Take, for example, your typical Medic Alert bracelet. It gets the job done, but it’s not going to earn you any praise on the runway. So I was excited when a friend of mine introduced me to a small San Francisco company called My Flying Star that designs bracelets and necklaces that don’t make you feel like you’re 90 years old, stuck in one of those Lifecall ads (“I’ve fallen, and I can’t get up!”).

I ordered one of their Vega Star bracelets a couple weeks ago and initially thought nothing of it. It was a medical bracelet, after all. Who cares? But a couple days went by, then a week, and I suddenly realized I was feeling a tingle of anticipation in my stomach every time I heard the mailman come up the stairs. Why was that? Have I really reached the point of such diabetic dorkiness that the prospect of a lanyard with a charm on it that says “Diabetes, Insulin Pump” really makes my heart go a flutter?

Apparently, I am — because after a week of waiting, I contacted the maker of the bracelet to see what the hold up was. (The answer: no hold up, just impatience on my part.) It arrived this morning, and I ripped open the package, slipping it onto my wrist even before I’d had a chance to remove the Medic Alert bracelet I’ve had on for the past 7 years (they make those suckers hard to open!). I’m now sitting here typing with an accessory on my wrist that, okay, fine, no one but me is probably going to notice — but something about it just makes me happy to look at. It’s even better than the feeling I get when I look at my new little carrying case for my Symlin (I appropriated a pencil case that happens to be the perfect dimensions for the pens).

So what’s this about? Do other people feel a rush of excitement at the prospect of having marginally cooler medical supplies? And what do you think — in terms of the hipster Medic Alert bracelets — about the safety trade-off of wearing something less traditional than the standard MA silver bracelet? The Vega, as you can see from the picture, has two charms that are decidedly medical-looking — but part of me worries that an EMT is not really going to take the time to process the subtle cues of the snake dangling from my wrist. Thoughts?

The reason, in this particular case, is that my husband and I have decided to move back to the east coast, and are going to be leaving our lovely Oakland home in a matter of weeks. Before we settle in, we’re going to be going on a big trip — stay tuned to the blog for details — that’s going to include some pretty diabetically unfriendly places. Like Latvia, for example. Or Russia.

I had my last appointment with my San Francisco endocrinologist this morning, and instead of discussing basal rates or boluses, we focused mostly on a checklist of prescriptions for me to take with me while abroad, just in case my supplies get lost or stolen or I find myself in a foreign country with a bottle of Humalog that’s expired. It was actually a pretty funny interaction — I’m quite worried that a Chinese-speaking pharmacist is not going to know what to make of Symlin to begin with, let alone if it’s written in my doctor’s handwriting. So as he kindly created a ridiculously long list of prescriptions for me, I kept gently prodding him to, you know, write a little clearer. (“Thank you so much!” I said, as he scrawled out a prescription for test strips. “Can you just write that a little more neatly?”)

He tried, and I now have a stack of prescriptions for any sort of diabetic calamity I might face. He also gave me some valuable travel tips, including the fact that apparently most insurance companies allow you to do a “vacation override” where you can get more than three months’ worth of prescriptions at a time (I’ll believe it when Blue Shield sends them to me), and suggested that I get a Frio, a carrying case specifically designed to keep your insulin cool. The office even provided me with five copies of a doctor’s letter stating that I have Type 1 diabetes, and that any delay in treatment could result in “serious, even life-threatening, medical problems.” Take that, Mr. Customs agent! You will allow me to receive that shipment of test strips!

I’m now moving into the real planning stages of this trip, and am very frustrated at the fact that, in addition to dealing with normal concerns like finances, plane tickets, vaccinations and the like, I have an entire litany of diabetic concerns that most world travelers don’t even need to think of. Forget the fact that I’m likely going to be in some places where most dishes include noodles — I have to pack a separate bag with enough diabetes crap (and backup diabetes crap) to last till I come home.

I’ll be posting more about my travel planning and adventures as the trip draws close, but in the meantime, I’m interested in hearing from other diabetic travelers out there. What resources did you find useful? What packing tips do you have? Did you bring all your supplies with you, or was it possible to have them shipped from home? What do you know now that you wish you’d known before?

Do tell.

It’s always great to get to talk about something you’ve worked hard on, but I found myself getting surprisingly nervous before this particular interview. Part of it was my typical worry that I am somehow going to lose my ability to speak English the moment the host asks me a question. (Words? What are words?) But this time, there was an added challenge: talking intelligently about immunology — an area in which I am not an expert — about a complicated subject in a way that the general public could understand. (You guys will have to let me know how I did!) Luckily, words did indeed come out of my mouth, and by the end of the segment,  I was actually enjoying myself. But it’s interesting to feel your body pumping up the adrenaline — and I have a feeling that may have had something to do with the fact that my blood sugar went high this morning and has only now come back down.

And that’s very good news: it’s 2:15 in the afternoon, and I haven’t eaten lunch.

This Challenge is asking InnoCentive Solvers to formulate well-defined problems or hypotheses aimed at advancing our knowledge about Type 1 Diabetes and ultimately eradication of the disease. This is a somewhat unusual Ideation Challenge in the sense that the Solvers are not expected to provide a solution to any problem. Rather, they have to define problems or areas requiring further exploration and research. Ideal problems are those whose eventual solution will greatly expand our knowledge of Type 1 Diabetes and advance our ability to cure/manage the disease. Once formulated, the proposed problems will form the basis of new research projects pursued by scientists at Harvard University and elsewhere.

I’m not sure how scientific these entries need to be (though I doubt, sadly, that one of my personal big questions –why does yogurt affect my blood sugar differently than cottage cheese — would qualify). But still, for all you scientific types, it’s worth checking out. Just keep in mind: the deadline is March 15th.

On a different subject, this morning I went to the Apple Store for a One-to-One training session in the new version of iMovie. As my teacher showed me some of the new features, he made disparaging comments about my personal favorite video editing program, Final Cut Pro. “The new iMovie is just so intuitive,” he kept saying. “It makes Final Cut’s interface look like it’s from, oh, I don’t know, 1999.”

It made me think of my recent experiences with the cutting edge of diabetes software — and how, when it comes to diabetes design, a product reminiscent of 1999 would actually be an improvement. If only Apple had an interest in medical software.

As someone whose pump once suffered a “button error” and began spraying insulin into the air like a fountain (or, less poetically, a peeing dog) I’m glad to hear that pump problems are something people are paying attention to. But I’m also curious as to what kind of issues they’re talking about. According to the Journal,

Manufacturers are required to report problems potentially associated with devices to the FDA. The FDA conducted a review of insulin pump-related adverse-event reports and found nearly 17,000 reports from Oct. 1, 2006, through Sept. 30, 2009. The reports don’t necessarily mean a device caused a problem but serve as a signal for more investigation. Even if a device is functioning properly patients can inadvertently misuse the device. Of the reports, about 12,000 reported a patient injury (such as problems with blood glucose levels) and 310 deaths.

The agency said the information provided by manufacturers involving deaths “was typically incomplete.” The agency said in 225 of the deaths reported the device problem was listed as “unknown,” although in many cases the device was never returned to the manufacturer for additional follow-up.

However, in 41 death reports, a device problem wasn’t identified but the circumstances involving the death involved diabetic coma and problems associated with blood-sugar levels being too high or too low, suggesting the device may not have been working properly.

So, uh, what are we supposed to conclude? Is the problem the devices, or the people using them?

I think it’s very important to keep track of these reports — since this is a situation where a product failure could kill someone, I want the companies who make insulin pumps to feel like there’s a fire under their ass. But at the same time, one of the reasons we don’t yet have a closed loop system (i.e. artificial pancreas) is because companies and the FDA are worried that the devices (or people using them) could make mistakes. Which, granted, they probably would — the question is whether those mistakes would be more severe and dangerous than the mistakes people with diabetes make every single day when we try to gauge interactions between insulin, exercise and meals.

I guess this is what I’m saying: it’s hard to draw conclusions from this article about how often the insulin pumps themselves are the problem (and how concerned we users should be about possible recalls). Looking at it on a more global scale, though, I have two competing desires. First,  for companies to pay close attention to product flaws that might kill people. At the same time, I don’t want an obsession with technical perfection — in the case of an artificial pancreas —  to get in the way of progress.

Bonus: Reading materials for the FDA conference yesterday

But yesterday’s session left me disappointed. It was for a computer program meant to work with a continuous glucometer — you download information from your meter and then use the program to look for patterns, keep track of trends, etc. I can’t say much about the specifics of the program (they tend not to like that, the companies developing the products) but I will say that an odd thing happened as I was speaking with the interviewer: I got a chance to speak directly with one of the people  who was working on the program.

The room had a one-way mirror (i.e. I saw a mirror but people in the other room saw me) and after I’d spent several minutes trying to clarify a particular aspect of the product that I found confusing, there was a knock on the door and a man entered, stepping in to answer my question. I thought we were going to have a pleasant back-and-forth, me explaining what I didn’t understand and giving him feedback from a diabetic’s point of view,  him clarifying the reasoning behind this particular aspect of the program. But instead, he aggressively repeated exactly what the woman conducting the interview had told me — and when I again explained why I didn’t understand it, loudly exhaled and just said the same thing.

Now. I understand that, despite my best intentions, I can occasionally come off as rude. Case in point: a romantic dinner with my husband-to-be in which we shared with one another our life dreams (you know, that conversation. Maybe date five?). I was asking what I thought were astute and attentive follow-up questions, but Peter — lovely, sensitive Peter — stopped what he was saying and said “What the hell is your problem?” (A phrase, I might add, that has never been repeated in the course of our five-year relationship.) Apparently what I thought was a sensitive follow-up question came across as me grilling him about loopholes in his list of life aspirations. Whoops.

Anyway, perhaps I was doing some of the same things to Mr. Programmer Guy. It is true that at some point before he came in, I’d referred to the screenshot as looking like “something from Microsoft, circa 1993.”  But dude — I wasn’t on a date. I was being paid to give feedback on a product they’re presumably going to try to sell to people like me, and I was pointing out things that did not make sense. I do  not think I was being the asshole.

But regardless, the guy kept repeating, in condescending tones, the same explanation he had given previously (okay, fine, the question was about how to look at situations where one particular event caused a hypo- or hyper-glycemic episode, and my question was about how the software was able to pick out what the specific cause was, given that multiple factors can work together to cause your blood sugar to rise or drop). And as he continued speaking, the dynamic in my mind shifted from “Cool, this guy is working to help improve the lives of people with diabetes” to “He clearly has no idea what it’s like to live with this disease.”

I hate that. I want to be excited by the idea that there are companies out there trying to build on patients’ suggestions and create well designed, intuitive tools to help improve our lives. But after being talked down to by this guy, I felt pretty certain that he and his team are not actually going to change anything based on my suggestions. The way I see it, that’s not just frustrating; it’s a real waste.

Which is why I’m happy to announce that Amy over at DiabetesMine just launched the 2010 DiabetesMine Design Challenge — a chance for everyone from patients, and parents to caregivers, students, entrepreneurs, developers, and engineers to come up with innovative diabetes devices or web applications. Got an idea? Check out the video below.

Click here to view the embedded video.

“What about oatmeal?”

What about oatmeal. A query so innocent, so straightforward, that I was surprised to actually feel my stomach jump. Oatmeal? For breakfast? What was she doing, trying to kill me?

Riva was not trying to do any such thing. Instead, she shared with me her go-to breakfast recipe, a combination of oatmeal, cottage cheese and various other good things that we hope to soon highlight on the site. It was a perfectly reasonable suggestion — a serving of oatmeal has about 23 grams of carbohydrates. Add some peanut butter, and you slow down absorption. And besides, I’m the type of person who insists to everyone I meet that there are no “forbidden foods” in diabetes — it’s just that certain foods aren’t worth the trouble it takes to manage your blood sugar after you eat them. Krispy Kreme donuts, therefore, are out. But eating oatmeal is hardly a sin.

Try telling that to my psyche — as I felt my stomach drop, I realized that there are certain foods whose very mention can make me feel a jolt of panic. Sometimes that reaction makes sense (“large Coke”); sometimes it is totally irrational. Like with oatmeal, for example. Or beans. Say the word “lentils” to me and I guarantee  my heart rate will increase, despite the fact that they have a low glycemic index and are so unproblematic that I end up overbolusing nearly every time I eat them.

I’m fascinated by the emotional side of diabetes, and already devote a lot of thought to the swings in my self esteem I feel every time I see the number on my glucometer’s screen. But it wasn’t till I noticed my reaction to Riva’s favorite breakfast that I realized I’ve really started assigning emotional value to foods as well.

Anyone have panic foods of their own? Tell me about them in the comment section.

If you’d like to read the full text of some of his tweets, check out Access Hollywood – my 160-character limit doesn’t allow me to fully express his creative use of abbreviations. But what interested me is his perspective on the disaster as a Type 1 diabetic. “Imma Type 1 diabetic, and was sppsd 2 leave sunday,” he wrote, according to Access Hollywood. “I only packed enuf insulin pump supplies 2 last til then….airports r closed!”

You might be quick to point out that Elliott Yamin is just one visible example of a much larger population of Type 1 diabetics in Chile (or, for that matter, Haiti), for whom a natural disaster like an earthquake could have even more devastating effects — and who don’t have easy access to Access Hollywood. But that’s my point: the horror of both situations is difficult to wrap one’s mind around. Having a particular person in mind helps make the situation more real, even if the person writing is an American best known for his hit single “Wait for You.” It also highlights the special challenges all of us face when traveling with diabetes — we can usually navigate our normal lives without calling too much attention to our disease. But it just takes one event — a malfunctioning pump or, in this case, a natural disaster — to remind us of the additional challenges diabetes presents.

A practical resource: one good way to help other diabetics on the ground is to check out the International Diabetes Foundation, which we mentioned in the tip section after the disaster in Haiti.

In the meantime, Yamin is continuing to send updates of his situation that are more elaborate than his intial tweets. “This country isn’t very keen on insulin pumps,” he recently commented. “Supplies for my pump are running low. Hospitals here are very crowded, and as you can imagine, they are dealing with bigger things.”

The source of these quotes?  Fox News’s “Pop Tarts.” And to think I made fun of Twitter.

(In all seriousness, best of luck to Yamin and to all the diabetics —  Type 1 and Type 2 — currently stranded without supplies. I hope that help comes soon.)

And those times are road trips.

Last weekend, after my pump-in-the-toilet fiasco, my husband and I were on our way back from Yosemite National Park and got hungry for lunch. California’s Central Valley might grow ingredients for salads, but the establishments that line its highways do not serve them — so we were eventually left with what I considered two unappealing options: Jack in the Box, or Carl’s  Jr.

Jack in the Box was out of the question. Many years ago — 15? 20? — there was a nationwide scare over Jack in the Box. Perhaps you remember it; I believe it had something to do with a rat’s foot ending up in a hamburger.  All I know is that I was grossed out, and that since then, every time I see the Jack in the Box logo, I think of minced rodents. I don’t care how much time passes (or the fact that similar rat catastrophes happen in meat processing plants all the time): I’m never eating there.

Carl’s Jr. it was. And on its menu, I believe I found a near-perfect diabetic road trip food: the “Low-Carb Six-Dollar Hamburger”  (offered, confusingly, for less than six dollars). What makes this low-carb? They replace the bun with lettuce.

I was doubtful at first. I’m so grossed out the idea of fast-food meat that I actually welcome the idea of a bun — not so much because I think they’re worth the carbs, but because they hide some of the texture and taste of the meat. I worried that if I were to get the low-carb burger, stripping down my meat’s protective layers until only a sheath of iceberg lettuce remained, I might not be able to finish it. Let’s put it this way: if there’s a rat foot in my hamburger, I’d prefer not to taste it.

But I was pleasantly surprised. My burger came carefully swaddled in green, pickles and sauces kept contained by a well folded leaf. What’s more, it actually tasted good. Not good enough that I’m going to give up my salad-eating ways and dive into the murky world of American fast-food eating, but good enough that this first visit to Carl’s Junior is likely not to be my last.

Also worth noting: It’s not on the menu, but In-and-Out offers the same lettuce leaf option. Just ask for your burger “Protein Style.”

When Splenda first came out, I remember raving about it to my roommate Max, a very smart guy who tended to know a lot about a lot of things, and he began teasing me for eating what he called “chlorinated sugar.” I didn’t let this stop me — but I always did wonder about the safety (and ingredients) for all these different sweeteners.

Looks like someone at the San Francisco Chronicle had the same questions, because they just ran a break-down of all the major sweeteners, from straight-up sugar to Splenda. (They also did a “cookie-bakeoff” with the sweeteners.) There’s a lot of useful information. Xylitol, for example, was judged as the best sucrose substitute, but “it shouldn’t be eaten in large amounts. Its side effects are gas, bloating and diarrhea. The good news is that it doesn’t cause tooth decay.”

As for my beloved yellow packets? Splenda is “one of only two sweeteners deemed safe by the Center for Science in the Public Interest.” But, the article notes, “It does enjoy some controversy over the fact that it was discovered during the process of developing an insecticide.”

I’m going to mull that last bit over while drinking a cup of sweetened tea.