October 30, 2007
Thanks for testing
I was reading an article in Cognitive Daily (CD to those of us in the cognitive know “A new cognitive psychology article every day” Wahoo!) and it got me thinking about an article on diabetes at CNN. (No doubt all this lofty reading has you thinking I have too much time on my hands – truth be told I have read exactly one article at Cognitive Daily and I skimmed a lot of it at that.) Anyway the CD article was about effectively praising a child and the CNN story was the rare fairly good one on type 1.
It seams that to be effective praise should be specific. According to CD, “When you are helping a child learn to read, saying "you are a smart girl" as opposed to "you did a good job reading" results in very different behavior when she has trouble reading in the future.”
Specific is good! I got it.
The CNN story quotes a young lady, "One of the hardest things about having diabetes as a younger child was being different. No one wants anything to make them stand out as a child, and having to take blood sugar readings and inject myself with insulin every day definitely qualifies." She also describes the feelings of guilt, "I thought I'd done something wrong to deserve diabetes. I was constantly searching and trying to understand why I was the only kid in my grade with diabetes."
The article goes on with the comments of a counselor of parents of diabetic children who says that diabetic adolescents "go through times where they want to forget about it. They pretend like they don't have it.” Sure enough the young lady quoted before goes on to say, “Whenever I had a bad blood sugar reading I would lie about it and say a different number, until eventually I was caught."
Now if you have stayed with me this long you may be wondering what, specifically, I have been smoking because there doesn’t seem to be much in common between the CD and CNN stories. You would be right, not about what I have been smoking, but about the wisp of a thread between them. Here it is, it strikes me that we need to be careful with how we praise the little diabetics so that we don’t feed into that pretending they don’t have it and lying about numbers.
The first step is to specifically praise testing (and correcting but that is the advanced class) not the number that comes from the test. The number isn’t good bad or indifferent, it is just a navigation check point telling us how close to the path we are. We are on course or left or right of it.
What important? That they checked to see where they are.
“Thanks for checking.”
“Whenever I had a bad blood sugar reading…” Remember the numbers are not good bad or indifferent. They are numbers. Period.
Were did she get the idea a sugar reading is bad? Our reactions maybe? Look in the mirror a few times when your kid tells tour the number.
“Thanks for checking.”
Not 102 GREAT! Not 309 WHAT did YOU *$@# eat!?
“Thanks for checking.”
Lord All Mighty this is a very hard thing to do!
It is harder than remembering washing sugar off the fingers before testing. (Thanks for washing your hands and testing.) It is harder than calculating new I:C ratios. It is even harder than getting used test strips into the trash. (OK that last one is scientifically impossible.)
But think about it, specifically, is there any behavior you want your diabetic child to adopt as a life long habit more than regularly checking?
“Thanks for testing.” Place your hand on your child’s shoulder. “I am proud of all the checking you do to manage your diabetes.”
What's the best way to praise a child? Be specific. - Cognitive Daily
Son's diagnosis 'knocked the life out of me' - CNN
It seams that to be effective praise should be specific. According to CD, “When you are helping a child learn to read, saying "you are a smart girl" as opposed to "you did a good job reading" results in very different behavior when she has trouble reading in the future.”
Specific is good! I got it.
The CNN story quotes a young lady, "One of the hardest things about having diabetes as a younger child was being different. No one wants anything to make them stand out as a child, and having to take blood sugar readings and inject myself with insulin every day definitely qualifies." She also describes the feelings of guilt, "I thought I'd done something wrong to deserve diabetes. I was constantly searching and trying to understand why I was the only kid in my grade with diabetes."
The article goes on with the comments of a counselor of parents of diabetic children who says that diabetic adolescents "go through times where they want to forget about it. They pretend like they don't have it.” Sure enough the young lady quoted before goes on to say, “Whenever I had a bad blood sugar reading I would lie about it and say a different number, until eventually I was caught."
Now if you have stayed with me this long you may be wondering what, specifically, I have been smoking because there doesn’t seem to be much in common between the CD and CNN stories. You would be right, not about what I have been smoking, but about the wisp of a thread between them. Here it is, it strikes me that we need to be careful with how we praise the little diabetics so that we don’t feed into that pretending they don’t have it and lying about numbers.
The first step is to specifically praise testing (and correcting but that is the advanced class) not the number that comes from the test. The number isn’t good bad or indifferent, it is just a navigation check point telling us how close to the path we are. We are on course or left or right of it.
What important? That they checked to see where they are.
“Thanks for checking.”
“Whenever I had a bad blood sugar reading…” Remember the numbers are not good bad or indifferent. They are numbers. Period.
Were did she get the idea a sugar reading is bad? Our reactions maybe? Look in the mirror a few times when your kid tells tour the number.
“Thanks for checking.”
Not 102 GREAT! Not 309 WHAT did YOU *$@# eat!?
“Thanks for checking.”
Lord All Mighty this is a very hard thing to do!
It is harder than remembering washing sugar off the fingers before testing. (Thanks for washing your hands and testing.) It is harder than calculating new I:C ratios. It is even harder than getting used test strips into the trash. (OK that last one is scientifically impossible.)
But think about it, specifically, is there any behavior you want your diabetic child to adopt as a life long habit more than regularly checking?
“Thanks for testing.” Place your hand on your child’s shoulder. “I am proud of all the checking you do to manage your diabetes.”
What's the best way to praise a child? Be specific. - Cognitive Daily
Son's diagnosis 'knocked the life out of me' - CNN
October 26, 2007
They Change Fast
I read a comment by a parent who's son dropped from the 200 to the 60 very quickly. He had felt low but tested high, then normal then low. Hand washing was suspected as a possible source of a false high but he had washed.
The little dude kept saying he felt low so they kept checking.
Way to go!
First and foremost trust a child that says they don't feel right, there are long term implications of that trust as significant as the short term implications of a low. Kids need to know that we respect what they feel. Hopefully they see that and since we respect them they should respect them selfs too.
Meters are lagging indicators I don't know how or why blood drops rapidly but there are plenty of folks who've see it. Maybe it is because blood takes time to move around, I don't know. We have seen rapid changes, and I will not discount that it happens. This is one of the issues that makes people worry about CGM as the fluid they test is even more of a lag than blood.
Some insulins are less predictable than others. NPH can be great one day and hit like a ton of bricks the next. So who knows maybe this was one of NPH's little tricks.
But that why lags happen or how meters work isn't really what it is all about. The big issue is trust and respect. If the kids says they feel low, check. If the meter says something other than what the kids feels keep trusting the child.
Washing fingers and retesting is good sound practice, so is respecting what the child if feeling and saying well maybe you are feeling what happening before the meter shows it and we should keep an eye on it.
Things change. Sometimes they change fast. You want to be sitting back, with grey hair, saying they change, meaning grow up, so fast, what shouldn't change is valuing what kids feel.
I think it was some genius like Plato, Aristotle or Einstein who said YDMV - LOL -
Sometimes what varies is how fast it varies.
Care, respect, love aren't diabetes, they don't vary.
Oh and keep the tabs and glucagon handy.
The little dude kept saying he felt low so they kept checking.
Way to go!
First and foremost trust a child that says they don't feel right, there are long term implications of that trust as significant as the short term implications of a low. Kids need to know that we respect what they feel. Hopefully they see that and since we respect them they should respect them selfs too.
Meters are lagging indicators I don't know how or why blood drops rapidly but there are plenty of folks who've see it. Maybe it is because blood takes time to move around, I don't know. We have seen rapid changes, and I will not discount that it happens. This is one of the issues that makes people worry about CGM as the fluid they test is even more of a lag than blood.
Some insulins are less predictable than others. NPH can be great one day and hit like a ton of bricks the next. So who knows maybe this was one of NPH's little tricks.
But that why lags happen or how meters work isn't really what it is all about. The big issue is trust and respect. If the kids says they feel low, check. If the meter says something other than what the kids feels keep trusting the child.
Washing fingers and retesting is good sound practice, so is respecting what the child if feeling and saying well maybe you are feeling what happening before the meter shows it and we should keep an eye on it.
Things change. Sometimes they change fast. You want to be sitting back, with grey hair, saying they change, meaning grow up, so fast, what shouldn't change is valuing what kids feel.
I think it was some genius like Plato, Aristotle or Einstein who said YDMV - LOL -
Sometimes what varies is how fast it varies.
Care, respect, love aren't diabetes, they don't vary.
Oh and keep the tabs and glucagon handy.
October 25, 2007
5 Easy Pieces
More for JDRF IDDP Fans*
(*I may be the only civilian in the lower 48 states who is aware of, let alone could be ranked as an IDDP fan.)
IDDP I
SKG
SmithKlineGlaxo announced an agreement with JDRF IDDP partner Tolerx, to develop and commercialize a different anti-CD3 compound from the Lilly / MacroGenics. So the fact that the deep pockets are stepping up seems to indicate that there is reason to believe there is good news in these anti-CD3s.
IDDP II
SKG / Lilly press release
I am happy to see JDRF issue a press release about the SFG and Lilly deals with their IDDP partners:
IMHO This is press release a step on the way to transparency that can give those of us who support JDRF comfort in how the funds raised for JDRF are used.
IDDP III
Housey Pharmaceutical Research Laboratories
JDRF has entered a IDDP agreement with Housey Pharmaceutical Research Laboratories (HPRL) for research “aimed at identifying small molecule compounds to promote beta cell growth and survival.”
The press release at one point says the idea is to,”support the company's studies to identify compounds to promote the regeneration of functional pancreatic beta cells.”
Wohoo! That’s what I’m talking about!
Now when I Googled Housey I was somewhat concerned that their web page talked exclusively about T2. So I emailed JDRF. They explained that JDRF is interested in seeing technology developed for other things (like T2), that has promise for T1, look to the T1 uses as well as the large population of T2.
Apparently it is no longer permissible to get top scientists to focus on research that benefits the type 1 by hittin’m up side the head with a 2x4 with a nail sticking out of it. So since the stick is out apparently a carrot is the next best thing. An IDDP agreement is a nice carrot.
IDDP IV
EpiVax, Inc
“EpiVax, Inc, a leader in the field of computational immunology, announced today that it has received funding from the Juvenile Diabetes Research Foundation (JDRF), the world's largest charitable funder of Type 1 diabetes research, to develop "Epi-13," a novel therapeutic for the prevention and treatment of type I diabetes, a devastating and chronic autoimmune disease that affects up to three million Americans today.”
IDDP V
Osiris Therapeutics
JDRF Partners with Osiris to evaluate an immunomodulatory cell therapy product for type 1 diabetes. JDRF will fund Osiris’ proof-of-concept trial of Prochymal™, a formulation of immunomodulatory adult bone marrow-derived mesenchymal stem cells, in type 1 diabetes.. Prochymal™ is currently being evaluated by Osiris in Phase III trials for Graft-vs-Host Disease (GVHD) and Crohn’s Disease.
"immunomodulatory" is the even a real word? I guess I'll have to look that one up.
I think there is a lesson to be learned here. That is I should keep my big yap shut and not be asking JDRF questions. or they come out with a ton of press releases and I can't up date the blog fast enough to keep up. This post started out with a reference to three...
(*I may be the only civilian in the lower 48 states who is aware of, let alone could be ranked as an IDDP fan.)
IDDP I
SKG
SmithKlineGlaxo announced an agreement with JDRF IDDP partner Tolerx, to develop and commercialize a different anti-CD3 compound from the Lilly / MacroGenics. So the fact that the deep pockets are stepping up seems to indicate that there is reason to believe there is good news in these anti-CD3s.
IDDP II
SKG / Lilly press release
I am happy to see JDRF issue a press release about the SFG and Lilly deals with their IDDP partners:
IMHO This is press release a step on the way to transparency that can give those of us who support JDRF comfort in how the funds raised for JDRF are used.
IDDP III
Housey Pharmaceutical Research Laboratories
JDRF has entered a IDDP agreement with Housey Pharmaceutical Research Laboratories (HPRL) for research “aimed at identifying small molecule compounds to promote beta cell growth and survival.”
The press release at one point says the idea is to,”support the company's studies to identify compounds to promote the regeneration of functional pancreatic beta cells.”
Wohoo! That’s what I’m talking about!
Now when I Googled Housey I was somewhat concerned that their web page talked exclusively about T2. So I emailed JDRF. They explained that JDRF is interested in seeing technology developed for other things (like T2), that has promise for T1, look to the T1 uses as well as the large population of T2.
“That HPRL’s prior experience has not necessarily been with type 1 represents some success in another strategic aim of our Research group, that is, to persuade more top scientists to focus on research that benefits the type 1 community, even if it had not been on their radar screen previously. One of the issues we’ve had to deal with over the years is a relatively narrow range of researchers and research institutions that are involved with type 1 diabetes.”
Apparently it is no longer permissible to get top scientists to focus on research that benefits the type 1 by hittin’m up side the head with a 2x4 with a nail sticking out of it. So since the stick is out apparently a carrot is the next best thing. An IDDP agreement is a nice carrot.
IDDP IV
EpiVax, Inc
“EpiVax, Inc, a leader in the field of computational immunology, announced today that it has received funding from the Juvenile Diabetes Research Foundation (JDRF), the world's largest charitable funder of Type 1 diabetes research, to develop "Epi-13," a novel therapeutic for the prevention and treatment of type I diabetes, a devastating and chronic autoimmune disease that affects up to three million Americans today.”
IDDP V
Osiris Therapeutics
JDRF Partners with Osiris to evaluate an immunomodulatory cell therapy product for type 1 diabetes. JDRF will fund Osiris’ proof-of-concept trial of Prochymal™, a formulation of immunomodulatory adult bone marrow-derived mesenchymal stem cells, in type 1 diabetes.. Prochymal™ is currently being evaluated by Osiris in Phase III trials for Graft-vs-Host Disease (GVHD) and Crohn’s Disease.
"immunomodulatory" is the even a real word? I guess I'll have to look that one up.
I think there is a lesson to be learned here. That is I should keep my big yap shut and not be asking JDRF questions. or they come out with a ton of press releases and I can't up date the blog fast enough to keep up. This post started out with a reference to three...
More on Lilly/MarcoGenics & JDRF
This just in from my buddy at JDRF, (Who was building a strong case for not being called a geek “I am not a geek.” See I said it was a strong case - until he wrote, in very good humor: “If you have any additional questions, please submit them, in writing, in triplicate.” - It was the triplicate the crossed the line into geekdome.)
Any way he wrote:
The Lilly-MacroGenics deal did not trigger any events for JDRF at this point. They’re essentially tied to development and commercialization.
I am good with that. I like others (aka Lilly) are stepping up with big money to invest in the better technology. Particularly in an environment where Pfizer is writing of a few billion on the diabetes market.
Any way he wrote:
The Lilly-MacroGenics deal did not trigger any events for JDRF at this point. They’re essentially tied to development and commercialization.
I am good with that. I like others (aka Lilly) are stepping up with big money to invest in the better technology. Particularly in an environment where Pfizer is writing of a few billion on the diabetes market.
October 24, 2007
Stupid Meter Tricks I
We do stupid meter tricks. Mostly for the fun of it but there is also some madness in the method, I’ll cover that madness later.
Shortly after our second case of T1 was diagnosed, on vacation at Disney, we found ourselves sitting at a restaurant table with a 7 year old who was in between thinking it was cool to be in the D club with her older brother and realizing much of the stuff she had to do, now that she was in that club, hurts.
So waiting for the waitress we amused ourselves testing everything we could get to wick into the strip and some stuff that wouldn’t. We tested Coke, Sprite, Milk, and tried for Ketchup and Gravy some where in there we tested a little blood.
So here is the madness, testing hurts. Period.
Diabetes care is a pain in the butt, sometimes literally if that is where you wear your set. In time, the fingers get calloused and so do the emotions but at first both are Very Raw
Joking around with the meter helps to de-mystify it. It isn’t some sacred relic is an every day tool. It can be part of play. It can be ordinary.
It needs to be ordinary, it needs to be theirs and it can be played with, all this because it needs to be used.
More Stupid Meter Tricks
Shortly after our second case of T1 was diagnosed, on vacation at Disney, we found ourselves sitting at a restaurant table with a 7 year old who was in between thinking it was cool to be in the D club with her older brother and realizing much of the stuff she had to do, now that she was in that club, hurts.
So waiting for the waitress we amused ourselves testing everything we could get to wick into the strip and some stuff that wouldn’t. We tested Coke, Sprite, Milk, and tried for Ketchup and Gravy some where in there we tested a little blood.
So here is the madness, testing hurts. Period.
Diabetes care is a pain in the butt, sometimes literally if that is where you wear your set. In time, the fingers get calloused and so do the emotions but at first both are Very Raw
Joking around with the meter helps to de-mystify it. It isn’t some sacred relic is an every day tool. It can be part of play. It can be ordinary.
It needs to be ordinary, it needs to be theirs and it can be played with, all this because it needs to be used.
More Stupid Meter Tricks
Stupid Meter Tricks II
The Science Project
One of the days when my kids were kicked out of school, because the school was having hissy fit over D care a few years ago, I had them do some experiments on test strip coding.
We dug up strips with as far apart codes as we could find. (We use one touch ultra smart meters.)
Using control solution we tested strips at their code values.
We calculated the variance between strips.
We tool a little time to talk about this: with the same fake blood the number bounced around a little, so a few points here or there isn’t a big deal.
Next we tested with transposed values for example 7 for 20 and 20 for 7.
We calculated average results and compared to the correct code results.
We found that the average difference when miss coded was about 1 point on the meter for every code number off. So a 7 vs a 20 is about a 13 point difference.
131 vs 144 - No big.
Now a 2 vs a 40 with a result of 68 - is that 68 or 30 or 106. That is an issue.
This is a great little science experiment that you may want your kids to do when they are the right age to discover for themselves why coding matters. If they discover it, they may take it to more to heart and practice.
Part of the point was to learn something on a day when they weren’t in school. The lesson was similar to the one in Stupid Meter Tricks I. Part of the point was in part to de-mystify the meter. Part was a little more, in this case it was to get real about miss coding. It happens from time to time. Knowing how the meter works and what the expectations are for a variance in BG due to a coding error helps. There is a margin of error in everything we do, knowing when that is a significant issues and when it isn’t is an important lesson.
More Stupid Meter Tricks
One of the days when my kids were kicked out of school, because the school was having hissy fit over D care a few years ago, I had them do some experiments on test strip coding.
We dug up strips with as far apart codes as we could find. (We use one touch ultra smart meters.)
Using control solution we tested strips at their code values.
We calculated the variance between strips.
We tool a little time to talk about this: with the same fake blood the number bounced around a little, so a few points here or there isn’t a big deal.
Next we tested with transposed values for example 7 for 20 and 20 for 7.
We calculated average results and compared to the correct code results.
We found that the average difference when miss coded was about 1 point on the meter for every code number off. So a 7 vs a 20 is about a 13 point difference.
131 vs 144 - No big.
Now a 2 vs a 40 with a result of 68 - is that 68 or 30 or 106. That is an issue.
This is a great little science experiment that you may want your kids to do when they are the right age to discover for themselves why coding matters. If they discover it, they may take it to more to heart and practice.
Part of the point was to learn something on a day when they weren’t in school. The lesson was similar to the one in Stupid Meter Tricks I. Part of the point was in part to de-mystify the meter. Part was a little more, in this case it was to get real about miss coding. It happens from time to time. Knowing how the meter works and what the expectations are for a variance in BG due to a coding error helps. There is a margin of error in everything we do, knowing when that is a significant issues and when it isn’t is an important lesson.
More Stupid Meter Tricks
Stupid Meter Tricks III
So here is a little game to play on a weekend morning. I call it how much do you go up.
OK before we go any further don't do anything stupid, start in range and try to stay in range.
Got it?
Good.
Get up and test first thing in the morning.
Eat a very know amount of carbs preferably not a lot - say 10 to 20 maybe even a few tabs.
Don’t bolus.
Test every 15 minutes for a few hours.
Plot the numbers on a graph
After a few hours or if your blood goes real high correct. Write down how much insulin you took.
Test every 15 minuets for a few hours. (By the way having a move or some cartoons on TiVo is a good plan to kill the time.)
Plot the numbers on a graph
How much did you go up?
How fast?
How many BG points per carb?
How much did you come down?
How fast?
How many BG points per unit of insulin?
How was the movie or cartoons?
All these things are part of our lives. Insulin sensitivity, correction factors, cartoons & movies. What important? All this stuff varies. Sometimes the cartoons are great sometimes sometime they aren’t. If the cartoons are no good you can change the channel. If you BG is no good you can change it too.
More Stupid Meter Tricks
OK before we go any further don't do anything stupid, start in range and try to stay in range.
Got it?
Good.
Get up and test first thing in the morning.
Eat a very know amount of carbs preferably not a lot - say 10 to 20 maybe even a few tabs.
Don’t bolus.
Test every 15 minutes for a few hours.
Plot the numbers on a graph
After a few hours or if your blood goes real high correct. Write down how much insulin you took.
Test every 15 minuets for a few hours. (By the way having a move or some cartoons on TiVo is a good plan to kill the time.)
Plot the numbers on a graph
How much did you go up?
How fast?
How many BG points per carb?
How much did you come down?
How fast?
How many BG points per unit of insulin?
How was the movie or cartoons?
All these things are part of our lives. Insulin sensitivity, correction factors, cartoons & movies. What important? All this stuff varies. Sometimes the cartoons are great sometimes sometime they aren’t. If the cartoons are no good you can change the channel. If you BG is no good you can change it too.
More Stupid Meter Tricks
October 19, 2007
The new phone book's here!
OK call me a jerk but I feel like Navin R. Johnson.
Amy at Diabetes Mine linked DisneyWithDiabetes!
Nothing you say?
Amy at Diabetes Mine linked DisneyWithDiabetes!
Nothing you say?
Nothing? Are you kidding? Page 73 - Johnson, Navin R.! I'm somebody now! Millions of people look at this book everyday! This is the kind of spontaneous publicity - your name in print - that makes people. I'm in print! Things are going to start happening to me now. - The Jerk
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