This occurred to me at midnight on Saturday, as I was surfing the Home Depot website and trying to decide whether my husband’s spare nails and drill bits would best be contained by a shelf set with 39 drawers of multiple sizes, or if a straight 18-drawer set (with drawer dividers) would be a better bet. Previously I had spent fifteen minutes deciding exactly how many Oxo Pop Top food storage containers I required for my walnuts, pumpkin seeds and Splenda packs (and, of course, in what capacity) and agonizing over whether I should get a spice rack that fit in a drawer, one that sat on a shelf, or if a cabinet Lazy Susan would make more sense.

I was in what Barry Schwartz, author of The Paradox of Choice, would refer to as severe “optimizing” mode, where you try to make the absolute best decision for every single circumstance in your life. It was not enough to know, for example, that a particular shoe rack fit the dimensions of my closet. I needed to read through all of the customer reviews of this shoe rack, so that I could weigh its pros and cons, its strengths and its failures, to make sure that opening my closet each morning would result in a rush of organizational contentment rather than stress. Despite most retailers’ generous return policies, I wanted to make sure that every dollar, every penny I forked over would be money well spent. 

But even odder, in some ways, was my compulsion to buy these things to begin with. When I was a kid, my mother used to tease me (some might even say nag) about the state of my closet, or my seeming inability to make my bed every morning or carefully fold my clothes. When I was in college, I don’t remember vacuuming our dorm room more than three or four times a year. I gave no thought to the status of my underwear drawer. 

This all changed after I graduated from college, which also happened to be shortly after I was diagnosed with Type 1. A friend lent me a copy of Julie Morgenstern’s book Organizing From the Inside Out, which uses an acronym (Sort, Purge, Assign, Containerize, Equalize) to help you organize your life. First of all, it should be noted that I read that book in the fall of 2001 and still remember both the acronym and what each letter stands for. That’s scary. But it explains the fact that when people ask me what books have made a difference in my life — perhaps expecting something literary, or at least vaguely philosophical — I respond with Julie Morgenstern. 

I’m serious. I spent a weekend with Julie (or, more accurately, her book), going through my closet piece by piece (sorting), donating extra clothes (purging), and stacking them into categories (assigning). Then I paid a visit to the temple of organization — the Container Store — attempting to resist the pull of a display of rainbow-colored but totally useless plastic boxes (know what containers you need before you buy containers, Julie wisely advises). After accepting the irony of my purchases — nearly $200 spent on empty boxes — I put together my newly cleansed closet. Since then, I have been attempting to live the last step: equalizing, which basically means maintaining your organized status so that you don’t end on the wrong e: entropy. 

As I’ve grown older, my organizational fervor has only increased.  I now own several Swiffers, and often think, while conquering dust bunnies, of the pride the inventor of the Swiffer’s mother must feel at knowing the revolutionary effect her son or daughter has had on dusting. I have three Clorox toilet wands. (And I love each and every one.) I spend an embarrassing amount of time contemplating how to cross reference receipts. My husband makes fun of me, but I can’t help it: organization makes me calmer. It makes me feel more in control. It makes me feel sane. 

Which is why I’ve been wondering recently if the timing of my diabetes diagnosis and my descent into organizational obsession might be more than coincidental. With a disease that is able to resist all efforts of control, have I been driven to seek organization and order elsewhere in my life? Does the satisfaction I derive from my file cabinet in some way offset the frustration I feel when my blood sugar strays out of bounds? (And I also should note that I recently decided to organize my diabetes supplies, which were getting out of control — and there was indeed something very satisfying about relegating my supplies to shoeboxes, rather than allowing them to take over the cabinet in which they were stored.) 

I think it might — and I’m surprised it hasn’t occurred to me before. (I mean, I knew I did that with exercise, but that’s kind of obvious.) So what do you guys think? Are there non-medical aspects of your life that diabetes has affected? What do you do in your daily life to give yourself more of a sense of power and control? 

In order to run a marathon with diabetes you have to work hard at every aspect of diabetes management.  You also have to get up very early in the morning, even if you don’t feel like it.

A typical morning for Mike, before he starts working, looks something like this:

4:30 a.m. Wake up

4:35 a.m. Blood sugar check and reduce basal rate on pump

4:45 a.m. Make sandwiches for kids’ lunches then get dressed

5:00 a.m.  Drink coffee/check email

5:10 a.m. Blood sugar check

5:15 a.m. Pack glucose meter and energy gels then out the door

5:30 a.m. Blood glucose check – it’s usually low – so one energy gel (breakfast)

6:15 a.m. Blood glucose check

7:30 Home.  Blood glucose check.  Help get the kids ready for school. Take the dog out.

If you want to run a marathon with diabetes there are no shortcuts. You have to have a plan and you have to stick with it.  Mike does, even in extreme situations.  Last weekend, for example, our oldest son Tom was in an sailing competition about an hour’s drive away.  Mike woke up extra early on Friday and Saturday in order to run before taking Tom.  He spent both days on the beach and on the water, and did not break his diet.  He came home starving, but his blood sugar was perfect.  Everything else, though, was starting to go to shit.

Our youngest son Adam, who is three-years-old, began to cough Saturday night.  We were up most of the night and on Sunday morning  Adam was having trouble breathing.  We could tell by the retractions in his chest.  We took him to an emergency clinic and he was diagnosed with pneumonia.  Adam received a few rounds of inhalation therapy, oral steroid treatment, and we spent most of the day in the clinic where the doctors could observe him.  He was limp and kept falling asleep in Mike’s arms.  But he felt safe in Mike’s arms.  Mike held him through a blood test, took him in for a chest x-ray, and held him through two rounds of inhalation therapy.  Adam did not cry once.  

After Adam’s blood test, Mike took out his glucose meter and showed Adam that he was doing a blood test, too.

We left the clinic once Adam’s breathing had improved, with antibiotics and instructions for continuing the inhalation therapy at a home.  The combination of the stress and lack of sleep left us both totally drained.  Neither of us had eaten all day because we left early in the morning, and were both too stubborn to break our diets on the quick snack food available around the clinic. The truth is, I didn’t realize I was starving until we got home.  By then I was almost too tired to eat.

We didn’t get much sleep Sunday night either, but don’t think for a minute that that stopped Mike from waking up at 4:30 Monday morning to run.  He had been going nonstop for days.  But if you’re going to run a marathon with diabetes, there are no breaks.  

*Thank you, Orit, for helping out with Tom and Guy on Sunday and totally saving the day.

*Adam is on day three of the antibiotic and seems to be improving well.  So far so good.

A study published in Diabetes Care in January of 2012 showed that patients with diabetes are more likely to develop cancer than people without diabetes and that adults with diabetes are more likely to die of cancer than their non-diabetic counterparts. 

The association between diabetes and cancer was first noted over 100 years ago, but physicians have become increasingly aware of this association only in the last few years as recent studies have demonstrated that having diabetes increases the risk of almost all types of cancer.  The risk of pancreatic, liver, and endometrial cancer is approximately twice that of the non-diabetic population. Some studies have reported a similar increase in the risk of bladder cancer and in cancers of the oral cavity. The risk of kidney cancer is reported to be approximately 40% higher, and cancer of the colon approximately 30% higher in diabetic individuals compared to those without diabetes.  Diabetes is also associated with an increased risk of breast cancer, and those with diabetes are more likely to present with advanced stage breast cancer and are more likely than those without diabetes to die from breast cancer. Notably, studies have reported that the risk of developing prostate cancer is lower in those with diabetes, although in men who develop prostate cancer, diabetes is associated with a greater risk of mortality, recurrence, and treatment failure.

The Link Between Diabetes and Cancer

Why the association between diabetes and cancer occurs is still unclear. Type 2 diabetes is characterized by insulin resistance, which means that the pancreas needs to secrete much more insulin in order to compensate and help sugar go from the blood to the tissues.  The high levels of insulin that result from insulin resistance might be responsible for the increased rates of cancer seen in patients with diabetes, as has been seen in animal models of colorectal and pancreatic cancers.  Another possible mechanism is that high blood glucose itself is contributing to this association.

Many studies around the world are currently underway to help understand the connection between diabetes and cancer.  In the meantime, the increase in cancer risk means that physicians who treat patients with diabetes must be aware of this association and should be making sure that patients get the appropriate cancer screenings done on time. 

Metformin as an Anticancer Agent

Another piece of the diabetes and cancer puzzle is the drug metformin (glucophage).  Metformin, a first line therapy for diabetes, seems to be emerging as a potential anticancer agent.  The primary actions of metformin include reducing the insulin resistance and also decreasing the production of sugar by the liver. This results in lower circulating glucose and plasma insulin levels.

A few years ago it was noted that diabetics had an increased cancer mortality compared with non-diabetics, as mentioned above, but that diabetics on metformin had a substantially (40%) reduced cancer burden compared with diabetics on other treatment. Since then, several population-based studies have suggested that metformin reduces cancer incidence and/or mortality among type 2 diabetic patients treated with metformin. For example, a study that was done in Scotland involved 11,876 patients with newly diagnosed diabetes which were followed from 1993 to 2001.  Results showed a 15% reduction of cancer risk in patients on metformin, looking at all types of a cancer together.  Another study published in Diabetes Care in February 2012, followed 8,392 patients with diabetes and showed that metformin was associated with survival benefit both in comparison with other treatments for diabetes and in comparison with a nondiabetic population. The studies show that the effect seems to increase the longer the patients take metformin.

This protective effect of metformin can also be seen in studies which looked at specific cancers, for example, liver, prostate, pancreas, breast, and ovaries.  A study published last month looked at effect of diabetes and diabetes medications on ovarian cancer treatment and outcomes.  It included 341 ovarian cancer patients.  Of these, 297 did not have diabetes, 28 were patients with type 2 diabetes who did not use metformin, and 16 were patients with type 2 diabetes who used metformin.  Despite the fact that all three groups received similar treatment for their cancer, their survival at five years was very different–  63% for the diabetic patients who used metformin, 37% the non-diabetic patients, and 23% for the diabetic patients who did not use metformin.

Another study showed that patients with type 2 diabetes receiving neoadjuvant chemotherapy for breast cancer as well as metformin were more likely to have a complete remission than patients not receiving metformin.  

The consistency and magnitude of the cancer-lowering effect seen in these studies have generated a great deal of enthusiasm.  Several prospective studies are now being done to more accurately describe this phenomenon in patients with and without diabetes.   Also, scientists are trying to clarify by what molecular mechanisms metformin is acting as an anti-tumor agent.  

If the research continues to show good results for metformin, we’ll have at our fingertips a safe, inexpensive, generic drug with relatively few side effects that could be used not just to treat diabetes, but to prevent or help to treat cancers in patients with and without diabetes.  

Dr. Mariela Glandt heads the Diabetes Medical Center in Tel Aviv.  She also practices endocrinology at Bronx-Lebanon Hospital.

1. I find myself screaming, “How many carbs are in that pancake? You don’t know?! Can I see the box?!?” My day is filled with stuff ordinary people never think about.
2. Shit, shit, shit! (and really I don’t usually curse) I wasn’t going to walk this morning because they predicted rain and now the sun is out! Walk? Don’t walk? Will I risk going low? Will I then have to eat when the last thing I want to do is burn calories only to have to eat more? Damn! How many other people beat themselves up for wanting to take a walk?
3. I am afflicted with a terrorist torture — sleep deprivation. “I’m so tired, can’t I just lie here and fall asleep?” No, gotta get up, go into the kitchen and stick a needle in my finger to check my blood sugar.” Sunday morning replay: “I’m so sleepy, can’t I just lie here just a little longer? It’s only 6:45 a.m. for goodness’ sake.” No, gotta get up and stick a needle in my finger, and then two more to take my insulin.
4. “Hmmm… That’s a cute designer diabetes accessory. It would carry all my syringes, vials, test strips.” God, did I really say that? I want out of this club, never mind the cute accessories.
5. Wiping blood off my counter, my cupboard, my shirt — yuck, my food — with absolutely no notice, hesitation or dismay.
6. “When’s dinner? When? You sure? Really? You’re sure?”
7. Glucerna has a cereal for diabetics — a product just for us. Hmmm, I notice there an “us.” I don’t really want to know there’s an “us.” Yet now people with diabetes are worthy of marketer’s attention. Right up there with Lexus drivers.
8. How often do I really have to go to my endocrinologist? I just found a prescription to get lab work done from July 30, 2011. Oops.
9. Sneaking lunch into a noon movie, no sweat. Taking my shot in the dark, not so easy. Last time, I think I stuck the guy next to me.
10. I just checked my blood sugar and forgot the number! Alzheimer’s? Dementia? Is it really true that lows cause dementia? Who cares, now I have to do it again!!

If you don’t know if you have diabetes, find out. Risk factors for Type 2 diabetes include family history, being overweight, having a sedentary lifestyle, high blood pressure, high cholesterol and having given birth to a big baby. You can take the risk test on the American Diabetes Association website.

If you have any of the risk factors, have your health care provider give you a simple blood test. While there are times I’d rather forget I have diabetes, there is never a time I wouldn’t want to know that I have it.

If you find out that you do have diabetes – seven million Americans have it and don’t know — you can write your own list!

Today’s topic is “find a friend” and asks us to introduce a blogger others may not know.  

Many of you have probably come across Laura Houston’s blog, Houston We Have a Problem.  If you haven’t, now is your chance.  It’s very worth your while.  Laura’s son Nate, now three, was diagnosed with type 1 diabetes when he was 14-months-old.  Shortly thereafter one of Laura’s daughters became ill with what was recently diagnosed as Crohn’s disease.  

I love Laura’s blog because it’s totally straightforward.  She doesn’t waste words.  It’s a completely honest account of her life as the mother of a small child with type 1 diabetes (and all the other crap she deals with).

To manage what Laura manages you’ve got to be extraordinary.  And she is.  Read her post Insulin Overload and you’ll see exactly what I mean.

 According to the State of the Nation 2012 report there are some areas where just six per cent of people with diabetes are getting the regular checks and services recommended by the National Institute of Health and Clinical Excellence (NICE).

The report details how the lack of diabetes care has helped cause the rise in rates of diabetes-related complications such as amputation, blindness, kidney failure and stroke.

These complications do not only cause a extreme reduction in the quality of life of people with diabetes and early death but are also account for the rising costs of diabetes care in the UK. These complications account for about 80 per cent of NHS spending on diabetes and are one of the main reasons that treating diabetes costs about 10 per cent of the entire NHS budget.

The report also highlights how a National Service Framework for diabetes – which sets out the healthcare people with the condition should be getting – has been in place for 11 years, but has yet to become a reality.

According to the report, the Government urgently needs to deliver a plan to implement these standards; to introduce more effective risk assessment and early diagnosis so people can either avoid Type 2 diabetes or get the healthcare they need to manage the condition and avoid complications; and for all people diagnosed with diabetes to have access to education to support them in self managing their condition to prevent complications.

As well as the large number of people not getting the checks they need to manage their diabetes, the report offers a comprehensive overview of diabetes healthcare in England. It revealed that, from diagnosis through to managing the complications of the condition, the approach to diabetes is in need of wholesale change.

The issues highlighted in the report include:

• A quarter of children and young people with Type 1 diabetes are only diagnosed when they already need emergency treatment
• There are some areas where just half of people with diabetes are thought to have been diagnosed
• Just 49.8 per cent of people with diabetes are getting the nine basic health checks and services recommended by NICE; this figure ranges from six per cent in the worst-performing areas to 69 per cent in the best-performing areas
• 40 per cent of people with the condition are not meeting their blood glucose targets
• The situation is even worse for children and young people with diabetes: just four per cent get all their annual checks, while 85 per cent are not meeting their blood glucose targets.

Diabetes UK is using the publication of the report to launch a new campaign for change urging people with diabetes to contact their MP to urge him to write to Paul Burstow, Minister for Care Services, to demand a plan for improving diabetes healthcare.

Diabetes UK will also be launching a Facebook and Twitter campaign to help spread the word and try to make a change.

iBGStar is the first FDA-approved blood glucose meter that plugs into an iPhone and iPod touch and is to be used with the iBGStar Diabetes Manager App.

I will get to the specs of the device shortly, but first I think it’s important to note what I am witnessing — and celebrating — more and more: the sure and steady rise of the patient. 

Sanofi, the third-leading global pharmaceutical company, is interested in what patients have to say. So is Roche, who invites me and 30-plus diabetes patient influencers to its annual social summit, and Medtronics, that just held its second annual event with patients.

While Marshall McLuhan’s famous line, “the medium is the message,” was oft-quoted during my college years, today patients are becoming deliverers of the message, especially in the online space. It’s smart business and, I should say, a healthy paradigm shift for all concerned as pharmaceutical Goliaths increasingly realize and respect the growing power of us little “Davids.”

Sanofi, maker of long-acting Lantus and rapid-acting Apidra insulins, is reaching beyond product into devices and services. Shawna Gvazdauskas, VP and Device Head U.S., told us the mission is to, “Meet patients where they live and improve their experience managing diabetes.” To be customer-centric through innovative and integrated solutions. The part I liked best was when she talked about “delighting customers.”

The iBGStar can be used as a stand-alone device. It has its own display where you’ll see your glucose reading. When you later attach it to your iPhone or iPod touch it will automatically download your data. When measuring your blood sugar while the iBGStar is attached to your iPhone or iPod touch, your number shows up on the small and large display.

Sanofi's Shawna Gvazdauskas, Brian Dolan of mobile health news, me, Emily Coles, Laura Kolodjeski, Sanofi Senior Manager, Patient solutions, Allison Blass of DiabetesMine, Kim Vlasnik of Texting My Pancreas.com, Kerri Sparling of SixUntilMe.com, Adam Brown and Kelly Close of Close Concerns, blogger Leighann Calentine and analyst David Kliff of Diabetic Investor attended the meeting but left before the photo was taken.

The hope is that patients will spend more time with their numbers during idle time during their day and consequently better manage their blood sugar. For doctors, their patients will have their logs with them when they arrive at their appointment or can email them ahead.

As you can see, the iBGStar is the width of an iPhone and less than 1 inch tall. It’s light as a feather, has a 6 second countdown, uses 0.5 microliter blood size — one of the smallest amounts — and meets accuracy requirements.

The iBGStar Diabetes Manager App captures blood glucose readings, records carbs and insulin doses, tags readings according to mealtimes and allows you to add customized notes regarding meals and exercise. You can analyze your data using a logbook, trend chart and statistics. Color-coded screens indicate if blood glucose is too high or too low.

A “share” function allows specific data to be sent via email to your doctor. 

The iBGStar is available for purchase at Apple retail stores and Walgreens stores nationwide and online at Apple.com, Walgreens.com and through Diabetic Care Services. It’s priced at about $100 through Apple and comes with 50 test strips. It’s about $75 at Walgreens and comes with 10 test strips. The iBGStar Diabetes Manager App is available for free from the App Store on iPhone and iPod touch or at www.itunes.com/appstore.

Sanofi offers a copay savings cardso strips will not cost more than $20 per order. Plus, plans are afoot to integrate Sanofi’s GoMeals App with the iBGStar Diabetes Manager App.

So, is this just moving chairs around on the Titanic, or a real advancement for helping patients better manage their blood sugar? I imagine only time and slated studies to analyze patient use will tell. People on average currently check their blood sugar .83 times (less than once) a day. 

Given that only 1.6 million people are today potential users for Sanofi — those who have diabetes and iPhones or an iPod touch — it’s a small pool, and a large commitment. Then again, we have to start somewhere.

Disclosure: I was given a free iBGStar to leave with, my transportation to the meeting was paid for by Sanofi and lunch was provided. I was not asked to write this post.

Salads are a big part of our diet, and we love Kalyn’s Kitchen because she has a fantastic collection of salad recipes.  You can search for salads by ingredient on her blog, and she’s got just about every vegetable covered.  Kalyn also has wonderful meals and side dishes.  This dish of sautéed spinach with Parmesan and pine nuts struck me as a perfect recipe for ASweetLife.  Thank you, Kalyn for sharing this with us.  

Ingredients:

1 bunch fresh spinach

1 T plus 2 tsp. extra virgin olive oil

(or slightly more, depending on your pan)

about 1 tsp. best quality balsamic vinegar (or more to taste)

salt, fresh ground pepper to taste

2 T freshly grated Parmesan cheese (coarsely grated is best)

2 T toasted pine nuts

Preparation:

Wash spinach well, trimming off stems if they seem thick. (I used a salad spinner to wash the spinach and spin it dry.) In large heavy frying pan or wok, heat 1 T olive oil over medium heat, add spinach and saute 2-3 minutes, stirring several times so all spinach is wilted and slightly cooked. Don’t overcook. Turn off heat, drizzle over remaining 2 tsp. olive oil and balsamic vinegar, season with salt and freshly ground pepper, and stir to coat spinach. Put spinach on serving platter, grate desired amount of Parmesan cheese over and sprinkle with pine nuts.

Serves: 2-3

*photo courtesy of Kalyn’s Kitchen