Easy on the Eyes

At the Friends for Life conference this year, Dr. Ben Szirth and a team of eye care specialists from the Institute of Ophthalmology and Visual Science from the New Jersey Medical School provided free retinal screenings for people with type 1 diabetes for the seventh year in a row. But this was my first time being screened at the conference.

I saw quite a few different people who all looked at my eyes at various stations and with various impressive pieces of equipment. It felt a bit like speed dating, going from chair to chair and talking congenially with pleasant strangers.

The first technician performed some basic eye chart style vision checks, having me stand at a distance and read the eye chart covering one eye, then the other. Pretty standard.

The second technician took some pictures of my retinas for the doctor to review. He showed me the photos and explained what he was photographing.

My third station included an autorefractor that I've seen at my usual checkups - you're asked to focus on an image of a hot air balloon while the machine measures your specific vision correction needs.

My next stop was to measure my eye pressure. I believe it's actually called a tonometer, but I have always thought of it in my head as "the air puffer thingy." I've often seen my eye pressure in the borderline high range (normal is 12-22 mm Hg). I'm usually 18, 19, 20. I don't know that I've ever seen above 21. The day of this retinal screening? I was clocking in 24s, 25s. WTH? We measured it again. Same. Hmm. Not pleased.

It had been a rough night. I'd had a pod malfunction that had sent my overnight blood sugar into the 400s. I had taken a correction injection around 3am and decided to deal with changing out the pod the next morning. By breakfast, I was down into the high 200s, and by my retinal screening at 10:20am, I was still floating in the 200s well above my target range.

I was then directed to the machine that measures the thickness of your retina. I've been going to the ophthalmologist for 17 years and I had never encountered this piece of equipment before.

Dr. Ben stood nearby to review the results and explained to me that this was a $50,000 piece of equipment that many of his contemporaries told him was unnecessary to bring to a screening like this...but I am so glad we had it.

289.

My right eye has always been my well-behaved eye. My right eye has always had clearer vision, fewer hemorrhages, lower pressure. But my retinal thickness on the left measured normal (between 250 and 280) and it was my right eye that was cause for concern. 289. Let's check that again. 287. Damn.

So what does that thickness mean? That's what this machine was able to tell us. He studied the image, focusing on the big black bulge in the middle.

A Little Less Caffeination

I was not a coffee drinker. Not for the longest time. I remember trying Starbucks when I was about 18 and it was the new thing in town. I would occasionally get something sugary and frothy at 7-11 when I had early mornings in college. But just brewing a pot? That wasn't something I ever thought I'd do.

In late 2006, a friend brought me some quality ground coffee from a trip to Seattle. I didn't even own a pot. I wanted to be able to tell him that I tried it, so I went to Target and bought the smallest $12 4-cup coffee maker I could find. I didn't care for the coffee, but now I had a coffee pot...and when you give a mouse a cookie...

Fast-forward to now, 7 years later. I drink a lot of coffee. I take insulin to cover it some of the time because my continuous glucose monitor has proven to me time and again that an 8 oz cup gives me a 30-40 mg/dL bump in blood sugar. I'm better about accounting for it in my dosing in the morning than I am later in the day.

When I tell people I drink too much coffee, they always commiserate and tell me they do, too. Then I tell them I drink at least 6 cups a day and they go "whoa, okay, I don't drink that much."

I don't need it. I drink it because I like it...because I'm bored...because my blood sugar might be high and I'm sleepy...because my kids wear me out...because it's easier to brew a lot than a little...because it's there...because it's tastier than water. But I drink too much.

Between the Splenda, the sugarfree Coffee Mate, and the caffiene,
I usually need to count a cup of homebrew as about 10g of carb.

Strip Safely

If you or someone you love has diabetes, I want to shock you for a second.

If you don't have diabetes, I want to put this shock into perspective.

Blood sugar meters are all crap. See these numbers?

They're all essentially wrong. My plasma glucose was 104.

And they're mostly within FDA's acceptable variance range. The one on the far left was -22% off, but the other four performed within the +/-20% allowance.

Meter companies and the FDA worked together to set these (arguably loose) standards. And they're thankfully petitioning for tighter standards (+/-15%) in line with international recommendations. The PROBLEM is:

1) More than 25% of blood glucose meters already fail to meet current standards.

2) There is no post-market regulation of these meters or their strips. Once released into the wild, subject to weather or age or drug interactions or, I don't know, Tuesdays, there's no one checking to see if they continue to meet standards.

3) New Medicare laws will bring low-cost, low-quality meters and strips to millions of people with diabetes. Without a regulatory process in place, people will get hurt.

4) I take a different amount of insulin depending on that number. Not enough insulin can kill me. Too much insulin can kill me. I play Russian Roulette every time I take my dosage. In the above example, I was about to drive a car. On a highway. I had to make a decision about taking insulin for the 124 or eating a snack for the 82 before I got behind the wheel. It's the kind of decision I make 6-8 times per day and I'm usually basing it on that number.

So what can we do? Join me in writing to our lawmakers. Join us. Please. Below is my letter.

Fear Itself

With the new year, rather than make any sort of resolution, I asked myself to be more aware of my fear. If I also prove to be a bit braver, that'll be great, but first, I just wanted to acknowledge fear.

I'm a bold person. You wouldn't immediately recognize my fears. I'm not afraid of people or performing or heights. Many people see me as courageous, outspoken.

But I have a not-so-public fear.