Living Well With Diabetes

Salt Lake City had a bunch of new snow this morning. The wet, sloppy, springtime kind. With the heavy snowing falling and covering the roads, it was, as the kids say these days, “sketchy” riding my bike to work this morning.

By this afternoon though, the sun was out and it all was melting. On my ride home from work, I was enjoying the sun and doing my best to avoid piles of snow left by snowplows and snow blowers. There’s an intersection at the bottom of a hill near where I live and from a few blocks away I could see a couple of kids playing at that intersection. I got closer and saw why. It was filled with water. The road I was on wasn’t filled with water, but there was an ten or twelve-foot wide puddle in the intersection between the road I was on and the road I was going to be turning on to.

As I was setting up for my left-hand turn, the girls at the intersection yelled “Hey biker, hey biker, I dare ya to ride through the water!”

“You dare me?” I yelled back. They didn’t know I was going to ride through it anyway.

“Yeah, come on!”

Alright then. I gathered some speed and picked a line, hoping I had picked one without the pothole. The splash as I rode through water up to the hubs was much bigger than I thought it would be. My shoes were soaked, but I kept my my forward momentum and started pedaling again at the far side.

“Oh, cool!” I heard one of the girls yell.

Yeah, I had to agree. It was pretty cool.

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I read in the Wall Street Journal this morning about Kris Freeman’s experience last Saturday in the 30-kilometer cross country ski race at the 2010 Winter Olympics.

Kris was trailing the race leader by just six seconds. He was in a very good position be the first American since 1976 (five years before Kris was born, I might add) to medal in an Olympic cross-country skiing event. This achievement is made all the more impressive when you know that Kris has to manage type 1 diabetes right alongside his rigorous training schedule.

As the Wall Street Journal story describes it, Kris was suddenly down in the snow calling for help. His blood sugar had gotten low. He needed some sugar and he needed it fast.

In a bike race or just out for a ride, I have felt those symptoms of low blood sugar — the shakes, the cold sweat, the confusion, the weakness — and it’s not a good feeling so boy, I can relate to what Kris was going through. Of course, I’ve never had as much on the line as he had in this race.

No, wait, that’s not true. I’ve had just as much on the line as Kris did. Hypoglycemia is a dangerous condition that, if not treated, can very quickly leave a person incapacitated or unconscious or in a coma or even worse. So, Kris and I and all other athletes out there with type 1 diabetes — and there are a lot of us — put our lives at risk every time we go out to exercise, no matter what the activity is. It’s only through careful monitoring of our condition and knowing very well how our bodies react to exercise that we know that we have minimized that risk.

If a person objects to that risk, well, the alternative is to do what the doctors used to tell newly diagnosed diabetic patients back in the 1970’s when I was first diagnosed: take it easy, don’t try to do too much, don’t think about strenuous activities because the risk of severe swings in blood sugars was too great. Well, you know what I say to that? To hell with that, is what I say.

There are endless ways that people can receive a wake up call that life is way too short and must therefore be lived to its fullest. Diabetes, for me, was that wake up call. It took probably 15 years for that wake up call to register inside my thick skull and sometimes I wonder if it still hasn’t fully registered, but I think the diagnosis of diabetes is probably one of the more gentle wake up calls to receive. I mean, think about it. The other classic “hey, stupid, life is short. Enjoy the gift while you can” wake up calls are things like cancer, a serious car accident, the death of a close friend or family member, etc, etc. I could go on, but you get the point. Getting diabetes is really pretty tame compared to those things.

So, I will continue cycling for the rest of my life. With any luck, on the day I die, I will finish my daily bike ride, dismount, and fall over dead. And until that day, I will do any and all other things that look like fun to me whether it’s bicycling to all 50 states (only Hawaii is left), learning to sail, reading all of the Modern Library’s 100 Best Novels of the Twentieth Century, climbing Mt. Kilimanjaro, visiting New Zealand, bungee jumping from the Royal Gorge Bridge in Colorado, or simply taking a long nap on a rainy summer Saturday afternoon.

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Whenever I write on Living Well With Diabetes, I wonder how many people are reading it? And who are they? Friends? Relatives? Complete strangers?

There a number of ways to find out the answer. My hosting provider has some basic reports by a program called Webalizer. These reports show that last week (February 14 through February 21), Living Well With Diabetes had 1516 page views. I’ve been a bit unhappy with those reports because provides only cumulative numbers of hits and page views on a daily, monthly and annually. Those cumulative numbers don’t differentiate between hits and page views by real people and those of automated web crawling programs such as Googlebot, Msnbot, and Yahoo! Slurp. I only care about the visits by real people because, well, I’m pretty sure none of the web crawlers have diabetes.

I finally got curious enough about my web site statistics that I installed a module on my web site to collect more detailed data. I did that about a month ago and I immediately noticed three things:

1. The module still collects all the visit data from web crawlers and there are a huge number of web crawlers scanning my web site. So many that it’s difficult to find the stuff I’m really interesting in. That is, the visits from real people.
2. The amount of data is large enough that it won’t be practical to collect it for very long.
3. The collecting of the data seems to slow down the web site.

Because of this, just over a week ago, I signed up for Google Analytics. By the nature of how it collects its data, it automatically excludes the visits by web crawlers. It still collects a large amount of data, but because the data is stored on my Google Analytics account where I don’t have a storage space limit, it doesn’t take up space where it counts: on Living Well With Diabetes.

I’ve been collecting data with Google Analytics since February 14 — just over a week. So, after excluding all the visits by web crawlers, the number of page views by real people is…wait for it…129.

Yep, 129 page views spread across seven days and five postings. And 59 of those 129 page views weren’t even to new postings on the site; they were to my Quotes page. Clearly, if I want this blog to be more than just a fancy electronic letter home to Mom, I need to get the word out about Living Well With Diabetes. How does one go about promoting a blog? More on that later.

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Most people can ride a bicycle. It’s one of those rituals most of us go though at an early age. We spend an afternoon, or a day, or a week with the assistance of a parent to learn how to balance and pedal to keep those wheels turning which, in turn, helps with the balance. I’m sure I’m oversimplifying this complicated miracle of learning, parental support, and stubbornness, but you get the idea. In any case, for many people. learning the basics of balance and pedaling and braking is about as far as they go in the area of bicycling as a “skill.”

But, bicycling safely should be a requirement too. And not just for people who do a lot of bicycling. According to the Alliance for Bicycling and Walking, relative to the number of miles traveled, bicyclists in the United States have a greater probability of being involved in a fatal accident (see their report here).

So, I was very pleased when a friend of mine forwarded a link to a web site dedicated to safe travel by bicycle. It’s been around in book form since about 1988, but it’s been kept up-to-date and customized for the needs and particular laws of a number of states. It has sold over 300,000 copies. Generously, they offer an online version here:

Bicycling Street Smarts: Riding Confidently, Legally and Safely

I’ve read through the chapters on riding safely in traffic since it’s something I do nearly every day. I was pleased to learn they supported my instinct that riding at the very far right edge of the pavement is not always the safest strategy. As my friend put it, their advice is “nuanced” for a wide variety of situations commonly encountered on the roads today.

If that “nuance” helps keep me out of the front grill of an SUV, I’m all for it.

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I was scanning through my previous posts and realized I hadn’t mentioned some very big news from 2009: my insurance plan now covers continuous glucose monitors and supplies!

I think I forgot to mention this because I’ve been using a CGM since 2006, but not very much back then because of the cost. I used it as much as I could afford though because I could see the value of the device in my HbA1C test results. In 2006 and 2007, I had to pay for 100% of the supplies because my insurance company didn’t cover them. At that time, they barely knew what a CGM was, I think. In 2008, they covered a ridiculously small portion of the cost. How ridiculous? If I had bought sensors as often as they would allow (every month), by the end of the year, I would be about 10 dollars short of satisfying the annual deductible which I recall was 250 dollars. Part of that was because the CGM manufacturer was considered “out-of-network” and therefore was covered at a lower amount.

In 2009 I saw an end to that though. I remember placing an order for supplies in early January of 2009 and having two things be different. First, they were allowing me to place an order for a two-month supply rather than the one-month supply they allowed in the past. That alone meant I would be paying half as much in shipping. The second thing that was different was amount they were charging to my credit card. In the past, it had been about 250 dollars and now they only needed a 10% co-pay (about 30 dollars). Very nice!

As happy as the end of this story has been for me, people all across the country continue to struggle with their insurance companies to get coverage for what is, I think, the best thing to happen in diabetes care in the twenty-first century. This is despite numerous studies (for example, here and here) showing their effectiveness in helping to manage blood sugar levels.

If you’re still fighting for coverage, check this site out:

CGM Anti-Denial Campaign Website – All you need to fight for CGM coverage.

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