usually, First Born has to test his blood sugar about 5 times a day (when he wakes up, before his two lunch breaks, before supper and at bed time).   the finger pricks are his least favourite part of Diabetes.  his fingers have scabs and scars.  i really wish he would go on a continous glucose monitor (CGM), but like the pump, he’s unwilling.

because of that, i’m making him do another finger prick every day.. when he gets home from school.  he’s not happy about it at all.. when i first suggested it, he said “i hope we’re not making this another routine!”.  however, he’s often a little bit low after school.. or on his way to being low.  also, when he gets home from school, he loves to eat and eat and eat.  he comes home so ravenous!  now, he’s allowed to have 20 carbs of snack “for free”.. aka without extra insulin.  most days, he goes way beyond the 20 carb limit, and it would be really great to know what his starting BG is, it greatly impacts how much insulin he gets, or if he should get any at all.  he’s also getting in the bad habit of not telling me about everything that he is eating at this time (i’ve usually still got daycare kids at this time, so i may be off changing a diaper when he’s stuffing his face).  i really don’t want this to continue.  i need to know exactly what his BG is, and exactly what he eats.

sometimes it’s hard to do something that i know is painful for him, even though it’s necessary.  i really want to get a tighter control on his diabetes.  his A1C is acceptable, but at the slightly higher end of acceptable.  i’d like to lower it a bit more.  to do that, it means even more learning, researching, pricking and poking.

the really good news in all this is that First Born’s new school nurses are working out SO well.  they have a good grip on the numbers and what they mean.  i am so very grateful to have them help take care of his medical needs during the school day.

A little over a year after Caleb was diagnosed, when the fog had cleared, we had experienced all our “firsts” and things were more or less chugging along, my attentions shifted.  The present was under control, now what about the future?

I made my first video.  The intent was to bring attention to work being done to find a cure for type 1 diabetes.  It turned into so much more than that.  It entered me into a world I hadn’t realized existed, or at least one that I could be so much a part of.

Caleb, his face, his story, his personality, have all stretched across the world and brought me, and him, within reach of a support system that we would not otherwise have. I am so grateful for this unexpected byproduct.

This is my first work.  When I made it, I could not watch it without crying.  No matter how many times I watched it, I would choke up.  Now when I watch it, there are two things that I note: (1) how much more effective my message could have been had I made it more succinctly (yes, it’s long – sorry), and (2) how my perspective has changed.  The story is still true.  The spirit of the message still resounds.  But now I know the Caleb who has been living with diabetes for almost three years.  He has adapted.  He has flourished.  He has shown me what perseverance is.  Diabetes does not define Caleb. He just happens to be living with it.  I can watch the video now without tears because I know that Caleb.

So, as this and other videos I have made begin, This is Caleb…

At least a part of him.

MARTES 10 DE NOVIEMBRE

9.15hs a 12.30hs

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• Lugar: Sede Asociación Argentina de Franquicias y Cámara de Grandes Marcas.

A. Del Libertador 222 – 7º A – CABA

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Docente: Carolina Borrachia – Lucio Santilli

• Temario:  La marca como vehículo para evidenciar la diferenciación. Ecualizar la marca: tiene que haber un motivo claro para que me elijan. Más allá del plan de negocio: el plan de marca. Etapas de la vida de la marca: franquicias nacientes y franquicias existentes.

• ¿Para qué asistír? El objetivo de la charla será trabajar sobre el Branding para franquicias y los temas más relevantes a la hora de pensar una nueva marca en el mundo del retail.

• ¿A quiénes está dirigido? Está dirigido a Franquiciantes, Licenciantes, dueños y  titulares de cadenas de locales. Gerentes de Franquicias, Gerentes de zonas, de marketing, Supervisores o Asesores de campo. Responsables de cadenas de comunicación. Franquiciados.

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Inversión Total del Curso

Socios $140

No Socios $160

Inscríbase aquí

I saw my Endo yesterday. The best news of the day was my A1C: 5.6! Can you believe it?! I am so happy with that number! I only hope I can keep it up for the next eight or so months.

He spent a good deal of time with me, which was welcome  because I came to the meeting with a list of questions (big surprise, huh?)

One of his most surprising answers was about the flu shot. He said I am not in the “target demographic” for the regular flu shot, but that I should ask my OB about the H1N1 shot. That was a shock to me and I’m not 100% convinced that I believe it. Everything I’ve read says that I have two risk factors — diabetes and pregnancy. Don’t get me wrong, I really don’t want to get the flu shot. It usually leaves me with a mild case of the flu for about five days. But if it  is important for the health and safety of my baby, than I am all for it.  So I guess I need to do a little more research on this.

Another (somewhat disappointing) response was when I asked to talk to a dietician. I really need to get my food choices under control. Donuts out of the vending machine are never a good choice, but especially now. It turns out that he does not have a dietician that works with him exclusively. He would just send me over the hospital where they will likely push the ADA’s carb-laden, high calorie meal plan on me. Sigh. It is as if I am living in the dark ages. I am going to give it a try, but I am not holding out much hope.

We talked briefly about a CGM.  He is still pulling for the  Medtronic Minimed product. I have been trying to figure out why given all of the anecdotal evidence I am finding that suggests the Dexcom is better. I am guessing it is because it’s  easier for him to assess the reports if they all come from the same device. I have to admit, the Medtronic reporting is pretty  impressive.

Aside from these responses, his knowledge seems impressive, but he really  doesn’t have that compassionate, you’re-going-to-be-fine bedside manner that I am looking for. I guess I am on the fence about whether I should stick with him or jump ship. Afterall, how important is the reassurance if he is helping me reach the “safe baby range?”

This morning I have my first “pregnant” appointment with the OB. I think I will ask  him what he thinks about my Endo and see if he has any advice for me.

What have you been hearing about flu  shots for diabetics? And for those of you who have already had children, what was your medical experience like? Did you have a team, or did you work with individual doctors? If you worked with a dietician, did you find it helpful?

OmniPod and DexCom matched up at 96

It’s been almost two months since Caleb had his first DexCom insertion.  Thankfully, the learning curve of CGM is not nearly as great as that of pumping.  Plus, if something goes wrong with the transmitter or sensor or even receiver, there is not as much panic as when something goes wrong with an insulin pump (like ripping it off the first night because you completely forgot about it).  You’re not cutting off life support after all.

So the transition to CGM is much more subtle than the transition to pumping.  That was a relief.

We have had a couple of bumps.  For nights on end, it would just not work.  It literally seemed to go to sleep when Caleb went to sleep and wake up when Caleb woke up.  With some help from fellow DexCom users, that was resolved.  The receiver works great when it’s in the bed with Caleb.  Not so great on the nightstand or windowsill.  We had a receiver go kaput.  We’ve had a couple of off sensors – one just complete fail. DexCom replaced them.

But otherwise.  No real issues.  It’s kind of “plug and go”.  Our training consisted of watching the nurse do Caleb’s first insertion.  Oh, and I read the manual.

CGM has had an immediate impact in several ways.

I was instantly more relaxed.  We had pizza that first night and I wasn’t on edge wondering if I got the initial bolus right or if the extended bolus would cause him to go low.  I could watch the changes in Caleb’s BG as they occurred.  But on the flip side, I get stressed as I watch the BG rise.  And when it continues to rise despite corrections, it’s downright maddening.

Because the blindfold is off, I could see for certain what I always suspected.  Caleb’s blood sugar was often rising significantly within the first hour after he ate.  It came back down at the two hour mark and I saw the happy in-range BG we typically see with fingersticks, but now I knew for sure what was happening in between.  Frankly, it was depressing.  His graphs looked like the lie detector charts of a big fat liar.  I mean, serious pants on fire.  It wasn’t surprising, but there had been comfort in dealing with the ten or twelve points in time and just ignoring the rest.

This new knowledge is power.  I was able to make basal changes or adjust the time of a prebolus making immediate impacts.  Caleb’s chart looked more truthful right away.

CGM provides another form of relief – during the times when I, his diabetes manager, am separated from him.  Caleb has a great support system at school, but now there is an added safety net.  Should he not feel a low coming on, there is a plan B.  Another voice buzzing from his hip that might notice a low before he does.  This applies to other times too – like after-school activities or the rigors of Walking Club before school on Wednesdays.  We have a little more freedom; a little less stress.

In general, there are times where we simply have information that we would not otherwise have; times when we do not have to stop, open up his PDM case and go through the whole exercise of a fingerstick.  A quick peek and we have a sense of what to do.  We’ve either eliminated the wonder or saved the inconvenience of an extra BG check.

And here is my favorite thing about CGM: I love, love, love the directional arrows.

Directional arrows make all the difference in the world to me.  If a regular blood sugar meter could tell the direction of blood sugar levels, even with just 10 points in time each day, that would be a huge improvement.  If Caleb is at school and the nurse calls me with an unusual situation, she will tell me his BG from the finger stick and the direction of the CGM.  This can change the course of action from that if only the BG was available.  If I had known the direction of Caleb’s BG that night after eating pasta at the restaurant, I KNOW we would have avoided that low.  I would have seen “121″ and double arrows down.  That is so much more meaningful than just “121″.

The last enhancement worthy of mention is nighttime.  It’s  a little less grueling.  Looking at the CGM is significantly easier in the middle of the night than inserting a test strip into the PDM, poking a hole in Caleb’s toe and (often pop-eyed) trying to align that little half circle with the drop of blood.  Some nights I am so out of it, with little depth perception, that I am dabbing a blood-free part of his toe waiting for it to register.  I still have to do all that when there are out of range BGs, but the “just make sure” checks are much more seamless.

So here we are.  We were reluctant to start.  Underwhelmed when we began.  We are starting to adapt.

Just a quick post today as I’m putting the final touches on my chili for the third annual chili cook off at work. Every year, we have a Halloween party complete with a costume contest and chili cook off. My company is not exactly the best place to work on a day-to-day basis, but they really do know how to throw a good party.

My Endo finally called yesterday evening. We ironed out a few things and we’ll reassess at my appointment on Monday. Basically, he does not want me to increase my basal rates, even through a temp basal. Instead, he wants me to use boluses to treat out-of-range numbers. I am also going to have to buckle down and log all of my insulin and carb intake, because my insulin pump does not do it for me (long story, but it does not communicate with the Medtronic reporting software.)

He also encouraged me to think about a CGM, which I have been thinking about, but I am leery of yet another hole in my skin. Also, he is pushing the Medtronic, and I have heard that it is not as accurate as the Dexcom. I also don’t look forward to the insurance fight to get coverage. So I guess I am still on the fence on this one.

Does anybody have any experience with any of the CGMs? How accurate do you find them? Did your insurance company make you jump through hoops to get the supplies covered? How are the insertion sites? Those sensors are so long!

Thanks for any advice you can offer! Have a wonderful weekend and a great Halloween.

In one of his recent posts, Drew McLellan offered an interesting insight by comparing social media to a cocktail party.

Drew gives an example: “Imagine a large room, filled with interesting people. There are many conversations happening at once. People are talking about themselves, asking questions about the other person and then a common thread is discovered. Something that both people have in common. That’s when the conversation gets very lively and a connection is made”.

This analogy illustrates the fact that listening is a critical component of every brand. Too often brands do all the talking; then, just when you think they are done, they talk about themselves some more. Can you imagining carrying on a conversation with someone who only talked about themselves? I know I can’t.

Your brand is a series of conversations with your customers. A conversation by definition is communication between two or more individuals; a dialogue, not a monologue.

Charles Schwab has used this idea of a conversation as the cornerstone for their “Talk to Chuck” campaign. I love how “Talk to Chuck” is an open invitation to engage in a conversation. Investors can talk to the company about their finances and Charles Schwab can provide answers by listening.

Following up on the importance of brand reputation, Chick-Fil-A is a great example of a company who is able to use authenticity to build trust and credibility.

Excerpt taken from Pete Bradshaw’s Satisfied Customers Tell Three Friends, Angry Customers Tell 3,000

Chick-fil-A, a fast-food restaurant chain, has earned an enviable mantle of credibility by doing things in an authentic way. At the root of its   business is faith and unabashed belief in serving the Lord, and this principle guides how the company does business and serves its customers. All Chick-fil-A restaurants are closed on Sundays so that employees can spend the day in worship; unit managers are expected to contribute to the well-being of their community and their employees through servant leadership–leadership that focuses not so much on what I want as on how to help others get what they want. And as a result, despite being open only six days each week, Chick-fil-A has the highest annual average unit volume of any fast-food chicken restaurant in the nation. In fact, its unit sales compare favorably with those of McDonald’s, Burger King, and Wendy’s despite fifty-two fewer selling days per year.

I wholeheartedly believe that Chick-fil-A’s success can be attributed to their authenticity and the fact that they are real and sincere.

I feel terrible. I am just getting started with this blogging adventure of mine, and already slacking off. But not without good reason. See, for the past couple of weeks I have been sick. So, no, I didn’t intentionally take a cyber vacation, I really didn’t. But I am better now, so I am going to try to be better about my blogging (and twittering!).

Through my sickness, I promised myself that once I got better, I was going to stay away from Tylenol containing products as much as possible. See, having a CGM is a wonderful thing, but not if you have to take Tylenol because the doctor didn’t listen when you said you couldn’t take pain meds containing acetaminophen. I was trying my best to avoid taking it at all cost because Dexcom’s sensors don’t play nice with it. Since getting the CGM, I have been able to see trends in my bgs and act on them, change a few basal rates, and get most of my readings under control. Now, I was excited to be able to chart the effects of being sick as well. But, true to form, within 30 minutes of taking the pain meds, I got the (???) code on my Dexcom receiver. I shut down the receiver so that I wouldn’t have to worry about it trying to get readings while I was on the meds at night (they were prescribed only for night, but eventually, it became an all day need too), but that didn’t work. So, for over a week, I was flying without my CGM. It is the weirdest thing to go from being in the dark about your glucose (outside of a few finger sticks per day), to having this wonderful thing given to you to help you control your bgs, only to be so hooked and reliant upon it within a few weeks that you panic to be off of it for a few days. So, I figured that since I almost had my basals and ratios figured out, I’d be okay without my new little friend by my side. Well, I was wrong. I had more unexplained ups and downs than I could think of. Even now, I am off all of the medication and back on the CGM, and guess where my numbers are? They are great at night, but now, during the day, it is teasing me by bouncing around the 200 line, whereas before I stayed between 80 and 100 during the day. I have finally doubled my basal to get it down to the 140 range. I am just as lost as I was when I first started.

My biggest hurdle to overcome with diabetes is that there isn’t any set in stone rules to follow. Just because your plan worked before, doesn’t mean it will work now. It’s not like a recipe on a cake box. You can eat the same thing, drink the same thing, and do the same thing every single day of your life, and each day will never be the the same. You work and work to figure out your personal diabetes pattern, and just when you think you’ve got it, you don’t. Two plus two doesn’t always equal four. Each day is a new equation, a new bowl full of ingredients to make a new cake… only without specific instructions. The only instructions you have are a pile of past experiences to rummage through and hope that they can help you this day. And, yes, there are days when your cake will fall flat because it all didn’t add up or mix well, but you go back the next day and try again. Another day, another cake. But, you can’t give up, because the days when the cake turns out great helps to make up for the days that they didn’t.

I admit it – I resisted.  Mostly because I could not bear to think of having to pierce Caleb’s skin for yet another reason.  Finger sticks and pump insertions seemed like quite enough. Adding a CGM – another poke, another pain, another apparatus strapped to him – seemed too much to ask.

But it remained in the back of my mind always.  Every time we waited for the blood drop to register – that little game of roulette we play ten to twelve times a day – what number would pop up? It’s part gamble.

Caleb and I talked about it.  He bravely agreed to try it.  I nonchalantly started the insurance process expecting it to be a long series of rejections and appeals. I was still reluctant and took every step with much more time than was necessary.

Then we went out to eat for grandma’s birthday.  Caleb chose his favorite – pasta.  I will not allow diabetes to make more choices for him than necessary.  So even though I hadn’t dosed him for regular pasta in a long, long time, I gave it a try.  I weighed his portion and bolused him reducing it by an amount I remembered working back when we weren’t eating new pastas.

We were off to a good start.  Blood sugars were behaving nicely.  But then shortly after he went to bed he yelled saying he felt low.  He was 22 and he got there within minutes. We’ve never seen 22 before.  More alarming was his reaction: “Mom, why does everything look so small?”  ”Mom, I feel like I’m gonna die.”

He was back in range quickly.  But I don’t want him to ever experience that again.  I couldn’t help but think CGM would help.  So I stepped up the insurance process and within a week I got the call that he was approved.

Fast forward to the first insertion:

So how is it working?

As expected.

I made the mistake of expecting miracles when Caleb started pumping.  I didn’t make that mistake with CGM.

It is helpful.  It is informative.  I appreciate having to play roulette less.  I felt a sense of relief immediately being able to watch Caleb’s blood sugar change rather than get slapped in the face every two hours or so.

But, like pumping, it’s far from perfect.  Glucose readings must be verified before acting, so we have yet to reduce finger sticks.  In fact, we’ve done more than ever to verify all the ups and downs within those ten to twelve times a day we traditionally check.  It’s not always accurate.  Sometimes it’s WAY off.  But much of the time it is meaningful.  And it’s true what everyone says: the trends are the real value, not necessarily the numbers.  But, when it does work and work well, it’s actually pretty fabulous.

I really want the theory behind CGM to be the true reality of CGM.  I want it to tell me what his sugar levels are 24 hours a day.  It doesn’t.  It doesn’t “catch” his lows and highs. It alerts us to the possibility or even likelihood of lows and highs – but sometimes not even that accurately because there is a lag between its readings and his actual blood sugar. Compound that issue with its readings being off maybe ten to twenty points and it’s easy to miss lows.  So it can catch his highs and lows, but it doesn’t do that as a rule.

So far CGM has softened the extremes in Caleb’s blood sugar readings.  It is a step forward in Caleb’s care regimen. I am glad to have it.  It is, however, a much smaller step than I would have liked.

In all fairness though, we are still new to it, and I am optimistic that our learning curve will improve and the small step will become at least a little bit bigger.

Nevertheless, it is too much to ask.

My doctor has lately been telling me that Minimed/Medtronic is going to close the loop very soon now in providing an artificial pancreas based on today’s CGM and pump technology. Given my own experience, as well as the responses I’ve gotten to my post Continuous Glucose Monitoring with Medtronic/MiniMed Updated, I find this rather difficult to believe. I’m curious whether anyone reading this blog would actually trust their lives to CGM technology telling your pump how much to pump, removing yourself from the loop. However, this peer reviewed article seems to confirm his comments.

Personally, even if I have a way to override this, I would be very uncomfortable with it. For starters, I find the device to accurately track my blood glucose about 80-90% of the time at most. Then, there’s the issue of the 15-20 minute lag. Further, I sometimes have issues with slow insulin absorption, especially during long drives. Unless they combine this with their old implantable pump technology that delivers insulin into the renal vein and unless they find a way to continuously monitor blood glucose rather than interstitial glucose, I think I’m going to have to pass on this.

At least that’s my initial take on the situation. Even at 90% accuracy, it means that it is putting my life at risk 10% of the time. That’s just not acceptable to me. I need much higher reliability. Or, perhaps if I can override the device on days when I know it is not tracking, that would help. More importantly, I think I would want to have to actively confirm that I believe it to be tracking accurately in order to use it. I think that is what might make me trust it, some active confirmation on my part that I believe it working for the next N hours and then I must reconfirm later.

To me, this is still too scary to trust with my life. The reliability just isn’t there. I’ll let you know if I hear or read something that changes my mind.

What do you think?

Have you ever said you were going to do something, like, multiple times and you never do it? Even when you tell LOADS of people you are going to do it? But instead you just sort of forget, or you pretend to do it for awhile so it seems like you’re doing what you said you were going to do even though you really aren’t actually doing it.

That’s how I am with my diabetes sometimes. It’s my one (but not only) big annoying habit that doesn’t seem to go away. The truth is, I’m a bit lazy with my diabetes. I don’t test nearly enough. I don’t count my carbs as accurately as I should. I exercise but not regularly. I don’t change my basal rates or bolus ratios and I certainly NEVER DO BASAL TESTS. I mean, come on…

Okay, okay.

I admit it.

I don’t do everything I should be doing to manage my diabetes. And not wanting to do is a piss poor excuse, right? I mean, yes, I can hate it ’til the cows come home but that doesn’t make the diabetes any better (or go away) .

Today, Kerri announced she has reached a low, very respectable A1C. And it made me think that, even though it was really hard for her, and even though she has to sacrifice a lot to get there, she really wanted to accomplish this goal and she made it.

My A1Cs, on the other hand, have gone in the other direction. During college, and even during my first year or so on the East Coast, my A1C was in the low 7s. Nothing fabulous, but they were decent. I didn’t have to work too hard and things just fell in line together. But then work got busier, and I started to travel more, and eat out more, and I’ve moved twice since then and suddenly my blood sugars started to creep up and I went from a 7.1 to a 7.8 to an 8.4 and God knows what it will be next. I don’t really want to find out.

More than two years ago, I was thinking the same thing. I asked Kevin Perese to send me his legendary Excel spreadsheet to help with keeping track of my blood sugars. He sent it to me and I never used it.

I found the email again in my inbox (thanks to Gmail’s bottomless pit) and I opened it. I looked at it again and I think it would be very helpful. I recently started using an Excel spreadsheet to track my finances, and I think I could probably do something similar with my blood sugars. I’ll also use my Carelink system to look at trends in my CGM as well. If I’m going to be wearing the CGM I might as well use it to make overall directional changes in my blood sugars rather than just using it as a defensive tool against blood sugars that have already started to creep up.

My next A1C is on November 2. That’s a little less than two months away, but it’s just enough time to actually do something productive with my blood sugars.

I have had diabetes for 15 years. And I know what I should do. But I just need work on that whole “doing” thing.

 Today marks the day that I started using my Dexcom Seven+.

I can tell you that I am honestly like a kid at Christmas when waiting for this kind of thing. Last night was terrible. The minutes and hours just seemed to DRAG by. Even today, the time between 8am and 1:30pm was SO long. I do declare that time pauses for those in anticipation just to pick at us.

My trainer turned out to be a really a nice lady. She actually explained that her two daughters and her husband all have type 1 diabetes. They all use a Dexcom and her daughters are currently on shot therapy for a vacation from the pump. After learning this, in a way, I looked at her differently. She doesn’t just sell this product, she uses and sees this thing personally with not only one person, but three. I took her advice more to heart with different tips she gave me.

Anyway, the time went by with the trainer very fast. She started off explaining the Dexcom receiver to me. I know it’s her job, but I had already read every bit of material they had sent twice or more and played with the receiver to set alarms (I know, that’s a no-no, but I couldn’t help it!!!) Then we got down to business. We got everything set up with the insertion device, got the Skin Tac placed, placed the insertion device right where it was needed. I pulled the safety latch out and got ready to push the plunger, and I wimped out. ME! You’d think after all these years of poking needles in me, I wouldn’t be nervous. Then, before I knew it, she pushed the plunger and it was in. I am here to profess to everyone of you who is reading this, I AM A DOWNRIGHT, HONEST-TO-GOODNESS CHICKEN!!! I felt so silly after it was in and all was done that I was that scared of it.

It was activated at around 2:30, so by 4:30, I should be able to do my calibration entries. Then I should be able to see my trends come up.  I’ll be starting to color with my Crayolas! How cool is that?!?!? I’ll write later and post some pics of my trends later.

(OH, by the way, for those of you who remember the A1C countdown blog, I officially have 5 days left. My appointment is Monday, so I will be getting it done then. It usually takes a couple of days to get the results, so in a week from today, I should have my new number to tell you guys!)

Let’s begin this inaugural edition of the CGM with a brief rant on showtimes. This particular show was an “early” show, beginning at allegedly 9 p.m. I showed up at 9:27, knowing that Plush has no interest in punctuality. How, pray tell, does this qualify as an “early” show? With three bands on the bill, the show was likely to drag until 1 a.m. (on a weeknight, no less). I simply don’t understand how this is a functioning business model. I’d go to WAY more shows if they began at, say, 8 p.m., and I know I’m not the only one. When your target demographics are insomniacs, raging alcoholics, and the chronically unemployable, what kind of clientele are you expecting to draw?

Most of the people interested in attending live music have, you know, jobs and stuff. My lovely girlfriend, Kelly, absolutely adores live music, but 90 percent of these shows take place well past her bedtime. Once we get the start-up capital, Travis and I are going to open up our own venue/bar, and we’re going to cater to Tucson’s young working class. We’ll be millionaires. Anyway…

Since this venue doesn’t exist yet, Plush is still the best place in town to catch live music — good sound, friendly staff, reasonable drink prices, and Kris Kerry’s insistence on booking really hip bands before they blow up. Fruit Bats gets a lot of love in the Pitchfork-type circles, but very few people are aware of their material (except for the always-ahead-of-the-curve Dave Low).

The first band up was a terrific local act called Golden Boots. They’re part of that Park The Van crew, made famous by the fantastic Dr. Dog. All of the bands on that label have an affinity for three-part vocal harmonies and ramshackle pop songs that are held together by sheer enthusiasm. What’s cool about PTV is how each of the bands on that label approach that sound from a different viewpoint. Dr. Dog seems to come at it from a late-era Beatles perspective (only if John and Paul still liked each other while they were recording “Let It Be”), the now-defunct The Teeth had a mod vibe to them (think The Jam or Nick Lowe), and Golden Boots has this rootsy, Basement-Tapes-Dylan sort of thing happening. They’re one of the few bands in town that has total strangers buying their music.

With that said, there were only 20-25 people there when they played their first note. Whenever people ask me why Redlands doesn’t try to make a go of it on tour, this is exactly why. Golden Boots is one of the three best bands in town, they’re playing at 9:30 p.m. on a Thursday, and they’re STILL playing to a near-empty room while opening for a pair of national acts. It’s damn near impossible to make any sort of money as a touring musician. You might as well play the lottery.

But by the time Golden Boots wrapped up their delightful 45-minute set, the room filled out and there were roughly 75-90 people. I don’t get to see these guys as often as I’d like to, but each time I see them, they get better and better.

The highlight of this portion of the show was the arrival of my dear friends, Ben and Gina. Any night on the town with these two is a cherished treasure.

I had just polished off my first (and only) whiskey-based cocktail, and we spent the next 20 minutes discussing the finer points of Kierkegaard’s theories on the alienating effects of modernity (not really) as we waited for the next band — the one-of-a-kind Death Vessel.

Oh, Death Vessel! Where to begin!

Death Vessel is a five-piece alt-folk act with the most unsettling lead singer in indie-rock history. He couldn’t have been taller than 5-foot-2, with jet-black clothes and long, flowing, Pantene-commercial hair. This had more in common with a horse’s mane than human hair. It was stunning. The rest of the band tried to match his flowing locks, except for the drummer, who was cursed to sport this business-like style. Ben hypothesized that the drummer actually had the best hair of all, but the lead singer forced him to cut it because it was too distracting.

Seriously, there was enough hair on that stage to open for Megadeth. And with a name like Death Vessel (and a frontman who had the build of Ronnie James Dio), you’d think they’d rock pretty hard.

Wrong.

Make no mistake, this was a terrific band with haunting, beautiful songs. But the lead singer had the most feminine voice I’ve ever heard — including every female singer I’ve ever listened to.

If you closed your eyes, you’d think you were at a late-90s Lilith Fair. This dude was a Jeffrey Eugenides novel sprung to live. His voice was so high and so pure, it almost defied logic. His speaking voice was that of a man‘s, but he sounded an awful lot like the lead singer of The Cranberries. In fact, I offered Gina 10 bucks to request that he play “Zombie.”

Other highlights:
* Gina loved him. “He’s like a beautiful fawn.”
* I wondered out loud who would win in a fanciful cage-match, this dude or Joanna Newsom. Ben: “Is that the girl who sounds like the lost baby?” Yes. Yes it is.
* When the second guitarist went to a banjo for the third song (an up-tempo country-esque knee-slapper), I commented, “I didn’t know there were unicorns in the Old West.”
* Green Valley News celebrity gossip columnist Jaime Richardson made her way with a pair of very tall men about halfway through the Death Vessel set. I think she really enjoyed these guys, given that the lead singer was almost as bewitching as Stevie Nicks.

Once Death Vessel exited the stage (beneath a beaming rainbow and a shower of pixie dust), Fruit Bats prepared for their set.

Keep in mind, I really like their songs. They’re professional structured pop songs with excellent musicianship. And their energy really kicks them up a notch in a live setting (especially those sunny vocal harmonies).

But I couldn’t get past the fact that they sounded EXACTLY like The Shins.

I always thought that the holy triumvirate of ripoff indie bands was Oasis, Muse and Silversun Pickups (three bands I actually enjoy). I never thought I’d find a group who’d give those three a run for their money.

But Fruit Bats sounded so much like The Shins, it was uncanny. The resemblance was even more striking live. This wasn’t even a case where you could say the resemblance was coincidental. It’d be like putting a piece of paper in a photocopier, then trying to explain that the photocopy was only “influenced” by the original. The singer even did that piercing falsetto thing that Mr. Shins does, most notably on “Kissing the Lipless.”

(Right now seems like a good time to mention that Redlands would’ve been a good opening act for this bill, but if we did play this show, Daniel — a notoriously high-voiced male singer — would’ve sounded like Nick Cave compared to Death Vessel and Fruit Bats.)

This didn’t make them bad. In fact, I liked their songs more than I liked anything off of “Wincing the Night Away.” And hell, it’d cost more than 12 bucks to catch The Shins in concert these days. But if this band ever wants to accomplish something great, they need to cultivate a personality of their own.

Given that it was roughly 4 a.m. (or maybe 12:45), the three of us decided it was bedtime. Check back soon for another edition of “The Concert-goer’s Manifesto,” just as soon as I get my sleep patterns back in order.

-Nick Prevenas

Ever since I started using Dex (it’ll be a week tomorrow evening, yay!), I’ve become hyper aware of what’s going on. Before, when I used to test four, six, ten plus times a day, I wouldn’t be able to see what’s going on in between these tests. Sometimes I’d eat lunch at noon, get busy with work, and test again at 4pm or so. Of course, at 4pm, my bg would be somewhere around 120, and I’d think, Woohoo, I’m totally in the zone! What I didn’t see was that my levels would skyrocket to close to 300 about an hour and a half to two hours postprandial…like they are right now. I’d like to see more (and more and MORE) of this.

Now, with my trusty spycam DexCom, I’m seeing the bigger, more detailed picture. Just because my numbers look good when I do a fingerstick does not mean everything is okay. Without Dex, I wouldn’t have been able to tell that I was hovering around 200 from about 1am to 7:30am. Without Dex, I couldn’t see that I was WAY up there after what I thought was a decent lunch.

Right now, I’m 264 and holding steady. What I want is to be 164 and holding steady, or at least 264 going down! So frustrating. I’m definitely going to make some major tweaks in my diet.

Eeks. I woke up a few minutes ago feeling completely sick. I grabbed my DexCom off the headboard, only to find ??? staring back at me.

“DOH!” I leaped up from bed and practically ran to my meter as fast as my sluggish body would let me. Something definitely did not feel right.

I clocked in at a whopping 361.

I gave myself a bolus, and, on a hunch, felt around my pod (on the adhesive part that sticks out) for any leaks. BINGO. A pod changed revealed that my OmniPod (which I had changed about 3 hours prior to this fiasco) had a bent cannula and thus wasn’t giving me my basal insulin properly.

But the kicker was that somehow Dex’s receiver lost communication with the transmitter as I was asleep, thus not alerting me even when I reached 200.

Does anyone have any ideas as to how I can prevent this from happening? Obviously I won’t know about the bent cannula until my bg rises with no explanation, but how about preventing the lost communication between the receiver and the transmitter? I currently have the sensor on my lower back, but I sleep on my stomach, so there is really nothing in the way except my shirt and blanket.

I’m totally blaming diabetes for this one.

I GOT THE CRAYOLA! MOM GOT ME THE CRAYOLA!!! (If you’re confused, please refer to my prior post about Comparing CGM’s to Crayons)

I went home Monday and had a message on my phone that Dexcom had called. I called back and couldn’t speak with the rep that hand been handling my case, so I talked with the gentleman who answered the phone. Here is how the conversation went:

Me: I was calling ( my rep ) because she just called me and I missed her call. Can you please look and see what she may have been calling about?

Rep: Yes, give me just a moment. Ah, it looks as if she was calling to let you know we have your approval and we were going ahead with the shipping details.

Me: Are you sure? It’s actually approved? You aren’t just looking at where they verified the benefits? The insurance company wrote back and approved it?

Rep: Yes, that’s what I think it’s saying, but if you would like for me to have ( my rep) return your call, I’d be glad to do so.

Me: Yes, please. I’ve already left her a voicemail, but that would be okay too.

~End of conversation

So, I waited an hour and didn’t hear anything back. I was like a little kid at Christmas. That hour may as well been a whole day… or week. Lots of clothes got folded during that time (when I’m anxious or mad, I clean). 

I later decided to call back and I finally got my rep. She was so nice. She confirmed that everything had been approved by insurance that morning and they were set to send everything out. I wasn’t expecting a decision that soon!  And neither was my rep. She said it was the fastest turn around she had seen. I was floored!  We got everything squared away and my brand new Dexcom Seven+ meter is now on it’s way. It is set to arrive Friday, but since I will not be here to receive it, I have called FedEx to hold it until Tuesday.

I have also already contacted my trainer and she will be here on the 9th if the shipment works out as planned, so, fingers crossed, I will be CGMing on Tuesday of next week!!!

**9/3/09 It is here!!! Now, to wait on training!! I will put up a new blog post when the training is completed along with pictures. Thanks you guys for all your support!!!

I’ve decided that rather than bombarding my tumblr with posts about diabetes that I should consolidate them into one diabetes blog. I want to be able to read back on these entries and not have to sift through other entries.

So Sugarbump at WordPress is born! And to kick it off, here is my post from last night about being a beat up diabetes robot:

My spreadsheet tells me I’ve been testing around 15 times a day (yes folks, that’s almost four times more than recommended). My right ring finger and left pinky are particularly beat up– I’ll try to get a shot of that and post it here.

I don’t mind though. Sore fingers are a small price to pay for the peace of mind of knowing where the heck my blood sugar is wandering (a la Big Brother). With the finger pricks and my brand spankin’ new DexCom system, along with the Kevin spreadsheet, for once in my life I feel like I’m adequately armed for this battle…or at least my next endo appointment in a couple of weeks. Diabetes is an annoying friend I’ve come to love. Sorta. Of course, there are times I want to kick it in its face, especially when it’s rearing its ugly head and I can’t get it to calm the eff down, but most of the time it’s manageable and, dare I say, even entertaining. My pod is a good ice breaker topic, that’s for sure.

I can’t even begin to describe how I feel about the DexCom. I’ve only had it for three days, and I can’t imagine what I did without it (kinda like my iPhone). Not only am I constantly checking it, Chris is as well! I’ll be sitting/standing there randomly, and all of a sudden, I’ll feel a little pressure on my side. And there’s my husband, eyes lit up like it’s Christmas morning, pressing buttons, eager to see how I’m currently doing and what the trends are. He’s the only person who can get away with pushing buttons on my diabetes gear, so don’t get any ideas, people.

He’s also expressed how glad he is that I have this thing– he’s still in CA until tomorrow, with no way of knowing when I go low, and more importantly, how low I go. Take this afternoon for example: since I was dead tired from my red-eye flight, I took a nap after work. About two hours into it, the receiver started beeping. My bg was 42 and falling. I did not feel a thing. A finger stick confirmed it with 46. This thing knows me better than I know myself.

Dex says I’m 100 and steady. I’m going to reward myself by sleeping.

The start of this adventure was back in December of 2008 after I started on my OmniPod system. I was getting much better control with this pump because, unlike my prior pump, this one had things like “Insulin on Board”, “Bolus Calculator”, and all that good stuff, not to mention, it was the perfect, closed loop system in my opinion because the PDM had the built in monitor as well. Everything could be kept in a neat, nice little pouch inside of my purse.

Well, as always with getting better, lower numbers, you also get more of the not so good, lower low numbers as well. I could deal with them at the time because there were only a few per week, or I’d only have one really bad day in the week where they just wouldn’t come up. But as with any time you make adjustments to lower the still-high-highs, you are more prone to getting the lows. Well, over time, I am losing the ability to tell when I am dropping low. It’s not quite as bad as some, but where I used to be able to feel a low coming on in the 80-70 range, it’s now down to the 50-40 range, and that, to me, is scary. I have a fear that I will drop too low and not be able to tell anyone what is happening or what to do. I’ve heard many of the horror stories of people passing out, and I have done so myself, and that is something I do not wish to revisit again. So, I decided to apply for a Freestyle Navigator CGM. I chose this one because it would take the same strips as my OmniPod PDM. We filed the paperwork, hassled with my unwilling doctor to get the papers signed, and waited for approval.

The weeks went by and finally I got a call from Abbott that said my insurance had denied my request due to lack of medical necessity. Okay, first off, I would like to know what doctor read my file and said that I, a diabetic of 20+ years, could not show evidence through my testing that I needed a CGM. It’s kind of like when you are a kid and you want to get crayons from the store. You want the best… you want Crayola. But your mom says, “no, these are just as good”, and gets you the dollar store waxy crayons that when you color with them, you get more wax than color on your paper. You are asking the insurance company for the Crayola… The insurance company basically says no and gives you the waxy crayon… They say “No, you can manage your glucose just as well with only doing 8-10 checks a day as opposed to having 288 readings per day, and you should have no problem attaining a great A1C to reflect it.” We were going to file for an appeal, but I never received the papers in the mail. I decided just to give it a rest and try to do my best on my own. Since then, the aim for tighter numbers has given me more lows, still in the 50-40 range, but with less symptoms than before, and also leaving me with killer headaches. Ones that have even recently caused me to lose time work because they would physically make me too sick to work. I looked over my readings on my CoPilot system, and it showed a LOT of lows in the below 50 range happening more frequently than before, most of them unnoticed…

I submitted paperwork back on the 11th of this month to Dexcom to try for their 7Plus CGM since there are reports that they are teaming up with Insulet to somehow integrate the two systems. This morning, the representative informed me that they have already verified my benefits, and were waiting on a fax from my doctors office (a new doctor, due to problems with my old doctor, we switched. That will be covered in another blog. My new one is much better and is in favor of and promotes CGMs as well), then they were submitting everything they had to my insurance company for preauthorization. So the wait begins. I am hopeful… wishful… and am being as patient as I can possibly be right now.

Companies active in social media encourage their employees to self-identify as such on Facebook and Twitter, and Best Buy has gone so far as to productize it with Twelpforce.

But as more marketing departments push to enlist rank-and-file employees and customers as brand evangelists, do they risk a “what’s in it for me” backlash?

As Peter Kim notes in an excellent short meditation on the issue:

“Most of the people I know who are involved in social media are of the white-collar salaried variety. Many of them participate in order to gain a competitive edge in their work. But what happens when the rest of the company gets involved?  In particular, when the participation happens for corporate benefit and being social becomes part of the job…how should employers reward this value creation?”

Ideas, opinions and (especially) followings have value — as the long-established mommy blogger gravy train and emerging market for sponsored tweets tesify – so why should employees who have invested in their own personal brands and established their own authority in social media be treated any differently?

Since the company materially benefits from and actively merchandise this content – it might not be long before savvy employees start exerting pressure for tangible quid pro quo for their voluntary marketing work.

And what about user-generated ratings and reviews? Hipster retail sites like CB2 push R&R on every product page, and software as service vendor Bazaarvoice assert “UGC may be the next SEO.” At what point will customers say, “Sure, I’ll rate my experience. What’s it worth to you?” 

I join Peter Kim in asking:

“So how is your company going to handle the journey? Are you prepared to potentially pay for it every step of the way?”

Algunos conoceran las historias de terror de las aerolineas muy de cerca, otros por amigos y familiares; pero lo cierto es que son infinitas.  Crei que la ultima, de las mas fuertes que he escuchado, seria la que le sucedio a un amigo cercano, que al regresar de su viaje de trabajo a Republica Dominicana, noto que en su maleta faltaba una de sus dos portatiles. A pesar de las quejas, la empresa jamas le soluciono el problema.

Pero Dave Carroll, un musico Canadiense, que viajaba con su banda “the Sons of Maxwell” de Chicago a Nebraska en United Airlines la primavera de 2008, nos ha dado otro maravilloso ejemplo de lo que puede hacer el internet por una persona que sufre con el Servicio al Cliente en una compania. Otra buena historio de “David vs Golliat”.

En las palabras de Dave en el video description de YouTube [y la version mas detallada en su website]:

In the spring of 2008, Sons of Maxwell were traveling to Nebraska for a one-week tour and my Taylor guitar was witnessed being thrown by United Airlines baggage handlers in Chicago. I discovered later that the $3500 guitar was severely damaged. They didnt deny the experience occurred but for nine months the various people I communicated with put the responsibility for dealing with the damage on everyone other than themselves and finally said they would do nothing to compensate me for my loss. So I promised the last person to finally say no to compensation (Ms. Irlweg) that I would write and produce three songs about my experience with United Airlines and make videos for each to be viewed online by anyone in the world. United: Song 1 is the first of those songs. United: Song 2 has been written and video production is underway. United: Song 3 is coming. I promise. Follow me at http://twitter.com/DaveCarroll . Video Produced by Curve Productions of Halifax, http://www.curveproductionsinc.com.

Parafraseando: Despues de 9 dolorosos meses de intentar que United Airlines le respondiera favorablemente por su Guitarra Taylor de US$3,500.00, Dave advirtio a la ejecutiva de la aerolinea, que produciria 3 canciones (+ sus videoclips) y que los publicaria en YouTube para que las viera todo el mundo. El error de Ms. Irwig fue no dimensionar la cantidad de personas que podian ver este video:

Y claro, con 3,719,721 views + 17,483 comentarios + 5 estrellas en 26,252 ratings en YouTube [Jul 23/2009]; y 3,710 diggs, y luego de aparecer durante 1 semana como el 3er resultado al escribir “United Airlines” en Google [aun sigue manteniendose en la 1a pagina], ese video publicado el 6 de Julio, ha generado covertura de publicaciones como USA Today, Newsweek, The Wall Street Jounal y de sitios con gran trafico como The Consumerist y Boing Boing.

United Airlines, que “noto” pronto el problema, intento pagar por la guitarra y terminar con la mala publicidad, pero el buen Dave publico un “video response” negandose a aceptarlo y defendiendo a Ms. Irwig.  No podemos negar que chico tiene clase.

Ahora, un par de dolorosas lecciones para todo mercadologo.

1. No subestimes el poder de un “solo” cliente. Everybody IS a Broadcaster.
2. La indignacion de un cliente produce empatia en otros clientes o en los potenciales.
3. Afectas a una persona, afectas a una red, invisible, pero notoria.
4. No importa cuan grande sea tu presupuesto de Publicidad, lo que cuenta para las personas, es lo que digan otras personas.
5. Terminar un caso de estos, en un final feliz, requiere de muchisimo mas trabajo “REAL” que simplemente publicidad.
6. Las companias deben tomar en serio estos casos para revisar sus politicas y procedimientos de atencion al cliente.

Hasta la proxima.