpose of this page, thinking that this blog had to evolve into other things. I was wrong. This blog is for me and the Diabetics, and especially the parents of, in the world that need to know there are others out there that feel the way we feel...and you know what? It's okay.

Guilt is a horrible feeling. I felt guilty that I hate diabetes more than my daughter hates it. I felt guilty about not checking her blood sugar last night because I desperately wanted to sleep...I felt it was selfish to put my need for sleep over her long term health. Granted she's 4 years old but she still feels the lows and highs. Nic and I feel bad d-days where we just throw our hands up and say "fuck you diabetes". Keeping in theme, I imagine me like Clark Griswold talking to Cousin Eddie, "maybe drive you out to the desert, leave you for dead." without Cousin Eddie picking up the reference. I think alot of parents feel this guilt and fear expressing their feelings for fear of being told "you're not the diabetic". A man whom I'd like to call a good friend, even though we've only met twice, is a 50 year old diabetic. He said "I think, as a diabetic, it's harder on the parents that it is the kid". To hear that from someone that has the disease was in part sad but in many ways brought relief and validation that it is okay to hate it, it is okay to be angry, and it is okay to feel helpless at times and hurt for my daughter.

So, I'm back and I'm not over diabetes, never over the fact that it will try to define my daughter's life, and no...as of Thursday morning, the answer to the question "so is that diabetes settling down, you've got it under control?" will still be answered in the fashion of: the last time I stabbed her tiny finger and took her blood, it was, but I'll let you know in 2 hours.

dead in bed.

2010-10-21T08:41:00.004-06:00

I'll admit I'd never heard about the "dead in bed" syndrome until a coupled days ago when a 13 year old girl with Type 1 diabetes went to sleep with a good blood sugar, in great overall health, and never woke up.

I will make no attempt to understand what the parents of this girl must be going through. I have myself watched my daughter's life flicker and come to within seconds of ending in my arms... is an image that I will never be at peace with. To actually have your child torn from you without an explanation, a cause, or a reason is unimaginable. Once again, diabetes gets off without a mark on it....dead in bed syndrome has no official cause but is responsible for 20-60 deaths per year or the equivalent of 6% of all deaths in type 1 diabetics under the age of 40 years old.

6% of type 1's die for no known reason. The assumption is that overnight hypoglycemia is to blame. But not diabetes, amazing. This was not the fault of anyone's, certainly not the parents, they did exactly what they should have...it's just one of those things...except that it's a young life ended shortly and without closure. I pray for their family that they can be a peace with this tragedy.

Over the last few weeks, out of a sheer desire for a full night's sleep, I have skipped Cadence's 2am blood test a couple times....3 years of an alarm at 2am 7 days a week, I needed a bit of break. To read this horrific news reaffirms that we need to be vigilant about our kid's blood sugars. Their life literally depends on our diligence both in the short term (dead in bed) and the long term complications. We also need to galvanize our efforts as warriors against this disease, educate, fundraise, lobby for a remedy. Just this morning a huge segment on our local news channel about the rising costs and complications of "diabetes" without identifying the types! It was from the Canadian Diabetes Association which is almost entirely type 2 focused, talking about prevention of long term outcomes and the cost of 2 billion dollars a year to the province. What they did not mention was that the Province of Alberta doesn't cover a DIME of type 1 prevention costs, insulin, test strips, syringes, insulin pumps. People who can't afford to protect their children, have no other option but to choose conservation of test strips, re-use a syringes, squeeze another few weeks out of that vial of insulin. It's not right and has significant consequences.

Teach people at every opportunity that Diabetes is multifaceted and needs the attention of citizens, our elected officials, the change needs to come, come swiftly, and be significant in order to prevent another young life ended without a reason.

Learn on November 14th for World Diabetes Day.

A Little Slice of Peace

2010-08-06T11:33:00.008-06:00

One thing that most parents of a diabetic fear is the night. Most parents put their kids to bed, sink into the couch and enjoy the time of no-kidness for a few hours. If you're a parent of a toddler diabetic...you play the "what would a pancreas do?". Bedtime, blood check, DECISON = snack, basal, or bolus and what's going to be best while she's unconscious for the next 8 hours. Lots of decisions to make.

For the last 3.5 years, I have set my alarm clock 7 days a week for 2am. I get up, walk down the hall to Cadence's bed, slowly creep in, pull back the covers to find her feet, lance her toe, squint to see the blood drop in the dark (c'mon testing light!!), see the number and decide what to do - DECISION - bolus, basal temp, wake to juice. Then I go back to bed, close my eyes...debate my decision...stay up for another 45 minutes because now I'm awake, made some mental calculations, started the mental machinery...and I get up at 5:30am for week absolutely trashed. I carry my luggage under my eyes :-) . Have I snuck a full night's sleep in here and there? Maybe once or twice. Usually what happens is I wake up to my alarm, decide not to bother, then lay there for 45 minutes thinking about checking her...then finally get up to do so, stay awake for another 45 minutes...rinse and repeat. LOL it's a never ending cycle of self-fail.

So last night, Cadence, for the first time that I can remember climbed into our bed at 10:30pm and stayed there. Normally this is a habit your don't want your kid to get into but strangely, this morning I'm kind of happy that it did. I still checked her at 2am but she was all curled up right beside me (makes me smile to think about it). The best part was that she was right there, I could hear her, know she's all good and I fell right back to sleep. At 5:30am this morning I had this funny feeling....oh yeah it was rest including piece of mind.

Weird.

Hailey has herself all around diabetes as well, she's been watching and learning for her 14 months of existence. Without the ability to say hi, she now knows the steps to checking blood sugar and gets mad when she's cant do her own everytime Cadence reluctantly has her blood tested - Oh the irony!

Hormone Discrimination

2010-06-16T09:22:00.003-06:00

Choose your injectable hormone wisely as it may be discriminated against.

I say that sort of tongue and cheek but it does directly stem from an interesting conversation that I had with the officials from the Calgary Public School system. As Cadence is getting older, she is starting to understand more about her disease and the role that it plays in her life. She is also asking alot more "why" type questions. These are great though, she knows exactly why she needs to have insulin. Being 3 years old, Cadence is getting to the age of going to school. An exciting, yet terrifying destination for us as parents as it will be the first time that we have to loosen our grip on her diabetes. In advance of the day, I wanted to find out more about how diabetics are handled inside of the school system and was quite surprised at the answers...or lack there of that I was provided.

I asked what the policy on diabetics in school is, to which I was told that there wasn't one. I then asked the simple question of whether or not someone in the school would be able to do a simple blood test with Cadence. She's 3 years old and can do it herself, but if someone in the school could supervise it and give her some insulin through her pump, that would be great. I was given the response "our teachers are not trained to do procedures, so no that would not be a possibility, but they will provide juice if required." I retorted "but how would they know if she needed juice without a blood sugar?" and was again hit with "our teachers are not trained to do procedures."

The conversation was stalling at this point so I tried to angle it a little differently. I said "okay, so if a teacher were willing to learn, based on my instructions to do a blood test and deliver insulin based on my direction, would that be okay?" Again, I was given the "our teachers are not trained to do procedures line.".

My frustration is growing a bit here, I can completely see their point on the issue: blood, DECISIONS, and most of all LIABILITY. So I asked my question a different way. "Alright, so if you have a child with a severe peanut allergy that eats a peanut butter sandwich because they're hungry, how would that child get an epi-pen or epinephrine injection?" I received this puzzler:
"All of our teachers are trained to use an epi-pen to an allergic child"....sounds like a procedure to inject a hormone doesn't it.

Giving juice to a diabetic is the same as giving a kid with a peanut allergy a peanut butter sandwich because they're hungry. The difference is how your chosen life-saving hormone is classified.

I asked them, what's the difference if the two are just injectable hormones? If Cadence did her own bood test and she required a set pre-set bolus of insulin...what would be the difference between an epi-pen and an insulin pen?

There was some dead air on the phone for a minute...and then...."our teachers are not trained to do procedures, as I've mentioned before, but let me give you the Principles number."

What's your school's policy on Diabetes?

B.

DIRONY

2010-05-13T07:09:00.004-06:00

No, I didn't misspell the title, it is exactly that. The heart of diabetes is it's own irony. It's a disease of paradox, where everything that should be normal is in fact exactly the opposite of. There are so many ways and reasons to hate it, but sometime you just have to admire and laugh at how clever this foe actually is. It's a brilliantly designed disease. Attacks one specific cell among the millions in your body and produces system effects. It will never be held responsible, but will end a life. Takes the simple pleasures of life and changes them to stresses. It not only affects the host but everyone around them. It truly is a magnificently designed enemy.

The irony of diabetes is especially present in kids, it wages war on the behavioural, the social, the economic, and not to mention the physical. It seems that many things that are the saving grace of parenting and being a kid are the most dangerous in a diabetic kid. Confused? Here's some examples to prove my point.

If your 3 year old has a temper tantrum, most parents would let them hash it out until they settle. With diabetic parents...we have to do that and then treat with a juice or candy since all the thrashing around causes a low. We have to reward the tantrum. Awesome.

Diabetes 1 - Parenting 0.

If you are preparing a nice family meal for you kids and one of them decides not to eat? Most parents would say "no problem, but there's no food later." If you've injected your 3 year old with a pile of insulin in this case however..."okay, let's have a bunch of candy then since you're likely to go into a coma in a couple hours if you don't eat". Reward not eating with sweets. Excellent message.

Diabetes 2 - Parenting 0.

With normal families, if your kid wants to play with friends, you find no other better stress reliever than to watch your child's endless energy expended with other kids'. In a diabetic family....you stress about how much Insulin is on board, did she have enough carbs to buffer it....did I bring enough candy to get her out of the impending low?

Diabetes 3 - Parenting 0.

In a diabetic family, there's not many more uncertain things than a night's sleep. You can't sleep while worrying that you might sleep through a scheduled blood check, miss a low and your 3 year old getting in trouble. You end up getting up anyway, check the sugar and make a decision if you can sleep for another 4 hours or not.

Diabetes 4 - Parenting 0.

So many examples of how a little thing like a pancreas can take "normal" and turn it on it's head. It's not an entirely one sided battle however.

If diabetes has the upper hand one day however, and is letting the blood sugar go high....you as a parent take great sorrow in the fact that you have to put a needle into your child for the 4 thousandth time...however there is an unspoken guilty pleasure in the fact you get to fight the disease with a sharp object. Take that Diabetes!...take that!

Diabetes 4 - Parenting 4000 and counting. WIN!! ;-)

b.

A view from the inside

2010-04-14T11:22:00.003-06:00

We often have to remind ourselves about the little girl in the diabetic. One of my greatest fears is the regret that her childhood is less memorable than her A1C's...I must not make the mistake of raising my diabetic instead of my daughter. Too often we look at her blood sugar before we look in her eyes.

Last weekend Cadence went to a birthday party, at which she met a father of one of the kids who is also a diabetic and an insulin pumper. I've talked to Cadence alot about her pump, her "special button" (infusion site), and all about how it's pretty cool that she has one. Ending soon, are the days when she can view her disease as an advantage. I hope she adopts the mindset of opportunity vs. misfortune. The man who she met showed Cadence his insulin pump and her eyes lit up. She was almost amazed that someone else had one. It was a connection that she's not made yet in her life, an instant kinship with another person. The ability to communicate with them empathically vs. being communicated to sympathetically about diabetes. It was an extremely important moment for her and while I am so happy she had the chance, part of me feels robbed that I'll never be able to connect with her that way. We'll have a plethora of incredible moments as father and daughter of course...but the single most important aspect of her life and longevity, that Nic and I for the last 3 years have managed around the clock...is never something we'll truly understand, and she'll never being able to truly share with us what she feels. I don't wish to have Diabetes...but I do wish I knew what it was like so that I can be there for her in more ways than the guy with the sharp stuff.

So, they talked for a few minutes and she asked him if he cries for "special buttons", to which he says "no... I don't cry, but sometimes they hurt, and sometimes the don't."

Cadence just said "Yep". That was the expanse of the interaction... but it completely changed her diabetic experience. Perhaps she now knows that there are others out there.

We interviewed a nanny last night for the girls as Nic really wants to get back to work. The nanny, is also a type 1 diabetic. We look at this in two ways, one we feel very slight some reservation about the remote possibility of her having an insulin reaction while in the care of our kids....in the other sense what an advantage for the care of Cadence. Someone with an understanding of what it's like. The nanny showed Cadence her insulin pen and blood checker, to which Cadence again had an instant connection.

For the last 3 years, we've tried to make Cadence's condition as anonymous as possible, try to make her feel as normal as we can. Perhaps however, we haven't defined normal properly. Perhaps more exposure and more frequent interactions with diabetics is what she needs in order to frame her world as normal. Perhaps our vision for her, is incompatible for her? I wish I could see the view from her eyes, so that we can make the best decisions possible...perhaps that is however, the crux of parenting.

b.

The State of the Diabetes Union

2010-03-19T06:56:00.006-06:00

I had a fantastic evening last night at the JDRF research symposium in Calgary last night. Good presentations, sensational families. It was great to meet like-minded folks. It's amazing that when we, as diabetes people, always seem surprised when we meet someone in the wild with a similar story. Instant kinship. It kind of reminded me of the dog park, where everyone has something in common and the thirst to say hello and find out about this other human being is insatiable.

I have to say, amid all the research and fundraising talk, there was one presentation that blew the room away. Colton, at the age of 11 controlled the pin-drop. He is the youth ambassador for the JDRF walk to cure diabetes. He gave a 4 minute monologue of why the walk is important for him, being a type1 diabetic. It was, in my opinion, the centrepiece of the evening for generating fundraising interest. Great job Colton!

The research presentations, as mentioned before were overall very good. The JDRF has embraced the idea of investing in people. I thought the bridge financing idea for companies with unique therapy ideas is revolutionary. Level the playing field a bit for research and treatment to succeed or fail based on it's efficacy and less on the financial burden of approval. I also thought the diversity of funding focus a breath of fresh air. The JDRF seems to be a growing snowball, the energy and passion in the room last night was palpable.

The CGM talk...well...seemed planted by the national sponsor to be honest. The data/research presented was outdated, the technology has not progressed in any significant fashion in the last 5 years, nor have the devices to monitor it. The distinction needs to be made that the CGM does NOT measure blood sugar, even though the presenter last night said it did measure "blood glucose". I think CGM is a vital key in the future of Diabetes care, but a couple of breakthroughs need to take place, including a way to directly measure blood sugar...not a calibrated algorithm of intertstitial fluid. For young kids, stable blood sugars are a luxury, the requirement for stable blood sugars in order to calibrate the CGM defeats the very purpose that parents want to use the thing. We wait for a better solution. Secondly, the marry of an infusion site and a CGM site into one unit is crucial for widespread adoption of the technology. Getting around this problem is going to also be a tough one in that the sites themselves will be difficult to produce in a cost effective manner. To explain further, a CGM site is approximately 40.00 per use. An infusion site is approximately 35.00 per use. So you're talking about doubling the cost of one infusion site, plus the fact that you can't guarantee or predict that both the CGM sensor and the cannula will have the same life cycle. At any one point, you will either be without CGM or good infusion. Either requires a site change, again worth 75.00 dolllars or more. I'm having trouble seeing how this is going to work for people but remain full of hope that the technology will progress sooner than later.

The presentation on the Edmonton protocol research was also quite good. They are making significant improvements in the life span of the implanted islet cells and reducing the complication rate of the immune suppression therapy. The overall success rate is improving but still not at a rate to make the procedure appropriate for the masses. I tweeted a question last night regarding whether or not a diabetic, if faced with the decision, would choose insulin or lifelong immune suppressant medication? The response was 100% insulin. Therein lies the elephant in the room. What research is being done to overcome the fundamental problem in type 1 diabetes? What is being done to try and overcome a diabetic's biologic intolerance for their own pancreatic islet cells? Dr. Senior has shown that the therapy works, upon implantation insulin is produced, but it's a matter of time before the cells are killed off. My personal opinion is that gene therapy will be the answer but that's a long way off from a marketable solution. Dr. Senior and his team have dramatically changed the way people look at a cure however and their efforts need to be STRONGLY supported.

If there was ever an opportunity to support the position that now is a great time to diabetic (if you have to be diabetic of course). I hope everyone that reads this post makes an effort to support a team in the JDRF walk to cure diabetes.

Oprah on diabetes

2010-02-05T08:49:00.010-07:00

I have to say, I love Oprah. I would be lying if I said I've never seen it, but the episodes I've caught, her energy and ability to connect is unparalleled. I always think about that scene in Oceans 13 where George Clooney is caught by Brad Pitt drinking a bottle of wine, alone, watching Oprah with a hint of tears in his eyes. In Pitt's attempts to rob Clooney's manhood from him...he gets caught up in the episode and his eyes well up. Great scene and so true.

A subject near and dear to my heart is of course Diabetes. You can imagine the excitement about someone like Oprah taking on the disease and making it relevant to the masses. She had her usual panel of energetic non-doctor doctors...meaning the ones that remove the white coat and connect with people (imagine that). They focused on the sensational and horrifying aspects of lack of control, showing amputations and other stuff, naming diabetes as the "silent killer". Okay, cool now everyone's attention has been focused....

Now I have to disclaim that I am absolutely in the minority of the populous by being type 1 diabetes centric. I manage one on a day-day and night-night basis. 90% of the diabetics out there are type 2. So of course mainstream media will try to communicate with a 90% market share vs. a 10%. That's just good business. Oprah's show is a business, with all of the philanthropy and connection that she brings, it's a business that makes money, freaking gobs of money. Type 2 diabetes will be the single largest financial burden on the planet (not just the health care system) in history, and that means that smart companies will be seeking ways to capitalize on it, we can only hope with good intentions. The most motivated customer is someone that has something to lose, exponential motivation when a life is on the line.

I wanted Oprah to clarify in the episode that:

- Kids get type 1 diabetes without any opportunity to stop it. Their own body (pancreatic islet cells) fails them.
- Adults get type 2 diabetes having ignored 15-20 years of preventable lifestyle habits. They failed their body. (in most cases anyway)

I'm asked on occasion, which means it's thought even more that between the ages of 0-8 months, we fed Cadence too much sugar and therefore she got "Diabetes" at 8 months old. It's not the fault of the person asking, it's just that the delineation between the two types is not made clearly enough, even by our own advocacy groups. The greatest disservice to type 1 diabetics was that we didn't get a cool and unique disease name...like "pancreatic insufficiency" or "islet apathy" LOL, I like that one.

Oprah and Dr. Oz, in my opinion, covered Type2 diabetes very well but didn't seperate the types properly, but the message of the show was a good one, and that is prevention is the key to save lives and lightening the immense impending health care system pressure from diabetes in general. When they talked about "warning signs" one of the top 5 was neuropathies, which are typically a late stage complication. What was left off the list was these 3 things (for type 2's):

1. Poor dietary habits - everyone who eats a big mac knows they shouldn't.
2. Poor/lack of exercise
3. Overweight.

How do those get left off the list?? The three silent but OBVIOUS symptoms aren't talked about??

I also wanted her to clarify that a 2 year old with 65-75 years of Type 1 diabetes expense, as much as 1000.00/month, may be as expensive to the system as type 2 diabetes. I don't know if someone has looked at the numbers but I bet it's close, but it wasn't touched upon. Dr. Oz said, with type 1 there's nothing you can do to prevent it, but there's alot of treatments for it....he should have said but why aren't these preventative measures funded and supported? Only outcomes, PREDICTABLE, expensive, and inevitable outcomes from the disease are funded and supported.

From a health care system standpoint, there has not be a death recorded from diabetes since the mid-70's. It was taken off of the list of possibe causes of death. Diabetes doesn't kill people, the complications of the disease do. Want to know the local irony of that policy? Preventative measures for type 1 diabetes (needles, pumps, insulin, test strips) are NOT covered in our health care system! The financial burden for control is shouldered by the caregivers based on their financial wherewithal. Treatment for severe retinopathy, neuropathy, organ failure, obesity, etc...are covered by the system! Talk about a band-aid for a bullet wound. If diabetes was labelled as a fatal disease, more might be available in advance of the inevitable.

Progressive thinking by governments about funding truely preventative measures for all diabetics (supplies for type 1's, fitness and lifestyle for type 2's) would save the health care system TRILLIONS. As it stands now...the deck is stacked against diabetics to fail...whether they had a fighting chance to avoid it or not.

I thank Oprah and Dr. Oz for doing a decent job of covering the topic, most of all bringing awareness, but I hope for a part 2.

Silence is deafening.

2010-01-04T21:35:00.004-07:00

Every parent tells their kids not to cry. "stop crying, stop your whining, grow up, etc"

Perspective is everything, we don't see what not expresssing emotion in a child actually looks like.

I did today.

There is a saying that the "silence is deafening". A useful saying to describe how the sound of silence can create an avalanche of chatter in everyone's self conscience, the deafening roar of self doubt that comes without the release of sound and word. A weakness of a social organism is that without constant communication or environmental stimulation, we must face the fear of our own inner voices.

Today, Cadence had her A1C testing, Thyroid testing, and Celiac disease testing. These are all done by drawing venous blood from the patient and running a series of tests. Since Cadence was diagnosed, she has a white-coat anxiety. She may not consciously remember her diagnosis but certainly there's part of that experience that must subconsciously stay with her. The phlebotomist wrapped both arms looking for veins while Cadence looked on, sitting on my "wap". With the decision that there was not a good enough vein in her arm, they decided to go into her hand for a vein. With shooken hand she moved the needle through the skin and into the tiny vein, the entire time, Cadence watching silently, me holding her tightly. As she moved the needle back and forth, up and down, round and round looking for the blood, Cadence's eyes never moved from the needle...tears at bay. She shook on my lap and her face turned purple, shaking with incredible power, I could feel the sweat forming on her back against my arm...but she wouldn't break. True courage beheld. The silence of her courage was DEAFENING.

When the phlebotomist decided that it was not going to work and they needed to go back to the arm, Cadence looked at me and said "I don't want another poke", her hair wet on her brow. All I could say is that "I know sweetie, it'll be over soon". The second needle, plunged into her arm...she held fast for a few seconds, shook, turned purple and then lost it. Crying, sobbing, writhing against all while the 2 phlebotomists now hold her arm firmly to draw the vials. Cadence never took her eyes off of the needle, fixated upon the blood coming out.

Once it was finished and i had her settled, she looked at me and said "daddy, I have to use the potty"...as if she felt guilty for violating the no-cry principle. She sat there, holding my hand, and spoke quietly about the jelly beans she gets for successful potty excursions. Almost like she didn't want to bring up the "poke", escape from the environment and focus on jelly beans. We could all learn how to deal with stress through a toddler.

Parents often wish for silence from their kids....we should all take a moment to determine how loud that silence actually is.

b.

Little bursts of honeymoon

2009-11-13T09:00:00.004-07:00

What's a honeymoon?

It's a little break from Diabetes. A type 1 can expect that at some point in their lives, their pancreas will magically kick back in for a period of time. Often it can follow an illness, ironically, much the same way that diabetes follows an illness. The "Honeymoon" as it's called, can last anywhere from a few hours to a few months, even a few years in rare cases. Imagine that, as a diabetic, you wake up one morning and your diabetes is in remission! No more shots, no more carb counting, no more 2am lows as you awake covered in sweat, disoriented looking for anything with sugar in it. Or that morning high blood sugar where you feel like you want to crawl out of your skin, the same skin that you have to plunge a syringe into to get control. A honeymoon is a little slice of happiness and confusion rolled into the same package.

Diabetes is a condition of routine. You eat what you eat because you've pre-planned what your sugar will do. You eat when you eat because that's what you've planned for with your insulin. Variations in any number of factors only leads to chaos and correction, which is why so many of the diabetics in the world are resistant to try newer, more advanced insulins, pumps, CGM's, etc. Change means uncertainty, uncertainty leads to stress, and stress leads to more uncertainty, all of which mess with your sugars and challenge your sense of control.

It would seem from all of the above that a honeymoon would be a romantic breakaway with any food you like, whenever you like, a full night's sleep (WOW), a untethered second helping of dessert maybe....hmm that does sound good. In reality however, for a caregiver of a diabetic at least, it's kind of like driving into the setting sun. It's gorgeous but you can't see a damn thing and you're not quite sure when it's going to end, just that it will. Every parent has this little flicker of hope during the honeymoon that maybe it's gone for good, but inevitably the highs come back and the glimpse of the cure fades.

Let me clarify that I don't mean to imply that honeymoons aren't great things. They are awesome for the diabetic I can assume. Come to think of it, maybe it's actually just hard on the caregiver as you're always looking on a map that you can't see. Maybe for the owner of the disease it's something you can feel?? I'd love to hear opinions on that foresure.

So, on Wednesday and Thursday we are on day 4 with a leg site on her, which only ever lasts until the 3rd day...and she's had 55 carbs of unbolused correction to handle sugar at or below 4.0mmol/L all day with a 30% cut of basal. It's stressful for us but such a nice little treat to see her system actually working. It shows that theres hope that one day we can hack into and crash the program that tells her islets to stay on the sidelines. I would LOVE to see them to come off the bench for a little longer.

8:30am 13.6mmol/L with 0.25 to correct, back to routine, thanks for the honeymoon.

b.

Animas Ping...first weekend review

2009-11-02T18:58:00.003-07:00

Cadence's new insulin pump arrived at the office on the weekend! The much awaited Animas Ping!

My review of "the new hotness":

The Animas Ping is Johnson & Johnson's newest product for diabetes, updating a great previous model in the animas 2020. Cadence has been pumping with the 2020 since March of 2008 and we've never regretted our Animas decision for a single day. Awesome company lined with an incredible device. The Ping was a bit of surprise release as the blogs, boards, and tweets all predicted that an Animas/Dexcom integrated product would be the next release but that has lost quite a bit of attention. My intuition tells me that they can't find a way to integrate an infusion set with a CGM sensor from a cost effectiveness standpoint and also how to make them last/fail at the same rate. Likely a hurdle that can't be solved in the short term, but I digress.

The Animas Ping is a swank new sparkle pink color (or green, or silver, or blue etc), and a bit bigger, probably 1cm longer than the 2020 predecessor. Aside from a small size difference, the guts of the pump are relatively unchanged. The display and readout are similar with some additional customizable features with sounds/alerts than what was offered on the 2020. One thing that Animas neglected was to add the IOB onto the home screen. This was a much talked about miss that the bloggers/boards discussed 2 years ago regarding the 2020 was that you had 3-4 screens to go through to get to the Insulin on Board. As any pumper or parent of one in our case, the IOB is just as valuable than seeing the current basal rate, especially for temping.

The magic of the Ping however, is the wireless function of the OneTouch Ping glucose meter. You literally have a remote display of the pump in the glucose meter. You can bolus from the meter without having to fish the pump out of yours or your running like mad toddler to push buttons. She can continue to run laps around the kitchen with a crayon coloring the drywall while you sit in a chair and casually bolus for her dinner....so to speak :-) . For those operating their own pump, the big advantage is discretion in that you don't have to reach into your clothing to remove the pump, you can do everything via the meter.

EXCEPT: change your basal rate, or temp your basal! That's right, you can bolus insulin but not change basal rate unless you have the pump in hand. (Yes, you read that correctly.)

With Cadence, we probably temp her basal rate at least 1x day if not more depending on sugar and activity. To not include this option onto the Ping meter can only be described as an EPIC FAIL. So we still have to fish the pump out while holding her down to tweak the basal rate. I'd love to know the reasons behind leaving this feature out but likely it was a time to market decision. Hopefully this is fixed soon with a software update. When we ordered the Ping I didn't even research as to whether this would be included.

This massive gaff in R&D judgement aside, I can't even begin to describe how much we love the new Ping. Proof in the pudding was at Cadence's Halloween party, her pump was buried under layers of princess costume and we never had to interrupt her play sessions other than for a quick blood test. The discretion that being "wireless" with the pump provides is just so valuable. Especially now as Cadence realizes that she's a bit different from everyone else. More proof of that was at each house she trick or treated at she followed the treat with "I don't wike candy..." and walked down the steps. It was hilarious to say the least. For her social circle though, for the other kids to not see a device connected with tubing to her body 24/7 is valuable enough for her self esteem to warrant the cost of the upgrade from the 2020.

Overall, this is a tremendously good product that is long overdue. The Ping pump carries the same great information and user friendliness found in the layout and function of the 2020 pump. The Ping blood checker works as well as any other OneTouch meter and the menus are easy to navigate and the setup between the pump and meter is very intuitive.

For those on the fence regarding an upgrade, in my opinion a worthwhile one indeed. For those contemplating a pump for yourself or your child, the Animas product is as good as they come!

B.

The gorilla in the room...

2009-09-29T15:16:00.002-06:00

The 2 most common questions:

1. How is Cadence, have you got the diabetes under control?
Answer: As of her last check an hour ago, she's under control.

2. Does Hailey have it yet?
Answer: No...I hope not.

Nic and I were hit from all sides on the debate about more children after Cadence was diagnosed with Type1 diabetes after just finishing a 6month bout of colic.

"You have enough on your plate"

"You guys really need to have a good baby next time"

"Why take the risk, what if the next on gets it?"

There's something about the constant puking, green poop, and long nights pacing the floor that the SMILE when I say "Hi Baby Hailey" doesn't completely erase. It's all worth it man to see her just so happy to be.

I find myself unconcerned for the most part about whether or not Hailey's islets cells are slowly shutting down. There's no way to know really, just wait until the Gorilla in the room (you see the analogy I hope) wakes up I suppose...if it does at all. The other day I went to check on her in the middle of the night and the diaper was absolutely full and she was very hungry/thirsty for milk. What was my first thought? Of course it was: I wonder what her blood sugar is....but i never checked. Change the diaper, give her some milk, and head back to sleep and hope that in the morning the diaper is bone-dry, which it was.

The truth of it is that for kids diagnosed under the age of 10, the risk of a sibling developing the disease is less than 1.5%. Is a 98.5% chance of a perfectly normal little baby/child worth the risk. That smile answers the question every time, you bet it is.

Finding comfort in the unfortunate.

2009-09-18T21:21:00.006-06:00

We had a wonderful night tonight.

Cadence had a tantrum, pee'd on the floor, splashed the pee-puddle onto me, pooped in her diaper, Hailey puked on my shoulders, arm, foot, shirt, shorts, and shoe, and we had a blast with "baby JJ" who only filled one diaper and his lap with food.

Two friends of ours became much, much closer friends. Two children that have only had one meeting now have a lifelong link. Diabetes is like any other disease in that it has no preference for who it affects, nor does it care how many it affects. It can't however choose who fights against and who they fight with.

Tonight was a rebuttal of sorts to the lurking "D" that we meet everyday and hate each time. Jeff and Karen remind us so much of us and JJ reminds me so much of Cadence a few short months ago. The link between Cadence and JJ was uncanny, at least from Cadence's perspective. Someone with diabetes......let's talk jibberish and figure it out is what they shared. Cadence knows she's different and knows JJ's different...that bond is forever.

It's amazing to watch a child have an injection of insulin. The ultimate of love-hate. You see the squint and tears but rejoice in the fact that the facial expression ensures another 4 hours of diabetes bliss...good sugar. Then the check, the discussion, the decision, the half hour in bed wondering if you made the right choice, only 90 minutes to sleep before the next decision.

It's unfortunate that our families are drawn closer as a result of our Children's misfortune but I can't imagine a better reason for families to come together than that of mutual support and dedication to our Children. We sadly welcome JJ to the D-family and wish he and his wonderful parents nothing but good sugars and a cure down the road and we couldn't be happier to have good friends to be good friends in the good bg's and bad. J-K-J had a hell of a week that we wish upon noone, but have handled it with incredible poise. We've done what we can tonight but hope they know that there are others out there and we are just a phone call away at any time of the day of any day. Diabetes never rests, nor will those that battle it. The bond that we share is a lifelong struggle for future generations and what more noble cause than that.

9.7 with 0.35 onboard....another 4 hours of peace.

Ping me.

2009-07-28T07:38:00.005-06:00

We quietly passed over Cadence's 2-year anniversary of diagnosis, July 19th. Funny how life-changing that day was. Now with a 2.5 year old and a 13 week old baby, we just let the day go by without any of us realizing it. A sign of moving on?

Speaking of moving on! We're pretty stoked at Casa de Kane. Cadence is going to be getting a new pump this year!

Cadence started pumping on March 31, 2008 and her life forever changed for the better. We, almost instantaneously gained better control, ensured a better life for her, and as a parent felt empowered to effect her diabetes in a meaningful way. I still can't emphasize the importance of this technology for a parent of a diabetic child.

We went through so much research when deciding what pump to get Cadence. Fortunately we chose Animas for Cadence and we still couldn't be happier with the decision. They have finally released a new product called the Animas Ping. What we now can do is deliver boluses of insulin, tweak basals, etc without having to fish her pump out of her clothing. As she runs around at a mile a minute, chasing her with the tubing hanging out just isn't working anymore. We're excited to have wireless control.

Had we gone the Medtronic route...we'd still be over-promised and under-delivered.

Cute diabetes moments...

2009-07-28T07:19:00.002-06:00

I woke Cadence up at 4am this morning with a 3.0 blood sugar. This was after a juice before bed that we only covered half of the carbs for. New infusion sites these past few months, one low day, one perfect day, one high day...rinse and repeat.

So, I took Cadence to the driving range for the first time yesterday, with her new set of US Kids golf clubs, including the BIG DOG. She probably bashed her way through a large bucket on her own before stating "time to go home dad." My Mom was with us and bought her a Big Dog headcover for her driver (Big Dog). So when she finished her juice at 4am, we had to make sure the "Big Dog" was under the covers with her.

Cute.

A new life of questions

2009-06-05T07:33:00.005-06:00

We had a new baby girl brighten our world on April 27th!! Hailey Grace is her name and she's a wonderful little girl. The nights are long but there's always coffee in the morning to make sure the day goes smoothly.

My conversations with people take a turn that I suppose I didn't foresee. The first question people ask me is: "is there any sign of diabetes?". It's a totally fair question I suppose. It highlights, at least partially, the misunderstanding out there about the disease. Many people, through no fault of their own, don't know that there is a difference between Type 1 (Juvenile) and Type 2 diabetes which is often a result of lifestyle issues. Many don't know that Type 1 diabetes a silent disease and there are no warning signs of any kind. Cadence is a perfect example of that in that she was healthy one day, within 24hours she was fighting for her life...both of her parents, who are physicians in their own right, had no idea what happened to her system in that time span until the ER doctor told us.

So, are we concerned about Hailey? No more than any other parent of a new born would be I suppose. Right now she's perfect and we have no reason to think that she'll ever be any different. There's no question diabetes will be at the back of our minds as she grows but we don't expect that she'll contract it. What's funny right now is that feeding is so easy with her in that we sort of feel like we're missing a step. So....no blood checks or pre-bolus...we don't have to weigh the breastmilk and count carbs?? Kind of seems all to easy!

Welcome to our family baby Hailey! :-)

Moral responsibility or occupational guidelines - the dilemma of action

2009-03-10T07:59:00.011-06:00

Who let it be March already? Woah.

Sorry to my readers for the lack of posting, I'd like to come up with a bunch of excuses but truly it's just out of sight - out of mind with a pinch of laziness that brings me to my first post in 60+ days. Nevertheless, off we go...

We took a trip to Phoenix in January to visit the grandparents. We ended up in the Emergency room the 2nd night we were there with Cadence vomiting profusely and her sugar plummeting despite our best efforts. Ambulances, Sheriffs, flying down the highway to the nearest hospital was not the way we intended to begin our vacation obviously. We were treated well and by the next morning, Cadence was doing much better with some IV fluid in her system. I had to use glucagon for the first time since her diagnosis as well. Glucagon is an emergency measure for diabetics. It's an injectable substance that will cause the patient's liver to dump emergency sugar storages into the blood stream. It's designed to be used in a non-responsive diabetic.

We got home at 7am, fell asleep, woke up about 9 am and we were all tired and hungry. Cadence had a normal breakfast for her, we bolused her the same as we would for any other day....food and carbs in a diabetic usually means they need insulin. As we were heading out to get some errands run, I looked over at Cadence and she didn't look right, checked her blood sugar and she was in the 2's. After a juice, fruit bar, banana, and 2 more glucagon shots she was still sitting at 3.2mmol/L and lethargic. We were scared and out of glucagon. We raced over to Wal-Mart to get some more of the glucagon.

Cadence was slumped over in Nic's arms, her sugar falling again. We ran into Wal-Mart right to the pharmacy. I announced to the pharmacist, "my 2 year old daughter is a type 1 diabetic and his having an insulin reaction, I need glucagon for her to bring her out of it." The pharmacist looked panicked and went over to her the manager of the pharmacy to find out where it was. He shook his head and walked away (no I'm not kidding) and the pharmacist came back to us and said, sorry we can't do that for you without a prescription. I showed her the diabetic letters that we travel with, the almost empty container of glucagon, and Cadence's pump. Meanwhile Cadence is slumped over in Nic's arms drooling on her shoulder, sugar sitting just below 4.

I said to her and loud enough that the manager would hear, "would you take a prescription over the phone from her endocrinologist, we need this for her!" He said yes, so I phoned the Children's hospital on my cell and got a hold of Cadence's endo. After a minute or two on the phone, he hands it back to me and says (no I'm not kidding) "I can't take this from a Canadian doctor, good luck." And walks away with my 2 year old slumped over on Nic's shoulder.

So...what would you do in his position? Would you leave a 2 year old little girl to the mercy of her disease in order to follow your protocols or do you make what seems an obvious choice to help her? What if you thought your job might be in jeopardy? Could you justify to an employer that the patient was in obvious distress, proven to have the condition stated, and needed help? Does a good samaritan action override a "policy" designed to cover your own ass? It's not an easy question. I told him what I thought of his decision, as did his staff but in retrospect...it had to be hard for him, at least I hope it was. If it were me, I'd break the rule to help a child in need but I come at that answer with a significant amount of bias. At very least I'd offer options "I can call you an ambulance" would have been a nice gesture vs. "good luck".

Now the question needs to be answered, why were we not on our way to the hospital in the first place? Ah, another ethical question that I have asked myself. The issue was that our travel insurance would not cover us for a second visit for the same diagnosis. Meaning that if we showed up at the Emergency room again for a diabetic insulin reaction, we would be uninsured. I don't have 10,000 or so to cover an ER visit in the US. So my judgement call was that if we can keep her sugar above 3.0 and she's not vomiting up the carbs we give her, she's would not be in immediate danger. What would you do? Did i make a decision that possibly put Cadence in jeapordy even though we were monitoring her extremely closely? Does our background as medical professionals help us in reaching this decison?

We went to the ER to get a prescription from the attending doctor for glucagon, while Cadence slept in her car seat in the parking lot, Nic checking her blood sugar every 20 minutes to make sure she stayed above 3.0mmol/L. If we bring her in to the ER, they admit her. I tore myself up deciding if I was making the responsible decision. I filled the glucagon prescription at the pharmacy and never had to use it. It still sits in the fridge or the diaper bag just in case. So, I was vindicated, I made the call that saved us money and didn't jeopardize Cadence...or did I?

These are examples of no-win situations, thankfully the decisions we made produced a favorable result. Fodder for discussion though and we chat about it often.

As a side note for parents of and diabetics travelling in the states. Make sure that you have a plan for an emergency. We have standing prescription for Cadence in Phoenix now for glucagon, so if we are ever down there and need a backup, we can get it. If you're in Mexico or something like that? Make sure you have enough emergency supplies to see you through it.

Happy - Merry - New

2008-12-31T08:14:00.008-07:00

Resolutions....definitely be more attentive to my blog!

2008 was an AWESOME year. We had many trials but more successes this year. Cadence turned 2 years old, started pump therapy, and our family began to enjoy things outside of the big D.

I spent some time and compiled a video of our year, I hope you enjoy.

b.

Pump Love

2008-12-11T07:06:00.002-07:00

Cadence calls it her "Pack-Pack", just like the one Dora wears at all times. She knows that she can't go anywhere without it, a permanent feature of her clothing is to have the lump on her back, dangling by her side, or wedged into one of those useless pockets they put on toddler's pants. "MINE!" she says whenever we go to change basals, deliver insulin, or just see what's going on. It's pretty funny how much she loves the thing, so do her parents but for much different reasons.

Here's a play-by-play of our decision making last night, we'll get back to the pump-love soon.

Last night was a "D-night", Nic was out for dinner with her sister and it was Daddy-Cadence time! We put in a new infusion site yesterday and it was working BEAUTIFULLY all through the day. Mid single digit blood sugars all morning. Around 3-4 pm though, just over 24 hours after the new site went in, Cadence started to run high. We changed out the insulin cartridge with some fresh stuff, just before. I corrected for a 16.4 and then we chased spokes around the kitchen to try and bring things back to Earth. To no avail, just before dinner, she was 21.4!! A relatively carb-free dinner in the belly and we were off chasing spokey up and down the stairs. At 8pm just after a bath I check again and she's still sitting at 19.4. Bummer.

So here's the variables you face. It's bedtime, she's through the roof on blood sugars. We changed the insulin, soon after she went high. The insulin isn't more than a week old and has been in the fridge. Her infusion site has been working awesome for 1.5 days, normally we change them out on the 3rd, maybe even early into the 4th day with no problems.

Scenario A: I change the insulin,? What if it does nothing to change it out again and she stays hight through the night, develops Ketones, gets sick, dehydrates, and pees through her diaper.

Scenario B: Do I change the infusion site and anticipate that she will invariably go low in the middle of the night? As a habit, we usually don't change a site at night because Cadence is very sensitive with a new infusion site and we have to watch closely for unexpected lows for the first 6-8 hours.

Scenario C: Correct again and see if she comes down through the night? If she doesn't, I'm faced with the scenario as I was with "A" and now it's the middle of the night and we will need to bring down her blood sugar before breakfast, where she invariably spikes.

Scenario D: Change the infusion site and the insulin, and eliminate all possible variables and deal with a night low, and frequent middle of the night blood checks.

What would you do?

I chose a hybrid of D so to speak. I made up new insulin, just in case, and changed the infusion site. That way if with a new site, she doesn't come down I can now suspect the insulin, change that out and we're okay. If the new site does bring her down, I've not wasted a whole bunch of insulin. Solves all issues other than Thursday morning sleep deprivation.

Well, the new site worked beautifully and when I got up to check her at 2 am, sure enough she was trending downward 6.8 with 6 hours of sleep to go. Now we talk about pump love. Without the pump, you have no control over how much work basal insulin is going to do for Cadence, at 6.8 at 2am without an insulin pump ie on insulin shots, I'm probably going to a wake her up and make her drink some juice. With the pump, I manually "temp" her basal, meaning I can control how much she gets over the next number of hours. I reduced her basal level by about 30% for an hour to see if that would bring her sugar up. It wasn't enough, at 4 am she was 4.8. On shots, this is a foresure wake up and juice scenario, but with the pump, we knocked her basal down by 50% for 90 minutes, 2 hours later, she's is back to 6.8. No major low, no toddler sleep interruption (which is the biggest win for everyone).

What the pump allows a diabetic or their parent to do is become a pancreas. We used the pump for Cadence last night in a way that allows her to have normal resting blood sugars and not have any interruption in her rest. It gives us variable control for a variable activity and eating level which is essential when working with a toddler. Now that I hear that British Columbia is directly funding insulin pumps for children....I'm wondering why Alberta is still behind the times. If the parents of a child are willing to learn, the insulin pump can offer a new level of normalcy to your family.

Thanks pack-pack!
b.

World Diabetes Day

2008-11-14T15:32:00.004-07:00

Today is an important day. Today is WORLD DIABETES DAY!! We hope you take time to consider what you can do to help.

I surveyed the diabetics in my practice this week to find out what they are planning on doing for the day and only one of two of them knew it was happening. That has to change.

We're heading out as a family tonight wearing the new and improved "One" t-shirts that I designed. We will ask for questions and provide the answers :)

Think it, celebrate it, find the cure.

Happy Halloween!

2008-10-28T09:12:00.006-06:00

Halloween is fast approaching and Cadence turns 2 years old on Thursday. Holy smokes, this has certainly been the longest - shortest 2 years we've ever had :)

I said to a patient the other day about parenthood, especially one with special needs, "it's amazing, there's never been a stretch in my life where i've been awake for more hours yet remembered little of what happened." Well...there was University....

I've had a bit of blogger-block of late, haven't had much to say in truth but as always, reading Sixuntilme always puts me in the frame of mind I need to be in, her energy is contagious.

Here's the current conundrum for this week. Cadence's birthday is October 30th...Halloween is the 31st. Obviously those two dates will be necessarily tied together for the foreseeable future. Sounds perfect, a great kids "holiday" to go along with a birthday, an instant themed birthday party. The only issue is that Halloween, for kids is predominantly based upon "loot", and that is Candy. Pure refined, tooth decaying, insulin sapping sugar. A diabetic's parent's worst nightmare in truth. So you take a child's birthday, necessarily tie it into Halloween and try to tell a 2 year old that you can have a birthday gift but not the candy. Oh the irony!

We're already planning how to bribe her with some broccoli :)

Tonight we plan the infusion site change, the new insulin, getting everything ready for Cadence's birthday/halloween party. We're finally going to get another Continuous Glucose Monitor into her again for this weekend, and that data I plan on posting here for reference. Hopefully everyone on the block is giving out diet candy on Friday......better have a backup plan.

Once again, as the old saying goes "exercise is the only Panacea we know", so as Cadence runs from door to door with the other kids, she'll be able to absorb the sugar in her system better. We'll probably let her have some candy, as every kid does, and just plan for a long night. Who knows, it's our first one and we'll be going at it with considerable creativity.

Happy Halloween!

Wow, it's been a while.

2008-09-10T12:04:00.003-06:00

Summer happened and I haven't written in over a month. Wow.

Lot's of things going on in our household for the last few months. Cadence continues to grow at a furious pace which of course brings mass sugar roller coaster sessions. We actually made a bunch of basal changes with her, mostly increases with timing tweaks, to accomodate her not breastfeeding any longer, and a ravenous appetite of a 22 month old. I would like to say that we carefully and deliberately made incremental basal changes armed with the knowledge of hour by hour basal testing...but that would be bullshit.

We guessed. Her sugars and basals were going along so great, so stable, then all of sudden it was like the pump turned off. She had massive ongoing highs, sometimes taking 2-3 corrections to restore and horrible night time lows to boot. All of this while Nic and Cadence were on the road in Windsor. What's been interesting in our experience with a baby, now toddler with Type 1 diabetes is that it's a road less travelled and one that's even less maintained. Almost no one, barring a few parents we've met online, have a clue how to manage a very young child with diabetes. We're essentially blazing new trail. So, after reading all the books, manuals, papers, guides, and websites we could about establishing insulin to carb ratios, Insulin sensitivity factors, correction factors, basal calculators....We took a W.A.G. , clinical lingo for a "Wild Ass Guess". We doubled her breakfast basal, 30% increase to her afternoon, 15% dinner, 10% lower nighttime. Guess what...it worked, she's doing way better now.

Now while I don't recommend anyone use this clinical approach for managing their diabetes, there's alot to be said about instinct. I've talked to many diabetics who can tell you to within a few points, what their blood sugar is. Certainly more accurate than the "acceptable 20% error" of traditional blood glucose meters. It once again highlights one of the famous acronyms used in diabetes, which is: "YDMV" - Your Diabetes May Vary.

The moral is that despite the rules and guidelines that are meant to help make decisions for people with or associated with this disease, asking questions and using your gut can be one of the finest tools of measurement at your disposal, certainly not one to be overlooked.

Here's an experiment for all you type 1's out there, if an endo asks you how you feel...don't tell them your blood sugar first, answer the question. It may change the approach to your care.

CGMing...revisted

2008-07-29T15:47:00.002-06:00

Well, after a long hiatus from the big needle of the continuous glucose monitor, we're back on as of last night. We've had a bit of a sugar battle with Cadence over the last couple weeks, she seems to be growing and eating quite a bit more, thus her sugars have been a bit more variable of late. She's funny though, certainly a product of her parents, go-go-go...EAT and so forth. So we popped the Dexcom into her yesterday, the insertion of that device is SOOOOO MUCH BETTER than the Minimed product, it was over in a matter of seconds and she was unbothered by it for the most part. The one thing about Dexcom is that the blood sugar values that it spits out seem to be a bit more accurate than the minimed. I just wish it had the proper units on there and some rate of change arrows, that would be awesome.

So, we're going to do some basal testing (as much as can be done with a ravenous toddler), and watch the sugars rise and fall over the week and make some changes. It's amazing though, prior to having the CGM in her, we just corrected or bolused, checked blood sugar every hour or so and just let the chips fall where they may (with great success I might add). Now that we have the CGM data in front of us it's addicting to see it change through the day. :)

Milestones.

2008-07-19T08:47:00.005-06:00

July 19th is Cadence's anniversary. It was one year ago today that my little girl came within seconds of losing her life, and started a brand new one at the same time.

I've been up since 4am just thinking about the day we had last year. Cadence had come down with a little flu the night before and was feeling off that morning and gradually seemed to

be getting a bit worse. I got home at about 10:30 as I was supposed to

go and play in a Cancer charity tournament that day and Cadence was getting a bit sicker. Nic and I are both doctors, we knew it was just the flu...and in an 8 month old it always seems to be worse than it probably is. We covered our bases, even called health link to make sure we weren't missing something.

A mother's intuition really is the sixth sense. Nicole just knew that something wasn't quite right with Cadence. Yeah it was the flu but there was something that she wasn't comfortable with. So, off to the Medical clinic we went to get her evaluated where we met the worst excuse for a physician (and perhaps the best testimonial of a broken health care model). He walked into the room, never looked at the chart, never said hello, never even asked us a question. He took one look at her and said "this child has pneumonia and needs an ambulance." To which I replied "do at least want to look at the chart and find her name first?" Nic was crushed and I was livid with this clown and unfortunately made sure he knew that I was unimpressed. I carried Cadence out of the clinic and put her into the car seat, the medical receptionist from teh clinic came out after us and yelled in the parking lot (and no I'm not kidding) "the doctor told me to tell you that you are risking this child's life by leaving!"

Off to the children's hospital we went from there, I was seething mad and Nicole was very distraught and while we zipped down Crowchild Trail, we didn't notice that Cadence was starting to go unconscious in the car seat. When I pulled her out of the car seat and hustled to the Emergency room entrance, we knew things were not going well, Cadence was immediately brought into the trauma room. 12 or so Doctors and Nurses worked feverishly to save her life. They tried to get an IV into her but Cadence was so dehydrated that they were unsuccessful in her arms, legs, groin, and armpits. Her veins had gone flat. They then shaved her head to try to get a vein on her skull, with no success. I was then asked to help hold her down as they took a drill and proceeded to drill a hole into her tibial bone marrow. She writhed in my hands as I tried to tell her it was okay. I'll never forget the sound. The pumped a number of syringes of saline into her shin/bone marrow to begin the rehydration process and Cadence slipped into a coma that would last 4 days. An 8 month old should not have to undergo something like this.

They wheeled her to CT scan to find out if there was any irreparable brain damage as the doctor talked to us in the hallway. "It's diabetes" he said. We were stunned, "in an 8 month old??" I replied, "it can't be, there must be something causing it." We walked to Cadence's next home for the weekend in the intensive care unit, spinning from the events of the last 2 hours, only then realizing that we had left the front and back door of the house wide open on our way out.

With diabetes, Cadence's own immune system killed the cells that provide her with insulin. Without insulin, the sugar that comes from the food (breast milk in her case) can't cross over from the blood stream to her muscles and organs. The blood becomes very concentrated and through the process of osmosis, pulls water out of the cells in the body to the blood stream to balance the mineral : fluid ratio. Cadence then pees out the excess fluid and the vicious cycle begins. Her body begins to shut down without sugar supply, the endless supply of which circlulates through the blood stream, leaching fluid from the very cells reaching for sugar. Without insuling, they are ignored.

The next 4 days were a whirlwind of emotional and physical drain as we watched around the clock for Cadence to show some signs of recovery. The nurses had never seen a worse case of diabetic ketoacidosis nor had they ever seen it in an 8 month old baby. Seeing my little girl hooked to tubes and IV's, unresponsive...essentially dead...scarred me forever.

Cadence came home with us on Tuesday, 6 days after our world just about crumbled. She was sent home early as she didn't respond well to blood checks, with lancets designed for 5 year olds, nor the veinous blood draws every 4 hours where I had to hold her down as she soiled herself in sheer panic. We feel blessed that she will never remember the experience, it's our burden to carry that for her. Now, with 15-20 blood checks every day and 6-8 injections, we resumed our new life at home, we fully comprehend how quickly life can change now.

In the last year we've gone from parents of a new baby girl, to nearly childless, to now the day to day life savers of a diabetic baby. We've gone from injection therapy, to insulin pump therapy, breaking new ground for the diabetes health care team at the children's hospital. I have become an insulin pump trainer and advocate for the therapy. We have taken her disease from being a sad story, to one of inspiration for many families. We have continued to make good on our pact to make Cadence's diabetes a positive in our life, not a negative.

We feel that the 2nd year of diabetes will be one of many challenges, but also one of self-discovery for Cadence. She will understand at some point this year that she is special....she is different. I am committed to helping her understand that the difference is a positive one. Diabetes is the one fatal, lifelong disease that the bearer has the opportunity to control. After a year, we look at the next years as an opportunity....not a curse.

D-Mergency (part 2)

2008-06-11T10:17:00.008-06:00

We almost made it a calendar year between hospitalizations.

It's been a very hard year for our family, yet a year with great successes. We went from a Coma, to an infant on 8 injections a day, to a pre-toddler on an insulin pump (shaking the diabetes establishment in this city) 6 months after diagnosis, and recently registered a lower, "absolutely amazing" 7.7 A1c for Cadence, only 3 months after her pump start. But you still can't predict the d-mergency. Nicole and Cadence went to Ontario to visit Gramma and Grampa, the first day they were there, Cadence had to be taken to the ER for an IV as vomiting and flu like symptoms threw her blood chemistry for a loop. I was in San Francisco, standing in the parking lot of the Olympic Club when I got the text message saying that Cadence was in the hospital. Everything that I felt last July came back to me as I read the words and I crumbled for a moment.

For diabetic children a trip to the ER for an IV is a part of life and it won't be the last one from what we're told. It turned out to be a positive as Cadence was feeling much better a day later. The fact remains that we strive to never have to be back to the hospital with Cadence and find it so ironic that our goal as parents, before diagnosis, was to never need emergency care for her. The irony now is that we depend upon it for something as simple as a stomach flu.

Our one year D-versary comes up next month on July 19th. We plan to make it a day of exceptional fun for Cadence and put last years experience far behind her. We work everyday to make diabetes a positive in our family's lives, not a negative, and encourage other families to ensure that diabetes is not their disease but their opportunity.

D-mergency

2008-05-20T07:58:00.005-06:00

Even when I tried to put in the title, the blogger program changed the first letter to E. Nobody understands :)

"Captain, we've got a D-mergency....Ketone field dead ahead, take evasive action"

The D-mergency is something that diabetics and their caregivers know all too well. It's sort of the secret handshake that you'd rather not know. The D-mergency is often associated with Murphy's Law as well. We were at a birthday part last night for one of Cadence's friends. First birthday party with kids, cake, pizza, and soda. We were so excited to let her experience these foods for the first time and to see the power of the insulin pump in terms of dealing with these carbs. We were all set, pump was going, infusion site did fine all day, as soon as we hit the front door apparently the infusion site decided it was finished...or Cadence's body felt that she was finished with it and it scarred over. 1 hour into the party before any food was put out she hit 20.3 on her meter, 4 times the normal range. She felt like (or so I perceive) she just downed 5 big gulps. She played quietly and jumped anxiously everytime anything around her made a sound, cried uncontrollably at the site of a party hat, weird stuff. Back to Murphy's law...the one time we leave the house without a backup syringe/insulin/infusion set...is when we need to use it.

So, as the pizza was unboxed and after 2 corrections Cadence's sugar only climbed, we had to make our exit, take her away from the party to go and try to bring her sugar down. We were all bummed out, it was a quiet ride home. After we put in the new site, gave her a big bolus of insulin, her sugar started dropping and we had a little party at home. Cadence had a taste of some frozen yogurt, danced to some music, and hit the sack a little later than normal. Nic and I got ready for a long night of fighting the lows often associated with a high correction and a new infusion site.

We know the secret "D" handshake and every day wish that we didn't. The trick is to make every attempt to use it as little as possible and make day to day life and normal and vibrant as possible. Diabetes is a life ending disease without an obvious disability or a cure. A great quote I read yesterday rings so true "you don't get time off for good behavior", you just have to try to keep the ship headed in the right direction.

For an awesome perspective on diabetes read this article on Jake Cutler, quarterback for the Denver Broncos. We are officially Bronco fans now.

The comfort of a needle...

2008-04-28T21:26:00.005-06:00

An interesting revelation was had earlier this week. Cadence has had a cold/ear infection/ eye teeth coming in...you name it, this week has been one for the books. Lying in the weeds, there is always the "D" and the sugar irregularity that comes with illness and irritability in a toddler. Is she high, super high, or low? Those are the questions we ask.

It brings me back to my original point about revelations. Parents of diabetics...scratch that...diabetics in general should not be too quick to switch to pump therapy, meaning that spending the first few months, let's say 3-4 months if we need to pick a number, is very important. An about face? No, just a realization that the time that we spent jabbing our baby with 6-8 needles per day, soothing the crying afterward taught us how to be strong, resiliant, and competent diabetic caregivers. We have a keen understanding of how insulin works on our daughter, we are not afraid to stick her with a needle if needed, no matter how hard she fights. That's a unique skill and not one to be underestimated. Not convinced? Ask someone on the street if they would be willing to give you an injection, would you trust them to do it for one? Number two, would they be willing to give you a lifesaving injection? Social experiment time.

I know from our situation, the answer to the latter is probably not. We have people close to us that refuse to learn how to save my daughter's life. It makes you scratch your head asking why, but then again perhaps it is just how anyone else would behave. Who wants to give a needle to someone? Is it unreasonable then for us as parents to ask for help? Is our wish for a couple hours off of diabetes forcing someone else to enter into an extremely uncomfortable situation? Are we being unfair?

So, the pump is absolutely awesome in the sense that it takes away the injection side of diabetes, which solves the social experiment. It can provide very finite control, and offers immense lifestyle flexibility. We celebrate those parts of it every day. I hope that most Type one diabetics, when they are ready take this step toward normalizing and enhancing your life. What the pump adds however is the uncertainty of the equipment, did the infusion site work, is the pump working properly, is there air in the line (we had to prime out bubbles twice today)? Combine the unpredictability of diabetes and you can quickly begin chasing your tail if you don't remain centered. With a needle, you always know the insulin went in.

That is the comfort of the needle.

Pumping - a 2 week check in

2008-04-17T11:54:00.003-06:00

What a whirlwind that last 2 weeks has been for our family!

Cadence began pumping on her Animas 2020 on March 31. We started on one basal pattern and then went from there. There's been alot of tweaking with her Insulin to Carb ratio (how many carbs 1 unit of insulin will cover), her Insulin Sensitivity Factor (of which I have no idea how they calculate), and of course the basal rates (how much background insulin she gets during periods of the day).

Four days into the pump start we started getting some highs, it turns out that Cadence picked that week to get a cold and pinkeye. Fun...not. So we rode the high sugar express for the next 5 days, threw out any hope of dialing in our pump settings for that period in time and just wiped the nose and soothed the cries. It was like real parenting!

After the illness was over we are back to the adjustment of no needles. That being said we still have to put in Cadence's infusion sets every three days. An infusion set (in our case) is a spring loaded needle device that puts a flexible plastic tube under cadence's skin with a port/interface above the skin which we attach her pump tubing. It's pretty slick and easy but there is more involved with it than a regular injection. Numbing the site, priming the pump, mixing new insulin, etc. etc.

We've worked out a few kinks in the system as well. We had an infusion set go bad on us one night and Cadence's blood sugar shot up into the 20's (VERY high), so I had to give her a needle at 3am one night to bring her sugar down. So, the no-needle streak lasted 6 days, but was also the last one I've given since.

One of the hardest adjustments to the pump thing is where we put it. We bought a bunch of tank tops from Pumpwear, which are simply a little pocket on the shirt to hold the pump. That covers the daytime hours, the night time is the weird one. We can't figure out exactly how we want to have the pump on Cadence at night, leave it loose? Drop it down one of the legs of her pajamas? Pump pack? We're trying everything out, One night Nic went to pick her up out of her crib and the pump was wrapped around one of the bars and "rip", out came the infusion site (ouch). Cadence was unimpressed and irritated by that. Luckily, on a tip from another diabetic, we left the old site in for a few hours "just in case", no we reconnected and changed the site again in the morning. GREAT tip there.

Overall we are loving the pump and Cadence's control seems to be better. Lots of tweaking to be done still but as I've said before, I can't believe we waited this long to go this way.

The Last Shot.

2008-03-30T15:22:00.007-06:00

I can't believe we're here already. March 30th, the eve of a very fresh start for Cadence. We start insulin pump therapy with Cadence as of tomorrow morning. From here till....well....who knows, Cadence will have the pink Animas 2020 saving her life everyday. The pump will be attached to her 24/7 delivery micro amounts of insulin. We can push buttons to deliver higher amounts for food or highs, suspend delivery if she's low or sick. It's very exciting to have the potential for incredible control of her diabetes. For the last 7 months, we give her a bunch of insulin and hope that she takes in enough carbs to cover the insulin and also that we've given her enough insulin to cover the breast feeds...let alone trying to figure out how many carbs are in the milk and how much she takes in. Our A1C is really just an average of the highs and lows.

I have 3 syringes left to give her, and then there's no more needles. That point is just so valuable to me, I can't even describe it. I came home the other night from work and she was happy to see me but ran away because she knew it was time for a needle. I can't even tell you how hard that is for me as a dad. Nic and I are so happy to be free of having to stick Cadence with 8 needles a day...for now. I remember the first one I gave her last year and I almost broke down doing it, it's easier to do now, I'm better at it. The hardest part is that she cries a bit, holds the injection site, and gives me the ultimate hairy eyeball. So I say (to a baby) "sorry Buttons." I'm sure she's saying "whatever dad, I'll get you when I'm 14."

The stomach bruises suck.

A quick calculation will show that Cadence has had diabetes for just over half of her life, she is now 17 months old. She has endured approximately 1856 needles and nearly 4000 blood checks. The little girl is tough as nails and she amazes me.

So, today is kind of like Christmas eve the anticipation is palpable but everyone in our house has a sense of confidence and anticipation for this next chapter in her life.

Until tomorrow,

Brad.

Random question...

2008-03-15T17:27:00.004-06:00

Why the heck is Diabetes plural? I understand there are two types but couldn't me more opposite of each other.

Perhaps Diabetes is plural because it is not only the patient that has to deal with it...it's everyone around them. Parents of a diabetic become diabetic by association.

In other news, we have received the Pink Animas 2020 pump and the Guardian CGMS system is on order and we should have it early next week. We're super excited to get started on things.

Also, all three of us are racing in the St. Paddy's Day 10km race tomorrow in support of the Canadian Diabetes Association. I made some race shirts for Nic and I and designed a family team logo.

Team Cadence is born:

Sales

2008-03-14T12:03:00.012-06:00

What a decision Cadence's insulin pump was. It would seem to be a simple choice when it comes down to 2 products:

1. Minimed 522 with CGMS

2. Animas 2020 with a standalone CGMS

Minimed was 1 unit for Cadence to carry, Animas would require 2. Seems like an easy choice until you factor in who is involved with providing and servicing the device that will be attached to my daughter for the next 4 years 24/7 saving her life every moment she wears it. It's a hard decision and I agonized over it.

In speaking with the different representatives of the pump companies it became abundantly clear that there are those who look at their job with passion and those that may not. A BIG

for instance: I made a deal with the minimed rep, confirmed it with a handshake, that this company would provide Cadence with free CGMS sensors for a year if I was willing to become an educator/advocate for their products. I let the rep know that we may not choose their pump, which is obviously the product they wish to sell (7000 dollars worth of reasons), but would most likely go with their CGMS product, if we decided against their pump (2000 dollars). The rep said that she that was no problem and just wanted what was best for Cadence, "the deal was still on".

So, we ended up choosing the Animas pump for many, reasons, and more which were revealed this morning. Unfortunately, Minimed's rep has pulled our "agreement" citing having to talk to the manager. I said "so am I to assume the deal that you made with me on Cadence's sensors is dead now and I am to proceed on my own?" which was replied "I'm going to have to take a step back".

Good deals sometimes have hidden conditions.

We love our Animas pump and the people behind it. Minimed in our experience is a big company with numbers of clients. After my conversation today we are more than pleased with our decision. That said, they have my money as I still bought Cadence the Guardian CGMS unit and sensors but it was based on the technology and its ability to help Cadence, not the pitch. A word of advice to the Minimed rep don't use someone's health the most valuable commodity we have, as leverage to make a sale. It's bad practice, it's bad business, it's bad ethics, you should know better.

Minimed Guardian

2008-02-26T07:44:00.005-07:00

The Dexcom 7 trial was awesome.

Despite some of its shortcomings, the accuracy of information gleaned from the Dexcom 7 was invaluable. Within 2 days we were able to set a much lower target BG for Cadence's bedtime as we noticed that she doesn't drop significantly in the middle of the night. This does usually require a small breastfeed at about 3 am and a correction dose (.5U) of humalog for those carbs but she is sleeping from 9pm to anywhere between 6:30 and 8:30 in the morning. I'm up and gone for work before 6am so I miss the sleep-in (bummer!). This tweak alone takes out Cadence's high nighttime BG's. Last night, she slept soundly and hovered at 5.6-8.0 mmol/L for the whole night. This has been so nice to see.

Some huge pluses for the Dexcom:

- small insertion needle

- no dangley bits on the sensor, everything is affixed securely.

- seven days of wear (sooo nice)

- good software program

- menu's are simple

Some downsides:

- It's been said before, that damn sync cable and choice of only the Onetouch Ultra.

- awkward receiver size

- not able to scroll backward on the receiver to see past data (love this about the minimed)

- no 24 hour trend screen

There are some other hassles but those are the majority. Overall we were extremely satisfied with the Dexcom 7 system.

When we tried the minimed paradigm 522 pump/CGM earlier this month I always felt like we didn't give it a fair opportunity to show us what it could do. Admittedly the sensor wasn't secured as well as it could be with the tegaderm. The clamshell/sensor interface was right at the top of the diaper, we calibrated during times of not so stable sugars, etc. We are now testing the Minimed Guardian system, which is the stand alone CGMS for minimed. It's essentially a 522 without the pump in it. The CGMS has quite a few more features than the 522 does.

The sensor insertion went MUCH better this time than our last go-round. Using some of the mistakes that we made last time, Cadence did fine with it. The sensor went in easy, we covered everything securely with tegaderm, and she was playing happily within minutes of the event. The startup and calibration went off without a hitch and the data through the day yesterday was very accurate. A nice change from our experience with the 522.

The Guardian has "predictive alarm" capability which already has come in handy. Cadence and I were out with Spokes, the family airedale terrier for a walk yesterday. About 3/4 through the walk I heard an alarm from the Guardian, checked it and it said "predicted low alert", so i did a blood sugar check and sure enough she was dropping quickly but still in an ok range. So, I gave her some fruit bar to chew on and we marched back to the house. As we approached the house I heard another alarm and the Guardian said LOW. I got everyone into the house and checked Cadence's blood sugar, it read 3.4. That's getting a bit dangerous so I quickly grabbed some banana and soy milk and we had some snacks. In checking the "Real-Time" BG reading, the Guardian showed her as 4.5 with 2 arrows dropping (very quick). So, that's the 15-20 minute delay that exists. The BG reading is not accurate but the trend is, we knew it was going to be lower.

So, this predictive alarm is fantastic...except at night. We were up a bunch last night to turn off the predicted low alarm as Cadence was 0.1 mmol/L under our threshold but holding steady. This isn't a knock against the feature, it's doing exactly what it's supposed to do, but we will now turn it off at bedtime and set her low threshold a tad higher. After I turned that off, the night went perfectly.

So, we'll spend the next 6 days or so testing the Guardian before we make our final decision on which device we will use and will keep things updated here.

On a side note, we had a meeting at the Diabetes Clinic yesterday and our nurse asked me "how are you doing?" It wasn't a casual, looking for a canned answer, kind of question. She was referring to how I was dealing with the experience of my role with Cadence in the hospital. I was the one who held her down while the ER docs drilled into her shin to get fluid into her, looked in her eyes and saw the fleeting life, fear, pain, and panic. I held her down when the phlebotomist came into draw venous blood as she would soil herself in panic. It haunted me for months, and still does I now realize. I guess I sort of repressed it a bit through alcohol and focusing on other things. I feel like I'm on the other side of those habits though. Her question really brought back some difficult feelings and flashbacks, but also a significant question:

Would I trade the experience of being there for her through those moments vs. not knowing the panic that she went through? Would it be better if I didn't see it?

It didn't take me more than a millisecond to decide: Not a chance...I feel lucky that I was the one to be there to try and comfort her, I hope she in some way remembers that I was there. So, yes I struggle but I wouldn't trade it either.

Dexcom - day 5

2008-02-20T07:02:00.011-07:00

We are dexcom day 5 with Cadence. What a great little device, which has already paid for itself in spades after a scary low on the weekend.

We were cruising through a showhome in our 'hood looking to

steal some decorating ideas for our little hacienda. Cadence was ripping around the house, up and down stairs, jabbering at all the other people milling about in there on Sunday afternoon. We heard the chirp from her Dexcom CGMS and the warning that she was dropping low. We sort of expected her to go down a bit as a result of her activity, so we casually picked her up, went over to the kitchen table in the showhome and did a quiet fingerpoke. The number on the blood glucose meter said 2.2 mmol/L (35 md/dL). That is a severe low and a very dangerous one for a 15 month old. The worst part is that she had no idea... confirming our suspicion of "hypoglycemic unawareness". Cadence doesn't feel her lows, where as most diabetics feel horrible during a low, it's their safety net.

So, I sprinted out of the showhome to grab whatever carbs we had from the car, while Nic put Cadence on the boob. I grabbed fruit bars, soy milk, anything really, and ran back into the showhome to the surprise of the salespeople there. So with about 25-30 people moving in and about the showhome we treated Cadence's second lowest glucose reading since her diagnosis. We had carbs, a sock, and bloody test strips layed out over the kitchen table...in the middle of the showhome. Sometimes you just have to make due LOL. Once recovered, we continued the tour through and upon exiting she showhome manager says "that must have been some diaper change! By the way, is that a GPS on your daughter?" :)

Now, onto the Dexcom. What a great little device, and proven so in the above story. We are on day 5 and the finger stick readings comparative to the dexcom trends are very close if not bang on. If there is a difference, it's usually as a result of taking a reading at the peak or valley of of change in glucose levels. Otherwise, the dexcom is usually well within 10 points (mg/dL) of the meter reading, a huge plus. With the minimed system we had values that were absolutely nowhere near what her blood glucose reading was, even at times of stable sugars. So the question begs: What's the point on putting a "real-time" blood glucose reading on your display if the user is amazed if and when it's accurate? The trending bars are invaluable though.

We are still undecided as to which technology we are going to invest in but the Dexcom appears to be a better product. If only they could pay one computer programmer for 3 hours work and make some rate of change arrows (like minimed's) and have an option to use mmol/L or mg/dL, it would be the giant killer of Minimed product. For the price of these "next generation" units it's amazing that a handheld poker game from the airport has more display and computing capability than these devices. We're going to give the minimed another shot next week though and see if it can stand the test.

With Cadence's hypoglycemic unawareness, it appears that we don't have much of a choice of not going with a CGMS.

The Dexcom experiment has begun

2008-02-16T18:56:00.007-07:00

I was able to secure a Dexcom 7 unit during my last trip south. We have engineered the rare opportunity to test both the Minimed CGMS system and it's competitor Dexcom. Dexcom is not available in Canada unfortunately. Through several conversations with many people in the US I was able to get one for her.

A couple problems with this system already is that it still is only capable of communicating with the OneTouch Ultra meter which IMHO is a POS. Further it needs to communica

te through a cable. Why this was deemed to be a good idea vs. manual calibration with whatever meter you like to use is beyond good reason and stinks of corporate collusion between Onetouch and Dexcom.

Dexcom has plans to change this but it hasn't happened as yet. Also, the Dexcom CGMS system was designed only to use the US mg/dl scale and cannot be programmed for

mmol/L, again the rep has said this is to be updated soon.

I greatly appreciate the 7 day wear and smaller needle insertion size (26 gauge Dexcom vs. 23 gauge Minimed) and the insertion of the Dexcom was definitely easier with Cadence. When we did the Minilink sensor Cadence cried hard and grabbed at the area for a few hours afterward, anytime we tried to inspect the area she was quite upset by our efforts. The Dexcom in

sertion however was absolutely easy, no tears, completely unbothered by it, and in fact immediately after sat in her highchair and had dinner, sitting on the sensor. Pretty amazing difference and definitely a +1 for Dexcom.

The insertion device is good, I would say a bit better than the Senserter (Minimed's) but the sensor latch/tab...the little doo-hickey to snap the transmitter in place is goofy in the way it must be broken off. Cadence, didn't like that part to be sure. Both units, Minimed and Dexcom, could be greatly improved...easily.

We are in the middle of the 2 hour calibration period and will report more tomorrow once we see readings.

so far so good!

brad.

P.S. - I find the google ad beside this post about how to reverse your diabetes oh so comical...if only :)

Gadgets rule - The Continuous Glucose Monitor

2008-02-12T07:23:00.000-07:00

Really interesting last few days. We finally generated enough courage to put Cadence on the Medtronic Minimed Continuous Glucose Monitor.

The CGMS system is designed to give "real-time" reading of Cadence's blood glucose readings. The problem is that it reads the glucose content of the interstitial fluid, the glucose meter that is used for finger poking measures actual blood glucose. The interstitial fluid is about 15-20 minutes behind. This may not seem like a bunch of time, but it does make a difference.

This little do-dad has a huge scary needle for insertion. In fact it took us 4 days to gather enough courage to do it. We finally decided that yesterday was the day. We numbed the insertion site with Emla cream, bent her over and using the "senserter" I jabbed the 23guage needle into her butt cheek....and it didn't go in...crap. Blood came out though and the crying ensued. A little panic by the parents and we decided to tray again. So, we grabbed the senserter again, reloaded and into the flesh we went again this time with success and actually no bleeding.

The readings yesterday were all over the map, we had a significant low yesterday afternoon that the CGMS completely missed. It did show a large trend downward though, so we had an idea that it was happening and that seems to be the value in this device. You can't trust the number and you're happy if it's close but you can watch to see if a trend is developing instead of finding out what's happening late.

We've only been hooked up to this thing for 24 hours now but I can already say that it's really a valuable tool in terms of seeing trends. The problem with point in time blood glucose monitoring (finger-pokes) is that you have an absolute value but no idea in which direction and how fast that value is changing. We did a poke with Cadence yesterday and she was 11.8, relatively high but the CGMS monitor showed a significant downward trend. Why is this important? Well, she was heading for a nap, if we had given a dose of insulin prior to that...the low would have been severe. Without a correction, she went down to 2.9. Now mind you, the CGMS missed the low but showed us it might be happening. We did a fingerpoke and caught it before it was too severe.

The big question is: Is it "WORTH" 6000 dollars a year....that's one that's hard to wrestle down.

I ordered the Dexcom 7 competitor unit last night as well to try it out. Many of the CGMS debates out there minimed vs. dexcom are based on an insurance coverage mindset of which we don't have. That puts us in a situation of being able to decide between the two based upon their merits.

Overall, very interesting experiment thus far.

teaching the teacher

2008-01-11T06:50:00.000-07:00

Cadence had her first flu since she was diagnosed this week. Vomiting, diarrhea, the whole nine yards. Our laundry machine need a vacation.

We had been prepped and educated about how different illness management is with a diabetic child. I didn't realize how difficult it actually is. With insulin working in her system and her being unable to take in any foods or fluids, we battle low blood sugars, dangerous lows at that. Oh what fun it was holding a sick baby down, forcing her mouth open and pouring maple syrup down her throat was on Thursday...otherwise it was hospital time.

It was during these moments (there were 3 this week) that we realized as well controlled as we keep Cadence's diabetes and how 'impressed' the diabetes nurses are with our management of her, how far from controlled she is. We react as there's almost no way to predict what her next sugar will be. Exhausting google about insulin management it seems as though continuous glucose monitoring (CGM) and insulin pump therapies are increasingly becoming the best predictive management tool for a type 1 diabetic. The problem is that these devices are priced for insurance coverage, of which we don't have.

Insulin Pump - 6000.00 (lasts 5 years)
Supplies - approximately 500 per month.

CGM - 800
Supplies - 250/month

So, another question comes up about our great socialist health care system in Alberta. Which is one of the provinces in Canada that does not fund a single thing for diabetes. Our health care policy rings with words of prevention, maintaining good health, etc....while fully aware that diabetes (predominantly Type 2) is reaching epidemic proportions worldwide and could soon be the single largest drain on the health care system due to long term complications. 1 in 10 hospitalizations are from diabetes related illnesses that stem from poor sugar control. Wouldn't it make sense for our government to make things like pump therapy and CGM available to diabetics so that they are less straining on the system?

The question of proactive health care funding for Albertans, and Canadians for that matter is one that is historically been rhetorical. Someone mentions it, governments adopt the terminology, and nothing really changes. More money is put into emergency care.

I've started to do some leg-work to lobby our government, which right now is swimming in money, to look at funding pump therapy for diabetics. I like to say I have completely altruistic intentions with this and it's for the good of the people...truthfully, it's so that we can avoid another week like this one. If the rest of the type 1's in Alberta can benefit from it though, that would be an enormous value added.

b.

Topic Change

2007-09-11T22:06:00.000-06:00

Diabetic by association.

I my 8 month old daughter almost died 6 weeks ago She was in a coma for 3 days after succumbing to acute diabetic ketoacidosis.

I am so disheartened by the drivel of negativity around bloggers with diabetes, perhaps moreso than my daughter's diabetes.

GET OVER IT, it's your life and life, in general, far too short to dwell in the negative.

Like I do for all my patients....I will try to bring honest positivity to this disease and what it's like to manage as a parent.

b.

Video analysis update!

2007-06-12T16:36:00.000-06:00

Throught the past number of years in practice I've had the opportunity to do form analysis on a wide variety of athletes: runners, golfers, cyclists, etc.

I am very close to being able to offer video analysis of these activities. I'm working a few bugs out of the process as we speak but should be up and running soon.

I'll post examples of this analysis here once we're ready to go.

b.

Seeing the want in need...

2007-06-08T20:34:00.001-06:00

Last year at ironman, my finish although one of the most unforgettably important moments of self discovery was also tagged by feelings of regret that I bonked in the marathon, spent 18 miles in nauseated delerium...only to recover and negative split the last 4 miles.

Truth: I am extremely proud and different as a person for having pushed myself through not only the distance involved, but more importantly, the pain of my body shutting down 4 miles into the marathon.

Truth: I signed on this year to redeem myself and crack 11 hours.

It's funny, in January of '06, I could barely swim. In August of '06, had never ridden more than 110kms, had never run more than 24kms. Fast forward 8 months and there I was....racing "debatebly" the single toughest one day event in the world.

Now this year, with my daughter Cadence being born...I look at my reasons for sigining on for another kick at the cat with clouded vision. It's hard to find and even harder to justify the time involved in training, balancing a career, a family.

Do I go to the start line with what I have in my heart and try to finish with respect "have 3 good events", but potentially disappointed again with what could have been??? Or do I pull the plug and spend the year enjoying the new addition to the family...and possibly be disappointed I didn't try....

confused,
b.

Newton Running Shoes

2007-05-25T09:35:00.000-06:00

"in the name of science" and my aching metatarsals, I ponied up and bought the latest of the greatest running revolutions aka fad. The Newton Running shoe.

Promoted by all the big names in running, it aims to create a forefoot/midfoot runner out of the average age-grouper and eliminate injuries. With a world champion price tag (although less expensive than the Asics Kinsei I have been running in), I'm going to try these shoes out and do a full review on their benefits. I'm really excited about these shoes, the research, science, and design seem to be right on track.

The package came from Colorado via the brown santa aka UPS. Now I have a particular loath for UPS because of the absurd "brokerage" fees they charge for US to Canada shipments. They appear to be the only shipping company who is still ripping off their international customers with blatantly unnecessary charges.

Newtons: 186.00
Shipping: 11.23
Brokerage: 44.21

55 bucks in shipping....Assholes. "What can Brown do for me?" - kick me square in the groin.

Too bad Newton is too inflexible to offer alternative shipping methods when I called them.

Anyway back to the shoes. The site describes your calfs will be tight after the first useage and they were right. My metatarsal were very comfy in these shoes though. I only ran for 40minutes and it was a fast one.

Some more wear and testing to come this weekend and a full report to come soon.

In the mean time support this.

b.

Blatantly Albertan

2007-05-02T20:50:00.000-06:00

The one thing I don't want my blog to be is another page of negative rants. I believe in being positive, every situation can be a win if you look for it.

However...the Federal government should be absolutely ashamed of themselves to call into question the ethics and motivations of the captain of our national team, Shayne Doan. He was accused in 2005 of derogatory comments toward a french official. The NHL aquitted him of any wrongdoing, case closed.

With all the crap that is ongoing in the world, the world hockey championships is just one small way to find a positive way to exist in the international community. For our government to bring one of our own into question about something he didn't say in 2005 while he is working his ass off in Moscow right now FOR OUR COUNTRY...

Layton, Harper, Dion, Duceppe, and all the rest of you clowns in O-Town...get a beer, have a glass, pop some bubble wrap, get laid, or do whatever you need to do and get serious about leading our country. Stop wasting my time and taxpayer money on yet another "we're so hard done by" drivel by the French separatists.

I would love to hear of one person in Montreal that is still offended by what Shayne Doan didn't say in 2005.

Give me a break.

We would have better direction under monkeys.

Ok...I feel better now.
b.

Ramblings on accountable business practices...

2007-05-01T08:00:00.000-06:00

My practice is based on a number of simple principles including:
- Accountability
- Win-Win solutions
- Ethical transparency

We make sure that the people that come through our door are met with sincere kindness and depart with sincere appreciation. People enjoy coming in, hearing their name and being thanked for their valuable business. They feel valued.

It's hard to not be frustrated at times with other businesses in the city. I purchased a new TV on the weekend at Best Buy, a floor model (that had been out for a day). The TV was missing some hardware to hold the base in place. The sales guy said he fixed it with hardware from another TV. When I got home with it, I found that he used one oversized metal screw in one of the holes, no hardware in the other three holes. The metal screw stripped the threads in the TV and now the screen wobbles back and forth.

I went back in on Monday to chat with the Manager, who was accomodating in person, (as opposed to when we were on the phone) and wanted to find a solution. The salesperson tried to tell a "we sold it As-Is" tale, even though the stand problem was not disclosed. I was able to poke significant holes in that story with the manager.

The other crux of the issue is that they told me that I would have to pre-pay for a replacement TV or I could wait for them to get the proper screws and just use 3 of them.

Now, let's put this in context. If your mechanic breaks something in your car, doesn't tell you about it, jerry-rigs a solution which you find out doesn't work after the fact. You go back to the shop to find a solution and the store makes you pre-pay for the replacement part that they broke or you're out of luck.

Exactly what happened at this store. This is not a rant against how the store "screwed me", it's more of a commentary of where business practices are centered. Are they customer centered or are they self-centered?

Thankfully, the manager understood my hesitancy toward putting another huge pile of money down on my credit card to fix their error and found a work around. My question is: If your business is about customer service, the "buying experience", etc... how can you violate these three principles:

Accountability - as company policy, the customer takes accountability for the error and the replacement?
Win-Win solution - obviously not.
Ethical Transparency - the sales person tries to cover his mistake and insults the customer's ethics by fabricating a story.

So, in the end I get a replacement and everyone is happy. The problem for Best Buy is that it took a few hours and no less than 5 different employees and managers to remedy their own error. If you look at profit margin compared to lost productivity in simple problem solving...the business model needs a tune up.

b.

sometimes you're the Louisville Slugger, sometimes you're the ball.

2007-04-15T20:14:00.000-06:00

Having completed my first Ironman last summer, I have a new way of looking at events. I have been out there, seen the suffering, felt the pain, and understand the enormity of the undertaking. All of the preparation, training, time, sweat, blood, effort, and pain...all for one single day of self discovery. And that is what racing is about for me, self discovery.

You can have the perfect plan, coach, program...but if one thing goes wrong, you're fighting for survival and victory then is found in finishing. I have never DNF'd a race...I don't think I have it in me to do so.

I took on the task of an Ironman last year with much doubt about whether or not I was capable physically and mentally of doing it. I could not swim 50 meters, I had never run farther than 20 kms at one time, never ridden farther than 110kms. How could I possibly complete a 4km swim, 180km bike, and a 42.2km run in the same day?? How could I assume I would be able to stand along a very select group of athletes who have conquered the beast? I discovered the core of how strong If I set my mind to it. When I ran into problems during the marathon and got very sick...I should have quit. But I decided that I would kill myself to finish this race, gain the accomplishment. Standing on the other side, how would anyone understand wanting to push yourself to the brink, just to finish a race. It's not something you can teach.

So, this morning while out for a longer run...I started to hurt pretty badly. My former self would have backed off and walked, bummed about my state and do something shorter the following week "for recovery". This morning, I lengthened my stride, gritted my teeth, and thought of myself crossing the finish line and the pain seemed to dissipate and the pain became my badge of honor.

What can you challenge yourself to discover?

brad.

I love toys

2007-03-21T12:51:00.000-06:00

I field about 3-4 questions per week about the current fitness electronics trend of workout data measurement rot runners.

Currently there are two standards that exist in the marketplace that will provide the recreational to professional athlete, feedback on their speed, distance, pace, and heartrate. These standards are:
Polar Foot Pod
Garmin GPS

Now, the disclaimer. I sell Polar products through my office and I like them alot. That said, I also own a Garmin. As I say, I'm a slave for gadgets.

The third device that has hit the market with considerable steam, due to the price, convenience, and capitalization on the Ipod nation, is the Nike Plus system. Basically, this is a similar technology to the Polar system but plugs directly into the Ipod Nano. It requires a small chip that fits inside special Nike shoes, or you can buy a shoelace holder (some claims of inaccuracy have been reported).

I had to have this too.

Now for the nerdy part. I decided to test the technologies side by side by side to see how accurate they are as compared to themselves. Meaning, I don't have an absolute perfect, objective, distance measurement standard to use, I just want to see how they all read a common distance.

I took all three devices for a variable elevation suffer-fest (hills), in my neighborhood. Out the door wearing all three devices and feeling like I was wearing taped glasses and a pocket protector too, I broke into stride.

Garmin 305 - the Garmin takes a minute to link up to the satellites but once it does, it gives outstanding information about the run. My knock on it is though, the pace is quite variable in that it eems to wobble up and down a bit. A bit frustrating while trying to keep a consistent pace. One feature that I love about this device is the auto-pause. It automatically stops the timer and recording when you stop moving. This is an awesome feature for those of us who live in suburbia with lights and crosswalks.
The on-screen info is great and everything is right there for you. The fact that you can customize which screen shows which information is pure brilliance. The knock on this device is the heart rate strap which is quite uncomfortable comparative to the Polar wearlink strap. Of course the knock on the Garmin is the dependence on satellite position and blockages to that signal thus the pacing information changed alot during the run even though I hadn't. The overall average on the pace was accurate, but instantaneous information is extremely variable.

The upload is the true gem of the Garmin system with the motionbased software/web client. It takes your gps data and overlays it onto a google map and shows the elevation, speed, distance, etc. Best of all, if I want to do a 10km run while travelling somewhere...other users will have a 10km run in that city uploaded to the site. I download to my garmin and follow the icons without worry about getting lost. I find myself excited to get the info off the watch when I return from a run.

Garmin showed distance as: 11.56kms

Polar 625X- The Polar products are scary accurate in my experience, as long as they are calibrated properly, however, what i've found was that the surface you're running on and the elevation changes can have big effects on its accuracy. The heart rate strap (wearlink) is dreamy, the readouts are easy to cycle through, and the information is excellent as well. The Polar is not affected by weather or buildings (unlike the Garmin), and the data when extracted t to the computer is very consistent, meaning paces are not wildly changing throughout the run. The problem, I believe, with accelerometer technology is that it's not very good with hills. The distance of your stride reduces but the turnover can increase. Definitely advantage to teh Garmin. However, on flat surfaces, the Polar wins.

The upload software is clunky and not very motivating to bother. I usually end up deleting my info from the watch before uploading. There's just not that much that's fun about it. Lots of information, but not alot of jazz.

Distance: 11.9kms

Nike + Ipod system
This a must have for the cool gadget factor. Admittedly I haven't calibrated this system yet but the distances are pretty far out of the range. Even on a straight out and back of 6kms the other day it was 200 meters out. But it's just so darn cool. It talks to you, you can hit the centre button your ipod to bring on your "power-song", it instantly sends your info to itunes and the nike website. It's a very, very well though out system. In terms of accuracy? Again, it's not very reliable but for the everyday runner for fitness, it's more than accurate. Even better, it's an excellent motivator, and that's half the battle.

Distance: 12.6kms

In conclusion, the Polar and Garmin have their strengths and weaknesses. I like them both. For a flat straight tempo run, the Polar is the device to have. The data is extremely accurate. For the hardcore training info consumer, it's the instrument for you. If you're out trailrunning and want a cool printout, the Garmin is the ticket. There's really not a clear winner between the two. The Nike plus system is ideally suited to the beginner to intermediate runner that needs the music motivator and the approximate distance they ran. To have your tunes on the run, it's great to have even in addition to the other devices.

Doctor's Blog

2007-03-17T08:33:00.000-06:00

Hello world!

This blog is a project of mine to be able to casually discuss health topics of all types. I intend to provide insight into healthy living while stimulating controversy and discussion all in the same run-on sentence.

Welcome and thanks for the time!

bk