Close Concerns Weblog

Get up and dance - only a few days left! ... PLUS Free diabetes screening for Bay Area residents

Do you dance while cooking dinner? Take a tap class?  Do the twist or another generational favorite move? Study classical ballet?  

Novo Nordisk and Drew Lachey are launching the "Dancin' to Change Diabetes" contest to give Americans two great reasons to get moving. An exciting reason to get up and groove is Dancing with the Stars Season 2 winner, Drew Lachey, who will watch video entries to the contest and help pick winners to raise awareness of the ways to prevent and combat type 2 diabetes. The top three unique entries will receive prizes of a year-long gym membership in their community, a Nintendo Wii videogame console (with the Dance Dance Revolution game and Wii Fit - gaming and fitness combined), or a $400 gift certificate to a sporting goods store. 

If you live in the San Francisco area, you should head to Pier 39 on Saturday June 7 at 11am to hear Drew Lachey announce the winner of the video contest at the Novo Nordisk Changing Diabetes Bus and Village. You can get a free diabetes screening, learn more about diabetes, and help raise awareness in the community of the need for improved prevention, diagnosis, control, and better education of diabetes.

Not exciting enough? How about dancing because it is good for you! Dancing is exercise and can burn as many calories as other forms of exercise like walking or biking. It's easy on your bones and joints and easy to fit into your schedule - you don't have to trek to the gym or put on special gear to get moving! The video is all about showing your ways to stay active and healthy in your every day life. 

Want to enter? Pull out your video camera and stick it on the counter or have some one else record you busting out your moves. Submit your video (click here for a sample) and check out the rules at www.dancingtochangediabetes.com (more samples available). Judging is based on your demonstration of dancing as a physical activity for exercise, fun, inspiration, and expression; your passion and energy; originality and creativity; and choreography. The contest ends June 1, 2008, so get moving! 

Reporting Bias – Insulin pumping in kids

We were disappointed with some of the headlines associated with a story on insulin pump use in teens that came out yesterday. The story was on an FDA review published in the journal, Pediatrics, on the risks of insulin pump use over 10 years (1996-2005) that found “13 deaths and more than 1500 injuries connected with pumps.”  These were attributed both to device malfunctions as well as human judgment error. 

What the AP did:

• Wrote an article on the top-line data from the study
• Described insulin pumps
• Distinguished between type 1 and type 2 diabetes
• Quoted Dr. John Buse (president of the American Diabetes Association), Dr. Judith Cope (lead author in the FDA analysis), Dr. Christina Luedke (Children’s Hospital, Boston) on their views on insulin pumping.

What the AP did right:

• Emphasized the importance of careful screening before starting children/teens on pumps – for doctors and educators, patient selection is key, and for patients, understanding the power of the therapy is really important

• Called on parents to be vigilant regarding pump use in their children

• Lauded the benefit of pumps by freeing kids from the pain/anxiety/stigma sometimes associated with injections

• Reported early in the story that the FDA study was NOT advising against the use but simply calling for more study on safe use of pumps in pediatric populations (although some headlines would have us think otherwise!)

• Mentioned the difficulty for teens (for anyone!) of good glycemic management with (multiple daily) insulin injections

What the AP forgot (in our view):

• Did not report on any of the dangers of the alternatives to pumps – for example, there are many problems that stem from MDI (multiple daily injections), such as diabetic ketoacidosis (DKA) and/or severe hypoglycemia – it would have been great to have this acknowledged in the article. Pumps enable the ability to deliver more physiologic therapy - a winner for many patients and for many, an enabler to better diabetes management.

• While it is true that mechanical devices can malfunction, we believe that real-life data would show this can be avoided - the 24/7 hotlines have enabled great advice to pump users and have given patients a feeling of well-being because they know they can call if they need to. Although I never use customer service (I virtually never have issues with my pump), I like knowing that it is there. While user error with pumps can occur, this goes back to patient selection, education, and training - indeed, user error can occur with any application of insulin! (An aside: why doesn’t someone write an article about how more diabetes education is needed and about how we need to prevent complications, not just treat them!)

• We believe that there should have been more emphasis on the fact that insulin pumping and glucose monitoring go hand in hand and that monitoring is very important in order to avoid any serious adverse event occurs.

Final thoughts

Dr. Francine Kaufman raised an excellent point when we spoke to her about this: “How many adverse events are there with MDI or traditional therapy! How many go unreported?" She emphasized that there are more under-reported adverse events with MDI and that more are reported with pump therapy. She stressed, "Done correctly, there is a real benefit perceived by patients, families, and pediatric endocrinologists and endocrinologists related to pump therapy ... A number of trials and studies have shown that in the right patients, with adequate education and patient support, pump therapy can be a major advantage.”

Virtually every trial done, for example, shows benefits related to hypoglycemia. And that alone is enough for me! I'll end by pointing you to a poignant piece written by Kerri Morrone on hypoglycemia,  "this is exactly what hypoglycemia has been like for me and yet another reason I'm so grateful to my insurance company for covering my pump. There are many, many fewer moments that I spend in hypoglycemia due to my pump and many fewer due to my CGM. Though I can't thank all insurers yet for covering this, I do send big thanks to the inventors. "

Creative ways to look at diabetes on a grey friday

1.    Create mnemonics – D.I.A.B.E.T.E.S. = Did I Ask (my) Beta cells (to) Extremely Suck?
2.    Search "diabetes song" on YouTube or click here
3.    You tend to be more aware of your state of health than the next person
4.    Injections/IVs don't quite bring the same amount of trepidation as before
5.    If you have kids, they will probably only drink 10X diluted juices
6.    You are somewhat of a whiz at carb counting and label reading
7.    Your feet tend to look better than everyone else's because you take such good care of them
8.    Your insulin pump is a great conversation starter
9.    You can always get out of awkward situations by excusing yourself to go and check your blood glucose ~ alternatively you can diffuse an awkward situation saying "this awkwardness is wreaking havoc on my sugars" after testing right there ... (Kaku came up with this one, he has diabetes envy)
10.    You gain some healthcare expertise without paying tremendous amounts of money or spending insane amounts of time to go to medical school