My daughter sent this and said I and my spelling would fit in the tea party well.
I may need a dictionary.
http://www.flickr.com/photos/pargon/sets/72157623594187379/
- Posted using BlogPress from my iPhone
March 25, 2010
How Did I Miss This Guy?
He is funny.
http://jimhuck.blogspot.com/2010/03/diabetic-word-problem-due-tomorrow.html
I felt his priorities, particularly cooking and beer making which are pretty much the same general thing, were sound right up to that last one.
http://jimhuck.blogspot.com/2010/03/diabetic-word-problem-due-tomorrow.html
I felt his priorities, particularly cooking and beer making which are pretty much the same general thing, were sound right up to that last one.
My beautiful wife and son, Type 1 diabetes, Math, Teaching, Low carb recipes, Diabetes blogs, Evolutionary fitness, Eating, Humanely raised foods, Locally raised food, the Lakers, Gardening, Hiking, Supporting our local economy, Beer-making, Cooking, Co-housing, Community. I obsess about my blood sugar and spelling words correctly.
... oh and Tequila is Health Food
I somehow have always know tequila was good for you.
ScienceDaily (Mar. 23, 2010)
"The plant that gave the world tequila contains a substance that seems ideal for use in a new genre of processed foods -- so-called "functional foods" -- with health benefits over and above serving as a source of nutrients, scientists reported at the 239th National Meeting of the American Chemical Society (ACS) in San Francisco on March 23."
ScienceDaily (Mar. 23, 2010)
"The plant that gave the world tequila contains a substance that seems ideal for use in a new genre of processed foods -- so-called "functional foods" -- with health benefits over and above serving as a source of nutrients, scientists reported at the 239th National Meeting of the American Chemical Society (ACS) in San Francisco on March 23."
Of Mice and Men: Leptin Therapy
Regulating T1 BG with Leptin.
This twisted my (limited) understanding of insulin and BG around.
Also From the News Wire:
Structure of Insulin's Docking Point Identified
My take away here is the time it takes to make steps in the science and that some real smart people understand a whole ot that I don't. (Of course there is the possibility they are not really smart - they are just normal and I am really clueless - or most likely They are real smart and I am real clueless. LOL)
This twisted my (limited) understanding of insulin and BG around.
Also From the News Wire:
Structure of Insulin's Docking Point Identified
My take away here is the time it takes to make steps in the science and that some real smart people understand a whole ot that I don't. (Of course there is the possibility they are not really smart - they are just normal and I am really clueless - or most likely They are real smart and I am real clueless. LOL)
March 24, 2010
Dear FDA II
Hi there FDA. Me again.
I don’t mean to get on your nerves and I am sorry if I am. Well not too sorry, maybe a little.
Anyway I was skimming through some websites tonight and I read a bit that seemed to relate to the whole meter accuracy thing. I used some of it here, admittedly a little out of context, but hey it still seems to make the point that treating diabetes is critical. There are real risks, so improvement to robust and reliable traditional blood glucose meters has enormous potential benefit.
Well kinda, these are the bit I lifted that from:
More accurate meters will help you acheive your critical path initiative. (Hey don't do it for us do it for yourself!)
Oh by the way we are artificial pancreases now.
(YDMV's note. I didn't put this on the FDA comments site. A bit flippant. Think I should?)
I don’t mean to get on your nerves and I am sorry if I am. Well not too sorry, maybe a little.
Anyway I was skimming through some websites tonight and I read a bit that seemed to relate to the whole meter accuracy thing. I used some of it here, admittedly a little out of context, but hey it still seems to make the point that treating diabetes is critical. There are real risks, so improvement to robust and reliable traditional blood glucose meters has enormous potential benefit.
Well kinda, these are the bit I lifted that from:
…critical initiative of the Food and Drug Administration (FDA) is to accelerate the development and availability of a safe and effective … treatment of diabetes mellitus.
Compounding… difficulty is the trade-off between improved glycemic control and an increased risk for hypoglycemia (low blood glucose levels), which can cause seizure, coma and death.
… robustness and reliability are still in need of improvement…
… require… using a traditional blood glucose meter…
…enormous potential benefitSo FDA, in case you still can’t place those bits here's a reminder. Y’all said’m. You were talking about the artificial pancreas.
More accurate meters will help you acheive your critical path initiative. (Hey don't do it for us do it for yourself!)
Oh by the way we are artificial pancreases now.
(YDMV's note. I didn't put this on the FDA comments site. A bit flippant. Think I should?)
March 22, 2010
BSparl by Dummies: How Not To Raise the Baby
Here's a way to say Love Ya / Mean It to Kerri, Chris and Miss BSparl!
Just before the birth of our first child friends and family passed around a small blank notebook. In it they recorded parenting advice, mostly of the possibly practical but certainly silly nature. It was fun. I particularly liked the stuff about a parent’s responsibility to embarrass their teenager.
With the highly anticipated début of Miss BSparl, I suggest that her mom’s online friends offer our brilliance on the topic of child rearing. Having been raised ourselves; I submit we all have more than sufficient expertise. Some of us may even have experience raising kids who successfully moved out of our houses. With our wisdom in hand, Kerri and Chris need only do the polar opposite of our suggestions to be assured total parenting success!
Your caring comments are welcome. We have even created categories to post under. Want to suggest a new category? There is even one for that at the bottom. Humor and joy are welcome.
Celebrating babies is what communities do jump on in.
http://bsparl.blogspot.com/
LY/MI
Just before the birth of our first child friends and family passed around a small blank notebook. In it they recorded parenting advice, mostly of the possibly practical but certainly silly nature. It was fun. I particularly liked the stuff about a parent’s responsibility to embarrass their teenager.
With the highly anticipated début of Miss BSparl, I suggest that her mom’s online friends offer our brilliance on the topic of child rearing. Having been raised ourselves; I submit we all have more than sufficient expertise. Some of us may even have experience raising kids who successfully moved out of our houses. With our wisdom in hand, Kerri and Chris need only do the polar opposite of our suggestions to be assured total parenting success!
Your caring comments are welcome. We have even created categories to post under. Want to suggest a new category? There is even one for that at the bottom. Humor and joy are welcome.
Celebrating babies is what communities do jump on in.
http://bsparl.blogspot.com/
LY/MI
Dear FDA
Thank you for providing the opportunity to comment on blood glucose meter accuracy. I am the father of two insulin dependant children ages 12 and 16. The younger has been on insulin for 6 years and the older 7 years. I write today from the perspective of a parent and type 1 parent’s advocate.
In the supplementary information provided to create the frame work for this discussion the FDA notes that, “Glucose meters are used by millions of people with diabetes every day. These devices have become smaller, faster, and more accurate over the past 3 decades and now allow for better glycemic control by diabetics than in the past.”
Many of those users are families of with children with type 1, insulin dependant, diabetes. Because of this insulin dependence these families are injecting insulin either with an insulin pump or with shots also know as Multiple Daily Injection. To minimize the risk of hypoglycemia these multiple daily doses of insulin must take into consideration the child’s blood sugar at the time of injection. We can only estimate or children’s blood sugar to be with in a range of plus or minus twenty percent with current meters standards.
I hope that the FDA will consider the difference between those diabetics who have this multiple daily need for actionable accuracy in the dosing insulin in addition the needs of those diabetics who do not use insulin.
What is important in this process is the glycemic control mentioned in the FDA quote above. While meters have improved over the past three decades, current standards have had the effect of halting innovation since the standards were created. The current standard of +/- 20% was defined by ISO 15197, established in 2003.
I am unaware of standards for quality assurance. I do know that variance from strip batch to batch has been reported to be an issue. Also counterfeit strips have been a cause for concern as has interference from medications.
As the FDA’s supplementary information also notes, “Blood glucose meters are being used in clinical settings and at home in ways that are not within the intended use of the devices as evaluated by FDA. For example, glucose meters are increasingly being used to achieve tight glycemic control despite the fact that these devices have not been cleared for this use.”
Every day millions of American households are treating type 1 diabetes in children with devices that were not intended or evaluated by the FDA for that use. It isn’t that we want to use meters in ways they were not evaluated or intended to be used. It is that the FDA has not evaluated meters for this use.
We have type 1 now. It needs to be managed now.
Type 1 diabetes is a 24/7 condition that is primarily managed by the individuals and families it effects. As noted above better glycimic control is achieved with multiple daily doses of insulin. While this is done in consultation with and coaching by a care team of physicians, diabetes educators, nurses and dieticians the day to day primary care management responsibility falls on the individual and family with type 1.
We would love the support of the FDA in this daily effort. Specifically by evaluation the tools we use for the use we put them to. Further the FDA should recognize that the technological progress of the past three decades didn’t stop in the early part of that past decade. We need accuracy standards that envision our daily lives, meet the actual use of our meters and progress with technology.
I hope the FDA will establish standards quality control, clear communication of accuracy standards, interference from other drugs and safeguarding the supply system from fraud.
Clear communication of accuracy standards met in meter marketing would allow consumers and their care team to select the tool based on capability. This would facilitate physicians’ ability to prescribe tools based to the degree of control and intensity of the management program they are recommending for their patients.
I hope that the FDA will be able to look back on the most this most recent decade and say that of meters, “These devices have become smaller, faster, and more accurate over the past decade and now allow for better glycemic control by diabetics than in the past.”
Tighter accuracy standards of +/- 10% would be a positive action step on that path.
Click here for the FDA and post your two bits.
FDA-2009-N-0604
Clinical Accuracy Requirements for Point of Care Blood Glucose Meters; Public Meeting; Request for Comments
In the supplementary information provided to create the frame work for this discussion the FDA notes that, “Glucose meters are used by millions of people with diabetes every day. These devices have become smaller, faster, and more accurate over the past 3 decades and now allow for better glycemic control by diabetics than in the past.”
Many of those users are families of with children with type 1, insulin dependant, diabetes. Because of this insulin dependence these families are injecting insulin either with an insulin pump or with shots also know as Multiple Daily Injection. To minimize the risk of hypoglycemia these multiple daily doses of insulin must take into consideration the child’s blood sugar at the time of injection. We can only estimate or children’s blood sugar to be with in a range of plus or minus twenty percent with current meters standards.
I hope that the FDA will consider the difference between those diabetics who have this multiple daily need for actionable accuracy in the dosing insulin in addition the needs of those diabetics who do not use insulin.
What is important in this process is the glycemic control mentioned in the FDA quote above. While meters have improved over the past three decades, current standards have had the effect of halting innovation since the standards were created. The current standard of +/- 20% was defined by ISO 15197, established in 2003.
I am unaware of standards for quality assurance. I do know that variance from strip batch to batch has been reported to be an issue. Also counterfeit strips have been a cause for concern as has interference from medications.
As the FDA’s supplementary information also notes, “Blood glucose meters are being used in clinical settings and at home in ways that are not within the intended use of the devices as evaluated by FDA. For example, glucose meters are increasingly being used to achieve tight glycemic control despite the fact that these devices have not been cleared for this use.”
Every day millions of American households are treating type 1 diabetes in children with devices that were not intended or evaluated by the FDA for that use. It isn’t that we want to use meters in ways they were not evaluated or intended to be used. It is that the FDA has not evaluated meters for this use.
We have type 1 now. It needs to be managed now.
Type 1 diabetes is a 24/7 condition that is primarily managed by the individuals and families it effects. As noted above better glycimic control is achieved with multiple daily doses of insulin. While this is done in consultation with and coaching by a care team of physicians, diabetes educators, nurses and dieticians the day to day primary care management responsibility falls on the individual and family with type 1.
We would love the support of the FDA in this daily effort. Specifically by evaluation the tools we use for the use we put them to. Further the FDA should recognize that the technological progress of the past three decades didn’t stop in the early part of that past decade. We need accuracy standards that envision our daily lives, meet the actual use of our meters and progress with technology.
I hope the FDA will establish standards quality control, clear communication of accuracy standards, interference from other drugs and safeguarding the supply system from fraud.
Clear communication of accuracy standards met in meter marketing would allow consumers and their care team to select the tool based on capability. This would facilitate physicians’ ability to prescribe tools based to the degree of control and intensity of the management program they are recommending for their patients.
I hope that the FDA will be able to look back on the most this most recent decade and say that of meters, “These devices have become smaller, faster, and more accurate over the past decade and now allow for better glycemic control by diabetics than in the past.”
Tighter accuracy standards of +/- 10% would be a positive action step on that path.
Click here for the FDA and post your two bits.
FDA-2009-N-0604
Clinical Accuracy Requirements for Point of Care Blood Glucose Meters; Public Meeting; Request for Comments
March 20, 2010
Ellen on Meter Accuracy
Good Friend of the Blog Ellen Ullman wrote this as a comment on accuracy but I upgraded it to a Guest Post:
I want significantly improved accuracy for all meters for all persons with diabetes.
It is not only the 20% inaccuracy that is permitted which I find UNacceptable, but perhaps even more so that it only has to be within that 20% above 75 mg/dl 95% of the time - NINETY-FIVE PERCENT OF THE TIME. The other 5% are considered "outliers" without explanation. To hear some in industry or academia discuss it, it felt to me as if outliers are considered nothing more than dots outside of the Clarke Error Grid A/B Zone. But I view the very same dots as flashing warning signs with alarms going off - CAUTION - because of the potential human consequences that may result from that # on the meter.
Some of us are very in tune with our bodies or our children's bodies and know enough not to dose based on a reading that seems so far beyond what we think may really be going on in the body. NOT every person with diabetes, and not every caregiver of a loved one with diabetes, has that intuition, or perhaps has ever had the education to know not to dose without checking again. Many of us are fortunate to have extra test strips to use when we question a number on a meter that doesn't seem congruent with the situation. Some people barely can afford a single test strip let alone 2-3 extra to figure out what the approximate bg value is. So what happens to the 2 yr old whose parents are underinsured, less well educated, or given the cheapest and least accurate meter on the market and the meter says, for example, 350 mg/dl prior to a meal and they give a whopping dose of insulin to correct for the 350 that had they rechecked would have discovered bg was closer to 120 mg/dl? Every single outlier is a potential disaster. It only took the memory of one seizure requiring glucagon injection in my toddler in 1989 or 1990 and the thought of how many have occurred and how many in the future may occur due to meter inaccuracy and excused outliers - to know I needed to stand up before FDA/CDRH and plead for the need for increased accuracy and the ability to compare meters based on performance accuracy. We need to eliminate every possible variable that we can in our daily journey of the diabetes roller coaster ride and tightrope walk. AND we are calibrating our CGMs based on these meters that require less than adequate precision and accuracy - what if your calibration is based on an outlier?
(Are you having Cheerios for breakfast? LOL )
Nope Ellen Just coffee. Cheerios are too hard to cook without coffee. ;)
I want significantly improved accuracy for all meters for all persons with diabetes.
It is not only the 20% inaccuracy that is permitted which I find UNacceptable, but perhaps even more so that it only has to be within that 20% above 75 mg/dl 95% of the time - NINETY-FIVE PERCENT OF THE TIME. The other 5% are considered "outliers" without explanation. To hear some in industry or academia discuss it, it felt to me as if outliers are considered nothing more than dots outside of the Clarke Error Grid A/B Zone. But I view the very same dots as flashing warning signs with alarms going off - CAUTION - because of the potential human consequences that may result from that # on the meter.
Some of us are very in tune with our bodies or our children's bodies and know enough not to dose based on a reading that seems so far beyond what we think may really be going on in the body. NOT every person with diabetes, and not every caregiver of a loved one with diabetes, has that intuition, or perhaps has ever had the education to know not to dose without checking again. Many of us are fortunate to have extra test strips to use when we question a number on a meter that doesn't seem congruent with the situation. Some people barely can afford a single test strip let alone 2-3 extra to figure out what the approximate bg value is. So what happens to the 2 yr old whose parents are underinsured, less well educated, or given the cheapest and least accurate meter on the market and the meter says, for example, 350 mg/dl prior to a meal and they give a whopping dose of insulin to correct for the 350 that had they rechecked would have discovered bg was closer to 120 mg/dl? Every single outlier is a potential disaster. It only took the memory of one seizure requiring glucagon injection in my toddler in 1989 or 1990 and the thought of how many have occurred and how many in the future may occur due to meter inaccuracy and excused outliers - to know I needed to stand up before FDA/CDRH and plead for the need for increased accuracy and the ability to compare meters based on performance accuracy. We need to eliminate every possible variable that we can in our daily journey of the diabetes roller coaster ride and tightrope walk. AND we are calibrating our CGMs based on these meters that require less than adequate precision and accuracy - what if your calibration is based on an outlier?
(Are you having Cheerios for breakfast? LOL )
Nope Ellen Just coffee. Cheerios are too hard to cook without coffee. ;)
March 19, 2010
Poke a Finger on the Invisible Hand
Mrs. YDMV and I have been splitting shifts between the home front and the hospital where they managed to pull Connor’s appendix out of a hole they cut in his bellybutton. Nice trick! Beats the heck out of a rabbit in a hat.
On my home shift I was helping the other boy edit a paper on Adam Smith’s Invisible hand. He did a nice job. I was particularly happy to see him using This American Life as a reference. I love that show.
For those of you who would rather have your appendix pulled out of your bellybutton than try to remember what a long dead economist had to say here is a quick A. Smith refresher; individuals acting in their own self interest lead the market to outcomes that are good for everyone. OK maybe that is taking old Adam a little loose but probably not much.
At the hospital it took both the Charming Mrs. YDMV and I three, maybe more, separate and fairly emphatic tries to make it clear we would manage Connor’s blood sugar with his pump and the 'log he is used to using rather than them hanging a slower insulin with their pump in his IV.
In my spare time I have been reading tweets and blogs on blood glucose meter accuracy. As usual my friend Scott has a nice bit. He advocates for lower accuracy margins of error. Another other good friend of the blog (I am shamelessly steeling that good friend of bit from Colbert even at the risk of getting on his list for swiping it) Kerri also writes on the topic today as did Kelly. Careful YDMV readers will recall I wrote a bit the other day that questioned what the heck accuracy is anyway.
I had a conversation on meters just hours before dragging Connor into the ER. In that chat I said I was sure there are folks, like Kerri, who work at diabetes hard enough that the meter accuracy matter in her (and the soon to be adorable BSparl’s) life makes a difference.
If you have read this far without bailing out you may be asking, “What the heck does this have to do with Adam Smith?” Seriously if you are thinking that you need a life - no wait I mean - Good question! Stand by for the kind of BS (not the blood sugar kind) that made me love writing essay question’s in blue books back in college. (Do they still have blue books?)
Don’t just tell the FDA you want accuracy in your diabetes care. Tell the market. Take an invisible 2x4 in Adam Smith’s invisible hand and smack the market up side its invisible head. You want more accurate meters - buy them. Well their strips - Never buy a meter. Let them give you the meter itself.
The market seems to be trying to supply cheap cr*p meters. The FDA has given the OK to boat loads of meters from firms over seas that may or may not meet our desired goals for accuracy. They probably don’t have the same level of phone support and who knows how issues with adverse actions are tracked. I don’t see these things as in myself interest and so we don’t use them.
Scott point out that there is a meter on the market at +/- 10%. We happen to use it. We started for the aesthetics, they made a pink meter and that mattered to a tween girl. We stay for the low blood draw, compact meter size and easy to read screen. In short they (a word that here means WaveSense) made a better product and we for our own self interested reasons use it. If a big wave (nice pun eh?) of people did too then maybe the market would move to something like WaveSense's form factor, accuracy, usability and pinkness. By then I expect WaveSense will have moved on to even more innovative products.
We didn’t let the Doc’s manage Connor’s blood sugar because we felt we could do it better. We didn’t want an insulin we didn’t have experience with in him. We didn’t know its effective time frame in him. We choose to managed his blood because doing so is in our self interest, We stayed with what we know works. Speaking of what we know, we know his pump well. If lots of parents of T1 kids also decline the hospital’s type 1 sugar management and do it well maybe the market (a.k.a. doctors there) will come to see that as a good care option and give up after the second clearly stated decline of their suggested treatment.
Choose well, as we each live Our American Life we are Adam Smith’s invisible hand.
PS speaking of invisible stuff. I have no relationship with WaveSense other than we use their stuff. Well OK I follow them on Twitter too if that counts as a relationship but they don’t say a lot and I am a highly incompetent twitter user. I did once look to see if they were publicly traded and was thinking about buying into their stock but they weren’t public so I was SOL. I have been to the Hospital’s community fundraisers and probably will go again. They did a very nice piece of surgery. They are right to be cautious about BG management. Side effects of reading this blog may include headache, blurred vision. Your dDiabetes May Vary.
On my home shift I was helping the other boy edit a paper on Adam Smith’s Invisible hand. He did a nice job. I was particularly happy to see him using This American Life as a reference. I love that show.
For those of you who would rather have your appendix pulled out of your bellybutton than try to remember what a long dead economist had to say here is a quick A. Smith refresher; individuals acting in their own self interest lead the market to outcomes that are good for everyone. OK maybe that is taking old Adam a little loose but probably not much.
At the hospital it took both the Charming Mrs. YDMV and I three, maybe more, separate and fairly emphatic tries to make it clear we would manage Connor’s blood sugar with his pump and the 'log he is used to using rather than them hanging a slower insulin with their pump in his IV.
In my spare time I have been reading tweets and blogs on blood glucose meter accuracy. As usual my friend Scott has a nice bit. He advocates for lower accuracy margins of error. Another other good friend of the blog (I am shamelessly steeling that good friend of bit from Colbert even at the risk of getting on his list for swiping it) Kerri also writes on the topic today as did Kelly. Careful YDMV readers will recall I wrote a bit the other day that questioned what the heck accuracy is anyway.
I had a conversation on meters just hours before dragging Connor into the ER. In that chat I said I was sure there are folks, like Kerri, who work at diabetes hard enough that the meter accuracy matter in her (and the soon to be adorable BSparl’s) life makes a difference.
If you have read this far without bailing out you may be asking, “What the heck does this have to do with Adam Smith?” Seriously if you are thinking that you need a life - no wait I mean - Good question! Stand by for the kind of BS (not the blood sugar kind) that made me love writing essay question’s in blue books back in college. (Do they still have blue books?)
Don’t just tell the FDA you want accuracy in your diabetes care. Tell the market. Take an invisible 2x4 in Adam Smith’s invisible hand and smack the market up side its invisible head. You want more accurate meters - buy them. Well their strips - Never buy a meter. Let them give you the meter itself.
The market seems to be trying to supply cheap cr*p meters. The FDA has given the OK to boat loads of meters from firms over seas that may or may not meet our desired goals for accuracy. They probably don’t have the same level of phone support and who knows how issues with adverse actions are tracked. I don’t see these things as in myself interest and so we don’t use them.
Scott point out that there is a meter on the market at +/- 10%. We happen to use it. We started for the aesthetics, they made a pink meter and that mattered to a tween girl. We stay for the low blood draw, compact meter size and easy to read screen. In short they (a word that here means WaveSense) made a better product and we for our own self interested reasons use it. If a big wave (nice pun eh?) of people did too then maybe the market would move to something like WaveSense's form factor, accuracy, usability and pinkness. By then I expect WaveSense will have moved on to even more innovative products.
We didn’t let the Doc’s manage Connor’s blood sugar because we felt we could do it better. We didn’t want an insulin we didn’t have experience with in him. We didn’t know its effective time frame in him. We choose to managed his blood because doing so is in our self interest, We stayed with what we know works. Speaking of what we know, we know his pump well. If lots of parents of T1 kids also decline the hospital’s type 1 sugar management and do it well maybe the market (a.k.a. doctors there) will come to see that as a good care option and give up after the second clearly stated decline of their suggested treatment.
Choose well, as we each live Our American Life we are Adam Smith’s invisible hand.
PS speaking of invisible stuff. I have no relationship with WaveSense other than we use their stuff. Well OK I follow them on Twitter too if that counts as a relationship but they don’t say a lot and I am a highly incompetent twitter user. I did once look to see if they were publicly traded and was thinking about buying into their stock but they weren’t public so I was SOL. I have been to the Hospital’s community fundraisers and probably will go again. They did a very nice piece of surgery. They are right to be cautious about BG management. Side effects of reading this blog may include headache, blurred vision. Your dDiabetes May Vary.
March 18, 2010
Not that I was planning to be here
This the Asplundh Atrium at Abington Memorial Hospital. It's very nice. Not that I was planning, or even wanted, to be here.
Connor is in to have his appendix out. I guess that isn't something anyone plans on.
And speaking of not planning, somehow we didn't replace the backup pump set in the glove compartment. So naturally last night at half past really late his set pulled off and we needed a set.
This morning looking over Connor's chart, the gas passer commented that his blood was all over the place. No kidding. He said they would watch it and if it went too high give him some insulin.
Really? Mrs YMDV asked what do they think is too high? He was disconnected and without basals is gonna have rising BS. Funny they didn't ask anything that would guide them as to how much insulin to give.
About that time I realized I probably didn't make sure Delaney bolused for breakfast. Oops better call the school nurse.
So here we are in this really nice waiting space but my mind is still in diabetes land. Not that I was planning, or even wanted, to be here.
- Posted using BlogPress from my iPhone
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