Don't you hate it when one of your smart-ass comments turns in to the idea of the century? Yeah, me too. This is pretty much how it went on the phone:
Brensdad's Boss: "We've got $100,000 worth of merchandise sitting in Florida that we need to get back here to our Texas locations, but shipping is going to be a nightmare, and we need that stuff here before January 31st."
Brensdad: "I know, why don't you fly two of us to Fort Myers, and we'll rent a truck and drive it all back!"
I swear that I was rolling my eyes through the phone as I said it.
Long silence. Too long. Oh shit. He likes it.
"That's actually a great idea."
"Say what?"
"It's a great idea! Call Mark in Dallas and see how soon he can go!"
"Um....really?"
"Hell yeah! Do it, and call me right back."
And so I had to call the regional manager in Dallas and explain to him exactly why it was that we had to fly, in two days, from Texas to Florida. And then rent a 26 foot truck, and then drive it BACK to Texas. And so began the trip to Florida and back.
Stay tuned for the entry about the flight to Florida...
Wednesday, January 30, 2008
You Mean I Don't Get Paid for This?
HEY! Guess what everybody! And when I say everybody, I mean all nine of you, I got myself a real life column-writin' gig over on Children With Diabetes. Myself and two other guys have been given the opportunity to write a humorous column once per week on the CWD main page.
The owner of the site, who obviously doesn't read this blog or he never would have allowed it, insisted that we provide him with several weeks' worth of inventory in case we get tired of it and stop doing it. How could anyone get tired of writing funny stuff? I guess maybe it's just that I am so over-opinionated that I am grateful to find a new audience. People who know me stopped listening to me YEARS ago.
Once our first column is actually up, I'll be sure to post the link here. And I TOTALLY plan on using that column to artificially boost my hit count here. It's the American Way, after all.
Oh, and for those of you waiting on the "Trip to Florida and Back" blog, hang tight, it's coming.
The owner of the site, who obviously doesn't read this blog or he never would have allowed it, insisted that we provide him with several weeks' worth of inventory in case we get tired of it and stop doing it. How could anyone get tired of writing funny stuff? I guess maybe it's just that I am so over-opinionated that I am grateful to find a new audience. People who know me stopped listening to me YEARS ago.
Once our first column is actually up, I'll be sure to post the link here. And I TOTALLY plan on using that column to artificially boost my hit count here. It's the American Way, after all.
Oh, and for those of you waiting on the "Trip to Florida and Back" blog, hang tight, it's coming.
Saturday, January 26, 2008
Home Sweet Home
Whew. Just got back from a VERY long road trip, so I haven't had time to blog, but I promise an extraordinarily amusing one about my adventure through the deep South. Well, maybe not extraordinarily. But it'll be well worth the wait.
Sunday, January 20, 2008
Ways to have fun with your child's diabetes
Of course diabetes isn't fun, but let's pretend it is...maybe for just a minute?
1. When eating with friends, constantly tell your child to hold their breath after each bite. When your friends ask why you do that, say "Air is FULL of carbs. Didn't you know that?"
2. While you're pushing buttons on your child's pump in public, loudly proclaim "There, that oughta shut you up for awhile!"
3. If you see someone staring at you while testing your child's blood sugar, look at their stomach and say, "You're next, tubby."
4. If your child's pump starts to alarm in public, hold it up close and say, "Dang it! Out of ink again!"
5. When drawing up an injection at a restaurant, ask the waitress if she would mind having the kitchen "nuke" it.
6. (This one's just for the older kids who can play along. The lawyers insisted.) While eating a meal with family or close friends, have your child tear a small ketchup packet, and when he pokes his finger, have him smear the ketchup on his hands. Hilarity ensues.
7. After giving your child an injection, remove the plunger from the syringe and use the casing as a straw.
8. Next time you are pulled over with your child in the car, tell the officer you were speeding because your child has type 2 and is late for an appointment with their trainer.
9. Go to a bar where people play darts and start throwing syringes at the board.
10. When your child's pump alarms at the grocery store checkout (doesn't it always?) Look up at the clerk and say "WHAT HAVE YOU DONE?"
Bonus: Collect every single test strip you use for an entire year. Mail them to your insurance company with a note that says "Are you SURE you don't want to cover a CGMS?"
Friday, January 18, 2008
CGMS, Here I Come!!!
I just got off the telephone with my insurance company, and I am more than thrilled to inform all six of you that they are covering the CGMS! I am absolutely ecstatic!
Of course, there is always the fine print. Maybe I'm just blinded right now by visions of stable blood sugars, but I'm not reall worried about them. Here they are, as I understand them:
1. CGMS and sensors are covered under Durable Medical Equipment as an "insulin pump accessory."
2. My DME has an annual maximum benefit of $2500.
3. My copay, once the deductible has been met, is 10%.
What does all that mean?
Well, thanks to A Plus Medical Supply, I am not at all worried about the deductible. Once they have billed my insurance company for my first supply order, my modest $500 deductible will be history in no time. As always, co-pays and other up-front costs are what will sting a bit in the beginning. $699 upfront to upgrade my pump from the Minimed 715 to the 722. Minimed informs me that United will pay for an upgrade to a pump every three years. I'm only on year two. The good news is that $400 of that is refunded once they receive my old 715 in the mail.
The transmitter costs $600, $540 of which will be covered by insurance. For those of you keeping score at home, that means $359 out of pocket so far, and $60 applied to my $2500/year DME maximum. Riveting, I know. The cool thing is that with A Plus, my deductible is "gone." I don't have to pay it.
Next come the sensors. The regular price for sensors is $35 apiece. I don't now if United has a negotiated rate with Minimed yet or not, but I suspect that is the case. Those sensors are approved for 3 days' of use, but the reality is more like 6. So I figure I can get by on 5 sensors per month. That's $17.50 in co-pays for me, and another $157.50 against the DME maximum. So, in a year that's $210 worth of copays, and $1890 against the $2500 maximum.
It's going to be close with that DME limit, but maybe if I ask her Emma will loan me one or two of hers.
Of course, there is always the fine print. Maybe I'm just blinded right now by visions of stable blood sugars, but I'm not reall worried about them. Here they are, as I understand them:
1. CGMS and sensors are covered under Durable Medical Equipment as an "insulin pump accessory."
2. My DME has an annual maximum benefit of $2500.
3. My copay, once the deductible has been met, is 10%.
What does all that mean?
Well, thanks to A Plus Medical Supply, I am not at all worried about the deductible. Once they have billed my insurance company for my first supply order, my modest $500 deductible will be history in no time. As always, co-pays and other up-front costs are what will sting a bit in the beginning. $699 upfront to upgrade my pump from the Minimed 715 to the 722. Minimed informs me that United will pay for an upgrade to a pump every three years. I'm only on year two. The good news is that $400 of that is refunded once they receive my old 715 in the mail.
The transmitter costs $600, $540 of which will be covered by insurance. For those of you keeping score at home, that means $359 out of pocket so far, and $60 applied to my $2500/year DME maximum. Riveting, I know. The cool thing is that with A Plus, my deductible is "gone." I don't have to pay it.
Next come the sensors. The regular price for sensors is $35 apiece. I don't now if United has a negotiated rate with Minimed yet or not, but I suspect that is the case. Those sensors are approved for 3 days' of use, but the reality is more like 6. So I figure I can get by on 5 sensors per month. That's $17.50 in co-pays for me, and another $157.50 against the DME maximum. So, in a year that's $210 worth of copays, and $1890 against the $2500 maximum.
It's going to be close with that DME limit, but maybe if I ask her Emma will loan me one or two of hers.
Thursday, January 17, 2008
Like a Thief in the Night
Diabetes takes a lot of things away from people. It takes away time, money, energy, and even limbs and lives. I try not to think too much about my own mortality. I know I am getting older, but not necessarily wiser. I worry much more about my daughter who, when she is my age, will have had diabetes for 32 years. Lately something else has bothered me more than any of these things though.
When I was a teenager and had fallen madly in love with this gorgeous brunette named Amy, I envisioned for us a future that included a house, two cars, a cat, a dog, and an absolute house full of children. I was absolutely certain that I was going to have a home so littered with children's toys that it would resemble a Toys R Us. And I really meant it. I wanted kids. And lots of them. Well, maybe not lots, but at least four. I imagined that one day when I was old I would have my four grown children over to visit us and ten or twelve grand babies running all over the place with Amy chasing after them offering milk and cookies. I seem to remember Amy being fine with that. But then I seem to remember lots of things that didn't happen, and not remembering lots of things that did.
And then came diabetes. You see, it's wise not to mess around with what many surveys indicate is most important to women: security. And I think that's true. Maslow's Hierarchy of Needs missed the boat on that one, I presume. Amy was once married to a healthy, strapping and robust young man. The next day she was married to a man with a disease that would probably kill him much sooner than she had planned. Granted she's probably plotted my death many times since, but not so much at the time. She's even hinted, "You know, I could give you a massive bolus in the night if I wanted to." Yikes. This was not a woman in any condition to produce at least four children.
After Emma's diagnosis, the first priority was making sure our second child was as stable and healthy as possible. The second priority, only very closely behind the first, was to make sure there wouldn't be a third child. So I went off like a good husband and had a vasectomy. And so diabetes had taken its first real toll on me. I never really discussed this with Amy. She was, after all, right. Emma was going to be a handful, and we knew that from the minute she was diagnosed. 
Diabetes had robbed me, and not even like a thief in the night as the title of this entry suggests. It had pistol-whipped me, tied me up, and stolen my virility from me at gunpoint. I hadn't wanted to give it up. I wanted to have lots of kids. Diabetes wins again.
Diabetes 360.
Wednesday, January 16, 2008
The Financial Side of Diabetes
I just finished making a spreadsheet for a mom over at Children with Diabetes that will hopefully convince her insurance company that a CGMS is not only an effective way to control blood glucose but also a financial advantage to both the insurance company and the patient. When we were trying to get Emma covered for the CGMS, a similar spreadsheet helped us to convince United HealthCare that the CGMS would be a good deal. At least I like to think so.
Every day I am amazed at all the posts on the various forums and blogs that have to do with financing diabetes. Let's take a moment to look at the retail cost of all the supplies I use in a month. Just me, not including Emma.
1. Novolog insulin, 3 vials per month: $246.96
2. Test strips, 180 per month: $159.96
3. Pump tubing, reserviors, and infusion sets: $250
4. Alcohol swabs, IV prep, the occassional syringe, glucose tablets, etc.: $50
That's easily over $700 per month in a good month.
I am lucky. I happen to have excellent insurance, great pharmacists, and a little place called A Plus Medical Supply. If you are a diabetic with PPO insurance, you must call them NOW.
Anyway, I digress. It's no wonder that the financial management side of diabetes becomes so quickly overwhelming. I used to scoff when the media would report that people were choosing between medication and food. I don't scoff anymore, because I see it now everyday in the forums. I'm not going to advocate socialized medicine here or anything, but isn't it really about time that drug companies stop charging $80 for a vial of insulin and $1.00 per test strip?
There is a fight brewing in Congress over generic insulins. Generics labs say that can make it, and the patent-holders say no way. The FDA can't do anything yet because there's no process for testing and approving generic insulins. Is there anything more frustrating than that?
Every day I am amazed at all the posts on the various forums and blogs that have to do with financing diabetes. Let's take a moment to look at the retail cost of all the supplies I use in a month. Just me, not including Emma.
1. Novolog insulin, 3 vials per month: $246.96
2. Test strips, 180 per month: $159.96
3. Pump tubing, reserviors, and infusion sets: $250
4. Alcohol swabs, IV prep, the occassional syringe, glucose tablets, etc.: $50
That's easily over $700 per month in a good month.
I am lucky. I happen to have excellent insurance, great pharmacists, and a little place called A Plus Medical Supply. If you are a diabetic with PPO insurance, you must call them NOW.
Anyway, I digress. It's no wonder that the financial management side of diabetes becomes so quickly overwhelming. I used to scoff when the media would report that people were choosing between medication and food. I don't scoff anymore, because I see it now everyday in the forums. I'm not going to advocate socialized medicine here or anything, but isn't it really about time that drug companies stop charging $80 for a vial of insulin and $1.00 per test strip?
There is a fight brewing in Congress over generic insulins. Generics labs say that can make it, and the patent-holders say no way. The FDA can't do anything yet because there's no process for testing and approving generic insulins. Is there anything more frustrating than that?
Monday, January 14, 2008
Sweet Stability
I'm proud to announce that after just a few short weeks in the gym, playing raquetball, and indoor soccer that my blood sugars have returned to some form of stability. After weeks and weeks of waking up to high blood glucose, then a long period of highs after meals the exercise is finally paying off. It's come at a price, of course. It takes up to two hours of preparation for me to engage in raquetball or soccer, but not quite as much before a weight-lifting session. I usually now just remove my pump while I am lifting weights- something I had never done before. I know, it's a luxury that I, being type 1.5, have over a true type 1 diabetic. That is, I still produce a little bit of insulin, so ketones are not really a problem for me unless I have a nasty stomach bug. It's been nice to be relatively stable, and of course the weight loss that has gone along with the exercise has definitely helped.
Yesterday Amy gave me a list of a few things she needed done before I went off to play raquetball, so I hooked up my iPod and got to work. While I was working on my various tasks (hauling Christmas decor up to the attic, taking down a few remaining lights, cleaning up the backyard, and scalping the lawn), I thought it might be fun to do a little experiment. My plan was to measure my BG every thirty minutes during the Dallas Cowboys playoff game versus the Giants to see how much impact emotions had on my blood sugars. I never did it, but I may still someday. Pity, guess it'll have to wait until next year.
Yesterday Amy gave me a list of a few things she needed done before I went off to play raquetball, so I hooked up my iPod and got to work. While I was working on my various tasks (hauling Christmas decor up to the attic, taking down a few remaining lights, cleaning up the backyard, and scalping the lawn), I thought it might be fun to do a little experiment. My plan was to measure my BG every thirty minutes during the Dallas Cowboys playoff game versus the Giants to see how much impact emotions had on my blood sugars. I never did it, but I may still someday. Pity, guess it'll have to wait until next year.
Thursday, January 10, 2008
Inactivity Penalties
Yesterday I was reading in USA Today about the little scam retailers run on consumers who buy gift cards. Specifically, if you don't use them within a set period of time, they begin to charge you fees. And like most things I see, I made an instant connection to diabetes. I have become much more physically active in the last week or two than I have been in some time. Raquetball, weightlifting, personal trainer, and now...indoor soccer. There have been some real upsides and even some downsides to my manic burst of my once-dormant athleticism. Believe it or not, I was once a pretty good athlete. Soccer, football, wrestling, track and field, and even lacrosse are all sports that at one time or another I participated in. Some of them I even excelled at. The difference is that back then I didn't have to account for blood sugars.
Now physical activity is really a must, and along with it comes the need for precise blood sugar control and lots and lots of planning. For example, last night I was getting ready to go play indoor soccer. After dinner, my BG was 102, which is great 99% of the time. When you're about to play a strenuous sport like soccer, it's not enough. More than once over the last two weeks I have been frustrated by my inability to get my BG up enough to play raquetball or lift weights. Don't get me wrong, the exercise has given me great numbers, and I am proud to report that as of last night I have lost 4.5 pounds. But the fact remained that 102 wasn't going to sustain me through a game of soccer, so I drained a juice box (actually it was one of those "juice-in-a-keg" things) and ate a couple of graham crackers. An hour later I was 223. That would be just about right.
Then I am sitting at the field waiting for my game, and all those nerves started to kick in. I get very excited before a game, and so I tested one last time: 318. 318!? My pump suggested 7.5 units. I corrected with just 2 and played. All the while knowing that playing a sport late at night was just asking for a severe late-night low BG.
When I got up this morning I was 150, so it all worked out just about right. But all in all, it took well over 2 hours of intense management to get ready to play soccer for an hour.
Diabetes 360.
Now physical activity is really a must, and along with it comes the need for precise blood sugar control and lots and lots of planning. For example, last night I was getting ready to go play indoor soccer. After dinner, my BG was 102, which is great 99% of the time. When you're about to play a strenuous sport like soccer, it's not enough. More than once over the last two weeks I have been frustrated by my inability to get my BG up enough to play raquetball or lift weights. Don't get me wrong, the exercise has given me great numbers, and I am proud to report that as of last night I have lost 4.5 pounds. But the fact remained that 102 wasn't going to sustain me through a game of soccer, so I drained a juice box (actually it was one of those "juice-in-a-keg" things) and ate a couple of graham crackers. An hour later I was 223. That would be just about right.
Then I am sitting at the field waiting for my game, and all those nerves started to kick in. I get very excited before a game, and so I tested one last time: 318. 318!? My pump suggested 7.5 units. I corrected with just 2 and played. All the while knowing that playing a sport late at night was just asking for a severe late-night low BG.
When I got up this morning I was 150, so it all worked out just about right. But all in all, it took well over 2 hours of intense management to get ready to play soccer for an hour.
Diabetes 360.
Monday, January 7, 2008
There's a Reason it's Called "Diabetes 360"
In the title of my blog, I state that no matter where I turn, diabetes is there. Well this weel I have been playing a lot of raquet ball as a way to get myself into better cardiovascular condition. It's great exercise, it's a lot of fun, and unforunately it requires a lot of preparation. A "normal" person just picks up their racket and plays. Well it's not quite as easy for someone with diabetes.
I won't get too terribly far into the details, but yesterday I was set to play at 5pm, so at 3:30 or so I had a nice big lunch and just barely bolused for it so I would have a blood sugar cushion before I played. The first day I played my BG was 199 when I started, and after just one game it was 97. That's a big drop! So anyway, I figured a plate of enchiladas and a yogurt would be plenty to carry myself through an hour of play. Before I left I tested...79. WTF? No way was that going to work. No way. So I stopped at 7-11 and picked up a Sunny Delight (58 carbs) and a bottle of Gatorade. Slammed the Sunny D and tested before I began. 77. It was as close to crying as I have been since the Steel Magnolias incident. It was just so frustrating. So I had to sit out the first 15 minutes of play and wait for the Sunny D to kick in. It finally did, and I played well and had a lot of fun.
An hour later? 225.
Diabetes 360.
Thursday, January 3, 2008
Day Two (and Final) Day Off the Pump
Last night I again struggled with moderately high blood sugar that stubbornly held in the 200 mg/dl range, but stubbornly I continued on. And with the aid of 64 ounces of ice water, got the BG down to 118 mg/dl at bedtime, which happened to be around 11:00. Fast forward now to 12:38AM, when I awoke to a pounding heartbeat and the general feeling of unease I get when my BG is low. So I got up and VERY unsteadily made my way to the kitchen to test. I finally managed to open up my kit and somehow got my shaky hand to meet up with the test strip. 52 mg/dl, and based on how I was feeling, it was still on its way down in a hurry.
There was no time to fool around with this one, so I went straight for the atom bomb...pop-tarts. And then a peanut butter sandwich, then another, then chocolate milk...
By now I was as scared as I have ever been while low. I could really feel myself struggling to hang on to consciousness. Scary thoughts began to race through my foggy mind. What if I took too much Lantus? What if my BG isn't coming up? I eyed the glucagon and considered a micro-injection to provide a fail-safe boost. I tested again after eating all that food. Still 52 mg/dl. That was actually ok because I knew that I wasn't dropping anymore, and so I went to bed. Normally I have a hard time falling back asleep because of the counter-regulatory response. Not this time. I'm fairly certain I just passed out.
At 7AM I awoke to the diabetes hangover. Sticky, dry mouth, headache, etc. This was not going to be good. Normally after one of my nighttime feasts I can drop a quick pump bolus to minimize the damage. Not this time. 483 mg/dl. I took an injection of 15 units of Novolog and hooked my pump back on with a temp basal of 4 units per hour for the next 3 hours. It's going to be a miserable day.
There was no time to fool around with this one, so I went straight for the atom bomb...pop-tarts. And then a peanut butter sandwich, then another, then chocolate milk...
By now I was as scared as I have ever been while low. I could really feel myself struggling to hang on to consciousness. Scary thoughts began to race through my foggy mind. What if I took too much Lantus? What if my BG isn't coming up? I eyed the glucagon and considered a micro-injection to provide a fail-safe boost. I tested again after eating all that food. Still 52 mg/dl. That was actually ok because I knew that I wasn't dropping anymore, and so I went to bed. Normally I have a hard time falling back asleep because of the counter-regulatory response. Not this time. I'm fairly certain I just passed out.
At 7AM I awoke to the diabetes hangover. Sticky, dry mouth, headache, etc. This was not going to be good. Normally after one of my nighttime feasts I can drop a quick pump bolus to minimize the damage. Not this time. 483 mg/dl. I took an injection of 15 units of Novolog and hooked my pump back on with a temp basal of 4 units per hour for the next 3 hours. It's going to be a miserable day.
Wednesday, January 2, 2008
Day One Off the Pump
So last night I decided I was going to take a break from my pump. I thought, and still think, that it will be a good way for me to re-focus on my diabetes management by making it a little more complicated and forcing me to be very aware of everything I eat. It's very easy to over-eat or go back for seconds on the pump, because I can just dial up the extra carbs. But is drawing up another syringe worth that second piece of toast with lunch? Nope. 
So I drew up 35 units of Lantus, and remembering that the stuff burns if you inject it too quickly, slowly gave myself the dose in my stomach. What I didn't remember is that you have to hold the needle in place for 10 seconds after injecting or, like what happened to me, you'll be treated to a little Lantus fountain coming out of the injection site. I don't know how much that was, but my guess is that about 3 units shot right back out. Then I set poor Angelina all alone over on the counter and she patiently beeped at me for about an hour before Amy filled the reservoir with water and put it on a .05 temp basal. Angelina was quiet.
I was encouraged last night at bedtime by a reading of 113 mg/dl. Amy suggested I get up in three hours and test. That would have been 2am. She should have known better. I should have known better. 253 mg/dl greeted me this morning along with a killer need to pee. I can always tell if I'm high in the morning based on how badly I need to go. That night was nice. No rolling over on the pump, no tangled tubing, and no having to take it off my belt when I undressed.
Today I have struggled with highs despite constant monitoring, corrections, and very careful carb counting. I'm fairly certain that I need more like 45-50 units of Lantus, but I'm going to only go up in 5 unit increments. I figure as my diet is better controlled, my insulin requirements will go down too. Today I also asked for my doctor to prescribe me a box of insulin pens and needles so I don't have to carry around syringes. This ought to be interesting.
So I drew up 35 units of Lantus, and remembering that the stuff burns if you inject it too quickly, slowly gave myself the dose in my stomach. What I didn't remember is that you have to hold the needle in place for 10 seconds after injecting or, like what happened to me, you'll be treated to a little Lantus fountain coming out of the injection site. I don't know how much that was, but my guess is that about 3 units shot right back out. Then I set poor Angelina all alone over on the counter and she patiently beeped at me for about an hour before Amy filled the reservoir with water and put it on a .05 temp basal. Angelina was quiet.
I was encouraged last night at bedtime by a reading of 113 mg/dl. Amy suggested I get up in three hours and test. That would have been 2am. She should have known better. I should have known better. 253 mg/dl greeted me this morning along with a killer need to pee. I can always tell if I'm high in the morning based on how badly I need to go. That night was nice. No rolling over on the pump, no tangled tubing, and no having to take it off my belt when I undressed.
Today I have struggled with highs despite constant monitoring, corrections, and very careful carb counting. I'm fairly certain that I need more like 45-50 units of Lantus, but I'm going to only go up in 5 unit increments. I figure as my diet is better controlled, my insulin requirements will go down too. Today I also asked for my doctor to prescribe me a box of insulin pens and needles so I don't have to carry around syringes. This ought to be interesting.
Tuesday, January 1, 2008
Taking a Break
This evening I took off my insulin pump. I've been wearing insulin pumps for over 5 years now, and I just want to take some time away from it for a bit. It can be a serious pain sometimes. So tonight "Angelina" is tucked safely away in a kitchen drawer and I am pumped up on Lantus. It's been a LONG time since I have drawn up 35 units of ANYTHING, and it was a bit alarming to inject that much insulin.
So this means back to careful carb-counting and not so many snacks, and that's exactly why I am doing it. I'm hoping that by going to MDI for a while will force me to eat less and be more dilligent about carb-counting. After all, before I got on the pump I never had an A1c over 6.5. In the last two years, I haven't had one below 7. So let's give it a shot....get it...shot?
So this means back to careful carb-counting and not so many snacks, and that's exactly why I am doing it. I'm hoping that by going to MDI for a while will force me to eat less and be more dilligent about carb-counting. After all, before I got on the pump I never had an A1c over 6.5. In the last two years, I haven't had one below 7. So let's give it a shot....get it...shot?
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