A Lovely Rant by Ira Hirsh

I started using the acronym YDMV years ago on web boards as a way of responding to individuals who aggressively pushed a single 'RIGHT WAY' of managing diabetes. Some time its was the right pump or meter. Occasionally it was shots vs pumps vs pens. Sometimes it was even this is THE I:C ratio you should use because it work for us perfectly.

I would typically agree making a general point about our family's approach to attention to care without mentioning "RIGHT WAY" and add Your Diabetes May Vary. That way when they disagreed with my way it was covered by the YDMV statement and gave others the same out if they didn't agree with the "Right Way."

I also thought it would be fun if it became a commonly used term on the boards. It did.

Part of the new care shake up in the US is grading doctors based on metrics. (For the record I HATE the word metrics. It is a buzz word typically used by people who substitute a number for thoughtful consideration.) Measures would be great if the metrics aligned with the current ADA treatment recommendation about individualization of targets based on the patient's specific situation. (1) It would be fantastic if there was a measure that identified that caregivers spend the time necessary to find the individual targets and customize goals for each patient.

That ain't how it works. (see I feelings for the word metrics above.)

The new system holds Docs to static levels of HbA1c, LDL-cholesterol, and blood pressure. So if you are the doc and you have a patient who is way out of range and you help decrease variability, lower A1C make progress on LDL and blood pressure it doesn't count. Progress is not the end static measure are. In this model success is a number not behaviors.

Hey Who ever makes this stuff up. YDMV.

All diabetes is a progressive. Succes is adapting and changing to make living with diabetes about life not about numbers.


Dr Ira Hirsch as a lovely rant about this. Have a read.

(1) American Diabetes Association: Glycemic targets. Diabetes Care 2015;38(Suppl 1):S33–S40.

Help New York Decide to Invest in Diabetes Education

Edited to add the video can be seen here if the NYC site is down, sadly this project didn't get to the next round. Still the idea and video are fantastic: http://vimeo.com/57393712

New York City is challenging, designers, and engineers to develop new products with potential.  Part of the process is a "Popular Choice Finalist" aka social media voting. Here is why this contest matters to people living with diabetes.

HbA1C looks like this: 

See the Video 

Here all this time we thought it looked like a number with a one place decimal like 7.6, 6.4 or 9.7. Often the number is accompanied by a look of disappointment from the person reading the lab sheet. So of course we thought it was a number that is all anyone ever said about it.

But look at the picture. It is a model of a hemoglobin protein. The red bits are the protein's HEME Groups, the part of the protein that move oxygen around the body. They give blood its red color. The spiky blue parts are glucose molecules attached to the hemoglobin. The more of them the higher the A1C. If the little blue bastard are sticking to every hemoglobin cell in our bodies, they are sticking to everything else too.

This model is one of a kind. Wouldn't it be kick ass if every educator had one of these so that patients could see, touch and and feel to understand that A1C in more than a arbitrary number?

We can help get these to educators by voting in New York City's Next Top Makers contest. The winner moves on to a round of professional advice and possible funding. I think better diabetes education tools is a fantastic idea. If you do too, vote. Vote early and often if you can figure out how.

Then, please, spread the word on you blog, Twitter feed, Facebook... where ever. Together we can help NYC think beyond commercial potential to public health value.

Voting is open to March 27 at 5:00pm EDT.