The State of Diabetes

The French author, Jean-Baptiste Alphonse Karr is credited with saying:

 plus ça change, plus c’est la même chose”

which when translated means “the more things change the more they stay the same”.  This phrase lends itself very well to describing the state of diabetes, research, treatment and prevention.  Last week was my 39th Diaversary. Today, as I write this post, I am 50 years and 13 hours old.  My world changed 6 days before my 11th birthday. For most intents and purposes, my perspective has mostly been about having diabetes, day in and day out. Like the shampoo bottles say “Lather. Rinse. Repeat.”

When I was diagnosed things were a lot simpler than they are now.  Please allow me to hit the highlights below:

Available Insulin in 1979
Short Acting Intermediate Acting Long Acting
 Regular – Beef  NPH – Beef  Lente – Beef
 Regular – Pork  NPH – Pork  Lente – Pork
 Regular – Beef/Pork  NPH – Beef/Pork  Lente – Beef/Pork

Recognize any of these? They don’t exist any longer. You can still find their cousin the rDNA biosynthetic human based insulins like Humulin or Novolin. The options were slim and there were only two major manufacturers in the game, Eli Lilly and NovoNordisk.

My parents had top of the line insurance and at that time I wasn’t concerned with the cost of the insulin. I know that even in the scope of things, the insulin was not astronomical in price.  I used “R” and “N” combined. I don’t think I used more than a bottle of each in a month. I remember, as a teen going to the pharmacy and getting my insulin, and the whole thing cost less than $20.

Eli Lilly Pork insulin, NPH

Let’s fast forward to today. My Humalog Kwik pen , 30 day supply, retails for $2,086.09. My Tujeo is $916.59 for thirty days.  My  co-pay is $40 for each. I haven’t purchased needles or pen tip in several years because I inherited over 500 tips a couple of years ago, and I re-use them until they can’t be used. (Don’t shake your head. You know what I am saying.) If insulin was the ONLY medication I used, and I did not test, my monthly expenditure would be $3002.68.  I have been unemployed and had to pay out of pocket before getting assistance.

Back to 1979.  I believe that I was sent home from the hospital with a U-100, 1cc 25G 5/8″ disposable insulin syringe. There was one BIG manufacturer of insulin syringes, Becton-Dickinson (BD).  They had the insulin syringe market wrapped up. Terumo and Monoject were in the race but were happy to have the hospital syringe market.  BD had a quality syringe.  I remember having to inject at a 45° to make sure the insulin was delivered into the subcutaneous layer and not muscle. Now the needles are 30-31 Guage and so short they are referred to as ‘shorts’ or ‘nano’. No longer do you need to inject at 45°. Perpendicular all day long!

Monoject Syringe and needle with rigid pack.

Part of my luggage, coming home from the hospital, included the ever popular Clinitest home chemistry set and it’s little brother the Acetest Ketone Test Kit:

Clinitest Urine GLucose Test Kit and the Acetest Ketone Urine Test Kit


My doctor also wanted to know the volume every time I urinated. So, I also had a graduated pitcher, in the bathroom, along with my marble notebook, to document it all.  Going to the bathroom took 10 minutes sometimes! This was part and parcel for me for several years.

Eventually, The home self-blood glucose meter (SBGM) became “affordable”. I remember my parents saying that my meter was roughly $300. That is the equivalent of $770 today.  I do not think that insurance covered it at the time. I may be wrong. What did I know? I was a teenager.  What I do remember growing up was that deciding on which meter to use was never a question of coverage.  I picked a meter system and insurance paid for it.  Fast forward to today.  I know in my plan, I have the choice of any of the OneTouch meters. Period.  And even then they restrict the number of test strips I can use in a month. When I was a telephonic disease management nurse my patients used to ask me “What is the best meter I should get?”  My answer was always the same, “Let’s look and see what your plan will cover. That will be the best one for you.” A little bit of trivia for you: The “Accu-Chek” meter, by Roche, is the clinical name for requesting a blood sugar value, whether from a vein or a fingertip. “Get an Accu-Chek on Mrs. Jones.” Regardless of the meter being used. The same as when you are making a photocopy you say you are making a Xerox despite the machine being another brand.

There is been a petition and campaign circulating called “Coverage2Control”. The JDRF started the campaign which targets these three factors:

“1) keeping out-of-pocket costs for insulin and diabetes management tools predictable and reasonable, 2) giving people the freedom to choose the insulin pump that’s right for them; and 3) covering all life-saving technology, including artificial pancreas systems.”

You can read the entire message from JDRF here.

We are still taking insulin.  Now it costs a whole heck of a lot more!

We are still testing. Now the supplies cost a whole heck of a lot more!

We have a lot of products available on the market to help manage our condition. Unfortunately, the insurance industry prevents us from being able to have the choice to use the products that will work best for us, not just the products that have the highest profit margin for the insurance company. Again, to do your best it costs a whole heck of a lot more!

The more things change. The more they stay the same!

You get the picture!


Stay safe. Do good!


Tim, aka The DiabetesDude



What do these things have in common?

Can you tell me what the common denominator is in the four items listed below:

  1. Your Amazon Prime membership
  2. A membership to the local gym
  3. A subscription to your favorite magazine
  4. Renewed funding for the Special Diabetes Program-Type 1

Got your answer?

I hope that you said all these things require that you renew them, after consideration.  Do you really use your Prime membership enough to justify the $99/year?  Do you really go to the gym frequently enough to justify the monthly fee?  How many of those magazines are still sitting in a pile, never having been read? Lastly, Have all the cases of Type 1 diabetes been cured and no more people will ever suffer from it again?

I really think that this is a no-brainer. Maybe I am wrong?  In 2015 Congress reauthorized the funding for the Special Diabetes Program for Indians (SDPI), which includes the Special Diabetes Program-Type 1, for 2 years. The quote below is from the American Diabetes Association Website,

“The American Diabetes Association has long been a leader and partner in efforts to increase the federal commitment to cure and prevent diabetes and to address the diabetes epidemic in disproportionately impacted populations. Since 1997, a key component of these efforts has been the Special Diabetes Program for Indians (SDPI) at the Indian Health Service (IHS) and the Special Statutory Funding Program for Type 1 Diabetes Research (SDP-type1) at the National Institutes of Health (NIH). These two programs represent a significant contribution from the federal government to combat, prevent and cure diabetes. Both of these vital programs require periodic Congressional re-authorization.”

The Bill (S.747) (H.R. 2545) to reauthorize the program for 2 more years was introduced to Congress on March 28, 2017. The 2015 Bill would expire on September 30, 2017.  The funding was extended to December 31, 2017. Congress had to think about it before giving it a thumbs up for 2 more years. Now, there are two thoughts that run through my mind:

  1. Congress being the omniscient legislators that they are, know something that we don’t. Perhaps they know that a cure is finally sitting in a research lab somewhere that needs until New Year’s Ever of 2017 to gestate and on January 1, 2018 there will be no more need for funding because the cure and preventative measures will roll out to the world, finally ridding the globe of this insidious disease.  I mean, every newly diagnosed PWD has been told “In 10 years we will have a cure for you and you will never have to worry about it again!”
  2. The other thought is that not one member in the Senate or the House of Representatives either has diabetes or has a relative with diabetes, so they really are not impacted, directly or indirectly, by the effects of this disease, including emotional, psychological, physical and let’s not forget financial.  It is damn expensive to be able to afford to stay alive!

Congress approves and earmarks millions and billions of dollars a year for programs, studies and grants that are unnecessary and sometimes outright ridiculous.  You can do the research on your own – I found too many examples to include,  None of which included a study or program that involved saving the world population from a deadly disease – at this point it could be any disease, not just diabetes. Not ONE!  But congress funded a production of Hamlet, in a field, in New York. The characters were all played by DOGS! What?!?!?! (I had to throw this one in because it was just so out there.)

Get your act together Congress!  You were elected by the people of your state, to represent them and create and pass legislation that will benefit, protect and hopefully enhance their lives. We have to start with the basic needs. Until everyone across this place we call the United States of America has enough food to eat, a safe place to sleep, a way to earn an adequate income and last but not least, affordable access to health care to allow them to maintain their ability to live and breathe. Until then, forget about the non-essential requests that come across your desk. Renewing the Special Diabetes Program for Indians & the Special Diabetes Program – Type 1 should not be an option. It should exist in perpetuity until there is both a way to prevent it AND cure those who already suffer from it!

As a constituent, human being, PWD or a loved one of a PWD, here is how YOU can help:

Tell your elected representative(s) in Congress to support the SDP on January 19th, 2018.   Then share it with your friends and family, Instagram, Twitter, FaceBook, anyway you can get this out there.  Remind your representative in Washington that they are elected and may be replaced by someone who SUPPORTS the SDP!


Thanks for stopping by. I hope you got something out of this rant. If you did let me know in the comments. Follow me because I have plenty more to come. Tell someone you know to stop by. Maybe they will like it too.  I you didn’t like it – leave me a comment. I am always open to other ideas.

Stay safe. Do good!


Tim aka “The DiabetesDude”

Counselor’s Last Stand

Welcome back!  My last few entries have been a little heavy so I decided to lighten it up a little bit.  I hope you enjoy this installment!

I have held many non-traditional positions in my 29 years as a Registered Nurse but none have been as fun as being a camp nurse at a residential camp for children with diabetes.  I spent 2 summers at camp.  My first summer was shortly after I graduated nursing school.  I had been a camper at Camp Glyndon, in Reisterstown, Maryland the year after I was diagnosed.  It was the life experience that had the most impact on my life as a diabetic, even to this day.  I had been to summer camp before but that was prior to developing diabetes.  I had a good time. How could you not? It was located on the Chesapeake Bay on the Eastern Shore of Maryland. But Glyndon was different. All the kids had diabetes. Many of the staff, as well, were diabetics themselves.  A hypo was not a catastrophe or something that induced panic and hand wringing among the adults.  You had a hypo – as is magical, someone appeared with a fanny pack of antidotes – a meter, Lorna Doones and Glutose. While you were being tested and treated life went on around you.  No crowds of onlookers like a 10 car collision had just occurred on the highway. gathered around gawking at the kid with the pale face and sweat pouring down his head. Nope! Non of that.  Just you and your personal “St. Bernard” taking care of business. Swimming, kickball, archery, tennis, arts and crafts continued. With any luck in 10 minutes you were back in the fray.  Like I said, camp was the experience that had the most influence on how I lived the rest of my life as a PWD. So, after I became a Registered Nurse, I felt it was only right to return to camp and join the care team.  More about that summer and my first summer as a camper later.

This installment takes place many years later.  I was in between jobs, it was Spring and Glyndon was hiring for the Summer.  I applied and was hired.  By this time I had become a CDE.  The DON and I were the only CDE qualified nurses on staff. Now, because Glyndon is located outside of Baltimore and associated with Lifebridge-Sinai Hospital the camp was also a learning environment for Resident doctors who were working on their Fellowships in Endocrinology.  They would come and spend a week or two on staff learning about intensive insulin therapy, pump protocols and everything else involved with both the clinical and psycho-social aspects of living with diabetes as an adolescent in an immersive 24/7 environment.

Normally, the visiting residents bunked in the Doctor’s Cabin and the nurses bunked in the Nurse’s Cabin.  I was the only residential nurse that summer.  All the other nurses lived off campus. I had the Nurse’s Cabin all to myself for most of the Summer. The exception was the last session of camp when one of the Fellows decided he would bunk with me. Cool.  I didn’t have to stay in the 4 room cabin by myself.

Now, if you have ever been to camp you know that there are is A LOT of mischief that occurs that is usually perpetrated by the counselors. Pranks are played on other counselors, staff and sometimes the campers.  I was never the target.  That was about to change.  Word got back to me, through the grapevine, that the counselors were planning an ambush on the Nurse’s cabin that night. Because we were on call 24 hours we had to keep our front door unlocked so a counselor could get us in the event of a nocturnal hypo or other emergency.  That was just an open invitation.  I don’t like pranks in any shape or form. I especially don’t like things that interfere with me sleeping. This was definitely going to interfere with me sleeping.

That day, the Fellow and I had the morning/day shift. So, when the shift was over, after filling him in on the threat, I disappeared into town. Upon my return I was bearing two large super soaker water guns. These were the ones that held 2 liters of water.  I stashed our weapons and went to the dining hall.  I quickly located a bottle of red food coloring. The nice thing about the kitchen was everything was in institutional size. So I procured a small bottle of red food coloring and returned to the bunk.  Operation Counselor’s Last Stand was in play.

For the next hour we prepped the bunk.  The backside of the bunk abutted a tree line.  The counselors had disclosed, earlier in the season, that they would sneak in the bunk by coming through the windows in the back. (If you know me then you know that I hear everything and remember all of it because you never know when you may need that information. Case in point.) First step was to make sure that there was no access to the bunk via the back windows.  I like to play fair, most of the time, So instead of securing the windows we left them alone. What we did do was secure the room door so that it would not open from the inside. A trapped counselor was as good as no counselor. The rest would have to wait until lights out.

After lights out we returned to our bunk.  I had brought some “party poppers” with me. You never know when you might need them.  These were like the Snap & Pop things that you throw onto a hard surface and they “explode” – these, however, had strings on each end to pull them to activate. I had about 100 of them. We went to work.  We locked the far door, forcing them to use the near door.  To that door we secured one string to the door and the other string to the door frame. All 100!  Next we mixed the food coloring into the bottles of the super soakers.  We had learned form our mole that the counselors were planning to ambush us by coming to the bunk and telling us that there was an emergency in one of the cabins.  When we emerged from the bunk they would be there with water guns to assault us. As they say, “best laid plans of mice and men” or this case, counselors.

The time had come. One of the other toys I had packed for the Summer was a night vision scope. Hey, we were in the woods, I want to see whatever I can at night.  I was in my room in the front of the cabin. The lights were off and it appeared as if we had retired for the night. IN my pitch back room, I peered through my window with my night vision scope – out into the darkness.  Like creatures of the night, the counselors appeared and gathered about 20 feet away.  It was not uncommon for previous counselors to come back and visit.  As it turns out, the ring leader was one of those visitors.  He had a reputation for being a master prankster and he thought it would be fun to get one over on the Nurse and Fellow. They were all gathered around their General.  Then orders had been given and one lone counselor heads to the far door, prepared to announce the need for a medico in her bunk. Remember, the far door was locked. At this point, the Fellow and I were hiding outside our rooms, guns pumped and ready to spray.  Off to the near door she went. She turned the knob, pushed the door open and prepared to walk in. Surprise one worked like a charm, or in this case, an explosion. All 100 poppers erupted almost in unison.  As soon as the noise ceased, the troops outside realize that their General had underestimated the enemy.  The order to charge was given, literally!

They only had access through one door.  It was like shooting fish in a barrel.  They were not expecting us to be in the living room.  The plan was that we were to be asleep in our rooms. As we had anticipated, we heard the doors to the back rooms trying to be opened. Foiled!  As the counselors, and their General, herded into the living room, we erupted our guns with red colored sprays. They were taken by surprise. As quickly as they entered they ran to the other door…opened it and escaped to regroup.  We quickly made sure the doors both were locked then turned the lights on and assessed the situation.  Round one to the medicos. We checked the rooms we had secured. No enemy. But to our surprise, one of the counselors was hiding in the Fellow’s room.  He was quickly dispatched after a thorough soaking and staining.  He was ejected and we locked the door again. Lights out!

They were still out there. The General was trying to form a new plan.  They never thought that they would need a plan B. With the lights out they could not see us inside. I watched them through the night vision. I went and grabbed my camera’s flash gun. Turned it on and waited for the ready light.  In the meantime, I turned the boom box on, full volume, blasting Yello’s “Oh Yeah” on repeat.  You know Oh Yeah. The song that is played in Ferris Beuller’s Day off when the parking attendant take the car for a ride.

I watched them planning and scheming. Then they moved.  They crept up to the cabin and tried to peak through the windows.  I let them look. They couldn’t see anything. Then I took the flash gun, pressed it against the window’s glass and fired the flash. Once, twice, three times. Screams erupted from the counselors. Foiled, again!  This went on for several minutes. Finally, accepting defeat, everyone returned to their bunks and there was Peace at last.

The next morning, the Fellow and I arrived early to breakfast. Then the walk of shame began.  One by one, the counselors involved in the Counselor’s Last Stand, filed into the dining hall.  Each one stained with red food coloring.  If you have ever been stained with it you know it take days to get off your skin.  The medicos had won.  By the way, the mole was the DON.

I hope you enjoyed this little ditty.  If so then please share it with others or leave a comment and please subscribe to my blog.  If you hate it – the leave me a comment and tell me why. Then subscribe so you can see if you hate the next one.  I may surprise you.

Until next time –



Thankful, You Say?

thanksgiving header

Yesterday was Thanksgiving Day in the United States.  A day we gather with family and/or friends for a traditional, or maybe not so traditional, meal and we share with these loved ones the things in our lives that for which we give thanks. Then all the adults quickly depart the table and head out to the pre-Black Friday sales.

So what does all this have to do with diabetes? As I blogged in the last post, November is Diabetes Awareness Month. Floating around your favorite social media site, if you are a PWD, you have probably seen the daily “Happy Diabetes Challenge” many folks are playing along and posting their answers. Perhaps you are one of them. The daily challenge for Day 23 is, you guessed it, “What are you thankful for?”  PWD’s all over the world have posted some pretty heartwarming posts of the things that make them thankful this month of Diabetes Awareness.  Being thankful for things can lift your spirits and change your perspective of your situation.

Happy Diabetic Challenge 2018 Source unknown

I know that every night, before I go to sleep, I take inventory of my day and my activities.  Like most folks, my days are not always filled with obvious things for which I should be thankful. Case in point, while the sweet potatoes were nestled in their brown sugar bath, caramelizing to a soft and sweet finish, the sweet aroma so familiar to Thanksgiving meals, became acrid. I asked my wife how long they had been in the oven? She replied that they should be ready in a few more minutes.  Then she smelled it too.  We both went to the kitchen. She opened the oven door and in the dish, where we should have been seeing a nice orange potato with a glistening caramel glaze was a surface of black charcoal!  The oven was radiating out the obvious cause of the charcoal.  The broiler was on and the oven door was closed. (For those of you not into kitchen appliances, the oven door must remain open when using the broiler.)  Long story short – due to no fault of my wife’s, the oven’s computer controller board had malfunctioned.  The oven was now non-functioning. (This is not the first time we haven’t had an oven or cook top but that is a story for another blog.) We salvaged the potatoes under the charred top and prepared a new glaze when we arrived to our dinner destination.  So I am sure you are asking yourself, “How can you be thankful for your oven breaking on Thanksgiving?”  Well, I am thankful that it happened while we were home and were able to intervene and prevent the food from catching on fire and causing damage to our house.

But, despite all the positive vibes folks are posting, I have also seen folks posting how much they hate this disease and how it has changed their lives, they didn’t ask for it, it is expensive, etc.  You know the downside.  Most of the posts I encounter are from the “young ‘uns” who have had their diagnosis for less than 5 years.  I would never wish that anyone be diagnosed with diabetes, especially Type 1. It is a devastating and life changing condition. But, if I could change when I was to be diagnosed it wouldn’t have been in 1979!  Believe it or not, NOW is the time to be diagnosed and treated. NOW is the time to have hope that there will be a cure soon.  I think that part of the angst that is displayed by these folks is their generation.  YES, diabetes will change your life but how you respond and use that change is entirely up to you.  One of the things that I did to control this change in course was to focus my nursing on Diabetes and patient education in my professional life.  I knew I could relate to both a newly diagnosed patient as well as the long term PWD. I kept myself educated and informed so I could pass along this knowledge.

You may not be a medical professional or even associated with the healthcare field.  That’s OK. Be loud and proud about your diabetes.  Be thankful that you are alive in 2017.  That you have cutting edge technology in your test kit.  Ifyou are so wired up, you have space age technology feeding you life sustaining medication by the DROP and the other device is constantly monitoring your blood sugar.  In 1979, a newly diagnosed PWD was sent home with a mini chemistry set:

Clinitest Urine Test Kit

10 drops of urine into the tube. Wait for the chemical reaction and the urine will turn a color that you compared on the chart.  The range of results was 0 – 1200mg/dl – sort of. To get the most “accurate” result, ideally, you should urinate to empty your bladder and then in 30 minutes go again to get a “fresh” sample. First, you are measuring urine. Urine is not fresh. It has been in your bladder for a bit. Secondly, it didn’t really tell you what was happening right now and it didn’t really correlate to the numbers. Oh, did I mention that the chemical reaction produced created a HOT bottom to the test tube.  I promise you would only touch it once.

Imagine making plans to go out with friends for dinner.  You have to test before dinner.  This is why diabetics when to the rest room in the 70’s! Oh and you had to bring your own cup to piss in.  It was just easier to set up shop on the counter in the rest room.

Be thankful for the breakthroughs in science that have superior treatments for the ravishing complications that come with diabetes.  We can still go blind but not at the rate we used to.  We still have amputations but wound care has improved and saving the limb is a lot more realistic these days.  We still have kidney failure but modern pharmacology is able to slow its progression. There are still complications that have not received the attention of the others but that is because Diabetes is still very much a mystery. But everyday researchers are learning more and more.

Having a chronic illness can bring about depression, especially diabetes. Below is the Patient Health Questionnaire developed by Pfizer Pharmaceuticals and is used in clinical practices all over the world to asses a patient’s potential for experiencing depression.  If you beleive youmay be depressed please print this page, answer the questions and take it to your health care provider:


Interestingly enough research has been done recently that found that living with diabetes may be stressful to an individual but not enough to cause clinical depression.  Nonetheless, the effect of this environment is still the same on our body.  Researchers have labelled this “Diabetes Distress” and have developed a screening form for patients to use, similar to the PHQ above, but specific to diabetes and the care it requires.

You can find the Diabetes Distress screening tool here.  (This is a PDF file that will open in a new window.)

With all that being said my friends, I wish you all prosperity, and as good health as you can manage to achieve!  Take a new look at your diagnosis as well as your situation and try to find the good things that have occurred because of the dark clouds.  (Even dark clouds mean sunny skies are on their way!)

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World Diabetes Day 2017


In case you didn’t know it, November 14th is designated by the United Nations as World Diabetes Awareness Day.  In the United States the American Diabetes Association designates November as Diabetes Awareness as well. Their Mission is to “prevent and cure diabetes and to improve the lives of all people affected by diabetes.”  All day I have been thinking about this.  The more I thought about it, the angrier I got.  I would like to believe in my heart of hearts that awareness campaigns are as successful as the promoters would like us to believe.

The American Diabetes Association, The Juvenile Diabetes Research Fund and the International Diabetes Federation are huge organizations who are doing great things in respect to furthering the much needed research to understand this most complex of disorders with an ultimate goal of learning how to prevent the onset AND how to reverse the malfunctioning organ that has all of us in chains to its whims. This condition has reached pandemic proportions. Pandemic means widespread over a country or the world. And here we sit in the pews, in our choir robes while the evangelists from the churches of ADA/JDRF and IDF stand at the pulpit and preach for the need to make the world aware of this terrible demon that is afflicting 1.5 million newly diagnosed Americans a year, as of 2015 according to the ADA. In 2017 the Center for Disease Control published that there are over 100 million Americans with some type of diabetes.  We are a tremendous choir so much so that even the Mormon Tabernacle Choir would shudder at our numbers. The problem is these very same evangelists are not out there in tent revival style homecomings preaching the word of awareness to the unbaptized.  The preaching does not commence until that poor, wretched soul is diagnosed. And then the first sermon they receive is that of the diligent, tireless researchers who are on the cusp of a cure right now. In ten years time this demon will be exorcised never to darken another metabolism.  I have had diabetes sine 1979.  When 1989 rolled around I was chomping at the bit to get in line to be blessed by the healers that had harnessed the ability to make me whole once again!

For the last 2 weeks, as I watch television or listen to the radio I am confounded by the number of advertisements for breast cancer awareness* campaigns. And then I sit there and get angry.  I understand that advertising takes money. Money that could be used to further research, but the big three proselytizers have budgets that have line items for research AND marketing.  If you want to increase the awareness of the need for people to recognize the symptoms of pre-diabetes and to give credence to the devastating effects of “having a little sugar” there needs to be a more public, in your face, exposure like breast cancer awareness. Especially in the month of NOVEMBER, for God’s sake!  There is a cartoon circulating on social media with Santa Claus and Tom Turkey having a conversation and Ole’ Tom is letting St. Nick have it because no sooner than Halloween turned in to All Saint’s Day the stores had already deployed their Christmas decorations and wares.

Cartoon: December, Fat Boy! This month is for MY Holiday! Now hop on that sleigh and WAIT your TURN!

Look at the image in the header of this post. Can you name all the awareness conditions that each ribbon represents?  Even within the diabetes community we can’t agree on whether it should be Red (ADA) or Wedgewood Blue (IDF)/(JDRF). The Rainbow of Ribbons has gotten out of hand.  I am not saying we shouldn’t support the causes that matter to us or have impacted our lives but now we need an app on our phone that when you point the camera at a ribbon it will identify all the causes associated with that color.  After that you will be on your own as to how to narrow it down or perhaps, like reporting roadwork or radar on Waze, you could report a sighting in the wild after confronting the awareness advocate and have identified and classified that particular ribbon’s species and family.


You may have seen these appearing in your social media feeds or perhaps you have one yourself.  This is the official badge of the Choir of Sweet Melodies. Some may look a little different.\, but the identity of the enrobed is the same: we all have a condition called diabetes.  And as the evangelists spread the good word the members of the congregation, dressed in their robes, eagerly and swiftly, post their new #T1DLooksLikeMe profile images, IGram stories and FBook posts for all their friends/family/followers to see.  I will concede, that in this modern world of anonymous and random “friends”, these posts may be enlightening to these “strange” friends. I am not really sure that the impact will be as expected. But, like it is said “If one person is reached then I have done my job.”  Hmmmm. 1:1,500,000, I should go get a MegaMillions lottery ticket. The jackpot this week is $82,000,000.00. Even 1% would buy some serious advertising.

So how do the members of choir go forth with the message and expose the heathens with healthy pancreases or perhaps failing pancreases to the importance of what is still not being publicly recognized as a serious, life altering and at time life threatening condition?  We need to stop talking just within our social circle.  Our friends and families know we have diabetes.  If they don’t, well they should and this is the time to sit them down and give them the basics.  People need to know what we encounter on a daily basis. In my 35+ years I have never shied away from testing or taking insulin in public. As a teen, if I went to the bathroom to inject it was because I needed to politely get access to a site and not because it was wrong to inject at the table.  Doing these things in plain sight are conversation starters.  I have had multiple occasions when strangers have seen me testing or giving insulin and have approached me and started a conversation. Secondly, acquire some type of medical alert jewelry.  It may save your life one day and it may also be an invitation to start a conversation.  It doesn’t have to be anything fancy or expensive. It just has to be…on your wrist, your shoe, or around your neck.

Bottom line folks, we need to pour out of the Chapel of the Unquenchable Thirst and start knocking on doors and introducing ourselves:

“Hello, I am Elder DiabetesDude. Have you heard the news? Diabetes is on the rise and we want to make sure that you are saved from this horrible affliction.  I only have 7 simple questions whose answers could save your life.”

“You’ve got a few minutes? Great!

Are over 40? Do you have any relatives afflicted with the demon called diabetes? Do you have high blood pressure? (If your neighbor is a woman – were you ever diagnosed with gestational diabetes?) Are you physically active? I only have one more question, brother/sister. You don’t have to tell me but would you please point to your weight category?

“Awesome. I am going to leave this assessment with you. Based on our score, as determined by the American Diabetes Association, you should discuss the results with your primary healthcare provider.”

Am I mocking certain church groups? If you think I am then you are probably right. But ask yourself this “Why do I know who DiabetesDude is mocking?” I’ll tell you. Because these folks get out there and make a presence in PUBLIC. We may not appreciate their tactics but I tell you this I sure as heck respect their dedication to spreading the word – whatever that may be.

Lastly, please don’t flame me because I appeared to downplay the seriousness of breast cancer.  That is not the case at all. I support breast cancer research as well as support for those who have been impacted by this equally devastating disease.






A Day that will live on in Infamy…

Well perhaps not infamy, but it will be a milestone in my journey with diabetes.  As promised in the last post this post will be about my visit with the endocrinologist after being completely dumbfounded and discouraged by my primary care provider.

I couldn’t see the new doctor until a month later so it was up to me to do the best I could with what I had.  The PCP wanted me to stop ALL carbohydrate intake, if I wasn’t going to stop all food except on weekends.  After I left the PCP I went to breakfast at Bob Evans.  They have very good omelets.  They also have scrumptious banana bread!  I don’t do things half-assed. As much as I really wanted the banana bread I stuck to my guns.  3 egg omelet with diced ham and cheddar cheese. There. No carbohydrates.  Of course now I had a different conundrum.  No carbohydrates meant no variable to adjust insulin dosage.  Where’s your logic now PCP?????After a little thought I figured it out.  Breakfast arrived.  It wasn’t as much as I usually got but it was enough and it was quite tasty.

The next 30 days were challenging.  There were days that were just as they should have been.  However, there were more days with 200-300 fastings, correction doses to get it under 150 only to repeat the rollercoaster again when I woke up.  It was clear that my body was pumping out its own glucose!  AS I had been told by the PCP that I was taking dangerous amounts of insulin, I had started to reduce the basal amount by 10% every three days.  I had been taking 100units at bed and had worked it down to 88units of Lantus (glargine i-100).

Not only was I feeling like crap because my blood sugar was consistently elevated with intermittent ketosis, but the hyperglycemia was impacting my productivity at work.  I couldn’t concentrate, my vision, already impacted by diabetes, was blurry – I stare at 3 monitors for 8 hours plus a small print reference manual.  Not to mention frequent trips to the bathroom.

Finally the appointment day had arrived.  The last time I had been in this office I had been talked down to by the Nurse Practitioner, questioned if I was really a Type 1 and because she would not help me put my socks back on – refused to look at my feet which she had asked to see.  She told me next time not to wear socks so she could look at them.  So to say I was a little anxious would be a safe bet.

I was called back and the usual things occured – height, weight (315lbs), medication lists, a finger stick for an A1C in the office and a download of my meter readings.  Next step – see the endo.  It was like waiting for the Great Oz to appear from behind the curtain.  A knock upon the door and it was show time…do or die.

Introductions were made.  Then straight on to the heart of the matter. “Why are you here today?”  I replied, “Because my PCP says I am taking too much insulin and I should eliminate all carbohydrates from my diet.”  The obvious next question was “How much insulin are you taking?”  “I am taking 48units Novolog before meals and 88units Lantus before bed.”  He then proceeded to review the numbers from my meter.  He was making notes on the paper, he pulled out his phone and punched numbers into the calculator. Then he stopped and looked at me. “Well, the problem is you are not taking enough insulin.  You should be taking as much basal insulin as your combined bolus doses. But first we need to get your basal amount increased.”  Again the calculator was employed, more notes written.  “OK. Let’s start here and go up every three days until your fasting is under 180.  As far as the carbohydrates, you need carbohydrates in your diet.  You can reduce them but do not eliminate them. Any questions?” “Yes. What is my A1C?” “8.3%.”

With that I left the office with a renewed confidence in managing my diabetes. I had finally found a provider who bought into the team approach, listened to what I had to say and what my goals were and together we develop a dynamic plan.  I also had new prescriptions for “massive amounts” of insulin to take to the pharmacy.

So what is the take away from this post?  You need to find a provider who is going to work with you without dictating your care.  We are the ones who must “suffer” this condition and unfortunately there is not a one size fits all for treating and managing this condition.  Lastly, the new endocrinologist confirmed that I most certainly was a Type 1 AND I was markedly insulin resistant.


Went back for my second follow up.  I am currently taking 35units U-200 bolus and 87units U-300 basal.  I have been on Invokana (canagliflozin) off label for 3 months.  Drum roll……….. my A1C—-> 6.4%.  In my 38 years of being diabetic I have rarely seen it at 7% let alone under 7%.  Maybe this day will live on in infamy, for me at least!

Thanks for coming along on this trip.  IF you have made it this far please do one of the following (or all):

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Until the next time, when I will discuss and review some technology tools out there for us sugar testers.  Remember, be good and if you can’t be good at least be as good as you can.

Peace+  Tim the DiabetesDude


Here is a book that you may find useful in your quest to make sense of this rollercoaster ride. I have no relationship with the author or the publisher other than receiving a commission through AMazon if you like it enough to buy it.

Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin–Completely Revised and Updated

Resistance is futile!?!

I cannot believe that it has been a year since I embarked on this journey of blogging.  I guess you could say that I was on hiatus. In all honesty, work, life and the ever present diabetes got in the way.  It is now time to treat this endeavor like a job and work it every day. That means giving attention to creating posts of interest and insight and getting them up at least weekly. Now, on to the show…

Let’s rewind to December 2015.  I had been seeing my new PCP for about a year. Prior to that I was going to a free clinic for my care.  They sent me to an endocrinologist associated with their care model but we did not see eye to eye on their style of diabetes management.  My PCP and I have a pretty good patient:doctor relationship and when I saw him in December the topic came up of whether I had had a c-peptide or insulin antibody lab work performed? Since I hadn’t, he went ahead and wrote the order. Let’s try metformin and see if that helps. Off I went to the lab. Also, try reducing your carbohydrate intake.  Follow-up in March.

March rolls around and there I am sitting on the exam table once again.  The results are in: My body is producing no insulin on its own AND the insulin I am taking is all but being destroyed by my body, also known as insulin resistance. That is how that conversation started. There in black and white was the evidence that I was insulin resistant AND a Type 1.  My PCP agreed that that was what it said.   The metformin had not been effective at the starting dose so we decided to try upping the dose. See you in 6 months.

Once again back in the exam room. In the interim Kwikpen was released. This is a U-200 insulin – which means 1 unit of U-200 is equal to 2 units of U-100. I had already been on Toujeo (a U-300 glargine insulin) with no great impact on my numbers.  This is where our relationship hit a wall.  I had written down what had occurred in my health over the last six months including office visits with the other members of my diabetes care team and any medications I needed refilled, discontinued or written.  I am not sure what part of that summary flipped the switch but my PCP shook his head and got up from his stool and said to me “We need to have a come to Jesus meeting, Tim!” At this point he was bobbing in place, short of jumping up and down.  “You are taking entirely too much insulin. Do you realize that you are taking a toxic medication? You need to take less insulin.”  Those statements were repeated several times.  I looked at him and told him that I was aware of the actions of insulin but I was also aware that what I was taking was not being utilized because of the insulin antibodies. So what is the answer? (If you are not already sitting down, please have a seat.)  He paused, sat down at his desk and pulled out several stapled print outs.  “Here. You should read these. You should sincerely consider fasting.”  I was dumb-struck.  OK. I was not sure how to respond.  The print outs were transcripts from several YouTube videos from a physician in Australia who has his Type 2 patients fast for up to 5 days a week. Every week.  Of course they all tout losing weight and reversing their insulin resistance.  He sat back down and said he really thought I should consider that because the answer was not more insulin.  He returned to my summary then looked up again.  “I will not renew your Toujeo.  The prior authorization is time consuming for my staff and I do not want you taking more insulin.”  We agreed on me getting a flu vaccine and he left the room.  See you in six months.  A few minutes later he returned and handed me a copy of Richard Bernstein’s book “Dr. Bernstein’s Diabetes Solution.”  “I know you are a type 1 but this may help.”

When I returned home and had cooled down I made a decision that has changed my life – No, I did not start fasting; I called the endocrinologist’s office and made an appointment.  If more insulin was not the answer then I wanted to hear it from the endocrinologist.  I was given an appointment for October 18.  and in the interim I read Dr. Bernstein’s book.  If anyone was going to have an opinion on insulin resistance being treated by decreasing insulin intake, it was going to be Dr. Bernstein.


The next episode I will tell you how my life changed on October 18th 2016.  Until then, be well or at least as well as you can be.


Tim, the DiabetesDude

I have provided a link to Diabetes Solution available through  I have no relationship with the publisher or the author. I do receive a commission from the sale of this product through the Amazon Affiliate program.


The Big Game

Last week I could not wrap my head around what I was planning to write. I had loads of lines floating around in my head but none of them felt right. So, I did not pursue posting anything and felt it better to let me be inspired and then post.  The inspiration indeed did materialize.

Let me tell you another story first.

Way back in the dark ages of the Internet, in its consumer infancy, when AOL, Compuserve and a plethora of other smaller portals were connecting people to the digital highway, I was a subscriber to a local BBS (Bulletin Board System) that connected me to other local users in “chat” boards and allowed the transfer of files between one user and others.  There was no instant messaging or peer-to-peer downloading but we managed to get by.  In addition to being connected to the local folks it also connected its subscribers to news servers.  One of the news servers I belonged to was a diabetes group.  This was probably the beginning of the DOC in its most primitive sense.  But here was a place that diabetics from around the world could come together and “chat”, share ideas, experiences and the occasional flame war when a member would post about the new nutraceutical that cured their diabetes or contributed to the ongoing debate of how bad artifical sweeteners were.  It was a great “place” to be just like the expansive DOC world that has blossomed from it.

There was a member who was quite active on the boards.  He was from England and a lot of the things he was saying I agreed with.  I made contact with him and after several back and forth posts our friendship began.  While I was working a diabetes summer camp there were several counselors and medical staff from all over the world.  One of the counselors was from England and his name was David.  (Now I know that just because you are form someplace you don’t know everyone else form that place.) However, there were a lot of similarities between camp David and BBS David. So eventually I asked BBS David if he was indeed this same person?  He was not, but that didn’t matter.  By this time we had been communicating on a regular basis and found that we had a lot of things in common: Obviously, we both had diabetes, he had a step-daughter, his wife was a nurse, we liked the same music.  We always had something to chat about.

David suffered from complications from long term diabetes.  He was essentially confined to a wheelchair for the most part due to neuropathy.  David’s complications earned him disability status.  David had a lot of time to watch the races as well as his beloved Arsenal.  I would get Arsenal updates from David on a regular basis…some of which occurred in the middle of the night!  Needless to say, David enjoyed his sports and he enjoyed keeping Ladbrokes in business as well. On occasion, Ladbrokes had to pay out.  We would always talk about who was in the Super Bowl and what I thought the outcome would be.  I am not really a gambling man but I would give my opinion.  David on the other hand knew the statistics and all the data that made the difference. It was just another sport for him.

Without going into details, David’s last few months seemed like he spent more time in casualty or inpatient then he did at home with his wife, Carole.

Carole was a real trooper.  One could only care for someone like she did because she loved him.  Being a carer is a tough thing to do, especially with an amputee. She and David were truly soul mates.

Back to last week…As I was mulling over how to proceed with my post I was browsing my FaceBook feeds.  There it was, Carole had posted on David’s page that he had quietly passed away in the night.  It didn’t matter what I had to say this week. My friend had passed away.  I don’t know what the official cause of death will be but regardless, diabetes had contributed to it.

That was it.  I knew that this week’s posting would be a tribute to a good friend who enjoyed life and enjoyed his sports and loved his family and friends.

Rest in Peace, David.  You will be missed.

The Prequel – The Journey Begins

Now that I have embarked on this journey I want to take a moment to step back a little bit and tell you what was happening to me that lead up to that fateful day in the phlebotomist’s office.

I was always a chunky kid. At times I was a downright fat kid.  Destined to wear “huskies” denim instead of Levis.  Genetically, I come from a line of big people.  Because I had a weight problem I was no stranger to Sweet-N-Low.  My family didn’t really eat sugary things. It was rare to have a box of Fruit Loops or Trix in the cupboard. We were strictly a Cheerios and Raisin Bran family.  TAB was the go to drink if we drank soda.  The quality and quantity of the food was never an issue.  The main issue was exercise.  I really did not like to be physically active as a whole.  I had friends and we would play together – like your average kids did.  I walked to school, it was approximately a mile, I participated in physical education and I rode my bike – at least one of these things occurred on a daily basis. But given the choice between going outside and playing or staying inside and reading – I would be inside reading.

Sometime around September or October, before my diagnosis, I developed what most likely was the flu.  Typical symptoms – fever, runny nose, cough, general malaise.  It ran its course and after about 10 days the fever and congestion had left but I still had the general malaise AND now I was constantly thirsty, always hungry and urinating more than I put in. (In the medical world we call that the 3 P’s-polydipsia,polyphagia & polyuria.) What we now know as the classical signs of hyperglycemia or diabetes.  However, there was no diabetes in our family AND I was just starting puberty so no one really thought anything of it.

I was losing weight and urinating every 15 minutes or so.  I remember having to go at every commercial break.  Everyone was happy to see me lose weight because I was finally fitting into the acceptable percentiles for growth for my age. Actually I was taller than I should have been.  That had lead me to a pediatric endocrinologist the year prior.  Nothing really came of that visit and hospitalization.  Finally, my tongue started to become irritated and swollen. Initially there was no reason to suspect anything earth shattering. Perhaps I had burned it, bitten it, or irritated it from my braces.

After losing approximately 25 pounds in a month, the chronic thirst – urinate cycle, lethargy and now swollen, painful tongue my parents decided to visit the pediatrician. We know where this story ends now.

Two weeks ago I attended a webinar from dLife, “Missing the Diagnosis“.  Part of the discussion was how physicians and diagnostic practitioners must do their due diligence to the fullest when presented with an acutely sick child or adult – especially when the diagnostic trail of a differential diagnosis can be started with just a drop of blood.  Among all the issues surrounding diabetes – the treatment, the complications, insurance coverage, cost of medication, new technology- it is all for nothing if we cannot get the patient correctly diagnosed in a timely manner to save their life. Please click on the link to the webinar – it is a PDF file of the slides.  Included are statistics and actions you can take as well as organizations created to enlighten the community on making earlier diagnosis of diabetes.

I would like to thank my pediatrician for doing his due diligence and putting me through the hoops.  Please keep in mind that when I was diagnosed most doctor’s office did not have a portable glucose monitor.  The A1C test was in its infancy. Fortunately, I did not have to experience the fatal effects of Diabetic Ketoacidosis. I was in ketosis on admission to the hospital.

That is the prequel to my story. Thank-you Dr. Brenner for pursuing the differential diagnosis to completion.

Diabetesdude is Tim Moeslein, RN.  He lives in Eldersburg, MD, a small suburb in southern Carroll County.  He is a former Certified Diabetes Educator and has had a diverse professional career as a Registered Nurse both in the diabetes arena and beyond.

The Journey Begins

Welcome to my little spot on the web and the DOC avenue.  For those of you not familiar with the DOC, it simply means the Diabetes Online Community. Several months ago I was listening to Dr. Matthew Hertert’s podcast”Thriving Diabetics” and this particular podcast was an interview with Scott K. Johnson of  Dr. Hertert made a comment to Scott that the blog world in the DOC was predominantly occupied by female voices and that it was good that there was a man who was willing to share his feelings about being a PWD (person with diabetes) – both positive and negative, the struggles and triumphs experienced throughout his life as a PWD.  Dr. Hertert has insulin dependent diabetes for 40+ years.  His story is quite interesting and I highly recommend that you take some time to listen to his podcast.

With that being said, that comment lit a spark in my soul and ignited my brain to start to formulate what I would write that may be of interest to others.  The more I thought, the more ideas I came up with that I believed would be worth sharing.  As the lyrics to “Do-Re-Mi”, from ‘The Sound of Music’, state “Let’s start from the very beginning.  A very good place to start.”

It was Wednesday, January 17,1979 – 8:00 AM.  I was scheduled for a GTT (glucose tolerance test) at the local lab.  I had been feeling poorly for the last month or so and the pediatrician could not figure out what the underlying cause was. Peculiarly, I had symptom that just did not make any sense – my tongue was swollen with papules all over the surface.  It was quite painful and burned.  There was no thrush or signs of infection.  I had braces, so they sent me to the orthodontist. Shrugs.  He sent me to the dentist. More shrugs. After that I was scheduled for the GTT.  Maybe that would shed some light on the problem.  This was not my first GTT. I had undergone one before a couple years earlier and it was negative.

As is protocol for the GTT a blood sample was obtained for a pre-challenge baseline.  That’s when it all went down hill.  It was classic. The phlebotomist called my mother back into her office.  I was left in the waiting room.  Unbeknownst to me my mother was on the phone with my pediatrician.  The baseline sample was elevated (I do not know the value) and because of that my pediatrician was pretty sure I was suffering from diabetes.  He told my mother that he would call the hospital and have me admitted directly to the pediatric ward.

And so it began.  I was 10 years old.  Soon to be 11 in 6 days and I was off to the hospital.  I didn’t know what diabetes was.  No one in our family had diabetes.  Before going to the hospital my mother and grandmother decided that it would be a good idea to take me out for a “last meal” at The Greenspring Inn. My favorite thing on the menu was a creme de menthe parfait. Boy was it good!

The hospital was ready and waiting when I arrived.  I had no idea what I was in for, but if it was going to make me feel better then I was all for it.  I think the parfait confirmed that I was indeed a diabetic.  My admission baseline blood sugar was >600mg/dl!

Well, that’s how it all began 37 years ago today.  Going forward I will share with you my personal experiences as a child, teen, young adult and adult with insulin dependent diabetes.  A lot has changed since that Wednesday in 1979 and as they say “The more things change the more they stay the same”.  I will try to update this blog weekly but bare with me if it happens before or after that schedule.

Diabetesdude is Tim Moeslein, RN.  He lives in Eldersburg, MD, a small suburb in southern Carroll County.  He is a former Certified Diabetes Educator and has had a diverse professional career as a Registered Nurse both in the diabetes arena and beyond.