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Posts tagged ‘diatribe’

Bright Spots & Landmines: An Interview with Adam Brown

Adam Brown has written a new – TERRIFIC – book for the diabetes community, full of the same brilliant, actionable advice that we’ve come to happily expect from his diaTribe columns.  His book, Bright Spots & Landmines, is billed as “the diabetes guide I wish someone had handed me,” and that sentiment is absolutely correct.  This book is a powerful tool that people living with diabetes can pour through and make their own, with moments of reflection and inspiration interspersed among research, recipes, and amazing graphic design.  
Bright Spots & Landmines by Adam Brown
Kerri: What inspired you to write Bright Spots & Landmines?

Adam:  When I started writing my diaTribe column (Adam’s Corner) four years ago, I never would have guessed that more than half a million people would read it! I’ve received hundreds of emails and comments sharing gratitude and kindness, which is what motivated me to do something loftier with Bright Spots & Landmines. Each Adam’s Corner column stands alone, so I wanted this book to be a single guide that distills all the most helpful diabetes tips I’ve learned in four areas: food, mindset, exercise, and sleep.

Kerri: What makes Bright Spots & Landmines different from what’s already out there? 

Adam:  I agonized over this question before writing this book – I wanted to make sure Bright Spots & Landmines would add value!

From the beginning, I had two major goals with this project: (i) write an extremely actionable book that anyone with diabetes can use to improve some aspect of his/her life immediately; and (ii) give it away at as low of a price as possible! Based on the early reviews and the free/name-your-own-price PDF download, I’m so excited about the outcomes. A few other things come to mind:

Bright Spots & Landmines is written from a person-with-diabetes perspective and based on more than 10,000 hours writing professionally about diabetes, over 50,000 hours of personal learning from CGM, and everything I’ve taken away from hundreds of diabetes conferences and leading thinkers.

The book focuses on food, mindset, exercise, and sleep, which are not often addressed in the same actionable diabetes guide.

Bright Spots & Landmines went through an extensive feedback process, with a combined 500+ years of diabetes experience between all the reviewers – yourself included!

Last (and perhaps most important), my girlfriend, Priscilla Leung, did all the wonderful illustrations and graphics in the book – these really make the writing come to life. I’m as proud of how it looks as I am of the words!

Kerri: How do you want readers to feel after reading your book?

Adam:  Uplifted, positive, and ready to try some new things and experiment! I hope people leave Bright Spots & Landmines with tangible actions and nuggets they can use to improve their life with diabetes – whether it’s a recipe I eat, a quote I like, or an answer to question that the book poses to them.

I hope this book also reminds readers that we all have moments of enormous diabetes frustration, self-sabotaging food decisions, negative thoughts and questions, busy days where exercise is hard to fit in, and nights without enough sleep. Bright Spots & Landmines shares my toolkit for navigating the choppy, unpredictable waters of living with diabetes. I hope it puts some wind in readers’ sails.

Adam Brown, author of Bright Spots & Landmines

Kerri: Is Bright Spots & Landmines made up of rules for living well with diabetes, or are these suggestions for people to implement in their own lives?

Adam:  Awesome question! This is a book filled with things that have made an enormous difference in my life with diabetes. By sharing them, I hope readers will glean tips they can try or adapt to fit their needs.

For instance, chia pudding is one that has been fascinating to follow. Some readers make it exactly like I do and love it! Others have tinkered with the recipe to fit their needs. And for others, it’s not a fit. I expect this variance with all 43 Bright Spots and 16 Landmines in the book – some will resonate, some will need to be adapted, and some won’t apply. This is why each chapter – food, mindset, exercise, and sleep – concludes with Bright Spots & Landmines questions so readers can identify what works for them.

Kerri: Is this a book you would want to give newly diagnosed PWD? Long-timers? Caregivers? Is there something for each group in this book?

Adam:  All of the above – and I don’t say that lightly. Every one of these groups read drafts of the book. A mom of a newly diagnosed son read Bright Spots & Landmines, as did a woman with over 50 years living with diabetes. Other readers fell in between (see testimonials and Amazon reviews). I even had some people with prediabetes read the book and find it useful!

Kerri: What was your favorite part to write?

Adam:  I love the Mindset chapter most of all, even though it comes second in the book. (Of course, Food had to be first in a diabetes book.) The right Mindset is like rocket fuel for living better with diabetes – it underlies everything and can provide such a boost, even on the toughest days. This chapter shares lots of tips and tricks related to perfectionism, motivation, stress, goal setting, hacking my brain and habits, and beyond. I’m a voracious readers of psychology and self-help, which is probably why I had so much to say in this chapter.

Kerri: What was the most challenging portion of this book for you to tackle?

Adam:  I struggled a lot with the title. We went through many iterations, including “Diabetes Bright Spots & Landmines” (too long), “Solving Diabetes” (a bit too presumptuous), and the original (read: not great) title, “Make Diabetes Awesome.” Probably the worst title in the original brainstorm was, “Diabetes should be less awful and more awesome.” Haha! I’m so happy about the final title:subtitle combination, since it really illustrates the book’s framework and why I wrote it in the first place.

I also spent an enormous amount of time trying to figure out how to make the book as low cost as possible, but still look amazing. I originally wanted full color interior printing, but this made the book twice as expensive in paperback. I wasn’t willing to accept that tradeoff. I love the current model of a name-your-own price PDF download in full color, a paperback on Amazon for under $7 (the black-and-white interior still looks really good), and a Kindle version for $1.99.

Funnily enough, the writing process was the easiest part, though getting feedback on the book was always scary. It’s never easy to show your work to other people.

Kerri: What’s next, now that the book is live?

Adam:  For now, I’m laser focused on finding every possible avenue to get this book into people’s hands – whether that’s print copies or free digital versions.  And we will certainly do follow-up Adam’s Corner articles that talk about different pieces of the book.I’d also love to do an audio version, video snippets of different Bright Spots & Landmines, weekly Facebook Live Q&As with readers, and perhaps translation into other languages. But whew… one thing at a time! If you have any ideas you’d like to see, please let me know at brightspots@diaTribe.org!

Kerri: And how can people find more of your writing?

Adam:  Adam’s Corner is here on diaTribe.org, diaTribe’s Facebook page is here, and diaTribe’s twitter is here (@diaTribenews), and my twitter is here (@asbrown1).

Kerri:  Thanks so much for chatting, Adam.  Also, you adopted a dog? Awesome!  What kind?

Adam:  A mini schnauzer mix! I talk about him in the introduction and the exercise chapter 😃 A dog is an incredible Mindset and Exercise Bright Spot, all in one package! I’m a huge convert, despite my skepticism when Priscilla wanted to adopt. Definitely one of the best life decisions we’ve made in the past year.

  *   *   *

Thank you , Adam, for taking the time to talk and also for creating such a powerful resource for the diabetes community.  (And I have a soft spot for Adam because he has never yelled at me, despite my occasionally being spotty back in the day on getting my diaTribe columns to him on time.  To that same end, look for a reboot of the SUM Musings column over at diaTribe in the coming weeks!)  

Adam is patient, ridiculously well-informed, and when it comes to bright spots in the diabetes community, don’t look directly at Adam or you may burn your eyes.  Congratulations again on the book launch!!!  

#DOCasksFDA – Your Feedback is Needed, DOC!

THIS IS THE LINK TO THE SURVEYRead below for more information on the virtual discussion between the diabetes community and the FDA, and how your input will shape that discussion, and potentially our future.

“On November 3 from 1pm-4pm EDT, the Food and Drug Administration (FDA) and the diabetes community will host an unprecedented event to discuss unmet needs in diabetes. As a community, our job is to present the numerous challenges we as patients face each day, and we need your opinions to be a part of this discussion! Please fill out this short survey to share your thoughts on what’s important to you when it comes to living with diabetes. Your feedback will go directly to FDA and help influence the conversation on November 3.

Please answer the questions that follow as honestly as you can. Your answers could affect the way the FDA perceives unmet needs in diabetes, and ultimately, how it reviews the risks and benefits of new drugs and devices.”

THIS IS THE LINK TO THE SURVEY AGAIN.  IT IS IN ALL CAPS BECAUSE IT IS IMPORTANT AND YOU ARE IMPORTANT AND YOUR OPINIONS ARE IMPORTANT.  As a community, we need to raise our voices.  Please show the FDA that we are many, we are empowered, and we are loud.

Link coming soon so that you can register for the discussion, but in the meantime, please fill out the survey and share it with your DOC friends.  And thanks!!

CGM in the Cloud and All Over the Web.

diaTribe has posted a new column about CGM in the Cloud and the why (and why not) of clouding your Dexcom data, and thanks to a lot of input from people in the diabetes community, there are a dozen different perspectives.  Click over to diaTribe for a read.

And diaTribe isn’t the only site talking about CGM in the Cloud this week.

Why wait?  #WeAreNotWaiting.

Go Bionic: Ed Damiano, Clara Barton Camp, and How the Bionic Pancreas “Really Works.”

During my visit to Clara Barton Camp yesterday, I heard the same sentiment over and over again from the kids wearing the bionic pancreas:  “It works.”

“It was weird not to touch the buttons when it beeped,” Addy said, an 11 year old camper at Clara Barton Camp who has been living with type 1 diabetes since she was two.  “I’d reach down to look at it or touch it when it beeped but then I’d have to remember not to touch anything.”

“A big change from needing to check every beep and look at the devices all the time, right?  So when did you feel like you were used to wearing it?”  I asked her.

“Yesterday.  Yesterday, it beeped and I didn’t reach down.  I just said, ‘Whatever.'”

“You trusted it?”

“Yes.  I trusted it.  It works.  If you check it, it’s perfect.  My blood sugars are perfect.”

Addy has been wearing the bionic pancreas since Sunday, part of  the Bionic Pancreas study taking place at The Barton Center (and also the Joslin Camp) this summer.  She’s one of thirteen campers at Barton taking part in the study, ages ranging from six to 11 years old, six girls suited up with the bionic pancreas last week and seven this week.  “My blood sugars have been perfect – I haven’t been low at all and I haven’t been high, except for one 203 mg/dL.”

If a week without blood sugar excursions sounds like an impossible dream, take heart.  Take pancreas, too, because this technology actually exists and is currently attached to seven girls in Massachusetts.  And not “seven girls stuck in a hospital bed under strict activity guidelines,” but seven girls who are running amuck at camp, swimming, dancing, singing in the dining hall, and burping at picnic tables outside of the cabins.  The bionic pancreas has been highlighted in the New York Times, NPR, chronicled extensively over at diaTribe, and has also been the subject of a frequently-downloaded-and-rabidly-shared New England Journal of Medicine article.

The system has a few moving parts:  two t:slim insulin pumps with the Bluetooth switched on for communicating with the phone (one filled with insulin and one filled with glucagon), a Dexcom CGM, and an iPhone.  An in-depth look at how the technology works together can be found in the NEJM paper, but the basic gist is that the Dexcom monitors blood sugars and sends that data to the iPhone, which is running an algorithm that doses insulin, glucagon, or refrains from dosing anything at all.  Lows can be corrected by glucagon, highs by insulin.  Meals aren’t carb counted, but instead the algorithm “learns” what a big meal, small meal, or snack is based on minimal input from the PWD.

“It’s beautiful,” I said to Ed Damiano, one of the principal investigators on the project, after seeing some of the blood sugar outcomes from previous studies.

“It’s still a little clunky,” he replied.  “I want to see one device, one infusion set.  But this?  It works.”

Currently, the camp study at Barton has girls on the full bionic pancreas system for five days, and then five days on their own insulin pump, but with the CGM blinded to the user and still uploading to the cloud.  Bionic pancreas campers are required to check their blood sugar at least seven times per day.  Due to camp safety protocols, the study team can’t let low blood sugars “ride” and assume that the bionic pancreas will step in with glucagon in time, so success on some levels isn’t judged by minimal time below 70 mg/dL but instead the reliable metric becomes how many times did the study team need to intervene for a low blood sugar.

This summer, there are a few new features on the bionic pancreas.  One is “microburst glucagon,” which is most useful for when people are disconnecting the system for swimming or similar, in efforts to provide a safety net for low blood sugars while doing that kind of activity.  There is also an option for temporary targets, which allows people to adjust their target thresholds.  “Normally, we aim for 100 mg/dL, but if we can adjust the threshold and show a change in the A1C based on that adjustment, we’re able to titrate A1C levels using the bionic pancreas,” said Ed.

Some challenges still exist with the system.  The bulky devices, for one, are their own challenge, but as the project moves forward, the diabetes community rallies to support current needs.  “Donna from Tallygear came up and made these ‘GO BIONIC!” belts in a matter of 48 hours.” Ed said, smiling.  “We didn’t ask her to do that.  She offered, and we are so grateful because the kids love them.”

The kids sing the praises of this device.  Ally, diagnosed in 2009 at the age of five, wore the bionic pancreas the week before Addy suited up. “It really works. When I saw the video online, I thought it was made up. I thought the girl in the video was lucky, and that her numbers were just perfect that day. And then I wore it [the bionic pancreas] and I was like, ‘Wait … it really does work!'”

Addy chimed in, her bionic pancreas belt visible over her shirt:  “Ally wore this last week and now I’m wearing it.  She said to me, ‘If you don’t want to wear it, can I wear it for you?'”

Ally nodded.  “I did say that.”

“Does the weight of the device bug you?”  I asked Ally.

“No.  It’s a little heavier but I don’t care.  Even with all the pumps on and the phone, I could still do a back-handspring in the grass.”

The study at Barton concludes this week and then moves over to the nearby boys’ camp.  But after this study finishes, there is still work to be done.  The amazing bionic pancreas team has come so far and the 2016 pivotal study is in sight, but needs community support to get there.

This is where the Bionic Challenge comes in.

According to the website call-to-action:  “The Bionic Challenge asks each family to raise $5,000 in 60 days (by September 1, 2014). If each family in attendance here today can turn to their friends and relatives and obtain 50 $100 donations (that means finding only about one donation per day for the next seven weeks), we can resume our development effort in September and keep on schedule for our final pivotal study in 2016. If we cannot resume in September, it could jeopardize our ability to secure a recently announced time-limited $20MM NIH funding opportunity, which is due in about nine months (April 15, 2015) and could support all of the clinical costs of our pivotal study.”

tl;dr:  the project needs the support of the diabetes community because, without it, the goal of a 2016 pivotal study may be delayed. If you can donate, please do. If you can’t, please consider sharing this information with someone who can. The more people who know how to help, the better.

After being promised a “cure in five years” back in 1986, the idea of the bionic pancreas being delayed because of money makes me feel insane. I could understand a delay if the technology wasn’t up to snuff, but to delay due to funding is unreasonable.  I saw kids playing outside yesterday afternoon, running around and laughing and having fun and the burden of diabetes seemed only as heavy as the belt around their waist, which with time and technology becomes smaller and lighter.

“I look at diabetes as management and maintenance,” said Ed, as we sat in the Barton Center bionic pancreas command center, where the study team was hard at work monitoring the campers blood sugars from the cloud.  “The maintenance part is the changing of an infusion set, the changing of a sensor, the checking of blood sugars.  The management part, to me, is the emotional part of diabetes.  The fact that you are so often told that you’re ‘wrong’ because you’re trying to thread the needle.  This device doesn’t take away from the maintenance part because it still requires that you wear something, do something, change something.  But it does make the management part smaller.  So much smaller.”

I don’t know if a biological cure will be seen in my lifetime.  I was diagnosed with type 1 diabetes in 1986 and have been living well, but not without frustration, as a host to this disease for almost 28 years.  My perception of what a “cure” is has changed as I’ve grown older, and my hope for something that takes this disease away fades with time.  But seeing the bionic pancreas at work, around the waists of children not much older than my own, and watching the worries of diabetes lifted from their minds and the minds of their families, I feel renewed hope.  More hope than I’ve felt in a long, long time because this is real.  I held it in my hand.  It filled me back up.

Because it works.

You can follow the progress of the bionic pancreas on the Bionic Pancreas website and “like” their Facebook page for more updates.  Links to articles featuring the bionic pancreas are here , and this video shows you how, and why, the bionic pancreas works:

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